TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: y)^^\ Date: \ (^ 1 JW 

Address: 111 f yb y

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs ' t f (i^Cf^^^fWH Y '^'X>]^VAl1i(M \ ^<7^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property^hfonnation from Douglas County Assessor's Office 

\ l^^ l I \ 

Ignature Datei 

30218532 

IINH 

Superfund 
^v 

Property Access Checklist 

PropertylD; ^j^^ ^ D WORK STARTED ON: / / 

Property Address: ; u ^ , ^ gj^. D WORKCOMPELTED ON: / I 

Owner: ^ •• ^^^ ^ 

ye.g.v ^ ! -J'-J- P:\rauL>.girgc»^ 

Address: Phone: UT):^- ft\?>- f^^q^ 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

^o'^.-w^u->^^b 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / By: 

fTJ Access Agreement Siened: nt^/3L'^/V0 By: 

fyl Restoration Agreement Signed: (^/^/_\ 0 By: 

D Topsoil Sampling (if applicable) / / By: 

D Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

^ UtiUty Clearance CaUed: 0^>/\3A O ^yo^U^lto 

Q Video/Photos (Before) On: / / By= VixrV 

D Video/Photos (During) On: / / By: 

D Video/Photos (After) On: / / By: 

D Video/Photos (30-Day) On: / / By: 

n Property Completion Agreement Signed: / / By: 

D FinalReport Issued: / / By: 

Air Monitoring (as appUcable) 

• Community O Crew On: / / By: 1 

Results: 

• Commimity Q Crew On: / / By: 

Results: 

• Conununity O Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account I: wltion Page 1 of3 

Douglas County, Nebraska Property Record - R1423560000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie (S scaie 0-50 ft west of 52nd St - Vle W O n Ma p Information is valid as of 2010-2-16 Treasurer's Tax Report 

New Feature ••-•• • Auto Sales Search 

Owner 

GAUDREAU BENJAMIN S 

3317 BURT ST #1 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 2356 OOOO 14 

Account Type: Residential 

Parcel Number: 1423560000 

Parcel Address: 111 S 38 ST 

OMAHA NE 68131-0000 

Legal Description: JEROME PARK LOT 3 BLOCK 10 45 X 167 

Value Informatio n 

Land Improvement Total 

2009 $13,100.00 $134,800.00 $147,900.00 

2008 $13,100.00 $134,800:00 $147,900.00 

2007 $13,100.00 $134,800.00 $147,900.00 

2006 $13,100.00 $81,500.00 $94,600.00 

2005 $13,100.00 $81,500.00 $94,600.00 

2004 $13,100.00 $81,500.00 $94,600.00 

Sales Informatio n 

Sales Date: 2004-05-10 

Deed Type: WD Book: 2004 Page: 131294 

Price: $120,000.00 

Grantor: Thomas VanBelle Etal 

Grantee: Benjamin Gaudreau 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1996-01-26 

Deed Type: D Book: 2025 Page: 215 

Price: $76,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142... 3/2/2010 
Douglas County Account I^ , tion Page 2 of3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Information 

Acres SF Units Depth Width Vacant 

0.17 7515.0 1.0 167.0 45.0 No 

Improvemen t Information 

Building 1 

i 2 12 Storv Finished '\ ' ' . . . • . t r^' HP IO J'" iriiiR Ut> 

Lsr 

rwdFkw b S»=«»il1o>3r frf.!li-:r kJ^^ .y 4r 

^!^ii^a »Cr i 1 

K(r 

U pi r 

«ii 

i M 1 ^ -T 

BsmM Bloci: 8 ft - MD i >« i 

Fin Bsm Not feicl In Li«' Ann = « 0 ii| ft. 

--^^L.JI/^y^ •»=rc-^,^==^ 

1 CLICK TO ENLARGE IMAGE | CLICK TO ENLARGE IMAGE 

Square Footage: 2250.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Average 

Built As: 2 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 15.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 3.0 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1905 0% 1905 102 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Blocl< 8 ft 960.0 

Basement Finished 400.0 

Fixture Additional Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142... 3/2/2010 
Douglas County Account I wltion Page 3 of3 

Fixture 

Fixture 

Porch 

Porch 

User 

User 

User 

Base Fixtures 

Bath Full 

Slab Roof Ceiling 

Slab Roof Ceiling 

2nd floor 

Attic Full Finish 

window A/C 

1.0 

3.0 

16.0 

140.0 

910.0 

356.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142... 3/2/2010 
Page 1 of2 

"> 

£!^* ^ An9J{!!gLll?!^^i I L__Bg<Jc to Irth Internet | j[ Send Email_,| 

• YOUR TICKET NUMBER IS 2542702. 

Original Call Date: 7/13/10 Time: 12:31 pm Op: ELIZABETH18790 


Work to Begin Date: 7/15/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 111 Street: S 38TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 20-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COT^TAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV MUDOl OMAHACOF OPPDGPRS PAETEC QLNNEIC 


UNITEOM UNOTEL 


Service Area Contact Phone Number UtUity 

Type 

BSHPCLKS NEBRASKA HEALTH SYSTEM NA 

Day:

Alt:

 4025523460 

 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/13/2010 
Page 2 of2 

OMAHA PUBLIC POWER 0PPDGPR5 DISTRICT 

PAETEC PAETEC COMMUNICATIONS 

QLNNEIC QWEST LOCAL NETWORK 

UNITE PRIVATE NETWORKS UNITEOM LLC - OMAHA 

UNIVERSITY OF UNOTEL NEBR/OMAHA 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

ELM LOCATING 

ELM LOCATING 

ANDREW TAYLOR 

Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4025543599 

Alt: 4025543036 

Emerg: 4025542648 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/13/2010 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

OLS#: 23031 

Date Excavated: 7/19/2010 

Date USEPA Sianed Off: 7/30/2010 • 

23«?t^ 

Omah Exterior Paint Nortti AiTow a Lead Site • Good Site Sketch 

Q^Poor 

Samolina Address: 111 S 38 ST • Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Firm: £P±_aBl^S ^ 

RYASCPXA-23031 Fl ^ 7 < ppm D Date; T-Vg-tf ^ 

RYBSCPXA-23031 F2 ppm sr D Time: Id:^ ^ A. n 

RYCSCP,XA 23031 B4- ppm D D 

Samples Analyzed RYD6CPXA 23031 B^ ppm D D 

RDZSCPXA-23031 DZ l(»^t^ ppm sr D XRF Unit: fo^HtP Book: Z) ^ 

RGZSCPXA 23031 6 £ ppm D D Date: n-2s--oe •nnZSCPXA 23031 PZ" .ppm D D Time: £c 

Numbe staff: M^v^ r of Samples = | O | | Q | 

Legend: Fl = Front Left, F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play All quadrants are as viewed from the street, facing property 

Legend 


Concrete m Drip Zone Excavated Quadrants Excavated 


Area replaced with Area replaced with 


Area left bare 
 Scxi Rock/Mulch 


Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

imv' 

Exterior Paint North Arrow Omaha Lead Site • Good Site Sketch 

Q^Poor 

Sampling Address: il l S38ST Q Not painl 

Sample Number Lead 

Concentration 

Sampie 

Coliected LAB Samples Collected 

Firm: /'P A Ofi / :S\-:^ 

RYASCPXA-23031 F1 ppm D Date: l-i5-^'2 ' 

RYBSCPXA-23031

RYCSCPXA 23031

RYDSCPXA 23031 

 F2 

> B1 • 

-9S­

^g g ppm 

__!!___ _ ppm 

D 

D 

n 

D 

D 

Time: /^.'Vg A, n 

Samples Analyzed 

RDZSCPXA-23031 02 i (o S (^ ppm 0 " n XRF Unit: foSH O Bool<; Z)' ^ 

RGZSCPXA 23031 QZ' " ppm D D Date: "7 ­ ZS"- 0 8 

RPZCOnXA 23031 P2­ - ppm D D Time: P m 

Number of Samples =rT Staff: M->W 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, G2 = Garden, PZ = Play 

Ail quadrants are as viewed from the street, facing property 

Rev 200.S..1A Creaied: l.l-Mar-08 ^'"Z^ 044701 01.2.> 
% 2 m^ 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch 

Q^Poor 

Sampling Address: 111 S 38 ST £2 Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: f-PA Ofi / :SV::> 

RYASCPXA-23031

RYBSCPXA-23031

 Fl 

 F2 

1± 

2g g 

ppm 

ppm 

0 ^ D 

D 

Date:

Time:

 1'J5-'^9 ' 

 y<?.'V§ A.r t 

RYCSCPXA 23031

nYDSCPXA 23031

 B4­

 B ^ 

* "

•*

 ppm 

 ppm 

D D 

D Samples Analyzed 

RDZSCPXA-23031 DZ I (aS b ppm n n XRF Unit: foSH O Book: Z) ^ 

RGZSCPXA 23031

RPZCGPXA 23031

 6Z­

 P2* 

—

•"

 ppm 

 ppm 

D 

D 

D 

D 

Date:

Time:

 1 ­ ZS"- 0 & 

 P m 

Number of Samples = | o | | Q | Staff: MS W 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Ail quadrants are as viewed from the street, facing property 

Rev 2008.3A 044701.01.2.1 
% 

2ir&yi^ 

Omah Exterior Paint Noitii Arrow a Lead Site 

Sit • Good e SIcetcli 

Q^oo r 

Sampling Address: 111S38ST Q Not paint 

Sampl Lead Sample Samples Collected e Numt>er LAB Concentration Collected Firm: f^PA dR / S ^ 

RYASCPXA-23031 Fl • ^ 7 / ppm \ar D Date: l-lS-^ ^ 

RYBSCPXA-23031 F2 •Zfi g ppm ET D Time: /^.-VS A. n 

RYCSCPXA aaoai ^ ppm D D 

Samples Analyzed 

RYDSCPXA 33031 S i ­ - ppm D D 

RD2SCPXA-23031 OZ I (tS" tv ppm 0 " D XRF Unit: foSH O Book: Zl ^ 

RczfiCPiYA aao3i -€£ • " ppm D D Date: •7-2S--0 8 

-pe- " ppm D D Time: JBQ3_ 

Staff: J^LSWl Numtwr of Samples = | 3 | | Q | 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants aiB as viewed fnxn the street, tadng propetty 

i-l •'••">':» yi j 

JUL 2 2008 

.i^. 

("^5^ 

I OL: 

/// s 38 

- ^ 

M 

:6V. 

I 

• r • * ' '• ^ ' ' 

i3est Rev 2003.3^ Cleued' l.3.Mn48 
COASTA I INVIKONHIHTAI 

C R O U r. > N C 

Consent fci Access To Propertj^ 

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: Z3D 3 ) 

^^rrfff^ n ^/?'^^^' ^ 

Owner's Name: ^ ^ Daytime Phone: 

5T- Address of Property l/( 5 ^ ^ covered by this 

Agreement: 

PuRPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to coiled 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 under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, v^ll contact 

the Grantor In-person to discuss the work to be performed, 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 K is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive vw-itten 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 performing the work. This access shall 

remain in effect until the work has bo&n satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
c

COASTA L mrmoNHiKTui 

c no u P IK c 

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

piles, dog houses, etc; 

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

y - to save; 

 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. 

e Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work 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 

/klg^ rant access to my properties 

D I do not grant access to my properties 

6y^^/,/o 

Signature Date Signature 

Date 

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

Page 2 of 2 
t 

^^ 

C OA S T A L 

a n o u p. INC . 

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 docimientation 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). 

PropertylD: 2<^6>? / 

Property Address: jl l 5 J ^ •^-r. 

Owner: ^V^j ; ^g, , ^^^^" ^ 

Piione: ^^ ^ (yil^l^4 U 

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

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

Photographically 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 removai, storage, disposal, and/or return of these items is the Owner's responsibility. 

Kem: 

yuy>2yi 

Item: 

Hem: 

Item: 

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

Item: 

t>i-^ct cJUs\^^ ^ Uoi ^ K CDO K 

Item: ' 

Hem: 

Hem: 

Page ^o,3 
C O A S T A L • MVIBONMSMTAI. O • O U P , IMC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: 

S^w ^ Soi l / o\y-tY yodt s'\ty?o\\jL^ ^\JZ^ S 

Kem: 

ffl-f^C 

Kem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Conditlon/Type/Species 

Pre-existing property area. f-i/O^ Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter / 

Number of trees <= 2 inch Each ^ 

trunk diameter 

Number of Sprinkler 

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

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. 2 Square Feet 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be / 

replaced bv contractor. / 

7

7 $ Note this value will be 

used to issue a plant 

voucher to the property 1 

owner. 

Easement Area, to be 

excavated 

Page 2 of. 
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BVID # Z3Q3/ 


XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

(- Z.( ' ZOil. 

Omaha Lead ARRA 

?y[oz2. 

Address 

Sample time 

sample length 

U l & ^Q> ^ T 

30 sec 

am/pm 

Shot# 

10^. 

[Oh 

[0 ^ 

Reading 

ZZ^ i ZL 

I U i ZO 

/46i IS 

Sample area 

Fi 

Depth 

6" 

Shot # Reading Sample area 

Depth 

Average (^Z ^ ZO y Average 

Shot# 

/O^ 

1/0 

\l \ 

Reading 

440 fc 3\ 

313 '­ Z& 

:35-6 i 2,4 

Sample area 

V I 

Depth 

/3 " 

Shot# Reading Sample area 

Depth 

Average .^-^ ^ ^ Z 8 ^ Average 

Shot# 

l\3 

/ K 

ii5 

Reading 

IIS i 16 

IZ°\ i • / ^ 

130 t n 

Sample area 

E A 

Depth 

/ " 

Shot# Reading Sample area 

Depth 

Average /Z.5 i / ^ / Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot # Reading Sample area 

Average 

yy 

Depth 

Average 

Depth 

Signature 

Print M^ ^ (^ymtK 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

108 

SOIL 

2011-01-21 12:59 

90.65 

Final 

Avg of 105-107 

111 S 38 ST 

Fl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 224.072 

Supervised By: 

Certificate of Verification 

105 

SOIL 

2011-01-21 12:57 

30.20 

Final 

23031 

111 S 38 ST 

Fl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.811 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 176.526 

Supervised By: 

Certificate of Verification 

106 

SOIL 

2011-01-21 12:58 

30.23 

Final 

23031 

111 S 38 ST 

Fl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.730 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 146.022 

Supervised By: 

Certificate of Verification 

107 

SOIL 

2011-01-21 12:59 

30.22 

Final 

23031 

111 S 38 ST 

Fl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.740 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 112 

Mode SOIL 

Time 2011-01-21 13:02 

Duration 90.83 

Sequence Final 

Flags 

AVERAGE Avg of 109-111 

ADDRESS 111 S 38 ST 

QUADRANT DZ 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 460.284 

Supervised By: 

Certificate of Verification 

109 

SOIL 

2011-01-21 13:00 

30.28 

Final 

23031 

111 S 38 ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 31.043 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 373.267 

Supervised By: 

Certificate of Verification 

110 

SOIL 

2011-01-21 13:01 

30.18 

Fmal 

23031 

111 S 38 ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 28.650 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 356.654 

Supervised By: 

Certificate of Verification 

111 

SOIL 

2011-01-21 13:02 

30.37 

Final 

23031 

111 S38ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 24.628 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

116 

SOIL 

2011-01-21 13:04 

90.59 

Final 

Avg of 113-115 

111 S 38 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 115.899 

Supervised By: 

Certificate of Verification 

113 

SOIL 

2011-01-21 13:03 

30.21 

Final 

23031 

111 S 38 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

• ± 16.923 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 129.193 

Supervised By: 

Certificate of Verification 

114 

SOIL 

2011-01-21 13:03 

30.18 

Final 

23031 

111 S 38 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 17.647 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 130.409 

Supervised By: 

Certificate of Verification 

115 

SOIL 

2011-01-21 13:04 

30.20 

Final 

23031 

Ill s 38 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

17.499 
iyf^\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc. vl ^ ^ S^~^j^ www.coastalhazmat.com 

%PBoT« ^ COASTA L ENVIIONNINTAL 

C I O U P. IN C 

EXECUTIVE SUMMARY: 

BVID #23031-(111 S 38 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 7/30/10 
S : ^ 

EPA Property Close Out Form 

 , . 

Property Addresr.-.Vil_2»^ 2£j—SA-- Property #: ^^?> \

Datenime: 

Owner's Name: yc-Pg^^^J- ,fi!.^V>^t^^" i

Quads Excavaied: 

Contractor Group 

Excavatio Yes n Geaeral 

I. ir necessaiy, were the correct quadnint(s) excavated and restored? y 

2. ir necessary, were the correct areas ofdrip zone excavaied and restored? y 

Grading Sod and VeKetetton 

Yes

I. Does the grading around the perimeter ofthe house in excavaied areas generally slope away 

from tbe house? _ / 

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

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

day tune period) ; y 

4. Are sodded areas generally firm and evenly graded? y 

5, Are the joints t)etween the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

6. Was the propeny graded such that water will not pool on the property'' yy 

r 7. Was damage to landscaping or plant materials avoided? 

yy 

Gates. Fepcea and Retatolng Walls Yes

I 1. Oo gates open and cio.se freely? (Ifappiicable) y 

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

3. Was danuge to gates or fences avoided? (If applicable) / 

4. Was damage to reuining walls avoided? (Ifappiicable) 7 

FouDdatioB, Sidintaad Gnlten Yes 

1 Was dainage to the siding or trim avoided? / 

2. Was dannge to the foundation avoided? y 

"y. Was damage to windows avoided? y 

4 Was damage to windows or door screens avoided? y 

5. Was damage lo downspouts or downspoul extensions avoided? 

J 

Sidewalks and Driveways (Concrete) 

Yes

I. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

y 

 >. 

­

 No 

 No 

 Nl) 

No 

 No 
OM'DCFS comments: 

jln.«:pection notes: 

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

EPA Representative JSL j^L Date: TiSOJlo 
Propeny Completion Agreement 

Ihis agreement documents the completion ot remedial activiiies perloimed on my property My signaiuie 

will designate ihat I am satisfied with the restoralion of my properly, and thai no items are in queslions. 

now. or at any lime in the future, except Ihose items listed below, if any 

PropertylD: 9,T^^ \ 

Property Address: ^^^ ^ -^ ^ ^ ^ 

Owne r ^•^fr^y CbxatAA.Arp^ WV 

Phone: ^0^-Vl^^Vr^^' B 

Restoration Items in Question: 

Item: 

ttem: 

Item: 

Item: 

Item: 

Item: 

lY I I agree i'e.«toralion is complcled, except as noted 

[_J i do not «i;rec restorApos i i como^ed 

Conti arlor's Signature i f DaUr 
Property Owner Assessment of Performancef'orHr 

American Recovery and Reinvestment Act (/^R)8A^4 2010 

Omaha t^^^^erfund Sitg^jp^j^^^ ^^^ ^ 

Remediation Contractor: Coastal Environmental Group - EP-R7-09-06 

Property Identifier Nuniber: CX'y^?>\ 

Property Address: \\\ <;.^ ^ft ?^. 

Property Owner's Name: '^wVv C^r...^Xron.,. 

Instructions to the Propertv Owner: 

This form serves to record the Property Owner's assessment of performance (Incentive 1 

- Quality Assurance Surveillance Plan) involving the listed remediation contractor, as applicable 

to the Omaha Lead Site. This form documents the timeliness of punch Hst resolution, business 

relations, complaint resolution and the overall quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Perfonnance Work Statement. 

The Property Owner will indicate his/her assessment of performance with the contractor's 

work by checking a nnmericai rating on the table below using the nmnerical deiinitions fix>m 

the rating scale below, then sign & date the form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 'Very poor" 

Propertv Owner's Assessment of Performance Regarding the Contractor's Work 

10 _X ­ ^ 

9

8

 4 

3 

7 2 

6 1 

Propertv Owner Additional Comments from (optional; continue on back page if neededl 

Property Owner Signature: /^// Y .^^/ ^ ^Date: / l^ f