TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: IM' ^ Date: ^|^S|f) q 

Address: d-sipy ^ ^^ P^ ^ "Eft" 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 40314803 

/ Executive Summary 

y Superfund EPA-provided property sketch 

& ^ Signed Access Agreement for subject property 

m Signed Access Agreement(s) for adjacent property 

\^ y Restoration Agreement 

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

Confirmation data 

y Photographs prc-ex/^AJlnn ^ D jCjbdcJnr^A^ J^n A Sd ^ 

As-built sketch 

w Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

m Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

Property information from Douglas County Assessor's Office 

y 

D 

4- Date Ignature 

yT^^cd^ti^ ^y ytO'^^-CA- ^ . 
Property Access Checklist 

Propert) ID: |Z_^g^ 

Property Address:.,^^ ^ VO C, ^v ^ ^t. . 

n

D

 WORK STARTED

 WORK COMPELTED

 ON: / /_ 

 ON: __/__/_ 

0^^"'^'-^Uxf.\\tv' l^^^r^As , Address: _ _ , 

Phone: n\^'BU-^'^ l 

F« : 

Cell/Pager. 

Renter 

Phone: 

Fa,\: 

Cell/Pager: 

Additional Information: 

D

[ p

•

CD

D

D

E

0

D

n

D

CD

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoil Sampling (if applicable) 

 DisposaJ Sampling (tf applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 ''"inal Report 

Sent: / / 

Signed: U / |D / 0 & 

Siencd: i\ / jO / O ^ 

/ / 

/ / 

/ / 

Called: il / l b /C & 

On: II / ( ^ (? ^ 

On: / / 

On: / / 

On: / / 

Sipicd: / / 

Issued: / / 

Bv: 

By=V"l^^o^o.<: 

By= l'^\ro\o. \ 

By: 

By: 

By: 

B)'= li|ia|Dft 

By- £^ylciA 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

D Community D Crew |

Results: 

 On: / / | By: | 

D Community'

Results: 

D Crew | On: / / | By: | 

D Communitj

Results: 

D Crew On: / / | By: 

Omaha Lead Site 
CONTACT FORM 

Property ID U 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Conlact: 

Final Action: 

Comment: 

0\vner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

7q 5 

2U21 N If) 5T 

Date: Time: 

Date: Time: 

Date: Time: 

Transmit to EPA D 

Action: 

Action: 

Aclion: 

Other Action: D 
Douglas County Account Information Page 1 of2 nnati 

Douglas County, Nebraska Property Record - R2003680002 

Print Report 

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

New Feature -•->- > Auto Sales Search 

Owner 

WOODS LUCILLE 

2622 N 25 ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 0368 0002 20 

Account Type: j Residential 

Parcel Number: 2003680002 

Parcel Address: 2622 N 25 ST 

OMAHA NE 68110-0000 

Legal Description: PATRICK PLACE LOT 2 BLOCK 2 ALL LTS 1 & 2 90 X 110 

Value Informatio n 

Land Improvement Total 

2008 $2,800.00 $60,300.00 $63,100.00 

2007 $2,800.00 $60,300.00 $63,100.00 

2006 $2,800.00 $60,300.00 $63,100.00 

2005 $2,800.00 $60,300.00 $63,100.00 

2004 $2,800.00 $14,700.00 $17,500.00 

2003 $2,800.00 $14,700.00 $17,500.00 

Land Informa tio n 

Acres SF Units Depth Width Vacant 

0.22 9900.0 1.0 110.0 90.0 No 

Impro vemen t Information 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/7/2008 
*!^PT'^rj3'^::^-v" 

Douglas County Account Information Page 2 of2 rmati 

2622N2SST 

Steeni Floor 4K.0Sq. Ft. ,0. Detached 312.0 Sq. Ft. 

rr ry \ 

•.V <t« 

1 1/2STORYFIN 

tonnt Blmlt t H 

9U.0 Sq. R. 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1760.0 Percent Complete: ; 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip/Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1908 1988 0% 1908 100 

Detail Type Detail Description Units 

Add On Brick Veneer 200.0 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 864.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 312.0 

Porch End Screen 176.0 

User ASBESTOS 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/7/2008 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Email L ^ ^ : 

YOUR TICKET NUMBER IS 2172992. 

Original Call Date: 11/10/08 Time: 7:51 pm Op: ELIZABETH18790 


Work to Begin Date: 11/14/08 Time: 7:15 am 


State: NE County: DOUGLAS Place : GI^IAHA 

Address: 2622 Street: N 25TH ST 

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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Omaha Lead 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: Coastal 


Depth of Excavation: 4 ft Corner Lot: Y Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

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

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK HA Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11 /10/2008 
As-Built Drawing ^ 

C OASTA L Omaha Lead Superfund Site 

'45 

Exterior Paint Nortti Arrow Omaha Lead Site Owner Name: Sit • Good e Sketch Add ress: 2 ^ N 25 ST^ • Poor Phone: H: W: • Not paint 

Sample Number Lead Sample ^. ^ Samples Collected 

Concentration Collected Firm Sverdruo 

RYASCPXA-745 YA 155.7 ppm 0 • Date 

RYBSCPXA-745 YB J30 ppm 0 Q Time 

RYCSCPXA-745 YC ppm • • Samples Analyzed 

RYDSCPXA-745 YD J 4 ppm 0 • 

RDZSCPXA-745 DZ JSe ppm 0 • XRFU nit: Book 

RGZSCPXA-745 GZ ppm D D Date 5/4/1999 

RPZSCPXA-745 PZ ppm Q D Time 15:44 

Staff Numt)er of Samples = 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

Z ./ / / ^ / / ^ y ^ y y y y y-y ^ "/'/"ryy OLS#: Z4S , Yp'54 Date Excavated:11/19«bdi55.7 

Date USEPA Signed Off: 

12/18/2008 

Area Sodded 1346 sq ft 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with Area lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc, 
745 

Exterio North Arrow Omaha r Paint Lead Site Owner Name: 

Site Sketch • Good A\ Address: 2622 N 25 ST • Poor 

Phone W: : ^­ • Not paint 

Sample Number 

RYASCPXA-745 ^ YA 

Lead 

Concentration 

155.7 ppm 

Sample 

Collected LAB 

• 

Firm 

Date 

Samples Collected 

Sverdrup 

RYBSCPXA-745 

RYCSCPXA-745 

RYDSCPXA-745 

^ \ YB 

f,, YC 

^>YD 

430 

84 

ppm 

ppm 

ppm 

• 

D 

D 

D 

Time 

Samples Analyzed 

RDZSCPXA-745 DZ 156 ppm D XRF Unit: Book. 

RGZSCPXA-745 

RPZSCPXA-745 

GZ 

PZ 

ppm 

ppm 

a

• 

D

• 

Date:

Time 

 5/4/1999 

15:44 

Staff Number of Samples = ' 4 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW). YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

[H^Uv^SP^ oty 

Rev 4 lo-lg}:^ l^S ^ i^y/; 046141,0123 

^ 
1 

745 

Omaha Exterior Paint North Arrow Lead Site Owner Name: 

Site Sketch Address: 2622 N25ST • Good A • Poor 

Phone: H: W: 

[^ Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: Sverdrup 

RYASCPXA-745 YA 155.7 ppm M a 

Date: 

RYBSCPXA-745 YB 430 ppm D Time: 

RYCSCPXA-745 YC ppm a a 

Samples Analyzed 

RYDSCPXA-745 YD 84 ppm D 

RDZSCPXA-745 DZ 156 ppm D XRF Unit: Book: 

RGZSCPXA-745 GZ 

ppm n • Date: _ 5/4/1999 

RPZSCPXA-745 

PZ ppm a Time: 15:44 n 

Staff: Number of Samples = i 4 

Legend: YA = Yard (NE), YB = Yard (SE). YC = Yard (SW), YD = Yard (NW). DZ = Drip Zone, GZ = Garden, PZ = Play 

7 WyyA. ' ^ ^^^ 

////// / 7 7/7//77/7/77 ~ 
745 

Omah Exterior Paint North Annw Owne a Lead Site r Name: 

Site Sketch • Good A\ Address: 2622 N 25 ST • Poor 

Phone: H: W: 

Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Finn: _ 

Samples Collected 

Sverdrup 

RYASCPXA-745 YA 155.7 ppm a Date: _ 

RYBSCPXA-745 YB 430 ppm D Time: _ 

RYCSCPXA-745

RYDSCPXA-745

RDZSCPXA-745

 YC 

 YD 

 DZ 

84

156

ppm 

 ppm 

 ppm 

D D 

a

• XRF Uni 

Samples Analyzed 

t: Book: 

RGZSCPXA-745 GZ ppm a n Date:. 5/4/1999 

RPZSCPXA-745 PZ ppm a Time: _ 15:44 

Staff: Number of Samples = i 4 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

, H I AM I 

V 

/ 7/77/777/7/7 .^ 

/

YI7--S4. YA-I5P.-7 / 

/ 

/ 

/ 

/ 

/ 

/ 

VL''\^\o /

J 

J / N 

2.1^2.2 H. Vh ^T 

Rev 4 046141.0123 
COASTA L ENVIRONHINTAl 

e R o u r. IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

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

following described premises: 

Owner's Name: Daytime Phone: 

LUCJL P LL)OCKJ<=. '?•/•/-g^9^ 

Address of Property 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. 

This work is being performed under the Omaha Lead Superfund Site remediation 

program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work is finished, the Grantor will be asked to review the 

work and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

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

agrees to: 

Page 1 of 2 
COASTA L tNVIKONNrNtAl 

C I 0 U P . IN C 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

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

the property to perform the 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 

grant access to my properties 

O I do not grant access to my properties 

Signature Date 

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

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

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

activities are completed to the satisfaction of the property owner and the United Stales Environmental 

Protection Agency (EPA). 

Property ID: ^t/ ^ 

Property Addresl: ^(^ ^ AJ.^S ^ .S ^ 

Owner: ^uc i li e LAJOQO^T^ 

Phone: S^^^j ^ /</d^) ^^f 7 ' f^C.<99 

On the attached diagram(s) indicate area(s) to excavated and depth of 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: 

Srr\ ^ l l l^kt n^S ~ — ^ 

Item: \ 

Item: ^ ^ 

item: ^,y ^ 

Item: ^y ^ 

Item: ^y ^ 

Item: y 

Item: / 

Page 1 of 1^ 
1 ^ ^ 

COASTA L 

a n o u p. IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use addrtional sheets as necessary) 

Item: 

Item: 

Item: 

Hem: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Kem: 

Page 2 .L P 
C Q A S T A L 

e a o u r INC 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^ K 

Item: 

iK - y^ 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Page 3 of(jP 
• ^ 

COASTA L 

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. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

% Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of/ ^ 
COASTA L 

O n o u r IM C 

Item Quantity 

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. xp 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced ^yf\ 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) f 

Easement Area, to be p ? 

excavated 

Unit Condition/Type/Species 

$ 

Each 

'g,(ue (S-r^^^ 

SF 

SF 

SF "Jo b^de.4eCM(^ed 

Pages of Co 

1 
C O A S T A L •MVIkftOMMCMTAI. « » • W P. IM C 

Additional Comments / Instructions: 

D Check the box if Owner does not want CEG to document interior foundation wails and possible 

pre-existing damage. By checking ths box CEG 6 rK>t responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

cn I do not agree 

Date Contoactor's SKnatsre I I'Date 

Page 6 gof ( ^ 
BVID# I^IT ) 

XRF PROPERTY SAMPLE SHEET 

Date VV-vc^-Cf t Address .^(^• ^ KD. 0-6-v^5V- Project Omaha lead FP 2nc) year opllon Sample time v^b­. o ^ am/pm 

XRFID# 3^^om sample length 30 sec 

Shot# Reading Sample area Shot # Reading Sample area 

.^7^i S 56A.'o'>t..5^.oC ^Bo M =;,^(„-C\^t.vg M ^ 

^^,0 0 ^6/fl i-^o.io t ncS\-t S.F>o<. vqs .n?.*- \i ^ ==.^> 

SSov PfST.V'^j::: i q .H3 Depfh 3 o c?(^ i6u QP.t \i,^ o Depth 

:^P,03 58Q.-?bt.a,^.^B (LJ2 -2,SO' l \<c.^, .q.«i t\ u .'4^ \ 

Average .Ql.^.Rl t ;:^f^.r.O Average -i)0 0 3(fi t \U.H5 . 

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 Sample area Shot# Reading Sample area 

Depth Depth 

..-""- ^ 

Average Average / ^ ' 

lab sample # Lab result Sample area XRF Avg. ( 

Signature, 

Print m^f^ Mi^T^'? 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3803 

Mode SOIL 

Time 2008-11-19 15:11 

Duration 123.38 

Sequence Final 

Flags 

AVERAGE l^v g of 3799-3802. A 

ADDRESS 2622 n 25 st 

QUAD/ZONE 

INSPECTOR Ventry 

DEPTH 

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 364.515 

Supervised By: 

Certificate of Verification 

3799 

SOIL 

2008-11-19 15:09 

30.78 

Final 

74S' . 

2622 n 25 st 

YB 

Ventry 

6 

CLEARANCE 

± Error 

± 23.023 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3800 

Mode SOIL 

Time 2008-11-19 15:10 

Duration 30.97 

Sequence Final 

Flags 

BVID # 745 

ADDRESS 2622 n 25 st 

QUAD/ZONE YB 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 190.098 ± 16.970 

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 257.870 

Supervised By: 

Certificate of Verification 

3801 

SOIL 

2008-11-19 15:10 

31.16 

Final 

745 

2622 n 25 st 

YB 

Ventry 

6 

CLEARANCE 

± Error 

± 19.423 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

-5^ XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 282.764 

Supervised By: 

Certificate of Verification 

3802 

SOIL 

2008-11-19 15:11 

30.47 

Final 

2622 n 25 st 

YB 

Ventry 

6 

CLEARANCE 

± Error 

± 20.582 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3808 

Mode SOIL 

Time 2008-11-19 15:15 

Duration 123.63 

Sequence Final 

Flags 

AVERAGE ^Av g of 3804-38q|g | 

ADDRESS 2622 n 25 st 

QUAD/ZONE feasement^ 

INSPECTOR Ventry 

DEPTH i l 

SAMPLE TYPE ^CLEARANCE 

NOTE 

Pb 200 

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 236.448 

Supervised By: 

Certificate of Verification 

3804 

SOIL 

2008-11-19 15:12 

30.75 

Final 

7m 

2622 n 25 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 18.443 
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 193.734 

Supervised By: 

Certificate of Verification 

3805 

SOIL 

2008-11-19 15:13 

30.87 

Final 

IMS 

2622 n 25 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 16.579 
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 186.283 

Supervised By: 

Certificate of Verification 

3806 

SOIL 

2008-11-19 15:14 

30.91 

Final 

745 

2622 n 25 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 16.277 
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 184.986 

Supervised By: 

Certificate of Verification 

3807 

SOIL 

2008-11-19 15:15 

31.10 

Final 

745 

2622 n 25 St 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 16.409 
X 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L 

{NVIRONMENTAL 

C R O U r , INC . 

EXECUTIVE SUMMARY: 

BVID # 745 - (2622 N 25 ST) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
S9 t EPA 

EPA Property Close Out Form 

Property tl: 

Datc/Ttmc: 

1 ^ < 

y 

Quads Excavaifd: Y \ 

Property Address: ^^^ ^ M -Z< H-f

Owner's Name: \j(Jll ^ VJOff^Jc, 

Contractor Croup (,vfi(^iy ^ 

 4 ^ 

Excavation General Yes No 

1. i f nccessao', were the correct quadrant(s) excavated and restored? t y 

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

Gradin g Sod and Vecetation

1 Does the grading around the perimeter of the house in excavated areas generally slope away 

from the house? 

 Yes

y 

 No 

2.

3.

4

5

6

 Has sod been laid in all areas that were excavated? 

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

day time period) 

 Are sodded areas generally fuTn and evenly graded? 

 Are the Joints t)etween the sod strips generally tight? (Only evaluate if inspected ai a 30 day 

time period) 

 Was the property graded such that water wil l not pool on the property'' 

i / 

y 

l y 

y 

^ 

7 Was damage 10 landscaping or plant materials avoided? ^ 1 

Gates, Fences and ReUinln c Walls

1 Do gates open and close freely? (Ifapplicable) 

 Ves

L ^ 

 No 

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

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

4. Was danuge to retaining walls avoided? (Ifapplicable) ^ 

Foundation , SidioK and Gutters

1. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? 

 Yes

y 

u ^ 

 No 

3 Was damage 10 windows avoided? y 

4. Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspoul extensions avoided? ty ^ 

Sidewalks and Driveways (Concrete)

1. Was damage to driveway surfaces avoided'' 

 Yes

u ^ 

 No 

2. Was damage to walJrway surfaces avoided? l y 
O ^'^ers comments: 

Inspection notes: 

Removal and restoralion activates complete including the 30-day sod warrant)': 

EPA RepresenlaUve.^-y'^^j^^^X.^^^J^^,'^ Date: l^77^/<^ ^ 

i 
Property Completion Agreement 

Ihis agreement documents the completion of remedial activities performed on my property. My signaiure 

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

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

Property ID : n ^ ^ 

Property Address: ^^^9g ) V") . Q'S ^ 5^ ^ 

Q""*"'^ UxoWy ixDo^ ^ 

Phone: ^\^-9(g^^ R 

Restoration Items in Question : 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additiona l Comments : 

'yC'-^.pu ' "t?''*'^ restoration is completed, except as noted 

 I I do not a(;ree restoration Is completed 

^ (<k V 

Owner' s Signature Date CContractor' ( s Signature Date 

I
jL^^X M 2^"^ ^f 

Punchlist Items 

ID# 71f 

Date: /X-OJ-Qg ' 

Description: 

7 ^ 

P^nc ^ &<^7e / ''h'ly^ j-y-c^cK^