TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID Date: v\ w 

Address: \\0 V 9 IV ' 'T T 

Remediation Contractor: Coastal Environmental Group_ Year: 20 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ 

-ar—, 

Video of property (DVD) 

Executive Summary 

EPA-provided property slcetch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs {pfiiNH ^

As-buih sketch 

 -I \ U tf(A]I^^O ^ 

a/ 

-IT 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas Couniy Assessors Office 

f l h 

Date 

30055462 

Superfund 
» • 

• • 

Property Access Checklist 

PropertylD: ;?/ 2 3 q 

n WORK STARTED ON: / / 

D WORK COMPELTED ON: / /

PropertyAddre«://^^^^;2. ^ 

Owner: fV,^J ^ D i 7n/) ^ 

Renter 

Address: 

Phone: 

Fax: 

Cell/Pager. 

QMftHMslF. JjSlQl. Phone: 

Additional Information*. kdP.. ?N7..ri&t3 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / Bv: 

I Access Agreement Signed;^/^/" ^ By: 

^ RcrtoratloB Agreement Slgncd:4i/_2/(^ By: 

O Topsoil Sampling (If applicable) By: 

G Disposal Samplmg (if applicable) / / By: 

(HI Garden Sampling (if applicable) By: 

g Utilitv Clearance Called:/^/3_/02 

Q ^ Video/Photos (Before) On: Jo / 9/ 9 ^y-/Uibr 

D Video/Pbotos (Dnring) On: / / By: 

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

D Video/Photos (JO-D«y) On: By: 

" ^ Property Completion AgrecmCTt Signed: Ll_/ie^i03 By: 

D Final Report Issued: By: 

Air Monitorine (as applicable 

D Community D Crew On: / / By: 1 

Rcsults: 

n Community • Crew On: / / By: 1 

Resnhs: 

nn Community QCrcw | On: / / By: 

Rcsults: 

Omaha Lead Site 
• • 

X)oiiglas County Account Ij [j^arn^on Page 1 of2 

y ^ 

Douglas County, Nebraska Property Record - R2216390000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vle W OH Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ^ r* ^ Auto Sales Search 

Owner 

DIZONA PAMELA M 

2138 S 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1639 0000 22 

Account Type: Residential 

Parcel Number: 2216390000 


Parcel Address: 1102 S 22 ST 

OMAHA NE 68108-0000 

Legal Description: SHULLS ADD LOT 1 BLOCK 2 N 37 FT LT 1 37 X 60 

Value Informatio n 

Land Improvement Total 

2009 $2,900.00 $17,700.00 $20,600.00 

2008 $2,900.00 $17,700.00 $20,600.00 

2007 $2,900.00 $17,700.00 $20,600.00 

2006 $2,900.00 $13,900.00 $16,800.00 

2005 $2,900.00 $13,900.00 $16,800.00 

2004 $2,900.00 $13,900.00 $16,800.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.05 2220.0 1.0 60.0 37.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 9/17/2009 
• • 

Douglas County Account I riSMrr^t^n Page 2 of2 

20.(r RANCH 

Hrsl Floor 16.0 

6720 SF 

38.9 

22.0 

BsfTTt Block B ft 

67Z.0S.F. 

CLICK TO ENUVRGE IMAGE 

Square Footage: 672.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 3.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 1.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuiit Physical Age Remodeled Remodeled Built 

1886 0% 1886 123 

Detail Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 672.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 64.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 9/17/2009 
Page 1 of2 

"> 

[ Create Another Ticket | Back to Irth Internet I Send Email | 

• YOUR TICKET NUMBER IS 2388343. 

Original Call Date: 10/17/09 Time: 1:56 pm Op: ELIZABETH18790 


Work to Begin Date: 10/21/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1102 Street: S 22ND ST 


Twp: 15N Rng: 13E Sect-Qtr: 22-SW,27-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 LOT 


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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV DOCOINFS LEVEL3 METHODIS MUDOl MUDO2 OMAHACOF 


0PPDGPR5 0PPDGPR6 PAETEC QLNNEIC QLNNEIF 


Service Area Contact Phone Number 

UtiUty 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

DOCOINFS DOUGLAS COUNTY 

INFORMATION SERVICES ALLAN 

Day: 4025107242 

Alt: 4024447188 

Emerg: 4025107242 

LEVEL3 LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

METHODIS METHODIST HEALTH SYSTEMS 

Day:

Alt: 

 8888474757 

Emerg: 8888474757 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
Page 2 of2 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

MUD02 METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER 

DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

OPPDGPR6 OMAHA PUBLIC POWER 

DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

PAETEC PAETEC COMMUNICATIONS NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNE 1F QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
OLS#: 21284 

As-Buil Date Excavated:10/23/09 t Drawing Date USEPA Signed Off: 11/10/09 

COASTA L Omah Area Sodden: 1071 soft a Lead Superfund Site 

Name: V^u^n /^flnf(n<it ^ Oinaha Lead Site Date: 6-/?'^.7 NorthArrow - | 

Address: I/OT- S • ^^Z" " Site Sketch Time: ?-:ZOot ^ 

Phone: V£>2,- 5VZ-7^ 3 ^ ^ 

Team -^//^irlU^J c fMe p BVID# ^/Zr V XRF Code. ^50ZSample Number Lead Concentration Confimifation Sample 

•t­ i n n ppm 

»*Yes a 

RYn.<irpyA - f>/2A'^ ppm *<Yes a 

^lYes CD 

C^Yes tD 

ppm Yes • 

ppm Yes • 

Oinaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 


Area left bare 
 Sod Rock/Mulch 


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

tl |0 

i— Name: M»t^<t 0>/hfUytkc^ Omaha Lead Site Date: North Arrow —i 

m r - Address: l/a z g . z 1Z Site Si(etch Time: _£VZ^^&**v. 

Phone: VCZ,- =^VZ-3^ 7 

Team •^502^ ^//<'ir/Le>A/ c fyUe ^ BVID# 1-1Z^ ^ XRF Code 

Sample Number Lead Concentration Confirmation Sample 

^Y/^SCP>XA - ^/f>A^ ^^Yes ° No ^ A ^'Ho^ ^ ppm H-Yes n 

»> Yes I^ Ryo3c/=>xA' g/^^ v - ^^^^4^S^m «2-Yes ^ ROZ.3CPYA- a/ZRJr- "'" #i_5Sl£_2J2i ppm i^Yes n 

ppm Yes a 

ppm Yes • 

Omaha Lead Site 46130 
• • 

Ll lo/l l • • 

Name: V^u^n Z^/h9(^ikt-s 

Address: f/nz. <.. 2^2.*"^ 

Phone: %32,- ^^-2,-1.f^-i 

Team '^/UtrlU^l c CM ^ BVID#

Sample Number 

/RYASCPXA - ^/?.Ai l 

RYR^CPXA- g/g<SV 

f?YcacP)/A - ^J^R ^ 

/?DZLSCPyA' 2JZR4 

Omaha Lead Site Date: (o-'^^^IS North Arrow 

Site SIcetch Time: ST/Z^c* ^ 

. ^ . 

 ^/ Z ?" / XRF Code ^B02^ 

Lead Concentration Confirmation Sampie 

^Wes ° 

""Yes n 

»i Yes ^ 

UtYes n 

<:^ ? ^ ^ •^•^ ppm C«Yes 1^ 

ppm Yes n 

ppm Yes • 

d;A^ . 

Omalia Lead Site 46130 
Name: V^UMI H^/hftMt ^ Oinaha Lead Site Date: fe-^g-^;? North Arrow —• 

Address: /M2. S.Tl'Z' ^ SttaSiwteh Time: £rZjOsjts -

Phone: ^r. - ^TZ.-ZSip-i 

Team '^flnr l UAl c fM& ) BV1D# Z-IZ^J^j XRF Coda SB 02-

Sample Number Lead ConoentROtion 

"^K 

^^V/ 9 pp;; 

MmJS£EXA-M£&iL 

ppm 

ppm 

Me ^'^ ^ 

I 

1=^ 

1^ -w 

^ ; 1 ­

^ ^ : ^ ^?i ) ^ 

^ ^ 

ggf 1^2,3. i-<2t J l {t^ ^ 1 ^ 

\—^ \ dn ^ ^ 

k--^ A v i 

-TQ-r^TT 

VZ3*.»$ 

a l . f. t ^ ^ £ I 

^g=^ >C"'y ^ 1^ =1^ 

^ '<Mil 

*^c ^ ^-z-' 

^ 

Omaha Lead Site 46130 
COASTA l IPTVIItONn l HIA I 

CROU P « N c 

Consent for Aocciss To Propferfy 

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 

follow^ing described premises: 

Owner's Name: Daytime Phone: 

K>)iyit.K Dj-2fino> , 3^Z- 3g><^3 

[ 

Address of I Property 

covered by this 

Agreement: 

W^l <^ 1 1 s> . 

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 perfonmed, 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 vwitten 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 t of 2 
C0AS 1 A i IPt f IROHHIKTA L 

C R O U » • f C 

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

piles, dog houses, etc; 

od 

f 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 

r 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 

t 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 

Qigrant access to my properties G ' do not grant access to my properties 

v y Signaturee V ^ v ^ '/ ^^^^/t)h//P ^***/AA/W) 1 Signature Date

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

Page 2 of 2 
RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # Jl a8 ^ 

Property Address / / Q XL ^ . ;i;i^ S^T 

Owner Name C^ (H ^ \ j^m^ U [)O.<J(V)AY^ llgTT 

Date \^-^ft-Q ^ 

Comments 

nmivlgtLS UJ^ATT P€AJ2 ^ QA) n>li£ A) Sir^^ oP 

^nfc irlt)/K^ T> l?/./Mit^') V>^t^A\ 0/j/l^fit IS A;<-) 

U)^^tX^\U7s?ci/\)^i(^u^ for? P^rrn/OftTfe Psy\/<^ g ^ 

Owner Signatur 

Contractor Signature ^vPfi)l/)Upf[pkaf J 
RestoratsoR 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: ^ 12B^ 

Property Address: /|p 2 "^ "22- "^ ^ 

Owner: Q > o>,,_ 

Phone: ':^^7^^B<^ ^ 

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 I enoval. storage, disposal, and/or return of these Itoms Is the Owner's responeibility. 

ttem: 

^mpA \ pUu^^^-^ ^ b<L ^>^vec\ 

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

ttem: 

*3>wvd\ 0\c.>ft-H^ W-^ 4 ^•.n' 4 

Page l o f X 
C

C3i 

 OASTA L 

Items to Be Removed By Contractor Durinfi Remediation and Repjaced 

ttem: 

^D\L f\ r V^ 

ttem: 

hoi^ f 1 Y h ^ V^ 

Item: 

Item: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

tninlc diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers. Head.s, etc. 

Aiiaih a sketch ol ilif 

"•rr't'klci liiv'.nii 

Number of and size of 

each garden/ flower bed 

area. 

Alliicli il skt'ifh ol ri.-!iiii\t.' 

MZOS nnd lociilicinN 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\cl c iM". ^»Il^lc \\\\\ nt 

\:%fC 10 livui .1 ;ilaiii 

mtiilii.': 1(1 llie |ira|)cii> 

ii\» ner. 

Easement Area, to be 

excavated 

Landscape Inventory 

Quantity 

\\K U 

XT 

IS 

9 

Unit 

Quadrants 

Each 

Each 

Each 

Condition/Type/Species 

^ K /lft^4 

or Fach 

Square Feet 

^ 

tJt7 

S 

Eacfa ^X^ 

1 

• 

Page 2 o, - > 
COASTA L 

! Additional Comments / instructions: 

L. 

Q Check the tx>x if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checldng this tK}X CEG Is not responsible for any damage done to the 

interior of house, including foundation cradks or fissures. 

\m^ n I do not agree agree 

\Owner*s signature Date Olntractor's Signature Date 

Page 3 of. 
BVID#_ZJL2_8^ 

XRF PROPERTY SAMPLE SHEET 


Date i0-33-0 y Address \\r)y^ S7. ^ ^^ 

Project Omaha lead FP 2n(] year opllon Sample time am/pm 

XRFID# sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

P/ : ^ ^ 

t il&. Depth Depth 

J ^ ^ ^ ^ /3> ^ y ^/ ^ 

Average ^ i •^Cc> Average //^J ^ ^ ^ 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sampie area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature ^mu^ 

Print C\mxm\ Oc(m(\ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 532 

Mode SOIL 

Time 2009-10-24 08:29 

Duration 120.00 

Sequence Final 

Flags 

AVERAGE fAvg'^of 528^531 "Tj 

LOCATION 1102 s 22 st 

INSPECTOR VENTRY 

COR 1 f l 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

-Pb/ .• " 91.201 ± l b. 196 

Cd < LOD 20.606 

Ag < LOD 14.788 

Sr 112.174 ± 8.434 

U < LOD 21.943 

Rb 52.782 ± 6.711 

Th < LOD 13.536 

Se < LOD 5.934 

As < LOD 19.750 

Hg < LOD 13.181 

Zn 102.466 ± 20.293 

W < LOD 78.335 

Cu < LOD 32.349 

Ni < LOD 74.583 

Co < LOD 175.303 

Fe 16587.320 ± 423.752 

Mn 450.485 ± 106.069 

Cr < LOD 115.068 

V < LOD 324.473 

Tl < LOD 724.408 

Sc < LOD 70.957 

Ca < LOD 1246.161 

K < LOD 1544.900 

S < LOD 1213.009 

Supervised By: C^KJ ^ m. !ei) 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

188.411 

< LOD 

< LOD 

105.837 

< LOD 

50.482 

< LOD 

< LOD 

< LOD 

< LOD 

162.565 

< LOD 

38.476 

< LOD 

< LOD 

19298.424 

500.739 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Certificate of Verification 

528 

SOIL 

2009-10-24 08:27 

30.00 

Final 

21284 

1102 s 22 st 

VENTRY 

f l 

6 

clearence 

epa gun 

EPA 

± 

± 

'± 

± 

± 

± 

± 

± 

Error 

21.715 

21.011 

15.218 

8.415 

23.591 

6.873 

15.357 

6.733 

27.839 

13.039 

25.046 

77.506 

22.997 

80.932 

193.099 

466.492 

113.099 

171.886 

512.800 

1164.752 

32.767 

1252.974 

1275.844 

1140.304 

Supervised By: 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR l 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

77.930 

< LOD 

< LOD 

112.442 

< LOD 

53.832 

< LOD 

< LOD 

< LOD 

< LOD 

99.737 

< LOD 

< LOD 

< LOD 

< LOD 

15221.332 

495.889 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

Certificate of Verification 

529 

SOIL 

2009-10-24 08:28 

30.00 

Final 

21284 

1102 s 22 st 

VENTRY 

fl 

6 

clearence 

epa gun 

EPA 

± 

± 

± 

± 

Error 

14.582 

20.090 

14.627 

8.442 

20.748 

6.637 

12.778 

5.417 

18.720 

13.158 

19.992 

71.118 

31.747 

70.149 

166.497 

406.147 

109.422 

121.400 

307.762 

315.166 

103.631 

1052.900 

1233.256 

984.987 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 530 

Mode SOIL 

Time 2009-10-24 08:28 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 21284 

LOCATION 1102 s 22 st 

INSPECTOR VENTRY 

COR 1 f l 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

49.428 

< LOD 

< LOD 

115.712 

< LOD 

55.591 

< LOD 

< LOD 

< LOD 

< LOD 

61.198 

< LOD 

46.773 

< LOD 

< LOD 

15996.362 

419.247 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

± 

± 

± 

± 

± 

± 

± 

± 

Error 

11.894 

20.240 

14.260 

8.229 

20.617 

6.530 

12.534 

5.484 

15.594 

13.711 

16.653 

82.390 

21.954 

73.230 

168.154 

401.204 

99.710 

128.753 

245.049 

801.196 

40.207 

1589.751 

1867.739 

1477.742 

Supervised By: 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR l 

COR 2 

MISC 

NOTE 

User Login 

Certificate of Verification 

531 

SOIL 

2009-10-24 08:29 

30.00 

Final 

21284 

1102 s 22 st 

VENTRY 

f l 

6 

clearence 

epa gun 

EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

w 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

49.035 

< LOD 

< LOD 

114.705 

< LOD 

51.224 

< LOD 

< LOD 

< LOD 

< LOD 

86.366 

< LOD 

< LOD 

< LOD 

< LOD 

15833.164 

386.064 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

± 

± 

± 

± 

± 

Error 

12.590 

21.083 

15.047 

8.649 

22.814 

6.805 

13.476 

6.102 

16.848 

12.814 

19.480 

82.327 

30.224 

74.019 

173.463 

421.164 

102.044 

38.234 

232.282 

616.517 

107.225 

1089.020 

1802.763 

1249.005 

V 
^1^^' % Omaha Lead Site—Fixed Price EP-R7-07-05 

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

SLJ^^^J ^ www.coastalhazmatcom "^ ^ 

^-i.Pno^' ^ COASTA L ENtltONHEMTAl 

G • O U r . IN C 

EXECUTIVE SUMMARY: 

BVID #21284-(1102 S 22 ST) 

No Issues or Concerns j ^ Issues/Concerns 

Detail Explanation: 

-COASTAL TO PUT FENCE AND BARRIERS BACK UP. (COMPLETED 11/8/09) 

-COASTAL TO BACKFILL ALL HOLES AND LEVEL OUT THE YARD BY THE SIDEWALKS 

AND IN FRONT OF THE PROPERTY. (COMPLETED 11/8/09) 

-PROPERTY WAS WALKED BY THE EPA ON 11/10/09 
tala a 

4

EPA Property Close Out Form 

Property #: S\Qs^^ . Property Address:- ­

Date/Tlroc: Owner's Name:. ^ 

Quads Excavated; Ki ^ pJ2^ ^ p ^ Contractor Group _ 

Excavation Yes No General 

1. If necessaiy, were the correct quadrant(s) excavated and restored? \y^ 

2. If necessaiy, were the correct areas of drip zone excavated aod restored? \ y ^ 

Grading Sod and Vegetation 

Yes No 

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

from the house? ^ 

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

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

i ^ ^ day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

6. Was the property graded such that water will not pool on the propert>'? 

U" 

7. Was dainage to landscaping or plant materials avoided? 

\ y ^ 

Gates, Fences and Retaining Wallt 

Yes No 

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

l y ^ 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) l y ' 

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

\^ ' 

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

\^ ' 

Foundation, Siding and Gmiers 

Yes No 

1. Was damage lo tlie siding or trim avoided? Lx' 

2. Was damage to the foundation avoided? \ y ' 

3. 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? 

\ y 

Sidewalks and Driveways (Concrele) 

Yes No 

1. Was damage lo driveway surfaces avoided? t y 

2. Was damage to walkway surfaces avoided? 

t y 
Owners comments: # 

Inspection notes: 

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

EPA Represenlalive Ugv> naJLtla y D'dXt: lj /d/d 9 
L 

Property Completion Agreement 

[Illi agreement docuinenls lhe complclion of remedial acliviiies perloimed on my pioperly My signalure 

will designate thai I am satisfied with lhe restoralion of my propeiiy. and Ihal no items are in questions, 

now, or at any lime in the future, excepl ihose ilems listed below, ifany 

PropertylD: 2./ Z 8 ^ 

Property Address: | | ^ 7 S 2 2 f E 

Ownc Wfqr>.\c\ V)\1nna 

Phone: qpZ. mi-39.ia^ 

Restoration Items in Question: 

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Item: 

Item: 

Additional Comments: , ~ /o ^v 1 

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I H^l Agree I'Ktoralion K compleled, except RS noleri 

[_J I lio not a|>rec rctlomtion i> compleled 

cnr^^/) )i\it/i(Pi 

Icr's Signatiirr Date Chi ntrarlor's Signature Dale 
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Punch List Items 

BVID#: Name 

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Date Address & Ph#: : 1109^ .^ 22. si r 

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