TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: ;5g>aC)'4 Date: ^jlQl m 

Address: ^HlQ \vx\\rmC\ "^3^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 ^ Video of property (DVD) 40314757 

y " Executive Summary ill ill III III III III 1^^ 

y EPA-provided property sketch Superfund 

y Signed Access Agreement for subject property 

/lt|iT Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

/u/fi' Settlement documents (i.e., for damage or to replace plants, etc.) 

W Confirmation data 

y Photographs IN-t-JlXCJiJailSA^ lYfyO^^JxCy^^ Sd-A/iy^ ^ ji/uj^^ ^ 

U As-built sketch ^ 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

/u)n Description of areas not meeting ROD cleanup criteria 

[5 Utility clearances 

W Property information from Douglas County Assessor's Office 

D 1 

D 

9Q(mmy\ <3/^g/o^ 

Signature Date 

^/l^of 
Property Access Checklist 

ProDCrty ID: ^ISoi^ ^ 

Pio|)erty Address: J^<// ^ ^^^,^^ ^ <^ ^ 

n

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

0«ner: \\f\^^(J^^[ JYlarOn ^ 

'""^'^^^P5^/ A^^/^ d^^^S . 

Phone: :^ ^ ^ ^ J< ^ 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fa.v: 

Cell/Paser: 

Additional liit'ormation: 

1 

i • " '—— ' 

D Notification Letter 

r ^ Acce.ss Agreement 

y(\ Restoration A<>reement 

CH Topsoil Sampling (if applicable) 

d l Disposal Sampling (if applicable) 

CH Garden Sampling (if applicable) 

I [El Utility Clearance 

ca Video/Photos (Before) 

D Video/Photos (During) 

n Video/Photos (After) 

n Video/Photos (3()-Day) 

O Pro|)ert> Completion Agreement 

1 1 Final Re()orf 

Sent: / / 

Signed: 1/ 1 /O ^ 

Signed: " 7 / / /<^ ^ 

/ / 

/ / 

/ / 

Called: i)l/ H /O^ 

On: ^/\D / " ^ 

On: / / 

On: / . / 

On: / / 1 

Signed: / / , 

Is.sued: / / 

By: 

B.v: /4 A 

B-V: J A 

By: 

By: 

By: 

Bv: t c 

By: iC/\yifl^ 

By: 

By: 

By: 

By: 

By: 

Air Monitoring ( 

II EH Community 

as applicable) 

D Cre>v 

Results: 

On: / / By: 1 

LJ Community Results: 

n Ci-e>v On: / / B.v: 

E] Community 

Results: 

n Cre^v On: / / By: 

Omaha Lead Site 
Douglas County Account Information Page 1 of 1 

Dougla s County , Nebrask a Propert y Recor d - R221051000 0 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90tti St - Vie w o n Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature -•-»-* > Auto Sales Search 

Owne r 

OMAHA ECONOIVIIC DEVELOPMENT CO 

2221 N 24 ST 

OMAHA NE 68110-0000 

Propert y Informatio n 

Key Number: 10510000 22 

Account Type: Residential 

Parcel Number: 2210510000 

Parcel Address: 2410 INDIANA ST 

OMAHA NE 68131-0000 

Legal Description: SHINNS ADD LOT 2 BLOCK 13 E 27.5 W 56.5 S 46.25 FT & E 24.5 W 53.5 N 26 

FT 

Valu e Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$200.00 

$200.00 

$200.00 

$200.00 

$200.00 

$200.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$200.00 

$200.00 

$200.00 

$200.00 

$200.00 

$200.00 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.04 1872.0 0.0 72.0 26.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221... 7/9/2008 
Page 1 of 2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2078208. 

Original Call Date; 

Work to Begin Date: 

7/09/08 

7/11/08 

Time:

Time:

 5 

6 

41 pm 

15 pm 

Op: ELIZABETH18790 

State: NE 

Address: 2410 

County: 

Street: 

DOUGLAS 

INDIANA ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 15-NW-SW,16-NE-SE 

 Sect-Qtr: 

Type of Work: Lead Remidiation 

Location of Work: ENTIRE PROPERTY ALL THE WAY TO THE STREET. 

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 LEVELS MAGELLAN MCLEODNE MUDOl OMAHACOF 0PPDGPR5 

OWWC QLNNEIC 

Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MAGELLAN MAGELLAN MIDSTREAM 

PARTNERS LP TONYA 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2008 
Page 2 of 2 t 

MUDOl 

OMAHACOF 

OPPDGPR5 

OWWC 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

OMAHA WORLD HERALD 

COMPANY 

 QWEST LOCAL NETWORK

EDWINA 

RON 

NA 

NA 

 NA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4024443169 


Alt: 


Emerg: 4024443169 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2008 
25204 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Omah a Lea d Site Exterior Paint North A/Tow Owner Name: OMAHA ECONOMIC DEVELO 

Site Sl<etch 

• Good Address: 2410 INDIANA ST • Poor Phone: H 402453930 W: 0 * Nol paint i

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: A^t^ l g&,\ (KT 

RYASCPXA-25204 Fl 2 3 I ppm D 

Date: ti-o-r-o c 

RYBSCPXA-25204 F2 H3 3 

ppm B- Time \-.w s p,v^ 

RYCSCPXA-25204 Bl l&3< p ppm/n & 

D Samples Analyzed RYDSCPXA-25204 B2 3-7 Q ppm D 

RDZSCPXA-25204 DZ ppm D D XRF Unit: /CX^y Book: 11 3 

nCZSCPXA 25204 6 2 .ppm D D Date: n-^n-t^ ^ 

nPZOCrXA-25204- -PZ­ ppm D n Time: AfYl

.Lab RYBSCPLA-25204 

Numbe Staff: JhitL . r of Samples = *1 2 Result 581 ppm 

L-cyc^j r I - riuiii Leu, r2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ • Play 

All quadrants are as viewed from the street, facing propeity 

: OLS#: 2S204 

Date Excavated :7/12/08 

Date USEPA Signed Off: 

Area Sodded 1865 sq ft 

Legend 


Concrete /j/XJ Dripp Zon Zonee Excavate Excavatedd |C)<XX Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare
 Sod ' Rock/Mulch 


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

25204 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: OMAHA ECONOMIC DEVELO 

Sit • Good e Sketch Adldress:24io INDIANA ST • Poor 

Phone: H 402453930 W: 

0 * Not paint 1

Lead Sample Samples Collected Sample Number LAB Concentration Collected Firm: A^v-il Ka.^ A T 

RYASCPXA-25204 F1 2 3 i ppm D 

Date; U-Q-T-O C 

RYBSCPXA-25204 F2 H3 3 

ppm Time: V.JA'Z prx. 

RYCSCPXA-25204 B1 J 0 3 6? ppm/n B' D 

Samples Analyzed 

RYDSCPXA-25204 82 3-7 0 ppm D 

RDZSCPXA-25204 DZ ppm n n 

XRF Unit: /OC H Book: \1 3 

nczccnxA 25204—s? — ppm D D Date i|-30-(P6' 

RPZOCPXA 25204 -PZ- — ppm D D Time v m 

Lab RYBSCPLA-25204 Staff: ^^Su/ 

Number of Samples = 

§ Result 581 ppm 

i-cycnu r i - riuiii Lcn, f l - FroHt Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

NOV. i 11.201)6. 

Rev 4 046141 0123 
25204 

Exterior Paint North Arrow Owner Name: OMAHA ECONOMIC DEVELO Omaha Lead Site 

Address: 2410 INDIANA ST

Phone: » 402453930

Sample Number 

RYASCPXA-25204 

RYBSCPXA-25204 

RYCSCPXA-25204 

RYDSCPXA-25204 

RDZSCPXA-25204 

nczccnxi^'i 25204 

RPZOCPXA 25204 

Lab RYBSCPLA-25204 

i Result 581 ppm 

ucycii u r I - riUM l LCTl,

Fl 

F2 

Bl 

B2 

DZ 

€ 2 

 f Z 

 ^'*® Sketch 

 W: 

Lead 

Concentration 

Sample 

Collected LAB 

£ 3 / ppm D 

H3 3 ppm 

ppm/n & D 

3-70 ppm B' D 

ppm D D 

ppm D D 

ppm D D 

Number of Samples = ^ 

• Good 

0 

• Poo

* Not pain

r 

t 1

Samples Collected 

Firm: A»>Jl g&.\ A X 

Date: ti-o-t-o c 

Time: r.^ s prvN 

Samples Analyzed 

XRF Unit: /PO ^ Book: 11 3 

Date: l\-^D-0 ^ 

Time: <f)n 

Staff: >^Su/ 

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 

• 

EKTERED 

-.10.1 .N.OV.i 4 201)6... . 

e>\ J5>2­

2 ^ ID jAcliarva $.r 

_._4 

4^ 

...FJ \..F 7 

^3 i l.HS'^.... . i 

ii1

-f

1. 

!

Rev 4 .•-•-^-..-..5 5 iciido^ . .ST. : _046I4J 0123 
COASTA L f NVIIONHINTkl 

C • O U r IH 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: i\ ^ ^•- \ K jv 

Owner's Namer-j^^^^^^^^^,^^^ ( ^ Daytime Phone: ({ 0^-O^i ^ ~ 3^3Q O 

3i^/0 -iKvci^om 6/-. Address of Property 

covered by ttiis 

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 
COASTA L 

{NVII0MMfMT4l 

• 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 v^sh 

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 

^" ^ I grant access to my properties 

D I do not grant access to my properties 

^-Ht 

^^y^^ 7V-/09 

Signature 

Signature Date 

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

The purpose ofthis agreement is to provide a mutual agreement as to conditions of the propert>' 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 ouner and the United States Environmental 

Protection Agency (EPA). 

Property ID: '^S^O ^ 

Property Address=3L|)|^^^(]^>Qt^ S f 

Owner: Qpngt^ ^^t>r)c^y bex/LJopeym^ Co 

Phone: MP S hm^-X}>C O 

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

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

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

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

Items To Be Rennoved By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item:, 

Item: 

Item: 

Item: 

Item: 

\ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

C « O u ' > N C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

:x 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity 

51 

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 ^ § ^ 

irunk diameter 

Number of Sprinkler 

Zones. Control Valves."" 

Timers. Heads, eic. ^ ^ 

Anach a >keich oi ine 

ijiriiiklc: !a\Oui. 

Number of and size of 

each garden/ flower bed 

area. " ^ 

•-.\..i^i. :•: NKcicii ,'i .c..i;i\c 

-l:'e^ ruij. locanons. 

Unit Condition/Type/Species 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of 

1 
•V^^S^^^"* 

COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

replaced by contractor. 

Note this \alue »il l be 

used to issue a plant 

>oucher to the propertv 

o»ner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch ol" were 

each plant \\il l be placed 

b_\ ihe coiuiackM-. 

Agreed upon area of 

propertv- to be replaced 

with grass sod. 

•'U'liide L- skeicli y ilic 

.iiea(S! [0 he ;epbci.-a ^v-ili 

ii'-ass >od. 

.Area of Cir\ or Count) 

propert) to be landscaped 

per their requireinents. 

Easement .Area, to be 

excavated 

Quantity 

- S , 

^ 

^ ^ 

^ 

no 

Unit Condition/Type/Species 

$ ^ 

Each 

SF 

SF 

SF 

Page 5 of 
COASTA L • MVIHOMMCHTAL C « O W P . IN C 

Q Check the box if Owner does not want CEG to document interior foundation walls 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. 

j<\\aLgTet Q I do not agree 

'yyu/,fy^ /^/-'^i ^ /%y/^cy r-z-g^ 

Owner's Signature ]^ ^ Contractor's Signature Date 

PageSof. 
Date 

Project 

XRF ID# 

Shot# 

^IR 

l i t 

4 ^ 

Average 

Shot# 

Average 

Shot# 

Average 

Shot# 

Average 

lab sample # 

1<^9i^ BVID# 

XRF PROPERTY SAMPLE SHEET 


'I 1^ Address ^^\ o \\AI^I/!V>A 

Omaha lead FP 2nd year option Sample time ll'. ><=^ am;i)m 

y?^^" sample length 30 sec ] 

Reading Sample area Shot# Reading Sample area 

HM. lit q.q 

^Lt'^^. lo-^l h 1121. 5"' \ ^n Depth TMT Depth 

^ ic-ut \y\. 211 

^1-^11 \oM Average JU^Il t j^.^ C 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

- — 1 

Average 

Lab result Sample area XRF Avg. 

Signature 

Print jMtol_MAlM 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 733 

Mode SOIL 

Time 2008-07-12 11:41 

Duration 121.36 

Sequence Final 

Flags 

AVERAGE Avg of 729-732 

ADDRESS 2410 INDIANA 

QUAD/ZONE f F2 

INSPECTOR MATEUS 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ''"± / Error 

Pb 57.37 4 10.324 

Supervised By: yf^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 44.112 

Supervised By: 

Certificate of Verification 

729 

SOIL 

2008-07-12 11:39 

30.16 

Final 

25204 

2410 INDIANA 

F2 

MATEUS 

6 

CLEARANCE 

± Error 

± 9.521 
• • 

Thermo 

S C 1 E N T 1 F 1 C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 57.881 

Supervised By: 

Certificate of Verification 

730 

SOIL 

2008-07-12 11:40 

30.30 

Final 

25204 

2410 INDIANA 

F2 

MATEUS 

6 

CLEARANCE 

± Error 

± 10.376 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 731 

Mode SOIL 

Time 2008-07-12 11:40 

Duration 30.26 

Sequence Final 

Flags 

BVID # 25204 

ADDRESS 2410 INDIANA 

QUAD/ZONE F2 

INSPECTOR MATEUS 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.865 ± 9.837 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 76.654 

Supervised By: 

Certificate of Verification 

732 

SOIL 

2008-07-12 11:41 

30.64 

Final 

25204 

2410 INDIANA 

F2 

MATEUS 

6 

CLEARANCE 

± Error 

± 11.563 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 738 

Mode SOIL 

Time 2008-07-12 11:46 

Duration 125.19 

Sequence Final 

Flags 

AVERAGE Avg of 734-737 * 

ADDRESS 2410 INDIANA 

QUAD/ZONE vei 

INSPECTOR MATEUS 

DEPTH •€ 

SAMPLE TYPE CLEARANCE 

NOTE 

"7 

ppm / Error 

Pb 112.717 13.455 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 51.647 

Supervised By: 

Certificate of Verification 

734 

SOIL 

2008-07-12 11:43 

30.54 

Final 

25204 

2410 INDIANA 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 9.791 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 174.286 

Supervised By: 

Certificate of Verification 

735 

SOIL 

2008-07-12 11:44 

33.36 

Final 

25204 

2410 INDIANA 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 16.474 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 128.641 

Supervised By: 

Certificate of Verification 

736 

SOIL 

2008-07-12 11:45 

30.27 

Final 

25204 

2410 INDIANA 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 14.630 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 737 

Mode SOIL 

Time 2008-07-12 11:46 

Duration 31.02 

Sequence Final 

Flags 

BVID # 25204 

ADDRESS 2410 INDIANA 

QUAD/ZONE Bl 

INSPECTOR MATEUS 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 96.295 ± 12.926 

Supervised By: 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMENTAL 

C R 0 U r , INC . 

EXECUTIVE SUMMARY: 

BVID # 25204 - (2410 INDIANA ST) 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

CITY CONTRACTOR MOWED AREA & DISTURBED THE SOD. 
^^EPA 

EPA Property Close Out Form 

|Wl^/l^»V 

Property #: 

Date/Time: 

Quad Contractor Group LyOttHyH s Excavated: p | ^ rZ^ 

Excavation Yes No General \[ArAhir Lor 

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

2. If necessary, were the correct areas of drip zone excavated and restored? ^ 

Gradin(; Sod and Vetetation 

Yes No 

1. Does the grading around ths pBrimotcr uf llic hou.^t in exca^iatcd-ateas generally slope vnv, y 

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 at a 30 

day time period) ^ 

4. 

Are sodded areas generally firm and evenly graded? y 

5. 

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

time period) y

6 Was the property graded such that water will not pool on the property? y 

7. 

Was damage to landscaping or plant materials avoided? iJ^ 

Gales, FeDces and Retaining Walls ^'es Nc 

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

2 Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) 

1 

3. 

Was damage to gates or fences avoided? (Ifapplicable) 1 1

4, 

Was damage to retaining walls avoided? (Ifapplicable) 1 

FouDdation, Sidiof; and Gutters Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? V * 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? iJA 

2. Was damage to walkway surfaces avoided? AiA 
Owners comments: 

Inspectson notes: 

(_yi\x^ (LCN^Vc^l^Vcv- ywOvOe^l GLTL/^ d Ai^TUf i^c^ So<i 

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

EPA Representati ve^,,^;/^^^^^^^^,^4 ^ Date:„ 9^^ ^ 
Property Completion Agreement 

Ihis agreemenl documenis ihe complclion ol remedial activiiies perioimed nn my properly My signalure 

will designale thai I am satisfied with (he restoration oi my properly, and ihal no ilems are in queslions. 

now, or al any lime in ihe future, excepi those items listed below, ifany 

Property ID ^S'JLO'- I 

Property Addre..: ^ l j { Q j /) ^ ) CK. ^V(\ s \ 

Qwne ' /Airiicv^l A^o^ro ne ^ 

Phone -^Hr. 'X^dO 

Restoration Items in Question: 

Item; 

Item: 

Item: 

Item; 

Item: 

Item: 

Additional Comments: 

l^n I afjrcc resloralion is complcled, cxctp l as noled 

 I I rio nol a^;i cc restoration is compleled 

f-iy 

Ownc i 's Signalui e Con n actor' s Signature Date 

I