TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 

/?^?^^t. Date: 11 \n^ k^ 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

y EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs L>re^-j2^n/iJ/l±lGr{ Q-CAUiUniJY\ 

i / As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check Hst signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

y Utility clearances 

Property information from Douglas County Assessor's Office 

y 

40316470

iliiii

n 

Superfund 

signature iMe 
m^ 

Property Access Checklist 

Property ID: 2gqp,^ ^ n WORK STARTED ON: / /_ 

Property Address: ;;)^^>-^ Q\A\ A n WORK COIVIPELTED ON: / /_ 

Owner: fa^^^^^r S i fiao\ Renter: 

Address: 2.1Z5 l^»(U\i Phone: 

Fax: 

Cell/Pager: 

Phone: ^"W'-^TtX Additional Information: 

Fax: 

Cell/Paiier: 

O Notification Letter Sent: / / By: 

0 Access Agreement Signed: % 1 lA/C % ^y-9c. 

\/\ Restoration Agreement Signed: / / By: 

1 1 Topsoil Sampling (if a|)|)licablc) / / By: 

[U Disposal Sampling (if applicable) / / By: 

1 1 Gaiden Sampling (if a()|)licable) / / By: 

1 {^ Utility Clearance Called: ^/2i,/.0 8 »>=€) Zftr« 

1 21

1 n

 Video/Photos (Before) 

 Video/Photo.s (During) 

On:_3./X

On: /

 /J i 

/ 

^y-^.u jAiy'lu^ 

{ ' 

By: 

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

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

nn Property Completion Agreement Signed: / / Bv: 

• Final Report I.s.sued: / / B.v: 

Air Monitoring (as applicable ) 

1 1 Community D Crov On: / / By: 1 

Results: [ 

1 L J Community D CixM>> On: / / Bv: 

1 Results: ] 

1 Q Community n Crew On: / / By: 

Results: 

Omaha Lead Site 
• 

CONTACT FORM 

Property ID # 38<^?^ U 

Property 

Address: a^ia Ohin 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time; Action: 

Final Action: Transmit to EPA D Other Action: D 

Cncen^r S4-, PmJl .34l-aa?,l OY :^^\-Altr,Kto 

Comment: 

Owner 

Comment (s): 

Site -^SS Called Uf+miSSQde 

Coordinator ^ 

Comment (s): 
Douglas County Account Infojaation Page 1 of2 )j||^t 

Douglas County, Nebraska Property Record - R0920480000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJe w O n Ma p Information is valid as of 2009-4-16 Treasurer's Tax Report 

New Feature -•-•- > Auto Sales Search 

Owner 

CITY OF OMAHA 

PLANNING DEPT #1111 

1819FARNAMST 

OMAHA NE 68183-0000 

Property Informatio n 

Key Number: 2048 0000 09 

Account Type: Ex Government 

Parcel Number: 0920480000 

Parcel Address: 2212 OHIO ST 

OMAHA NE 68110-0000 

Legal Description: DENISES ADD LOT 18 BLOCK 1 50 X 122 

Value Informatio n 

Land Improvement Total 

2008 $0.00 $0.00 $0.00 

2007 $0.00 $0.00 $0.00 

2006 $4,800.00 $700.00 $5,500.00 

2005 $4,800.00 $700.00 $5,500.00 

2004 $4,800.00 $2,800.00 $7,600.00 

2003 $4,800.00 $2,800.00 $7,600.00 

Sales Informatio n 

Sales Date: 2008-07-31 

Deed Type: \NDU Book: 2008 Page: 077507 

Price: $38,320.00 

Grantor: GREATER ST PAUL MINISTRIES INC 

Grantee: CITY OF OMAHA 

Valid/Invalid: Invalid 

Exclusion Reason: Multiple Parcel Sale 

Sales Date: I 2003-05-30 

Deed Type: WD BooAr: 2003 Page: 103631 

Price: $6,000.00 

Grantor: Stacey Anderson 

http://douglasne.mappmg-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092... 5/2/2009 
Douglas County Account Infoj|^tion Page 2 of2 

Grantee: 

Valid/lnvalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/lnvalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/lnvalid: 

Exclusion Reason: 

Land Informatio n 

Acres SF 

0.14 

Greater St. Paul Ministries, Inc. 

Valid 

2002-12-19 

WD 

$1.00 

Pearl Taylor 

Stacey Anderson 

Invalid 

SooAr; 2003 Page: 103542 

2001-04-12 

QC 

$1.00 

Book: 2177 Page: 738 

Invalid 

Non Bono with Doc Stamps 

2000-04-24 

D Book: 

$7,000.00 

2150 Page: 085 

Valid 

6100.0 

Units 

1.0 

Depth 

122.0 

Width 

50.0 

Vacant 

No 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092... 5/2/2009 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2117116. 

Original Call Date: 8/26/08 Time: 3:39 pm Op: ELIZABETH18790 

Work to Begin Date: 8/28/08 Time: 4:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2212 Street: OHIO ST 

Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidiation 


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


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


: UNSURE OF CORNER PROPERTY 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF OPPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 


MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 


Emerg: 9185747098 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

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

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2008 
Page 2 of2 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2008 
As-Built Drawing 

C OAST A L Omaha Lead Superfund Site ENVIHONMENTAL CMOUP . INC . 

28986 

Omaha Exterior Paint Lead Site 

Sit • Good e Sketch 

0 Poor 

Sampling Address: 2212 OHIO ST r~| Not paint 

Sample Number Lead Sample Samples Collected Lft,B Concentration Collected Firm: 

RYASCPXA-28986 F l 3C>q 

ppm D Date: &//7/A 7 

RYBSCPXA-28986 F2 31 1 ppm 

D Time: 2.lbfm 

RYCSCPXA-28986 Bl ppm 

Samples Analyzed 

RYDSCPXA-28986 B2 ppm n 

RDZSCPXA-28986 DZ ppm i n 

XRF Unit: L^HT . Book: 19, ^ 

RogoopxA-eosoo—ee ppm n 

n n Date: <=i jT. ! I O l 

RPZOCPXA.20900 PZ ppm 

n D Tinfie: P M 

Staff: AtyU/ " Number of Samples = 5 

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

An quadrants are as viewed Uz^^ffR,V^\ facing property 

OLS#:28§5& ENTERED Date Excavated: 9/15/2008 

date USEPA Signed Off: 1/28/09 AD6 2 T ZPD7 

Area Sodded 3365 sq ft 

Rrt 5 «-fe*«l «.'>> 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with I Area replaced with 

Area left bar e Sod ' Roclc/Mulch 


Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc 
28986 

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

0 Poor 

Sampling Address: 2212 OHIO ST 

Q Not paint 

Sample Lead Sample Samples Collected Number 

Ccxicentration Collected LAB 

Firm JtM__E^_C6. RYASCPXA-28986 F1 ppm Date ^/{7/n7 

RYBSCPXA-28986 F2 31 1 ppm Time >m_ RYCSCPXA-28986 Bl ppm D 

Samples Analyzed RYDSCPXA-28986 B2 ppm D 

RD2SCPXA-28986 DZ ppm D XRF Unit <^*^ Z Book: /9 3 

RqgoopXA-eosoo oe ppm a D Date <^IZ I lO l 

RP20CrXA-20900 P2 ppm D Time £J± 

Staff Number of Samples = 5 h^\y 3 ^ o 

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

AH quadrants are as viewed tiq^jjfgUi^ . facing property 

^ yTr^ti.—- ^ 1 AlS "*• W ENTERED 

I'kr 

^ 
• 

28986 

Omah Exterior Paint North Arrow a Lead Site 

Site • Good Sketch 

^ 0 Poor 

Sampling Address: 2212 OHIO ST 

• Not paint 

Sample Number Lead Sampie Samples Collected LAB Concentration Collected Firm: j^ M FRC£7 

RYASCPXA-28986 Fl ppm D Date: &//7/A 7 

RYBSCPXA-28986 F2 31 1 ppm D Time: Z • 13 pm 

RYCSCPXA-28986 B1 ppm D 

Samples Analyzed RYDSCPXA-28986 B2 6*f0 ppm D 

RDZSCPXA-28986 DZ ppm D XRF Unit: LS'j2. Book: /9 3 n5?. nogoGr)(A-iB0900—e£ ppm D Date: <^IZI J O l 

RPZOCPXA'2090G P2 ppm n D Time 2J± 

( ^ Staff Mr:\y Number of Samples = 5 .S:^ 

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

All quadrants are as viewed fr(^/|2^t^t , facing propei 

ENTERED 

s 

^ 5 ^ 

1 ^ 

f 

^ 

% • ^ 

' jn'.»«)»i';» i wT.-nm^idrtjwr j««T<»'i«ot j.^,- .-at w .a* jnr JW: >•»:•«' » V >M1 MT.-<Wt m> /)•' IMT KM^MMt : I 
I 

28986 

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

0 Poor 

Sampling Address: 2212 OHIO ST Q] Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-28986

RYBSCPXA-28986

 Ft 

F2 

36 ^ 

3 \ 1 

ppm 

ppm 

D 

D 

Date:

Time: 

b/t7/h 7 

Z:l.5f>Pi 

RYCSCPXA-28986

RYDSCPXA-28986

 Bl 

B2 

\l^ H 

(^HO 

ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA-28986

RqgOGPXA-e0900

F!PZOCrXA-2090C

 DZ 

OE 

PZ 

l'?52 . 

— 

ppm 

ppm 

ppm 

Number of Samples =

D 

D 

^ 

D 

D 

D 

o 

XRF Unit: 6S^ Z Book:

Date: ^I2lj0 7 

Time 

Staff 

2 ^ M^ U 

/^ 3 

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

All quadrants are as viewed frqAMaftti^t, facing property 

-4 "f^ > !> • ^ ¥• 

ENTERED 

AUG 2 r 21107 
.y^y^^.. • m 

% •! • o* COASTA L '*'/i, . y EHVIBONMENTA L 

^ ' "ROl* ­ CROUP . INC . 

Consent For Acces s 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: 

pyip^h 

Owner's Name: Daytime Phone: 

ftr^»-ify ^ . y^ y syyy^\ 

Address of Property 

covered by this 

Agreement: 

;J;^17^ /^k(6 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 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 
— * > .s^^^ ,itosr<. 

• 

COASTA L ENVIRONMENTA L 

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 ofthe 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 (877) 234-6270. 

Q i grant access to my properties n I do not grant access to my properties 

^b4k asi. Signature Date Signature Date 

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

Page 2 of 2 
Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This wiil also serx'e as documentation for the purpose of assuring that restoration 

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

Protection Agency (EPA). 

Property ID: "Sy^^^y 

Property Address: ^-^NQDW O 'Sl^ 

Owner: ^.^^^^^ ^ ^- ^ Q^t^ Q 

Phone:(^^N^ ^U F 

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

utilities, subsurface features, 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 these items is the Owner's responsibility. 

Item: 

Item: 

Item: 

Item: 

k\\i\ 

J 

cX^J.1 pi(iv\i^ {.CV(\^n.^ye\](\¥A\^\ 

y^^-

OoJner

/ 

-—­ ^ 

x ^ 

Item: ^ y 

Item:

Item: ^ 

 ^y ^ 

^ y 

Item: 

Page 1 of. 
COASTA L 

CMOU P > H < 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

^./in .Plf bkn^i ^^.:^- .-_^ 

Item: y 

^ 

Item: y 

Item: y 

/ 

Kem: 

y 

Item: / 

7 

Item: / 

Item: / 

Item: / 

/ 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
< ^ 

COASTA L • MVlNOMM I NTA L 

c M o u r t N C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^y y i^i p,o n-?. Item: 

1^^ SVa QZ 

\ Item: "^^^.^^^ 

' Item: y 

^ 

Item: ^ ^ 

Item: 

1 ^ 

Item: y ^ 

Item: y 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

Item: 

Item: 

Page 3 of. 
( ^ ^ 

COASTA L l*avtROM'*t*«r« L 

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 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

y 

# 

* * 

# 

/ 

Unit 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

•­

j 

Page 4 of. 
I

COASTA L 

 MV(|ION'*tNT* l 

C * O U r IM C 

Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketcii of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity 

^ ^ 

Unit 

$ 

Condition/Type/Species 

^ ^ Each 

y 

O SF 

SF 

SF 

Page 5 of. 
# 

C O A S T A I. KMVUKOMMCMTAL «NOwr . IN C 

^ D Check the box rf 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, includingfoundation cracks or fissures. 

0^ n I agree n I do not agree 

^N(<^<^ 

Owner's Signature Date ^Contractor's Signa^re Uate 

Page 6 of. 
\ 

BVID#rQ^P8<: n 

r^\Si ono "^y 

iU'-oS s^^p ^ 

30 sec 

Date 

Project 

XRF ID# 

Shot# 

<-\h;z ^ 

^c^U > 

^OQ I 

^0,- ^ 

Average

Shot* 

^.o^ o 

^a^u> 

4o.^ T 

4D.V:5 

Average

Shot# 

Average 

Shot# 

Average 

lab sample i*

XRF PROPERTY SAMPLE SHEET 

^-l^ - Q8" Address 

Omaha lead FP 2nd year opllon Sample time 

sample length 

Reading Sannple area Shot# 

jn(^.'^-.5: l3..?A ^i^ y 

lO:^ .5>«?t t2,.,.TK P.^=-^ ' ^o'^\ Depth \H\ •ie'^t i^S »8 O-^?^ 4 ^ l4i-,St . k<,.\2l 6? os^ 

 i^^^-^'^ t i M • Q< r Average

Reading Sample area Shot# 

iUi^.-At^ri ^ cS -4oHo 

lAi, . Ai t W^.'tT b"^ ^(^ i 

i'-ft.o&i n n Depth -40^ ^ 

^^^\ . n - il« iB(^ I ;> ^(rl.^ 

 li q . ^1( g t Uo-G t Average

Reading Sample area Shot* 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

 Lab result Sannple area XRF Avg. 

Signature 

Print /(y ^

Reading 

tO-?,ctfenM. ^ 

i-70.:^a i^ ^La^>^ 

o>^U. S H t .<3.<o K

lao-^^ ^ ,-;> .'i< 

 -.-/.Q.^ a ^

Reading 

ri^.l^ i 15,. ^ 7 

lOQ.//^,'^* i?.,(•;':< 

i'A'S,.,r> >^.o8 

L5r, >«i:)M.aq 

1 ^ ^ .^?> J

Reading 

Reading 

 CO (Cc-c,

Sample area 

1^1 

 Depth 

_L5 

 i(^ . l^-> 

Sample area 

B9 

Depth 

L ^ 

 i M 'o Q 

Sample area 

Depth 

Sample area 

Depth 

 L<>p,. A 

1 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4025 

Mode SOIL 

Time 2008-09-15 16:09 

Duration 30.31 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE easement 

INSPECTOR lopez 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 106.496 ± 13.391 

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 102.583 

Supervised By: 

Certificate of Verification 

4026 

SOIL 

2008-09- 15 16:10 

30.27 

Final 

28986 

2212 Ohio st 

easement 

lopez 

6 

CLEARANCE 

± Error 

± 13.280 
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 141.620 

Supervised By: 

Certificate of Verification 

4027 

SOIL 

2008-09-15 16:11 

30.33 

Final 

28986 

2212 Ohio st 

easement 

lopez 

6 

CLEARANCE 

± Error 

± 15.178 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4028 

Mode SOIL 

Time 2008-09-15 16:11 

Duration 30.24 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE easement 

INSPECTOR lopez 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 141.119 ± 15.131 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4029 

Mode SOIL 

Time 2008-09-15 16:11 

Duration 121.15 

Sequence Final 

Flags 

AVERAGE Avg of 4025-4028 

ADDRESS 2212 Ohio st 

QUAD/ZONE e easement 

INSPECTOR lopez 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

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 127.983 

Supervised By: 

Certificate of Verification 

4030 

SOIL 

2008-09-15 16:15 

30.46 

Final 

28986 

2212 Ohio st 

Bl 

lopez 

13 

CLEARANCE 

± Error 

± 14.322 
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 170.319 

Supervised By: 

Certificate of Verification 

4031 

SOIL 

2008-09-15 16:16 

30.04 

Final 

28986 

2212 Ohio st 

Bl 

lopez 

13 

CLEARANCE 

± Error 

± 16.117 
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 264.592 

Supervised By: 

Certificate of Verification 

4032 

SOIL 

2008-09-15 16:16 

30.05 

Final 

28986 

2212 Ohio st 

Bl 

lopez 

13 

CLEARANCE 

± Error 

± 20.143 
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 120.378 

Supervised By: 

Certificate of Verification 

4033 

SOIL 

2008-09-15 16:17 

30.08 

Final 

28986 

2212 Ohio st 

Bl 

lopez 

13 

CLEARANCE 

± Error 

± 13.948 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4034 

Mode SOIL 

Time 2008-09-15 16:17 

Duration 120.63 

Sequence Final 

Flags 

AVERAGE *Avg of 4030-4033 

ADDRESS 2212 Ohio st 

QUAD/ZONE # 1 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4035 

Mode SOIL 

Time 2008-09-15 16:20 

Duration 30.07 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE DZ 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 146.302 ± 15.078 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4036 

Mode SOIL 

Time 2008-09-15 16:22 

Duration 30.04 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE DZ 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 183.306 ± 16.990 

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 199.046 

Supervised By: 

Certificate of Verification 

4037 

SOIL 

2008-09-15 16:22 

30.12 

Final 

28986 

2212 Ohio st 

DZ 

lopez 

13 

CLEARANCE 

± Error 

± 17.108 
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 191.173 

Supervised By: 

Certificate of Verification 

4038 

SOIL 

2008-09-15 16:23 

30.03 

Final 

28986 

2212 Ohio st 

DZ 

lopez 

13 

CLEARANCE 

± Error 

± 16.878 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4039 

Mode SOIL 

Time 2008-09-15 16:23 

Duration 120.26 

Sequence Final 

Flags 

AVERAGE Avg of 4035-4038 

ADDRESS 2212 Ohio st 

QUAD/ZONE pz- INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

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 154.732 

Supervised By: 

Certificate of Verification 

4040 

SOIL 

2008-09-15 16:24 

30.08 

Final 

28986 

2212 Ohio st 

B2 

lopez 

13 

CLEARANCE 

± Error 

± 15.468 
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 102.599 

Supervised By: 

Certificate of Verification 

4041 

SOIL 

2008-09-15 16:25 

31.04 

Final 

28986 

2212 Ohio st 

B2 

lopez 

13 

CLEARANCE 

± Error 

± 13.039 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4042 

Mode SOIL 

Time 2008-09-15 16:26 

Duration 30.31 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE B2 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 145.604 ± 15.081 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4043 

Mode SOIL 

Time 2008-09-15 16:27 

Duration 30.28 

Sequence Final 

Flags 

BVID # 28986 

ADDRESS 2212 Ohio st 

QUAD/ZONE B2 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ± 14.494 135.176 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4044 

Mode SOIL 

Time 2008-09-15 16:27 

Duration 121.71 

Sequence Final 

Flags 

AVERAGE Avg of 4040-4043 

ADDRESS 2212 Ohio st 

QUAD/ZONE « 2 

INSPECTOR lopez 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

Supervised By: 
X 

m Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

%. • . ^ www.coastalhazmat.com 

^PBoit^"^ COASTA L 'in a ENVIHONMENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY; 

BVID # 28986 - (2212 OHIO ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

- NO ISSUES PENDING 
.^EPA 

EPA Propert> Close Out Form 

Property ft: y)(yRSL o Property Address: ^\ ^ Oh\ Q ^) ' . 

Date/Time: Owner's Name: /jryr-^^ ^ ff^- V^XAJ U 

Quads Excavated: 'Q>\. xgaS). ^" ^ Contractor Croup Qj-y-^ n Q \lf^,An>,rMrji irt^cJL 

Excavation General Yes No 

1 If neccssiry, wert the correct quadrant(s) excavated and resiored? y 

2 Ifnecessary, were the correct areas ofdrip zone excavated and restored'^ y 

Gradlpg Sod tod Vetetation Yes No 

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

from tbe house? VAcu^. XoMJt> Vs >>-<-A a LIL V rc^W^^crn . gw^ 

Has sod been laid in all areas that were excavated? -Se?: cl re-^vco/e-X /J4 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspecied at a 30 5 ^ 

day lime period) itt4 

4 Are sodded areas generally fum and evenly graded? 

y ^ 5 Are the joints between the sod strips generally tight? (Only evaluate ifinspected at a 30 day 

time period) _^____ 

r 

6 Was the property graded such that water \* ill not pool on the property' 

7 Was damige to landscaping or plant materials avoided'' y 

Gates, Fepcea and ReUinlD£ Walls \e i No 

Do gates open and close freely'^ (Ifapplicable) 

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

W^ 

3 Was dam»ge to gates or fences avoided? (Ifapplicable) 

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

Foupdation, SidicKand GuClers Yes No 

I. Was damtge to the siding or trim avoided? 

2 Was damage to the foundation avoided? jm:^ X 

\VDIA^ 

'y vi^y ­

3 Was damage to windows avoided'' ik 

4 Was damage to windows or door screens avoided'' ^ P ^ 

5 Was damage tc downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) Ves No 

Was damage to driveway surfaces avoided'' A/^ 

2. Was damage to walkway surfaces a\'oided? y 
O voers comments: 

Inspection notes: 

1

If^ld^ - OvO^^^ ^^^^ ^ ^ ^'i ^ pr^towcs o^i^er/f[toJ Ou)'-^ 

Removal and resloralion aclivales complele including ihe 30-day sod warranty 

EPA R,^:,stumt^f/^^^-^^^^^^^-^^ Hale 
Property Completion Agreement 

This agreemenl documents the complclion of remedial activities perlbimed on my properly. My signalure 

will designate that I am satisfied with the resloration of iny properly, and thai no items are in questions, 

now, or al any lime in the future, excepl those ilems listed below, ifany. 

Property ID: z^7^)^ 

Property Address; 2- 2 / 2 . ^^/o i" t 

Owner: G IT «SL.<5~T € . IT s\. ?- o \ 

Phone: ?H ( ^^^ i 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I agree restoration is completed, except as noted 

 I I do ont a(;rec resloration is completed 

Owner's Signature I Date Cdntractor's Signature Dale 

I