TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA1D# : f^^^l( Date: ^h<\\ o 

Address 

Remediation Contractor: _CoastaI Enviromnental Group_ Year: 2000 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ Video of property (DVD) 

Executive Summary 

p' EPA-provided property sketch 

y Signed Access Agreement for subject property 

-B-, Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

-B-< Settlement documents (i.e., for damage or to replace plants, etc.) 

-B' Confinnation data 

f/ Photographs yif^^p(^U>v\ f W M^t)(\xr ^ 

nf As-built sketch 

Satisfactory restoration signed by Property Owner 

6^ Property close-out dieck list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Propertyinformation from Douglas County Assessor's Office 

' Date' 

30055441 

Bomi 

Superfund 
m 

Property Access Checklist 

Prcpca,ID:fp<^H7 5 D WORK STARTED ON: / / 

D WORK COMPELTED ON: / / Propeny Address: 2H1, 1 jVj Hf S aST P 

Rcntt r Owner Hcx^o\ ^ S0>iVj\+7 . 

Phone: 

Addrcs:^^^ ^ T)\\\\CiY \ "D c 

P<L\: 

Cell/Pager: 

Phone Additionul Inlnrrnntion: 3CjC>.^^^^qi 

F«T : 

Ccll/Pager. 

Q Notirication lifte r Sent: / / By: 

^ Ql Acceu Agreemenl Signed: 7 /23'C? 

B>=Di^v\a 

^ ^ Restoration Agreement Signed: :2./29 ^CQ »y Ve lrv\Y\/ 

O Topiorl Sampling (if •pplicuble) / / By: 

O DisposnJ Strnplio g (if ;ipplictble) / / By : 

O Gnrdcn Sflmpling (i f ap|)licabte) / / By : 

©'^Utilit y Clearance Called: £l/-?/ / D^ By: ^/Z5/0 ^ 

Qvideo/Photo s (Before) On:£/l^/Q ^ ^y-6c7Av/o /t/^iA-fe^iz-Y 

D Video/Photos (During ) O n : / / By : 

D Video/Pholos (After) O n : / / By : 

D Video/Photos (30-Dj»y) O D : / / B y : 

1 1 Property Complelion Agreement Signed: / / By: 

n fina l Rcpo n Issued: / / By: 

A i r Monitorint : (<U applicable) 

D Communrt y D Cre w O n : / / By: 

RciuJls: 

D Communit y Q Crew- O n : / / By: 

Results: 

D Communit y D Cn:>v O n : / ' By: 

RjKulli : 

Omaha Lead Srte 
Property ID U 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

# 

CONTACT FORM 

b^m 5 

ZM2\ N "At^ ^Vf. 

Date: Time: Action: 

Date; Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 
Douglas County Accoimt Info: )ri|||jon Page 1 of2 

Douglas County, Nebraska Property Record - R0811090000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 H west of 52nd St - VJeW OP Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature *•->• * Auto Sales Search 

Owner 

SCHULTZ HAROLD D 

ETAL 

1101 DILLON DR 

OMAHA NE 68132-0000 

Property Informatio n 

Key Number: 1109 0000 08 

Account Type: Residential 

Parcel Number: 0811090000 

Parcel Address: 

Legal Description: 

2421 N 45 AV 

OMAHA NE 68104-0000 

CLAIRMONT LOT 28 BLOCK 2 50 X 125 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$66,100.00 

$66,100.00 

$66,100.00 

$66,100.00 

$67,100.00 

$61,000.00 

Total 

$72,500.00 

$72,500.00 

$72,500.00 

$72,500.00 

$73,500.00 

$67,400.00 

Sales Informatio n 

Sales Date: 2000-06-16 

Deed Type: 

Price: 

Grantor­

$95,000.00 

Book: 2157 Pago: 341 

Grantee: 

Valld/lnvalld: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.14 

SF 

6250.0 

Units 

1.0 

Depth 

125.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accoiintinfo.jsp?accoiintno=R081... 7/7/2009 
- Douglas County Account Inforrmipn Page 2 of2 irtmipr 

Building 1 

QpenS)>t 

Jia 

I »(r [<J 

" SccendFlaar " l=irsi Floor 

7n.O iq. tt 

a«RK»cnL_Ir 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1368.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gambrel Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1923 0% 1923 86 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 768.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch EncI Screen 119.0 

Porch Open Slab 119.0 

Porch Slab Roof Ceil 28.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081... 7/7/2009 
Page 1 of 1 

• # • # 

[^ Create^ Another Jjcket J j [L ^ ^^ck to Irth Intemet J I [-Send Email ,i| 

• YOUR TICKET NUMBER IS 2359224. 

Original Call Date: 9/08/09 Time: 5:16 pm Op: ELIZABETH18790 


Work to Begin Date: 9/10/09 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2421 Street: N 4STH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 08-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENT LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE OF CORNER PROPERTY 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: coastal 


Depth of Excavation: 4ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, ING HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFiC.SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/8/2009 
OLS#: 63475 

As-Built Date Excavated :9/10/09 Drawing Date USEPA Signed Off: 11/13/09 

C OASTA L ENVIftONMENTAL Omaha Area Sodden: 1257 sa ft Lead Superfund Site GROUP . IN C 

63475 

Omah Exterior Paint a Lead Site 

• Good Site Sketch 

g^Poor 

Sampling Address: 2421 N 45 AV • Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Coflected Firm _££. r..c. e..<- RYASCPXA-63475 Fl 33" ? ppm D Date 10- I- Of 

RYBSCPXA-63475 F2 1 H I ppm Time i z : ST, n P-v»- RYCSCPXA-63475 Bl 

Samples Analyzed nYDSCPXA 63476 B2- ~ ppm D 

RDZSCPXA-63475 DZ >qfcW pom D 

XRF Unit: [eSHl> Book: 22 0 

RCZSCPXA 63478 -62 - •* ppm D D Date: / ^ -H ' O B 

nPgDCPXi»r6a476 PS- " " ppm D D Time: 

D Staff: '^St ^ Number of Samples = [ 4 | | ( ^ \ 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Pla< 

A" q'j^Tt'a"*'^ S'C as viewed from the street, facing property 

^•- >: X y y \' y X" V 

: « » Crej KJ :7..\i« l « 

Legend 

Dri p Zone Excavate d 

Area replaced with Are a replace d wit h 

Concret e Quadrants Excavate d 

Are a lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
ZV^/ A/ <V5>V 

vs— 

o 

pA/i/^ , 

^ 

S l ^ 

^ 

- ^ ^ 

/ 
63475 

Omah Exterior Paint a Lead Site 

Sit • Good e Sketch 

H^Poor 

Sampling Address: 2421 N4SAV • Not pamt 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 Pg . /'..C . E.tg. 

RYASCPXA-63475 Fl 33*7 ppm D Date: 10 - 1 - o t 

RYBSCPXA-63475 F2 JLi .ppm D Time: 12.: S-j ^.^f.. 

RYCSCPXA-63475

nYDSCPXA 63476

 Bl 

 BS­ _3ll .ppm .ppm 

D 

D Samples Analyzed 

RDZSCPXA-63475 DZ I9ID H ppm D XRF Unit: (cSH O Book: 2Z 0 

RCZSCPXA 63176 -62­ ~ ppm D D Date: 10 -iH - O S 

nPZSCPXA 63476 P2- ~ ppm D D Time ^ 

Number of Samples = | ^ | | ( ^ \ Staff: '^•it ^ 

Legend: Fl = Front Left. F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Plav 

All quadrants are as viewed from lt]a atracL facing properly 

r^ 

TK 
63475 

Omaha Lead Site Exterior Paint North Antw 

Site SIcetch • Good 

E^Poor 

Sampling Address: 2421 N 45 AV Q Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Finn: p g . r.c . g.ig . 

RYASCPXA-63475 F l ppm 

D Date: 10- \-o t 

RYBSCPXA-63475 F2 -La ppm D Time: n-.s-h 

RYCSCPXA-63475 B l 31 ± ppm I D

Samples Analyzed RYDSCPXA 6a<78 Bd - ppm D 

ROZSCPXA-63475 DZ ppm D XRF Unit: ^SHO Book: 22£) dsm. RCZSCPXA 63478 62 - ppm D D Date: •/H-d>S 

nPZSOPXA 63476 PZ- ppm D D Time: rP7 

E] 

Staff: 

Numt>er of Samples = | 4 insiii. Legend: F l = Front Left, F2 = Front Right, B l = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as vievmd ftem the atiBct,tacing property 

v::0il8 Creatwl: :7-.\ug­
COASTA L 

ENVIHONHENTAL " t PflOlt^ C I 0 U P. IN C 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Daytime Phone: 

Mdh 'iG\u.ir7. 

Address of Property 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed underthe Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be perfomied, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of perfomiing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
•-»---" ' J f 

COASTA L ENVUOHNEHTA L 

CROUP . IN C 

e Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

e Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

A Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

e Abide by health and safety guidance provided by EPA; 

«> If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the wort< activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

^ I grant access to my properties 

D i do not grant access to my properties 

7'M-£>^ 

Signature Date Signature Date 

.Q I would like to be present during any sampling that is required. 

Page 2 of 2 
COASTA L • HVinONnrNrA L 

GROUP . < M C 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID; {/p'^l{'] ^ 

Property Address: "2, l^7^\ |>^ 4^"$ /^-^— 

Owner: 4-\UWZDU 7 

Phone: ^C ^ {^{^ 

On the attached diagram(s) indicate area(s} to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photogr^hically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or retum ofthese items Is the Owner's responsibility. 

ftem: 

AVW / ^-^ W / PUT)^^^ . 

ttem: =f

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Item: 

A^ . ^'^ -w/f (eh Sfl^.-W' 

Item: 

Ot-v. o ' 0(^\(^ •\> ^ r 

Item: y > 

Item: 

^ ^ 

Page 1 of Z_ 

I"y 
m 

COASTA L CNVrnOMH f NTAt . 

C H O U r . IN C 

Items to Be Removed By Contractor During Remediation and Replaced 

ttem: 

-60) U - T^\ , [?Z^ 

Item: 

^ 0 ^ - 1^] 

Item: 

Item: 

Landscape inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

^1 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter ^ 

Number of trees <= 2 inch Fach ^ trunk diameter 

It 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc, 

Atiach a sketch of the 

sprinklci hi\oui. 

Number of and size of 

each garden/ flower bed r^ Each 

area. Square Feet 

Aiuicli u sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. %wv 

Note this value will ht v^c,ii^ ^2 - o~-»^ h \ 

used to issue H plant 

voiielier to the property 

owner. 

Easement Area, to be ^<p ^ Each P^^ ^ ^ ^ t c^H <

excavated 

Page 2 of. 1 
• 

C O A S T*K L • MV<nOMnLMTA L 

anoun t IN C 

Addttionai Comments / Instructions 

Mb-ri6C ^ 2 ' 3 ^'^^ 

fePO o r qjuCo- ^ ^ 

a^tmc^ \^ B^l^^ C^t:i^ xMuiOi. 

n Check the box rf Owner does not want CEG to document Interior foundation walls and possible 

pre-existing damage. By checking this t)ox CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

O I do not agree 

7-2'^-rfi dco-fdim H2Piioc>i 

Date Contractor's Signature Date 

Page 3 of 7 
BVID # ^3'^05' 

XRF PROPERTY SAMPLE SHEET 


Date Address •Z-M-ZI NWS'^ ' 

Project Omaha lead FP 2nd year option Sample time am/pm 

XRFID# sample length 30 sec 

Shot# Reading Sample area Shol# Reading Sample area 

^ r'-z- /fel ^ A -' 11 

tiHO-o*^ 

n/ nA ^1 ^ ^ ^ lfo2. 9.9 ^ 11. n^ r' 

<^q Depth I6>3 IT^i. < "W Depth '12 ­ "PTH" / £ V 1 / q t / ^ G" 

Averag /O t ^/J> e S^ ^ 12^ Average 

Shol# Reading Sampie area Shot# Reading Sample area 

i_Lk. -zt^n 't-z.o O l ifcn ?«r^^^'^ 

Depth Depth i^A. •^^?.-g^ ^ 0 

XLEL -ZQi "^ n

J ^ l 

Average :2JH^ ^("^ Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab resull Sample area XRF Avg. Uia 

mU\^ []am(^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 170 

Mode SOIL 

Time 2009-09-10 17:33 

Duration 122.08 

Sequence Final 

'f^K^^\,?>ii­ :&iigj)fJ^^169J 

ADDRESS 2421 n 45th ave 

QUAD/ZONE DZ 

INSPECTOR VENTRY 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 241.483 ± 18.943 

Supervised .r.^MMM. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 256.806 

Supervised By: 

Certificate of Verification 

166 

SOIL 

2009-09-10 17:30 

30.68 

Final 

63475 

2421 n 45th ave 

DZ 

VENTRY 

10 

CLEARANCE 

± Error 

± 19.506 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 167 

Mode SOIL 

Time 2009-09-10 17:31 

Duration 30.40 

Sequence Final 

Flags 

BVID # 63475 

ADDRESS 2421 n 45th ave 

QUAD/ZONE DZ 

INSPECTOR VENTRY 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 255.002 ± 19.211 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 252.655 

Supervised By: 

Certificate of Verification 

168 

SOIL 

2009-09-10 17:32 

30.48 

Final 

63475 

2421 n 45th ave 

DZ 

VENTRY 

10 

CLEARANCE 

± Error 

± 19.620 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 201.468 

Supervised By: 

Certificate of Verification 

169 

SOIL 

2009-09-10 17:33 

30.52 

Final 

63475 

2421 n 45th ave 

DZ 

VENTRY 

10 

CLEARANCE 

± Error 

± 17.437 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 165 

Mode SOIL 

Time 2009-09-10 17:29 

Duration 122.88 

Sequence Final 

Flags 

AVERAGE ,Avg of 161-164 

ADDRESS 2421 n 4SfFrave~ 

QUAD/ZONE Bl 

INSPECTOR VENTRY 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 105.815 ± 13.045 

Supervised By: 'pCmMh 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 95.954 

Supervised By: 

Certificate of Verification 

161 

SOIL 

2009-09-10 17:27 

30.81 

Final 

63475 

2421 n 45th ave 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 12.642 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 162 

Mode SOIL 

Time 2009-09-10 17:28 

Duration 30.27 

Sequence Fmal 

Flags 

BVID # 63475 

ADDRESS 2421 n 45th ave 

QUAD/ZONE Bl 

INSPECTOR VENTRY 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 82.420 ± 11.750 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 126.202 

Supervised By: 

Certificate of Verification 

163 

SOIL 

2009-09-10 17:29 

30.90 

Final 

63475 

2421 n 45th ave 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 14.004 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 118.683 

Supervised By: 

Certificate of Verification 

164 

SOIL 

2009-09-10 17:29 

30.90 

Final 

63475 

2421 n 45th ave 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 13.783 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 175 

Mode SOIL 

Time 2009-09-10 17:36 

Duration 122.99 

Sequence Final 

Flags 

AVERAGE ^Avq of 171-174J 

ADDRESS 2421 n 45th ave 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

Error 

Pb 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 80.014 

Supervised By: 

Certificate of Verification 

171 

SOIL 

2009-09-10 17:34 

30.47 

Final 

63475 

2421 n 45th ave 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

11.611 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLETYPE 

NOTE 

ppm 

Pb 78.863 

Supervised By: 

Certificate of Verification 

172 

SOIL 

2009-09-10 17:34 

30.93 

Final 

63475 

2421 n 45th ave 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

± 11.336 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 173 

Mode SOIL 

Time 2009-09-10 17:35 

Duration 30.63 

Sequence Final 

Flags 

BVID # 63475 

ADDRESS 2421 n 45th ave 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 88.990 ± 11.970 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 89.329 

Supervised By: 

Certificate of Verification 

174 

SOIL 

2009-09-10 17:36 

30.96 

Final 

63475 

2421 n 45th ave 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

± 11.980 
m 0 

iJOLi\ Omaha Lead Site—Fixed Price EP-R7-07-05 

1 ^^^^ ^ I Coastal Environmental Group Inc. M ^ ^ ^ www.coastalhazmat.com 

'*^L,^a^ COASTAL ENVItONHINTAL 

CROUP , IH C 

EXECUTIVE SUMMARY: 

BVID #63475-(2421 N 45 AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
4

^i^BBfflli^^ S 

EPA Property Close Out Form 

Properly #: l^'^Ur\ ^ 

Datc/Tlne: Owner's Name:. .feB^'./JDJd.ifi'^t^^*- ^ ^ ^ 

Quads Excavated: Contractor Group ^ xmo\) 

Excavatio Yes No n General 

1. If necessuy, were the correct quadrant(s) excavated and restored? ' ^ 

2. If necessary, were the correct areas ofdrip zone excavated and restored? 

I P ^ 

Gradlp Yes No g Sod and Vegetation 

1. Does the grading around the perimeier ofthe house in excavated areas generally slope away 

from the Iiouse? 

2. Has sod been laid in all areas that were excavated? 1/' 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if Inspected at a 30 

day time period) 

4. Are sodded areas generaiiy Hrm and evenly graded? v 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) I/' 

6. Was the property graded such that water will not pool on the pTopert>''! 1 / ' 

7. Was damage to landscaping or plant materials avoided? X/' 

Gates, Fences and Rctainlnj Walls 

Yes No 

1. Do gates open and close freely? (Ifapplicable) 

2. Were all gates or fences taken down during restoration activities reinsulled? (If applicable) 

3. Was damage to gates or fences avoided? (Ifapplicable) i / 

4. Was damage to retaining walls avoided? (Ifapplicable) iX" 

Foundation, SidlaKand Gutters 

Yes No 

t. Was damage to the siding or trim avoided? V 

2. Was damage to the foundation avoided? U ' 

3. Was damage to windows avoided? V-\ 

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Drh'eways (Concrete) 

Vcs No 

I. Was damage lo driveway surfaces avoided? 

^ 

2. Was damage to walkway surfaces avoided? 

u^ 
Ov»'ners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative UGyxDoAf^I y Date: I[j/ 3 O^ 
I

Property Compietion Agreement 

ih)S agreemenl documenis lhe complclion of remedial acliviiies perloimed on my pioperly My signature 

will designale ihal I am satisfied with llie restoralion of my propeiiy, and ihal no uems are m questions, 

now, or al any lime in Ihe future, excepl those ilems listed below, ifany 

Property IP: {^'^^'^ 5 

Property Address: 2,L\X \ \ 4 l^ ^ KyJ ^ 

Owner: Y\(.j^^^^ ^ ^^jy^^^^ ^ 

Phone: ^^- ^ ^^ Q ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

ttem: 

 I I agree I'C^fortirion K complcltd, except as noleri 

[_J I Ho nol »\trtc restomtion is compleled 

Ovlncr's SicnatUr DntcU ^ Oentraclor's Signature Date 
Water Bill Settlement 

Property ID 63475 

Property Address 2421 N 45 St 

Tenant Mr. Shultz Harold 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 12.63 for 

water usage required to maintain the sod. 

Check Number 1875 

Value of Check $12.63 

Made Out To Haiold Shultz 

Description of Settlement 

To reimburse tenant for estimated water charges on their MUD monthly invoices. 

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be feir compensation and fuii payment for the above, and release Coastal 

Environmental Group inc. from further obligations or liability. 

hlS'^iolo 

Ofwner's Signature V ^ Date «j>ntractor's Signatur Date 

T^.. ^ ir-TT^ 

COASTAL 1875 ENVIRONMENTAL GROUP INC. 2411 MARTHA STREET 27-V1040003 

OMAHA NE 681(» 6247372904 

\\\'-\\\c:) DATE 

SS siMnAd_Sbiit^ $ \z^­

-Y\i^-tflA/^(XAA^^igD 

«IMbPBrgo>wli.NA. 

IWnBila 

iMnniyouconi 

u..'^\^\^i'^ ^^2.\t\^<>f^g. *^K/v<g<?w^ C&t^-w^ 

i:iOl«00005Bi : e.EitTSTB'iOitii* QLB7 5 
Property Damage Settlement 

Property ID 63475 

Property Address 2421 N 45 Ave. 

Owner Harold Schultz 

Phone (402) 350-6691 

1 have received from the contractor, Coastal Environmental (jroup Inc. (Coastal), the simi of $200.00 to 

compensate for plants that were removed during the removal of lead impacted soil from the property. 

Compensation type Check 1874 

Value of Check $200.00 

Check to the order of Harold Schultz 

Description of Damage 

While excavating 2421 N 45 Av (BVID 63475) Coastal damaged some plants beyond salvage and 

removed some river rock. Property owner received a check for the amoimt of $200.00 dollars for the 

replacement ofthe plants. 

My signature below acknowledges the replacement of my plants; further, i acknowledge that this 

work was completed satisfactory and within my and release Coastal Environmental Group, Inc. from 

further obligations or liability related to this property. 

w^wmm. ~i 

COASTAL ENVIRONMENTAL GROUP INC. 1874 

2411 MARTHA STREET 27-S/1040003 

6247372904 OMAHA, NE 68105 \\\^\\o 

DATE 

PAY 

ORDE>^5^iiiQJcMJ^ruxtt R 

^ $ 200^ 

T\)0O\\KVA(VM (W^'^ltob 

. DOLLARS I' l DaiilU < 

«MIlFtoVOBwli,NA 

FOR ^v\DVi.5^n6^^^^^'^^^ ^ "^^TA/u ^ 

11101*0000san E.Bi,7 37Eqoi.ii' oiavu 

/-/S'^0/0 

over' s SignafurT Date ontractor's Signature Date 

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