TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID #: tr??>SU a Date: S/2o/i n 

Address: Z ^ fSf^ Fnn-hm^W ^ Bxi d 

Remediation Contractor: Coastal Environmental Group_ Year: 2009 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

\ y Executive Summary 

\ y EPA-provided property sketch 

0^ Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

feT Restoration Agreement 

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

V y Confirmation data 

^ Photographs 

^ As-built sketch 

Vy Satisfactory restoration signed by Property Owner 

'fe' Property close-out check list signed by EPA 

t]//^ Description ofareas not meeting ROD cleanup criteria 

tf Utility clearances 

^ Property information from Douglas Coimty Assessor's Office 

^ R(^.4nrQlion Ohanae: Qrij^ r 

• 

Signature Date 

30218000 

Superfund 
• 

Property Access Checklist 

Property ID: (,A<^^L t 

Property Address: 7^9.UF;kY.WnP\\lB^^ 

D

D

 WORK STARTED 

 WORKCOMPELTED 

ON: 

ON: 

J

I

 l_ 

I 

o^"*^"^ Krx\y\op^.\^\i\\\rLy^y, Address: 

Renter 

Phone: 

SAMe 

'•'>°'"^--UQ??) ssi - Quu-^ 

Fax: 

Fax: 

Cell/Pagen 

Additional biformation: 

Cell/Pagen 

D Notification Letter 

[^ Access Agreement 

] S Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

\ ^ Utmty Clearance 

Q^Ideo/Photos (Before) 

D Video/Photos (Dnring) 

n Video/Photos (After) 

n VIdeo/Phoftw (30.Day) 

^p 3 Property Completion Agreement 

t n Final Report 

Sent: / / 

Signed: li_/Ul/i2 9 

Signed: IL/IU/ ^ 

/ / 

/ / 

/ / 

Called: U A ^ lOf\ 

On: JifJ±l_S. 

On: / / 

On: / / 

On: / / 

Signed: i_/^_/l£? 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: ll \9)\0 ^ 

^ry^/o 

By: 

By: 

By: 

By: 

By: 

Air Monitorine (as aiwlicable] 

O Commnnity QCrcw 

Results: 

On: / / By: 1 

D Commnnity

Reantts: 

 DCre w On: / / By: 

DComnranhy

Results: 

 QCrcw On: / / By: 

Omaha Lead Site 
Douglas County Account Infomiation Page 1 of3 xm^t 

Douglas County, Nebraska Property Record - R0812070000 

Print Report 

NEW Fsntiim - Pflmfil Dimfinsinns availahln (^ sralH 0-SO ft west of 52nd St - ViO W O n Ma p Infomiation is valid as of 2009-10-15 Treasurer's Tax Reoort 

New Feature -» -> ^ Auto Sales Search 

Owner 

WILLIAMS KATHLEEN M 

2456 FONTENELLE BLVD 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 1207 OOOO 08 

Account Type: Residential 

Parcel Number: 0812070000 

Parcel Address: 2456 FONTENELLE BD 

OMAHA NE 68104-0000 

Legal Description: CLAIRMONT LOT 1 BLOCK 6 50 X 125 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$45,400.00 

$45,400.00 

$45,400.00 

$45,400.00 

$76,800.00 

$69,800.00 

Total 

$51,800.00 

$51,800.00 

$51,800.00 

$51,800.00 

$83,200.00 

$76,200.00 

Sales Informatio n 

Sales Date: 2007-07-25 

Deed Type: WD Book: 2007 Page: 085617 

Price: $108,210.00 

Grantor: Walker Clettis R etal 

Grantee: Williams Kathleen M 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1994-10-25 

Deed Type: D Book: 1996 Page: 164 

Price: $64,900.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 

1 
Douglas County Account Infojuation Page 2 of 3 omaz 

Grantee: 

Valid/lnvalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6534.0 1.0 0.0 0.0 No 

Improvemen t Informatio n 

Building 1 

MS«fC«TE"ej.EBC' 

Fini Floor , Ssoond Floor 

:^n SSO.O SO. jt 

2 1/2 STORY LNFIN 

BxntEkxkec 

IX 0 55 t 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1100.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: i Average 

Unit Type: Condition: i Average 

Built As: j 2 1/2 Story Unfin Condo Square Footage: I 0.0 

HVAC: Forced Air Rooms: : 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: I Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Percent Adjusted Year Year 6ui7t Physical Age Remodeled Remodeled Built 

1922 0 0% 1922 88 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 550.0 

Basement Minimal Finish 152.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Douglas County Account Infoanation Page 3 of3 amas 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 378.0 

Porch End Screen 176.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Page 1 of 1 

Create Another Ticket Back to Irth Intemet i[f SendEmaH | ]C 

• YOUR TICKET NUMBER IS 2407201. 

Original Call Date: 11/16/09 Time: 9:19 am Op: ELIZABETH18790 


Work to Begin Date: 11/18/09 Time: 10:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2456 Street: FONTENELLE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 08-SW 


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: 4 FT Corner Lot: N Front : y Rear: Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICHATRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/16/2009 
OLS#: 63564 As-Built Drawing ^ Date Excavated: 11/27/09 

Date USEPA Signed Off: 1/19/10 

C

ENVIRONMENTA

 OASTA L Omaha Lead Superfund Site Area Sodden: 4806 sa ft L 

e ft O U P , INC . 

63564 

Omah Exterior Paint a Lead Site • Good Site Sketch 

[T^Poor 

Sampling Address: 2456 FONTENELLE BD Q Not paint 

Lead Sample Samples Collected Sample Number LAB Concentration Collected 

I Firm pg. a-C. CK- RYASCPXA-63564 F l ^(Il U ppm D Date: IP-7-08 -

RYBSCPXA-63564 F2 U22. ppm 

D Time IO:i9r A-w^. 

RYCSCPXA-63564 Bl .5flO ppm D Samples Analyzed RYDSCPXA-63564 B2 MfSH ppm D 

RDZSCPXA-63564 DZ HZd O ppm n XRF Unit: t^'JHCi Book: IT O 

nOgOCPXA 69664 GZ- ppm D Date: l b • 2.t • 0 & 

RPZSCPXA 6366 < PS- — ppm n D Time: Hr o 

E Staff: f*^'^ U Number of Samples = 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back Right DZ = Diip Zone. GZ = Garden, PZ = Pla; 

All quadrants are as viewedfrom the street, facrng property 

OCT q»2{iee 

B2 = 37 PPM @ 6" 

F2 = 70 PPM @ 4" 

EA=108PPM@1 " iu: Rc\',>> * CreJKd, (iS-Scr-*! 

Legend 

Concrete Dri p Zone Excavate d Quadrants Excavate d 

Area replaced wl'th Area replace d wit h 

Are a lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
IL H in 

63564 

Sampllrig Address: 2458 FONTENELLE BD 

Omaha Lead Site 

Site Sl<etch 

Extenor Paint 

Q Good 

0'Poor 

Q Not painl 

Nortti AfTOW 

Sample Lead Sample Samples Colleded Number LAB 

Concentratio Collected n Fimi: pg • C -C. CK ' 

RVASCPXA-635M Fl m»t * Dcm D Date: /O-T-aaRYBSCPXA-B3SM F2 _JtZ2^PP m a Time: in-.ifr A .w. 

RYCSCPXA-83564 B1 

Samples Analyzed RY0SCPXA-53SB4 B2 _aao_ppm a 

a 

RDZSCPXA-«35«4 _fLSjaL_Pp m DZ n XRF Unit: ^*iH O Book: 22L ^ 126 0 ppm nOgCCPXA 83Sg4 S* ­ ~ ppm a D Date; ip-2. 1 • O d 

RPZ6CPXA.83664 PZ- ~ ppm o D Time: J r 

Staff: m^L j Number of Samples »| 5 \ \ Q | 

Legend: F1 » Front Left. F2 = Front Right, B1 = Back Lefl, B2 = Back Right 02 = Drip Zone. GZ = Garden. PZ = Pla; 

AH quadrenis are 89 viewed from Hie street, factng pi 

if 

( ^ ' 

^ 

i-iii-ni tM :.* 

/^V'vlXV^^ 
lb uli i 

63564 

Omalia Lead Site Exterior Paint Iv jrth Arrow 

Site Sl<etch Q Good 

0'Poor 

Sampling Address: 2456 FONTENELLE BD • Not paint 

Sample Lead Sample Samples Collected Number 

I 

LAB Concentration Collected Firm: PE- d-C- CK ­

l?YASCPXA-63564 Fl M i a IM ppm D Date: iQ-T-aq: 

RYBSCPXA-e3564 F2 U12. ppm D Time: ln:\9r A»W.-

RYCSCPXA-6356* 81 ^fi O Dom Samples Analyzed RYDSCPXA-63564 B2 Mfi H ppm 

RDZSCPXA-e3564 DZ .H Z S o ppm n i XRF Unit: ^>«>V6 Book: 27. 0 

D 

nOZeGPXA63S64 6Z - ~ ppm D Dane. ip-Z I • 0& 

RPZ6CPXA 63664 P2 - u D ~ ppm Time: n D Staff: S

Number of Samples = | 5 \ \ Q | _Cisu_ Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Pla; 

(Wl^V? f^ 
63564 

Omah Exterior Paint NoithAtTwt a Lead Site 

Sit • Good e SIcetcli 

[pfPoor 

Sampimg AddreM: 2456 FONTENELLE BD Q Not paint 

Sample Number Uad Sample Samples Colleded LAB Concentration Collected Flmt pg. QC. g-K-

RYASCPXA-63564 Fl 

D Date: iO-7-oa-

RYBSCPXA-63564 F2 yjli2^ppm D Time: /Q-.fg

 A .vv-

RYCSCPXA-63564 81 _S£0 _ ppm 

D Samples Analyzed RYDSCPXA-63564 82 Mfi M Dom 

RDZSCPXA-63S64 DZ 4/2flQ ocn. n 

XRF UnH: r^tt d Book: 7 7 Q 

nCIZCCPXA-63664 OE " " ppm D D Date: ib'2^t - a A 

D

RPZSCPXA 68664 PZ- • " PPW D Time: D 'ra. Staff: PiSh? Number of Samples ° I S x \ o l 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Lefl, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla< 

AB quadrails ars as vtewad (Rm the stiBet, IMng pmpeity 

Q 

0CTfr»2(liie 

Q 

SW»f 

t**"' jg=^ 0«­

v t • • 

DZ..' .;^2.8.& 8 .4 .

i 

f^ 

.^"•^felF^jWrlU Bl> PI 

0^^ 

.fl...: o o M2i 

.•\<'.'yV«t^t.VH.B.l?. TrMifcl trt-S«p-Ol 
-f • ^ COASTA l 

••' Pm-^ " HOUf.iB C 

Consent foF 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: Wl.... yi 

/ l O Address of Property 1<\j^h ycy4^'<J^ bi-^' ^ 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 confimn 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 ali 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 
i -•'J

 COASTA L 

"** pqo^ * C H O U » I t* C 

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

piles, dog houses, etc; 

c 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 (402) 991-1199 

I grant access to my properties D I do not grant access to my properties 

11-NW 

Signature Date 

Q I would iike to be present during any sampiing that is required. 

Page 2 of 2 
I 

e 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property H) # (^3S"6 Y 

Property Address 7. ^ ^ ^ ^ ^ ^ "^^ ^'^^ ^'*- l^ /yJ 

Owner Name kvl^Vv^iA [\) i\ \ \ (^hl^^ 

Date / ^/^// ^ ? 

Comments 

Jpy fi^i7e..rh/ o ui) y\^yr Y^<^ L/^ SI Fey)yC. 

mill hy A-eyiAcje Q^W yl diS^c^y~yl ^\\)J 

^r.f" ry f \^ (^ e- J ^ . 

Owner Signature //5^ 

^ ^ " - ^ ' ^:2 - Contractor Signature ^.J^f^"^ yy^yyyt^'' 
••':r ­

vCC;: 

COASTA L 

G n r. u ' • *. r 

Restoration Agreement 

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

romediation activities. This will also serve as documentation for the purpose of assuring that restoratton 

activities are completed to the satisfaction ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: '^5^/V 

Property Address: Q^J^ ^ fmh// i /S^u'^y 

Owner: ^^4^^^, ^ lAJ.//;, Il/h ^ 

.!^!!!L^|-f?^^3 . 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access Iocation(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 isnoval, storage, disposal, and/or return of these items is the Owner's responsibility. 

ttem: 

/Ky N-^// / w 

Item: 

Item: 

Item: 

Items tf 3 be Removed by the Contractor During Remediation and Not Replaced 

Item: / 

H

/ ^^/Ot^/ / yL^ u/-r y.L ^ 

item: 

ttem: 

Item: 

Page 1 of. 
COASTA L 

Hems to Be Removed By Contractor During Remediation and Replaced 

ttem: 

-,iiL^yywfi,y7^ I) ^

Krnn: y-^ 

St>0 - Sl, g^ i f^/,r?,|>^. Item: 

Item: 

Landscape Inventory 

Item Quantity Unit ConditioTi/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. 0/ &,fEP DZ 

Number of trees > 2 inch Each I

trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 

Number of Sprinlder 

Zones, Control Valves, 

Timers, Heads, etc. Each 

Aiiach ,1 skcicl) ol llie 

'•(•rii'lvlci liiy'.Kji 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Alliith a ski.'ich ul rc!;ilivL' 

<i/fS nnd lac;itii'i)v 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

VCK' l!ii ' \«lu c vwll fl i 

i:ivC 10 li'.ut .1 ;iljlli ; 

>oin.!u'; Id the iiropciu 

i)>»n«r. ' 

Easement Area, to be 

excavated y$ Each -<e^^^ :z 

Page 2 of. 
C O A S 1 A L 

! Addttional Comments / Instructions: 

^ K)Ai^ ^%y^y y Q^^\^^ ^ 

J^ 7. D^f 1^0+"^^ • 

^ Check the tx)X if Owner does not want CEG to document inteiior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

inteiior of house, including foundation cracks or fissures. 

,jZli agree Q I do not agree 

/ 

iH yyB. 9yr\oo9br^ s\\n\Ci^ 

Owner's Signature Date Contractor's Signatarr Date 

Page 3 of. 
t 

BVID# QZ6 ^ ^ 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

Shot# 

5"^ 

SH 

es 

Average

Shot# 

41 

42. 

( ^ 1 

Average

Shot# 

nn 

ns 

7^ 

Average

Shot# 

Average 

ir-2.l'c^e t 

Omalia Lead ARI ^ 

-yyioia. 

Reading 

//fl ^ / ^ 

un ^15 

9^7 -t iH 

 f O ^ - ' ^ 

Reading 

7 2 ^/ Z 

7;^ tz-z 

4>5 ^ /2. 

 W f) ' ^ 

Reading 

-3f + /0 

12, ^' /O 

-^'y^/ o 

3 / ^ ' O 

Reading 

Sample area 

6nq 

Depth 

1" 

Sample area 

F^ 

Depth 

^ " 

Sample area 

12,Z 

Depth 

d:-

Signature. t^Uiim 

PrintBlx/Jiati-JtK (jdMSi^ b 

Address 

Sample time 

sample length 

Shot# 

• ^ T l 

1%0 

3 3 / 

Average 

Shot# 

70 

n/ 

7 2 . 

Average 

Shot# 

zis ­

316 

i n n 

Average

7^7 ^ PnA^/xe.U^ B/u7 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

30 sec 

Reading 

/03 ^'S 

//C ' IS 

/06 t/2 

iO^ '/ S 

Reading 

/^^ -!:/5 

/•2.6 t /5' 

<?o i: / 3 

'32- t l 5 

Reading 

Z5--/2 . 

'2.1*-iT. 

'ZS-^ 12. 

^ 5 ^ ^ /£ • 

Reading 

am/pm 

Sample area 

P/ 

Depth 

^ / . 

Sample area 

12,1 

Depth 

y 

Sample area 

P^ 

Depth 

13" 

Sample area 

Depth 
Thermo 

S C i E N T i F i C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 382 

Mode SOIL 

Time 2010-02-11 14:27 

Duration 90.53 

Sequence Final 

Flags 

AVERAGE \.AMQ nf ^TQ-IBT ) 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT Fl 

DEPHT 4 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

Error 

Pb ^^;;;;;T^33Z 117:93 

ppm 

U7I93^ 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Ceitificate of Verification 

XL3t-39022 

Reading No 379 

Mode SOIL 

Time 2010-02-11 14:25 

Duration 30.19 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT Fl 

DEPHT 4 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 103.394 ± 17.596 

Supervised By: 
H 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 380 

Mode SOIL 

Time 2010-02-11 14:26 

Duration 30.21 

Sequence - Final 

Flags 

BVID 63564 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT Fl 

DEPHT 4 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 109.624 ± 18.111 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 381 

Mode SOIL 

Time 2010-02-11 14:27 

Duration 30.13 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT Fl 

DEPHT 4 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 105.993 18.096 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 378 

Mode SOIL 

Time 2010-02-11 14:14 

Duration 90.39 

Sequence Final 

Flags 

AVERAGE 

ADDRESS ^-'2?56Fontenelle Blvd, 

QUADRANT DZ 

DEPHT 13 

XRF TECH 0. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb c:25309^ -42T094I? 

Supervised By 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 375 

Mode SOIL 

Time 2010-02-11 14:13 

Duration 30.26 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 24.754 ± 12.004 

Supervised By: 
«l» 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 376 

Mode SOIL 

Time 2010-02-11 14:13 

Duration 30.03 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2456 Fontenelle Blvd. 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 26.600 ± 12.118 

Supervised By: 
# • # • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 24.575 

Supervised By: 

Certificate of Verification 

377 

SOIL 

2010-02-11 14:14 

30.10 

Final 

63564 

2456 Fontenelle Blvd. 

DZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 12.159 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By 

Certific 

56 

SOIL 

2009-11-27 11:29 

91.71 

Final 

C$ig-of-53=55l] 

2436 fontenelle 

em 

1" 

R. VENTRY 

clearence 

ngnc 

Error 

]2^5g___-> 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 110.069 

Supervised By: 

Ceitificate of Verification 

53 

SOIL 

2009-11-27 11:27 

30.59 

Final 

63564 

2436 fontenelle 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 14.465 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 117.944 

Supervised By: 

Certificate of Verification 

54 

SOIL 

2009-11-27 11:28 

30.58 

Final 

63564 

2436 fontenelle 

em 

I" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.042 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 97.673 

Supervised By: 

Certificate of Verification 

55 

SOIL 

2009-11-27 11:29 

30.54 

Final 

63564 

2436 fontenelle 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 14.011 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 64 

Mode SOIL 

Time 2009-11-27 11:33 

Duration 93.55 

Sequence Final 

Flags 

AVERAGE 1" Ayg of bI?S3~~ ^ 

ADDRESS 2436 fontenelle 

QUADRANT F2 

DEPHT 4" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb ^^^^^J$^A^ ^^^.S^ l 1 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 72.755 

Supervised By: 

Certificate of Verification 

61 

SOIL 

2009-11-27 11:32 

31.82 

Final 

63564 

2436 fontenelle 

F2 

4" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.774 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 73.463 

Supervised By: 

Ceitificate of Verification 

62 

SOIL 

2009-11-27 11:33 

30.51 

Final 

63564 

2436 fontenelle 

F2 

4" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.800 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 63 

Mode SOIL 

Time 2009-11-27 11:33 

Duration 31.22 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2436 fontenelle 

QUADRANT F2 

DEPHT 4" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 65.805 ± 12.125 

Supervised By: 
% 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 73 

Mode SOIL 

Time 2009-11-27 11:39 

Duration 92.76 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 2436 fontenelle 

QUADRANT Bl 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Supen,ised By: ^^^MVM ^ 
% 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 139.364 

Supervised By: 

Certificate of Verification 

70 

SOIL 

2009-11-27 11:37 

30.61 

Final 

63564 

2436 fontenelle 

Bl 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 16.029 
% 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 126.994 

Supervised By: 

Certificate of Verification 

71 

SOIL 

2009-11-27 11:38 

31.61 

Final 

63564 

2436 fontenelle 

Bl 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.207 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 130.761 

Supervised By: 

Certificate of Verification 

72 

SOIL 

2009-11-27 11:39 

30.54 

Final 

63564 

2436 fontenelle 

Bl 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.573 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 77 

Mode SOIL 

Time 2009-11-27 11:43 

Duration 92.61 

Sequence Final 

Flags 

AVERAGE C5yg_QfJZ4=zO 

ADDRESS 2436 fontenelle 

QUADRANT B2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb 37.829l^ ± 

Supervised ^r^ymM^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 74 

Mode SOIL 

Time 2009-11-27 11:42 

Duration 31.82 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2436 fontenelle 

QUADRANT B2 

DEPHT 6'' 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 37.390 ± 10.542 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 75 

Mode SOIL 

Time 2009-11-27 11:43 

Duration 30.39 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2436 fontenelle 

QUADRANT B2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 38.630 ± 10.753 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 76 

Mode SOIL 

Time 2009-11-27 11:43 

Duration 30.40 

Sequence Final 

Flags 

BVID 63564 

ADDRESS 2436 fontenelle 

QUADRANT B2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 37.468 ± 10.689 

Supervised By: 
^\A.\

S ^^^2 L

^7^^ ^ ^^tPRO^''^

 °

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

 Coastal Environniental Group Inc.

 www.coa8talhazmat.com ^ 7 

 vi 

 COASTA L 

ciour . INC 

EXECUTIVE SUMMARY: 

BVID #63564-(2456 FONTENELLE BLVD) 

No Issues or Concerns [[^ Issues/Concerns 

Detail Explanation: 
EFA Property Close Out Form f(f,J^^C /lie// 

Properly #: 

(Mid- Property Address:

Date/Time 

r - <»,-» Jtl - tjwwc Owner' r »s Name name: Date/lime : /A. : ../fe-JES'X"r;~^^.'*^^-^=^^^^' ^ 

Quads Excavaled; ^j^ ^ W ^/-^ ffl, b^tP/ ' Contractor GrovpQQQ^pfa ^ (p^ ^ 

ExcaYBtlon General Yes 

No 

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

2. If necessary, were the corrtct areas ofdrip zone excavaled aod restored? / 

GradlDK Yes No Sod and Venetattoa 

1 Does the grading around the perimeter ofthe house in cxcavatcri areas generally slope away y from the house? 

1. Has sod been laid in all areas that were excavated? y ... i. Docs the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

y day time period) - — 

4. Arc 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) I ^ 

' 6. Was the property graded such that water will nol pool on the property"' 

' 7. Was damage to landscaping or plant materials avoided? y 

Gates. Fences aad RctaJBlng WaHt Y « No 

'. Do gates open anil close freely? (If applicable) y 1 

2. Were all gates or fences talcen down during restoralion activiiies reinstalled? (If applicable^ y 

( 

3 Was damage to gates or fences avoided? (Ifappiicable) 

~ y ' _ - i 

1. Was damage to retaining walls avoided? (Ifappiicable) , 

; 

: 

Foundation, SidiBK and GnMer» Ves

 No 

I. Was damage to the siding or trim avoided? 

y 

2. Was damage tn the foundation avoided? y 

.'. Was damage lo windows avoided? _y 

<i Was damage to windows or door screens avoided? y

_ 

5 Was damage to downspouts or downspout extensions avoided? y 

Sidewalks »nd Driveways (Concrete) Vcs No 

I 1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? r 

y

y 
v>M'pcrs commenlls: 

In.spection notes: j,Jf* 

y" y* 

f*' 

Rernoval and restoration activates compiete including the 30-day sod warranry: 

If.PA Representative B*^jM Date: i/ii/io 
Property Completion Agreement 

riiis agreement documenls ihe completion of remedial acliviiies perloimed on my properly My signaluie 

tt/ill designale ihal I am satisfied wilh the restoration of my properly, and thai no iiems are in queslions. 

now, or al any lime in the future, excepl ihose ilems hsled below, if any 

rropcrtyIP: (^;2^^^L ^ 

Property AddrcM: 2 g ?a ^ Plf)hAi^l\€ . BKf< ^ . 

^""'" kh-fV)! ^ \}\\\\\<Sf<\SL 

Phone: X:^^^ ^ ^^j,^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

nyrcc restoration 'is completed, except as noted 

[_J I do not a|;rec restoration is compleled 

ddkM^'^ tiHiio 

Date Contrarlor' s Sicnadirc Dale