TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: \'C&&D Date: 2.]7.^\Tf\ 

Address: ^Slf P S 8 4 S t 

Remediation Contractor: Coastal Environmental Group_ Year; 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[3 / Video of CLXL 

•propeny (DVD, ^^-^tCl^k ^ 4 f^^ , F^'K^"^ ^ W 

B^ Executive Summary 

^ y EPA-provided property sketch 

[ y Signed Access Agreement for subject property 

0 / Signed Access Agreement(s) for adjacent propert) 

y ^ Restoration Agreement 

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

H / Confirmation data 

Q / Photographs (JG/^s,^ W't.-e/nzaktwi^ 0^COju}aLi<\^

y As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

|\||^ Description of areas not meeting ROD cleanup criteria 

\ y Utility clearances 

B^ Property information from Douglas County Assessor's Office 

y doAMj-fPTi 

D 

Signature

 Y'^d^dd 

 Date 
Property Access Checklist 

Propcrtj ID: 1 ^ 3 ^ 0 n WORK STARTED ON: / / 

Property Address: 2.^J ^ <^ 3MS T D WORK COMPELTED ON: / / 

Owner: /.Ci|yrA An.^<L)^O n Rcnten 

Address: ^^^y ^ Phone: 

Fa.\: 

Cell/Pager. 

 -iqQ'2.\Z\ a L\AJor\0 Additional Infonnation: j Phone:

Fax: 

Ccll/Pager: 

D Notification Letter 

13 Access Agreement 

C^" Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

n Garden Sampling (if applicable) 

0 Utility Clearance 

0 Video/Photos (Before) 

D Video/Photos (During) 

n Video/Photos (After) 

D Video/Photos (30-Day) 

n Property Completion Agreement 

• Final Report 

Air Monitoring (as applicable) 

D Community Q Crew On:

Results: 

CD Communit}' Q Crew On:

Results: 

O Communitj O Crew On:

Results: 

Sent: / / 

Signed: _Ll2/Jl/Jig 

Siened: }0 / R / OS^ 

1 1 

1 1 

1 1 

Called: Jl2/il/_Q.?' 

On:J^/Jl/_0S: 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

/ / By: 

/ / By: 

/ / By: 

Bv: 

By:^C 

By.QZ 

By: 

By: 

By: 

^r-\0/tllD% 

^y-H\OK 3V\rNY\ 

By: 

By: 

By: 

By: 

By: 

Omaha Lead Site 
CONTACT FORM 

Property ID# 

Property 

Address: 

Inilial Conlact: 

Second Contact: 

Final Conlact: 

Final Action: 

Commeni: 

Owner 

Commeni (s); 

Site 

Coordinator 

Comment (s); 

l^^sn 

S ^ M Si -

Date: 

Date; 

Date: 

Transmit u 

Time: 

Time: 

Time: 

DEPA D 

Aclion; 

Action: 

Action-. 

Other Action; D 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R1942000000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w O n tVlap Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -»->• * Auto Sates Search 

Owner 

ANDERSON LAURA L 

2815 S 34 ST 

OMAHA NE 68135-0000 

Property Informatio n 

Key Number: 4200 0000 19 

Account Type: Residential 

Parcel Number: 1942000000 

Parcel Address: 2815 S 34 ST 

OMAHA NE 68105-0000 

Legal Description: PARKVALE LOT 4 BLOCK 1 40 X 130 

Value Informatio n 

Land Improvement Total 

2008 $5,800.00 $81,300.00 $87,100.00 

2007 $5,800.00 $81,300.00 $87,100.00 

2006 $5,800.00 $67,300.00 $73,100.00 

2005 $5,800.00 $67,300.00 $73,100.00 

2004 $5,800.00 $67,300.00 $73,100.00 

2003 $5,800.00 $67,900.00 $73,700.00 

Sales Information 

Sales Date: 2007-09-10 

Deed Type: QC SooAr; 2007 Page: 106259 

Price: $0.00 

Grantor: ANDERSON GREGORY S 

Grantee: ANDERSON LAURA L 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 1990-04-18 

Deed Page: Type: Book: 1877 427 

Price: $48,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Douglas County Account Information Page 2 of3 

Grantee: 

Valid/Invalid: \ valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5200.0 1.0 130.0 40.0 No 

Improvemen t Informatio n 

Building 1 

l i a 

First Floor lap i»c 706 0sq n 

15* S«cond Floor 

512.0 s q ft. 

I6.(F, 

IK 

tMMK 

1 1/2 STORY FINISHED 

Oiimi siact e ft 

C72.Dsq.s. 

CLICK X0_EN LARGE. IMAGE 

Square Footage: | 1218.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1915 0% 1915 93 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 

1.0 

Basement Bsmnt Block 8 ft 672.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Douglas County Account Information Page 3 of 3 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Base Fixtures 

Bath Full 

Detached 

End Solid Wall 

Slab Roof Ceil 

1.0 

1.0 

216.0 

105.0 

160.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Page 1 of2 

W^y 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2157604. 

Original Call Date: 10/17/08 Time: 7:45 pm Op: ELIZABETH187 90 


Work to Begin Date: 10/22/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2 815 Street: S 34TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-SW,33-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING HOUSE ALL THE WAY TO THE 


: STREET. 


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


Company : COASTAL ENVIRONTffiNTAL 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 LEVEL3 I«IUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Ah: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2008 
Page 2 of 2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 8887289343 

Emerg: 4067289343 

QLNNEIF QWEST LOCAL NETWORK MA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2008 
9 As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

3S 

Name: Omaha Lead Site Date: North Arrow 

Address: :t.^t5' Site Sketch Tirne; 

Phone: _ -t—• 

Team \i:\[:VjMJj:yfiV^ BVID# K3^O XRF Code 5'S'O I 

Sample Number Lead Concentration Confirmation Sample 

P-SAS.^PX A - /5"SS Q 

ppm flYes n No ^ 

ppm fjYes O No ^ K i c s t ^XA - I y^s- ^ 

ppm ^,Yes • No g ^ P t C ix. PXA - I3-3S-0 

ppm No E T 

No B ^ 

l^pe^<:f>XA - •'J'^S^ No • ppm 

ppm 

ppm Yes • No • Lab RPZSCPLA-15350 

Result 93.5 ppm 

CC :5#:"i^3"5irT 

Date Ex( avated 10/28/2008 ' 

trateiuSEP^ SignddOff: 1/14/201)8 " l^ V ry r 

Area Spdde .dded1346sqf d 

t 1 W^'-y^ 

y H y 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bar e Sod ' ' Rock/Mulch 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 
3 

t 

Name: Omaha Lead Site Date: North Arrow 

Address: :i^i5' Site Sketch Time: 

Phone: _ 

Team \/J;if\."t^ MJjil^f ^ BVID#_±£350 

Sample Number Lead Concentration 

f 

I^SAStpxA - /vTS.So 

RVi^S^+^A - /5-iS-o 

/??C i c ^XA - /^^3- 0 

P^iiS^ p>A - isss o 

^fc^SC PXA- - /ris-t ) 

^pes^cfxA - '^> ^ 

Lab RPZSCPLA-15350 

Result 93.5 ppm 

AS-' 

^ 

vs 

,?^ sL^ 

¥ 1^^ ^ 
-a— 

Name: 

Address: ;ivi5 5, :iK ^ 

Omaha Lead Site 

Site SItetch 

Date: 

Time: 

North Arrow 

Phone: _ 

y ?y y 
ie'^* ^ 

COASTA L ENVIRONMENTA l ' ^ . PBO''* C « 0 U r . 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: 

Owner's Name: /? Daytime Phone: 

yyn. ~AQ ^ ulK- dlD'^ig.1^ 

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 under the 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 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 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 performing the work. This access shall 

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

agrees to: 

Page 1 of 2 
,tO ST., 

M ^ g 

COASTA L 

ENVIKONMENTA L ••two-t*"^ CROUP . INC . 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• 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 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 (712) 352-0188 

[33^I gran r t access to my properties 

D I do not grant access to my properties 

^Cjyc- r^^yo^x^ ^^[n/o8 

Signature Date Signature Date 

[U I would like to be present during any sampling that is required. 
y y^i5 s n y OLCces iM COASTA L CNVIIONHENTAt 

C i O U f . 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: 

Owner) ler^s Name: Daytime Phone:

Address of Property 

covered by this y^/7 I.JYyr 

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 under the 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 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 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 performing the wori<. This access shall 

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

agrees to: 

Page 1 of 2 
COASTA L CHVmOffNFNTAl 

C I 0 U f . IN C 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• 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 wori<. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any ofthe 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 (712) 352-0188 

[B I grant access to my properties D I do not grant access to my properties 

Igniture Date Signature 

Date 

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

\ Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: / 5 ^ ^ 3 

Property Address: ^J^/S " 5 ~)^'^ ^ i^~J~ 

Q^^""*"' 7ou/'C K /4Ao/^r,<>Orx 

Phone: .^o ^ a } 'Xi^ 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface feauires, syrface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of tiiese items is the Owner's responsibility. 

Item: 

Item: 

f ^n y ^ 

\ 

1 y^ h y ' o t ^ '^ ^^\je.(y 

/ 

7 

/ 

Item: 

y . / 

Item: / 

y 

Item: 

Item: 

y y 

Item: y 

Item: 

y y 

Page I o f P 
COASTA L 

C n O u p IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(LJse additional sheets as necessary) 

Item: 

Item: 

7^y 

( 

5 M^v n Un f 5 

/ 

ley I 

ykyd y 

/ 

Item: / 

ttem: y 

Item: 

Item: 

item: 

Item: 

Item: /

/ 

Item: / 

/ 

Item: 

/ 

/ 

i 

Item: 

/ 

Item: 

/ 

/ 

Item: 

/ 

Item: 

Page 2 of 7 
( ^ 

COASTA L • MViaoitniMTA L C f> O U r IN C 

Items To Be Removed By Contractor Durinq Remediation And Replaced 

(Use additional sheets as necessary) 

1 Item: \ 

^ O l l 

B2y) -y 

Item: 

5sX 9>iy\ 

Item: 

(raroLe. / y V^riGlds ^®)/ n l-fycTA^^ ' Item: 1 

Item: 

/ 

Item: 

/ 

Item: 1 

1 

Item: /

/ 

1 

Item: 

/

I 

/ 

Item: 

/ 

Item: 

/ 

Item: 

Item: / 

Item: 7 

Item: / 

/ 

Page 3 . y 
• • 

C O A ^ T ft L • n vlMOMHiNTA l C • O U P IH C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

1 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Nuinber of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

0' 

y 

y 

7' 

Unit 

Square feel 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

7' 

Page 4 of_ ^ 
- • - < » 

COASTA L 

Item Quantity 

Agreed upon value of 

plant materials not to be 

renlaced bv contractor. 

Note this >alue will be 

vouche

used t

r

o

 t

 issu

o th

e

e

 -A

 propert

 plan

y 

t y owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were y each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced $7 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 7^ 

grass sod. 

Area ofCit y or County 

property to be landscaped 

per their requirements. 

V 

Include a sketch of the 

area (s) 

Easement Area, to be ^ ^ excavated 

Uriit 

$ 

1 

Conditlon/Type/Species 

Each 

SF 

SF 

SF y \o ^ 

Page 5 of LP 
C O A S T A L 

Additional Comments / Instructions: 

6-11^^ ^H\[i y AO-^iC^. h€.^re^ ^^Ccit/^yicn 

• Check the txjx if Owner does not warrt CEG to document interior foundation vralls and possible 

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

interior of house, including foundation cracks or fissures. 

0 I agree Q I do not agree 

TToiXr^ \y^ y 

Owner's Signature DatMe Coiftnctor' Cofitnctor's Signatur SlgDal e Date 

Page 6 Of 
Date 

Project 

XRFID# 

Shot# 

lEs: 

Z\*b^ 

) - « 

^ mX 

Average

Shot** 

JAIUCL 

7-\w\ 

XUgX 

JAifll^x. 

Average

Shot # 

21 L? ^ 

'2.\\D 

TI 1^ 

I Xi^^'^ 

Average

Shot# 

Average 

lab sample # 

ISlO^fc"! 

BVID# J015_ D 

XRF PROPERTY SAMPLE SHEET 

[C\-Z%yeio'^ Address ^^1 ^ '^> 7^H^dL 

Omana lead FP 2na year option Sample time am/pm 

^7n^c), sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

l\^.^ l •

t2%.^ ^ £A 

Depth Depth \•^^^s 

^ c^^qH T 

 \ \ \ ,fl'= S j \?^ . \S ' Average 

Reading Sample area Shol# Reading Sample area 

IOV.^2 

-71-:? ^ SO. Depth Depth Jfi. ^ ^ 

I J L 

 7^.?^- y 1 - W.^^-g^ Average 

Reading Sample area Shot* Reading Sample area 

•^lo.^l 

A Fl I. nM 

Depth Depth llo^.lO 

T^.^q 1 ^ 

 ^Q ^ 1 1. \Q.P9 Average 

RETEST AREAS 

Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Av 

Signature_ 

H i . E 

lt3T Pnn\_£jjJJ)J^tyh QjkCtrL3 

TTT~ TTprr 
Report Number: Date Reported: 

08-357-2195 /•iN^/lidwest 12/23/08 

Account: Date Received: 

20666 V| 12/18/08 < Laboratories, IncI 

Page: 1 of 1 Date Sampled: 

13611 B Street • Omaha, Nebraska 68144-3693 • (402) 334-7770 • FAX (402) 334-9121 • www.midwestlab3|2^8/08 

COASTAL ENVIRONMENTAL GROUP 

MARCOS MATEUS 

2411 MARTHA ST 

OMAHA NE 68105 

QC-15350 2815S34THST 

PO/Project #: OLS-2008 

Analysis As Detection Analyst Verifier 

Performed Received Units Limit Method Date Date 

Lab number: 1520369 Sample ID: Fl 

Lead (total) 173 mg/kg 5 EPA 6010 rrd/12-22 kkh/12-22 

Lab number: 1520370 Sample ID: B2 

Lead (total) 77.3 mg/kg 5 EPA 6010 rrd/12-22 kkh/12-22 

U b number: 1520371 Sample ID: EASEMENT 

Lead (total) 111 mg/kg 5 EPA 6010 rrd/12-22 kkh/12-22 

leather Ramig / / 

Client Service Representative^/ 

heather@midwestlabs.com (402)829-9891 

The result(s) issued on this report only reflect the gnalysis of the sample(s) submitted. For applicable test paramaters, Midwest Laboratories is in compliance with NELAC requirements. Our reports and fetters are for the exclusive and confidential use of our clients and may not be reproduced in whole or in part, nor may any reference be made 

to the work, the results, or the company in any advertising, news release, or other public announcements without obtaining our prior written authorization. 
"^ > [L£fe@[?®G®PD( 

13611 B Streei • Omaha, Nebraska 68144-3693 = (402) 334-7770 ° FAX (402) 334-9121 = www.mldwestlabs.com 

ACCOUNTNUMBER CHAIN OF CUSTODY RECORD: Yes No 


PURCHASE ORDER NUMBER. 


IREPORT&BILLTO IDENTIFICATION 

COPYTO 

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PROJ. NO. PROJECT NAME/COMPANY: f 

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COMPANY: (Signature)/' J. ^ OL^'^" ^ 

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SAMPLER: (Signalure) 

c "re M 're £ A Ol T c G CL R 0 R a 1 M A o X y /^^VAP'' ^ • ^ / ^ y y ^^^ Numbcr/Ordei fl 

SAMPLE ID/LOCATION DATE TIME p e 2 o 

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.._.^^-^-'._...r_,. 

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- - Relinquished by: (Signature) Dale/Time Received by. (Signature) Cooler arrived inlaci: Yes Nn 

Femperalure on Arrival (VSI 

Kelinquished by: lingnaiure) uaie/iime Keceiveo oy: {Signature) 7y\yc 

'reserved in Field: Yes_ No — -. r~. ; = 

Relinquished by: (Signature) Dale/Time Received in Lab by: (Signature) 

Chain-of-Custody will have a signature upon receipt but n0 subsequent signatures ^^'^ 02/02 

Distribution: Original accompanies shipmenl; copy lo Coordii laior Field Files 

. . . . . ..._. . f./-\ c--;i VA(A iAi..i«. Cl c\.,Mno PI T - riih o •Matrix

 Code; SO - Soil, WA - Waler, SL -.Sludge, OT - Olher . -^.—-— 

Ou ' rpff-ffirr h.c c-r.^,- i ,'-£po!'£s ciic IEKS.'S i-.i for the eiicluE've sric coni-oentic! uss o' o-j- ciisivts tn:- r^ay riOi ie leprur.i.'cto '?, who; e 01 i:: pc.'"!, f';;'' ".sv ETA

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Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2164 

Mode SOIL 

Time 2008-10-28 10:23 

Duration 123.22 

Sequence Final 

Flags 

AVERAGE Avg of 2160-2163 

ADDRESS 2815 s 34 st 

QUAD/ZONE B2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE PI'PE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 108.924 

Supervised By: 

Certificate of Verification 

2160 

SOIL 

2008-10-28 10:20 

31.58 

Final 

15350 

2815 s 34 st 

b2 

Ventry 

6 

CLEARANCE 

± Error 

± 13.044 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 77.248 

Supervised By: 

Certificate of Verification 

2161 

SOIL 

2008-10-28 10:22 

30.52 

Final 

15350 

2815 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 11.275 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 56.157 

Supervised By: 

Certificate of Verification 

2162 

SOIL 

2008-10-28 10:22 

30.15 

Final 

15350 

2815 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 10.091 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pr-PE 

NOTE 

ppm 

Pb 71.157 

Supervised By: 

Certificate of Verification 

2163 

SOIL 

2008-10-28 10:23 

30.97 

Final 

15350 

2815 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 10.894 
f 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2169 

Mode SOIL 

Time 2008-10-28 10:27 

Duration 122.97 

Sequence Final 

Flags 

AVERAGE Avg of 2165-2168 

ADDRESS 2815 s 34 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2165 

Mode SOIL 

Time 2008-10-28 10:25 

Duration 30.85 

Sequence Final 

Flags 

BVID # 15350 

ADDRESS 2815 s 34 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 46.876 ± 9.557 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE PI'PE 

NOTE 

ppm 

Pb 91.044 

Supervised By: 

Certificate of Verification 

2166 

SOIL 

2008-10-28 10:26 

30.89 

Final 

15350 

2815 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 

± Error 

± 12.292 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 168.102 

Supervised By: 

Certificate of Verification 

2167 

SOIL 

2008-10-28 10:27 

30.64 

Final 

15350 

2815 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 

± Error 

± 15.991 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2168 

Mode SOIL 

Time 2008-10-28 10:27 

Duration 30.59 

Sequence Final 

Flags 

BVID # 15350 

ADDRESS 2815 s 34 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 73.896 ± 11.044 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2159 

Mode SOIL 

Time 2008-10-28 10: 18 

Duration 122.92 

Sequence Final 

Flags 

AVERAGE Avg of 2155-2158 

ADDRESS 2815 s 34 St 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2155 

Mode SOIL 

Time 2008-10-28 10:16 

Duration 30.60 

Sequence Final 

Flags 

BVID # 15350 

ADDRESS 2815 s 34 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 113.911 13.303 

Supervised By: t.,LL^J^ii. J (jUJyn^^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 128.333 

Supervised By: 

Certificate of Verification 

2156 

SOIL 

2008-10-28 10:17 

30.58 

Final 

15350 

2815 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.103 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 113.958 

Supervised By: 

Certificate of Verification 

2157 

SOIL 

2008-10-28 10: 18 

30.46 

Final 

15350 

2815 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 13.096 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2158 

Mode SOIL 

Time 2008-10-28 10:18 

Duration 31.28 

Sequence Final 

Flags 

BVID # 15350 

ADDRESS 2815 s 34 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 89.940 ± 12.121 

Supervised By: 
/t|tt^' o Omaha Lead Site—Fixed Price EP-R7-07-05 

S J^^2 ^ I Coastal Environmental Group Inc. 

V^^^Tj ? www.CGastalhazmat.com 

^^tin.ott'' COASTA L ENVmONMENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY: 

BVID # 15350 - (2815 S 34 ST) 

I I No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

HOMEOWNER RECEIVED COMPENSATION FOR THE SUM OF $ 25.00 FOR THE 

REPLACEMENT COST OF PLANTS THAT WHERE DESTROYED DURING THE 

REMOVAL OF LEAD IMPACTED SOIL. 
^ -^^EPA 

EPA Propert) Close Oul Form 

Prop«rt> ft: \5"?^5 C^ Proptrt) Addrrss: ^^iS1^...3Hi ^ ^ 

DBit/Tlnt: Owner's N.mt: 1 A^VCk ^vnA<^^^(\ n 

QuBds Excsvalfd: F \ an d fS^ ConlrBCtor Croup OnaSVc v \ P nM y^A^^ X^O U I 

ExcivatloD GtDcrel Yc^ No 

r If necessary, were the correcl quadrant(s) excavated and resiored? y] 

2 If necessary, were the correcl areas ofdrip zone excavaied and restored'' ivtt 

GradlDK Sod and VcfcUlio n V « No 

1 Does the grading around die perimeter ofthe house in excavaied areas generally slope away 

y

from Ibe house? 

2 Has sod be«n laid in all areas that were excavaied? y 

3. Does the sod appear lo be generally healthy and growing' ' (Only evaluate if inspecied at a 30 y day lime period) 

4 Are sodded areas generally firm and evenly graded'' y 

5 Are the joints between the sod stnps generally light? (Only evaluate ifmspecied ai a 30 day 

y lime period) 

6 Was the proptcrry graded such thai water wil l not pool on ihe property'' y 

7 Was damige to landscaping or plani materials avoided'' y 1 

Gates, FcDcca and RdjinlD C Walts Ves No 

1 Do gates open and close freely'' (Ifapplicable) 

y 

2 Were all gates or fences laken dowTi during resloration acnvines reinstalled'' (If applicable) 

y 1 

3 Was damage to gates or fences avoided? (If applicable) y 

4 Was damige to retaining walls avoided? (Ifapplicable) y 

FouDdation, Sidiag and Gulier s Yes No 

1 Was damage to the siding or trim avoided? y 

2 Was damage to the foundation avoided? y 

3 Was damage lo windows avoided'' y 

4 Was damage lo windows or door screens avoided'' y 

^ Was daruage lo downspouls or downspoul extensions avoided'' y j 

Sidewalks and Driveways (Concrelt) Ves ,No 

Was damage lo driveway surfaces avoided' 

_A/^ 

2 \^'ii5 damage lo v»allcway surfaces a\oided'^ y 
O tDe?-$ comments: 

Removal and resloralion aclivales compleie inclu{jing ihe 30-day sod uanani) 

F P A 
Property Completion Agreement 

This agreement documents the completion of remedial activities perloimed on my properly My signalure 

will designate thai i am satisfied with the restoration of my property, and thai no items are in questions, 

now, or al any time in the future, excepi those items listed below, ifany 

Property ID: ^^:2^f ^ 

Property Address: ^Q^/ ^ ^ ^L^^fJO ^ ^ 

Owner: 

\—CK.\. P^rse^n r-^O"^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

1^ 1 agree restoration Is completed, excepi as noled 

 I I rio nol aijrec restoration Is complcled 

dijor 

c>^jjy(X-_ I-VVWAD O L 

Owner's Signatiire Date ontracfor's Signature Date 

I
Property Damage Settlement 

Property ID 15350 

Property Address 2815 S 34 ST 

Owner Laura Anderson 

Phone 402.390.2126 

I tiave received a check from the contractor, Coastal Environmental Group Inc. (Coastal), for the sum of 

$25.00 for the replacement cost of plants that where destroyed during the removal of lead-impacted soil 

from the property. 

Compensation Type Check 1689 

Value of Check $25.00 

Check to the Order of Laura Anderson 

Description of Damage 

Coastal Environmental Group will reimburse Ms. Anderson for the plants destroyed during the remediation 

for Lead at 2815 S 34 ST 

My signature below acknowledges the receipt of the check listed above; further, I acknowledge that 

the compensation amount is fair for the replacement cost of the plants and release Coastal 

Environmental Group, Inc. from further obligations or liability related to this property. 

yoxyo- \y^ h^OL 

12-

ki o f \n'Tilo^ 

Owner's Signature Date Contractor's Signature Date 

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