TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID Date: 1 1 

Address: 1^1 OZ |s| l"/ ^ W 

Remediation Contractor: _Coastal Environmental Group_ Year: 20«9 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video of property (DVD) 

a/ Executive Summary 

A EPA-provided property sketch 

A Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

-&- Confirmation data 

tA' 

Photographs \ k (S^(>yi^Wl ^ ^Cf(\lfi(^a^ 3^ ffi^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

t/ 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

A Utility clearances 

A Property information fi'om Douglas County Assessor's Office 

i h y signature Date 

30217539 

Superfund 
• • 

Property Access Checklist 

PropertylD: ;:>^U22 . 

D WOBK STARTED ON: / / 

D WORKCOMPELTED 0N:_ Property Address: 5-7^ ^ /y^ Z ^ hV . 

o^'^'^ Renter: \^ihu \ar)C<vin 

Address: 

Phone: 

Fax: 

Cdt/Pager 

Phone: 4K^^ . (^L|C|Q^ Additional Infonnation: 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / By: 

^ Access Agreement Signed: tL/0/ ^ By: 

^ Restoration Agreement Signed: i/./i^/Q3 By: 

D Topsoil Sampling (iTappIkabfe) / / By: 

Q Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

5 ^ Utility Clearance Called: _lL/i^/i:2Q By: j Ir-^ro^ 

Q^ Video/Photos (Before) ^:dliJ2nJS By: ^ryam 

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

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

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

D Property Completion Agreement Siened: / / By: 

D Final Report Issued:

 / / By: 

Air Monitoring (aa aoDlicable 

D Community Q Crew On: / / By: 

Results: 

Q Commnnity Q Crew On: / / By: 

Resnhs: 

DConuminity QCrcw On: / / By: 

Results: 

Omaha Lead SKe 
Douglas County Account Infotau^o )r|U^ 0 n Page 1 of2 

Douglas County, Nebraska Property Record - R2015090000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w OH Ma p Information Is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature - • -> ^ Auto Sales Searcii 

Owner 

JACKSON ISAIAH 

ETAL 

3702 N 23 ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 1509 0000 20 

Account Type: Residential 

Parcel Number: 2015090000 

Parcel Address: 3702 N 23 ST 

OMAHA NE 68110-0000 

Legal Description: PLAINVIEW LOT 6 BLOCK 12 50 X 124 

Value Informatio n 

Land Improvement Total 

2009 $7,000.00 $37,400.00 $44,400.00 

2008 $7,000.00 $37,400.00 $44,400.00 

2007 $7,000.00 $37,400.00 $44,400.00 

2006 $7,000.00 $37,400.00 $44,400.00 

2005 $7,000.00 $13,300.00 $20,300.00 

2004 $7,000.00 $12,100.00 $19,100.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6200.0 1.0 124.0 50.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R2... 10/22/2009 
Douglas County Account Infqm^^o om^^o n Page 2 of 2

J702M23St. 

T2r 

"" • V " lii> 

6 v M«­

' JSTS* 

! story 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1416.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Batiis: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip/Gable Stories: 2.0 

Floorcover: Allowance Foundation: ' Block 

-+- Sprinkler Square Footage: | 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1910 1974 0% 1910 99 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 696.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 308.0 

Porch End Screen 133.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/22/2009 
Page 1 of2 

"> 

Create Another Tjcket .^^ j Back to Irth Internet L-^nJf.T'j'JLjl 

• YOUR TICKET NUMBER IS 2409700. 

Original Call Date: 11/19/09 Time: 7:42 am Op: ELIZABETH18790 


Work to Begin Date: 11/23/09 Time: 8:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3702 Street: N 23RD ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-SW,10-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOTS 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


ALTS72 CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

UtiUty 

Type 

ALT872 WINDSTREAM COMMUNICATION NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS 

LP DEBORAH 

Day: 9185747098 

AU: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Ah: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/19/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHH-RAFFIC

Day: 4024447197 

 AU: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/19/2009 
OLS#: 32422 

w As-Built Drawing ^ Date Excavated :11/27/09 

Date USEPA Sianed Off: 2/3/10 

C

ENVIRONMENTA

 OASTA L L Omaha Lead Superfund Site Area Sodden: 450 sq ft CROUP , IN C 

32422 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch • Good 

[ 3 Poor 

Sampling Address: 3702 N 23 ST [ ] Not paint 

Lead Sample Samples Collected Sample Number 

I 

LAB Concentration Collected Firm: P E C.C. E K 

RyASCPXA-32422 Fl 2 / e ppm D Dale: .S']°t-i t 

RYBSCPXA-32422 F2 ppm D Time: li t OS A .KA . 

RYCSCPXA-32422 B1 .^A. ppm D

Samples Analyzed RYDSCPXA-32422 B2 3GH ppm D

RDZSCPXA-32422 DZ 1 0 3 ppm D XRF Unit: Co*iH n Book: 20 T 

RCZSOPXA 32422 SZ - —- ppm D D Date ^ .

 2.f ^ • 0- 7 

nPZGCrXA-324gg P?- * " pp m D D Time A M 

E] 

Staff 

Number of Samples = /^6i/ 

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 (tie street, facing property 

"LJ I , Bl ^­

iiiNTEFFDJ G>...r..% .^* 

1^; 

DRrV E J: .pi.my. 

M/ ^Y 2 212008 1 

t 

;; \>p% J. 36li ; Bf^H^ ^ 

8 1 

yyzzzi ^TTAAyt 

• 

:T1 i .3.702,.HZ35^ 

PZ DZ=198PPM@13 " . 'yyyyyyyyA^ A 

F2 = 77PPM@13 " a/a.:. ' 

Fl ; ' i 

^^J^9i i EA=163PPM@1 " 

^IJliJSi:, RevilMJS.N tftaied 26-Ket>-(Hi 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod ' ^ 

Area replaced with 

Rock/Mulch n. Area left bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
A h 11^7 . 

5T)S N <93^ 

32422 

Omaha Lead Site Exterior Paint Noriri Arrow 

Site Sketch • Good 

[ g Poor 

Samplina Address: 3702 N 23 ST Q Not paint 

Sample Number 

RYASCPXA-32422

RYBSCPXA-32422

RYCSCPXA-32422

RYDSCPXA-32422

~ ROZSCPXA-324a2^

F^CgSCPXA 33422

RPgSCPXA-3g4gg 

Lead Sample Samples Collected 

i 

LAB Concentration Collected Firm:

 F1 2 / e ppm D Date:

 FZ 577 p p m D

Time:

 81 ppm n 

 B2 PPJTl D 

 DZ 7 0 3 p p m D XRF Unit:

 G3 - ppm n D Date 

-Pf- ppm Time 

E

n 

Staff Number of Samples ' 

 ? £ CC . £. K 

 .^-\<\-' ^ 

 Ir. OS A. , n^ . 

Samples Analy7ed 

 Ca^i^ O Book: 20 7 

^•2.f>.-0- 7 

A/^ 

Mfiu^ 

Legend: F1 = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Dri p Zone, GZ = Garden, PZ = Play 

• )•' All quadrants are as viewed Irom Itie sireet. facing property 

W-j HI ' Y' 
32422 

vl ^1 /^^ 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch 

0^Poor 

Sampling Address: 3702 N 23 ST |~1 Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collecte Firm: V i CC . £• K 

RYASCPXA-32422 I Fl 2 / e ppm D 

Date: .V\'\-'r{ 

RYBSCPXA-32422 I F2 51 1 ppm 

D Time: II-.QS n..i^ . 

RYCSCPXA-32422 I Bl 39, \ ppm D 

Samples Analyzed 

RYDSCPXA-32422 I B2 3Cf 4 .ppm D 

RDZSCPXA-32422 

I DZ 7 0 3 ppm D XRF Unit: CafJHO Book: 20 7 

nczecpxA 32422—s^­ ppm D Date: At- Z9b, - o V 

r^rzocpxA024gg—p?- ppm 

Time; A M 

E

n 

Staff; M6V/ Number of Samples = 5 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

MAY 2 212008 

f^.iL^:^A^.\)(U\,<^'^ 
32421 

Omaha Lead Site 

Site Sicetch 

Sampiinq Address: 3702 N 23 ST 

Sample Number Lead Sample LAB Concentration Collected 

RYASCPXA-32422 F1 z i e ppm D 

RYBSCPXA-32422 F2 5 77 ppm a

RYCSCPXA-32422 B1 .2B_L ppm [Ir D 

RYDSCPXA-32422 82 3G^ ppm n 

RDZSCPXA-32422 DZ ppm D 

nGzccpxA-3a4a2—ez- ppm D a 

nPZ0GrXAO2422 PS- ppm D n 

Number of Samples = | 5 | \ Q

XRF Unit: Cof^Ho Book: 201 

Date: B - if e - 0*7 

Time: A M 

Staff: MfiU/ ^ | 

Exterior Paint North Arrow 

• Good 

[ g Poor 

• Not paint 

Firm: 

Date: 

Time: 

Samples Coliected 

PE C.C. £.u 

.K-'\<h'<k 

ll'.OS iV.KUv 

Samples Analyzed 

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

All quadrants are as viewad from the street, (adng property 
.•v^*";<>. 

COASTA l fHVIffONKIHTA l 

CROUP . IH C 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environnrtental Protection Agency (EPA) or Its authorized representatives, collectively 

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

following described premises: SZ^^"^ 

Owner's Nanne Daytime Phone: 

I'^iki/^i J^tevv- 161 • M'?^ 

Address of Property 25 T-T 

covered by this 37^z i^

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 perfomned, 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 confimi 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 perfonrting the work. This access shall 

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

agrees to; 

Page 1 of 2 
.>*^'-"v. 

COASTA L tHViaOHHIKTAL 

6 « O U » I h C 

( Remove obstructions including boats, trailers, vehicles, playscape items, wo

piles, dog houses, etc; 

od 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may w

to save; 

ish 

« Water and maintain replacement vegetation, including fertilizer application,

necessary subsequent to an initial watering period by EPA; 

 as 

c Abide by health and safety guidance provided by EPA; 

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

the property to perform the work. 

to 

a 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 

/d^l I grant access to my properties [U I do not grant access to my properties 

signature C \ Date / / Signature Date 

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

Page 2 of 2 
« T 

^4L.:^ 

COASTA L 

Restoratson Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe properly 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). 

PropertylD; 5^^^ ^ 

Property Address: 37^ ^ / Q Ty^Z"'^^ ' 

Phone: A^ ) - jyAi n 

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. 

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 removal, storacje, disposal, and/or return of these itoms Is the Owner's responsibility. 

ttem: LIA. . 6U / P/^i 

Item: 

Item: 

ttem: 

Items to^be Removed by the Contractor During Remediation and Not Reolaced 

ttem: 

V'^^-^/f IA, 

.s ?UA ]y r iyyy ttem: ' / 

ttem: 

ttem: 

Page 1 of. ? 
•'•{ ^ €(l ^ COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

ttem: 

f^/A ­ ttem: 

5 P ' 

Item: 

ttem: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered whh grass. 

Number of trees > 2 Inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aiiath !i sU'icli ol llie 

.».rrirkloi liiv'.iiii 

Number of and size of 

each garden/ flower bed 

area. 

Atiiith ;i ski.'irh 1)1 rdiitivi' 

<iZi"S nnd lociiiiiMis 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

\oi<' l!-ii' \HIII C SS\\\ nt 

i;six' 10 lit U( .1 plan; 

>oiK-lu'.- l(j lhe |;riii)crl\ 

iis\ ner. 

Easement Area, to be 

excavated 

 f^-A ^rP­

/^^ ; 1) ^ 

Landscape Inventory 

Quantity 

>"^/ O z 

; 

/ 

7A 

/ 

y ^ 

Unit 

Qiifldrants 

Each 

Each 

Each 

Each 

Square Feet 

S 

Each 

Condition/Type/Species 

PtMDl/^f^ &5C.IT. 

Page 2 of. 
C O A S 1 A L 

enow' . * •* « 

!! Addttionai Comments / Instructions: 

]t dfUmh Sm^ i-Louei^ 56^c>s 

L 

'~~~f ^^ec k the box if Owner does not want CEG to document interior foundation walls and possible 

p e-exlsting damage. By checking this box CEG is not responsible for any damage done to the 

interior of house. Including foundation cracks or fissures. 

O I agree O I do not agree 

Owner's Signature \ J Date ^ Contractor's Signature Date 

Page 3 of. 
BVID #^4 ^ 

XRF PROPERTY SAMPLE SHEET 

Date nianicH Address 

Project Omaha Lead ARRA Sample time 

XRF 1D# SMDSQ sample length 

Shot# Reading Sample area Shot# 

(Kzz i^^^ie ra qc^ 

q^c, '\[c-^\ ^ Depth qs 

Qao ^1-^ic. 45 ^ ^ 

Average *^ 1 "J ^l ^ Average

Shot# Reading Sample area Shot# 

<^32\ iqi±5a D2. 

^ SS ^lu t 5^ Depth 

^3!^ m^-^^ 13 

Average ^^ 8 It 3 ^ Average 

Shot# Reading Sample.area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature ^i?/x/!ew 

Print Fii-zobeHi Caccfig^ 

31031 KJP'SSV 

am/pm 

30 sec 

Reading Sample area 

»/^q 1-»WJ 1 4 

IU>I/, t n Depth 

\ft3ll«^ / " 

 WD.^ ^ \(^ 

Reading Sample area 

Depth 

Reading Saniple area 

Depth 

Reading Sample area 

Depth 
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 

ppm 

Pb 76.985 

Certlfic 

941 

SOIL 

2010-01-30 15:49 

90.48 

Final 

Avg of 938-940 

3702 N 23 St 

F2 

13 

0. BARAJAS 

1 

1 

Error 

15.662 

supervised By: ^CMW/ ) 
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 68.525 

Supervised By: 

Certificate of Verification 

938 

SOIL 

2010-01-30 15:48 

30.19 

Final 

32422 

3702 N 23 St 

F2 

13 

O. BARAJAS 

1 

1 

± Error 

15.015 
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 75.909 

Supervised By: 

Certificate of Verification 

939 

SOIL 

2010-01-30 15:49 

30.18 

Final 

32422 

3702 N 23 St 

F2 

13 

O. BARAJAS 

1 

1 

± Error 

± 15.767 
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 86.521 

Supervised By: 

Certificate of Verification 

940 

SOIL 

2010-01-30 15:49 

30.11 

Final 

32422 

3702 N 23 St 

F2 

13 

O. BARAJAS 

1 

1 

± Error 

± 16.203 
^ 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 937 

Mode SOIL 

Time 2010-01-30 15:32 

Duration 90.61 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm Error 

Pb n-^r^xAAA ± 22^13-

Supervised By: 
H 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 934 

Mode SOIL 

Time 2010-01-30 15:30 

Duration 30.20 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 N 23 St 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 191.475 ± 22.309 

Supervised By: 
% 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 935 

Mode SOIL 

Time 2010-01-30 15:31 

Duration 30.22 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 N 23 St 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 214.035 ± 23.252 

Supervised By: 
% 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 936 

Mode SOIL 

Time 2010-01-30 15:32 

Duration 30.19 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 N 23 St 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 188.795 ± 22.278 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 97 

Mode SOIL 

Time 2009-11-27 13:17 

Duration 93.36 

Sequence Final 

Flags 

AVERAGE r?5glor94=96__Il3 

ADDRESS 3702 n 23 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

P r-46;24rp b ^;;16Z82l 

Supervised By 
t 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 94 

Mode SOIL 

Time 2009-11-27 13:15 

Duration 32.23 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 n 23 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 168.750 ± 16.368 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 95 

Mode SOIL 

Time 2009-11-27 13:16 

Duration 30.55 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 n 23 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearance 

NOTE ngnc 

ppm ± Error 

Pb 166.362 ± 16.518 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 96 

Mode SOIL 

Time 2009-11-27 13:17 

Duration 30.58 

Sequence Final 

Flags 

BVID 32422 

ADDRESS 3702 n 23 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb 153.352 ± 15.845 

Supervised By: 
/wA^ \

 Omalia Lead Site—Fixed Price EP-R7-07-05 

o ^^^^ ^ I Coastal Environmental Group Inc. 

V"^^ ^ wvvw.coastalhazmat.com 

%PBO^<^ COASTAL IHVIIOIIHEIITAL 

c lour , IN C 

EXECUTIVE SUMMARY: 

BVID #32422-(3702 N 23 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-COASTAL TO GUARANTEE THE SOD THROUGH SPRING 2010 
EPA Property Close Out Form 

2:^^ ^ Property #: ^TJAIL^ . Property Address: -. > .^ Q 

Date/Time: Owner's Name: /...J. J.l/!^. " '^T9.l^iMi 

Quads Excavaied; F2. t PS ^ Contractor Croup 

Excavation Y« No Generel 

1. If necessaiy, were the corrrct quadrant(s) excavated and restored? A 

2. If necessary, were the correct areas of drip zone excavated aod restored? / 

Gmdlng Sod and VenetatJon 

Yes ^() 

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

from the house? 

y 

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

i. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at s .10 

day time period) 

A

Arc sodded areas generally firm and evenly graded? 

A 

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

I time period) _j _ ­

r Was the property graded such that water will nol pool on the propeny j A 

"y- Was damage to landscaping or plant materials avoided? 

Gates. Fences aad ReulBiog Walls 

Yes No 

Do gates open and close fl-eely? (If applicable) v

/ 

2. Were all gates or fences taken down during restoration aclivilies reinstalled? (Ifapplicablr) y 

3. Was damage to gates or fences avoided? (Ifapplicablc} A_ 

A. Was damage to retaining walls avoided? (Ifapplicable) / 

Foundation, SidJBK and Cutlers 

— .No 

I. Was damage to the siding or trim avoided? / 

2. Was damage tn the foundation avoided? / 

':. Was damage lo windows avoided? / _ . 

4 Was damage to windows or door screens avoided? / 

Was damage to downspouts or downspoul exiensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

I 1. Was damage lo driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 

/ 
owners comments; 

Fnspection notes: 

y y'^ 

Removal and resloralion activates complele inclu(iing the 30-day sod warranry: 

EPA Representative Qc^ A ^ Date: 2\i\K> 
Property Completion Agreement 

This agreement documents lhe completion or remedial aclivmes perloimed on my property. My signalure 

will designate Ihal I am satisfied wilh the restoration ofmy propeily. and Ihal no items are in queslions. 

now. or al any lime in the future, except Ihose ilems lisled below, ifany 

PropcrrylD: 3ZQZ2 . 

Property Address: p.-^ ^ M ^ ^ ^ 

Q"""= lf>iA\n jAfi^ty ^ 

Phone: IX<=^\- ),QQ2 , 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: / 7 T / ] , ] Ti /tZ. ^ i 

0^ <oov -^v.c Si%/^i ^ a^^'oyagree rutoralion is compleled, except as noleri 

[_J I rio not aur^c restoration ii. completed 

iMdoy^^:^_\hh 

Owner' s Signatn Date 

y^^bntrarlor's Sicnaturc Dale 
@ 

REC 

/-£8 . ^h. i 

Propeity Owner SEtisfsciion Survey 

Omaha Lead Superfund Sit " '^i^^r{J\ Of\/j^ff)M 

2008 

Remediation Contractor: Coastal Environmental Group 

Property Identifier Number: 'PAl lA^ i 

Property Address: TV/DT­ ' M "Z^ ^ ^ -

Property Owner's Name: K'!>) i::\M JOtCAu^^QT^ 

(above information to be filled out by remediation contractor prior to delivery ol form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the work performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's work by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-A "poor" 

1-2 "very poor" 

Property Owner's Satisfaction Ratine Regarding Contractor's Work 

' ^ 5 

9 4 

8 . 3 

7 2 

6 1 

Additional Comments from Property Owner (optional: continue to back of page if needed) 

Property Owner's Signature: