TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 

y}K 

Date: ^1(1^ 1 

Address: 7^1 1 1 W\^]i^rv^O\ 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

40314824 Executive Summary 

EPA-provided property sketch 

Superfund 

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.) 

M Confirmation data 

Photographs TjCt- Jli.Cn^aks<\^ JL^CA^OhMj^ 3 d -(LAJ 5<3 d^ jtnJUSc d 

y 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

rl{y Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

Property infonjiation from Douglas County Assessor's Office 

F \ y Date 

0/^^ 
Property Access CSiecklist 

ProiK-rt) ID: 2S\ ^ I 

D WORK STARIKD ON; / / 

n WORK COMPELTED ON: / / 1 PropcHv Address: QL\B^ \ I^M^dnC t S \ 

Renter: 1 ^''"'''"• OtwMo^ EConoivvc'Dev. Co 

.-AddiTSs: 

Plione: 

Fax: 

Cell/Pager: 

Additional Information:

r''""'' ZLUQ-BJOO .J 

Ccll/PuKer: 

• Nofilieation Letter Sent: / / Bv: 

y Aeeess Aj^i-eenient Sisrned:(i /^o / C^/ 

^y- frdfj ^ 

f f-y \y\ Resloration Agieenient Si«ned: 4

 l\6 lo}^ ^yydju ^ . ^. _ 

1 1 Topsoil Sanipliiii; (if applicahle) 1 1 Bv: 

1 1 Disposal Saniplin;4 (if applicable) 1 1 By: 

O Garden Saniplin<> (if applicable) 1 1 By: 

11 r^Klliilitv Clearance Called: ^//4^/0 ^ ^y^XLJ^^'lll^C^^ 

1 p^ Video/Photos (Before) On: / / B.v= /f c 

1^ Video/Pholos (Dnrinj;) On: / / B.v: I h 

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

n Video/Photos (3()-Da>) On: / / By: 

j ^ Pioperfv Completion Ajirccnienl Siuned: 1 1 ^ /6'S^ 

yi 

n Eiiial Repori 

Issued: / / By: 

Air IVlonilorinj; (as a|)plicable) 

1 1 Community CD Crew 

Results: 

On: / / 1 

j n Community

ResuKs: 

[11 Crcvt On: / / By: 1 

CU Community

Resuhs: 

CU Cretv On: / / By: 

Omaha Lead Site 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

1 Comment: 

Owner ! 

Comment (s): 

Site 

1 Coordinator 

Comment (s): 

56-/^/ 

aV^V %J,a ^ 5A 

Date: 6.-/^ Tmt:l2' ^ 

Date: Time: 

Date: Time: 

Transmit to EPA D 

Action: ^y^y / 

Action: "^ 

Action: 

Other Action: D 

1 
U

o 

n 

a 

J 

o 

o 

3 

c 

z (0 

Q 

O 

3 

ro 
Douglas County Account Information Page 1 of 1 orma 

Dougla s County , Nebrask a Propert y Recor d - R221061000 0 

Print Report 

Parcel Dimensions available @ scale 0-50 ft west of 144 St - Vie W OTl Ma p Information is valid as of 2008-4-17 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owne r 

OMAHA ECONOMIC DEVELOPMENT CO 

2221 N 24 ST ^^ ^ ^ 3^6 " <t>^h^ ^3^ 0 

OMAHA NE 68110-0000 

Propert y Informatio n 

Key Number: 1061 0000 22 

Account Type: Residential 

Parcel Number: 2210610000 

Parcel Address: 2424 INDIANA ST 

OMAHA NE 68131-0000 

Legal Description: SHINNS ADDLOT5BLOCK13 S 1/2 60X71.15 

Valu e Informatio n 

Land Improvement Total 

2007 $500.00 $0.00 $500.00 

2006 $500.00 $0.00 $500.00 

2005 $500.00 $0.00 $500.00 

2004 $500.00 $0.00 $500.00 

2003 $500.00 $0.00 $500.00 

2002 $0.00 $0.00 $0.00 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4260.0 0.0 71.0 60.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221... 5/7/2008 
5191 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Exterior Paint Nonn Arrow 

Owne Omah a Lea d Sit e r Name: OMAHA ECONOMIC DEVELO • Good Sit e Sketc h Address: 2424 INDIANA ST • Poor Phone: H 402453930 w f v f Not paint i 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: 

RYASCPXA-25191 Fl ^R A ppm D Date: i \ - r^-l - OCr, 

RYBSCPXA-25191 F2 3o ^ ppm D Time: 

RYCSCPXA-25191 Bl •L3'^H ppm n Samples Analyzed RYDSCPXA-25191 82 1 oT5r ppm [ T n nozocrx A 20101 D Z ppm D n XRF Unit: /CX^'f Book: IT ^ 

r<OZGCPXA25101 G * - ppm D D Date: 

RPZSCPXA-20191 P2 - ppm D Time: n Staff y^o^ j Number of Samples = 

legend Fl = Front Left. F2 = Front Right, B1 = Bacl< Left, B2 = Bacl< Right DZ = Drip Zone, GZ • Garden, PZ = Play 

AH quadrants are as viewed from tiie street facing property 

OLS#: 25121 

Date Excavated:6/25/08 

Date USEPA Signed Off:7/16/08 

Area Sodded 440 sq ft 

04<)I4I 01 ; i 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Roclc/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
^ 6 U^iol U)6fk 25191 

Exterior Paint North Arrow Owne Omah a Lea d Site r Name: OMAHA ECONOMIC DEVELO • Good Site Sketc h Address: 2424 INDIANA ST • Poor 

Phone: H 402453930 

[^No t paint 1 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm; A<:W^ I P«. | ftT 

RYASCPXA-25191 F1 58/6 PPrn D Date; n -f>-i - of c 

RYBSCPXA-25191 F2 3 0.5 ppm D 

Time; l:^f ; pM 

RYCSCPXA-25191 Bl ZZ'^ H ppm D Samples Analyzed RYDSCPXA-25191 B2 I OlK ' ppm D 

RDZGCPXA 2G101 DZ " ppm D D XRF Unit; /QQ 7 Book; il3 _ 

RGZOCnXA25101 S ^ ppm D D Date / / - ^^-OC s 

RPZOCP)(A-2G191 -PZ ppm D Time n '£OL. .R 

Staff V^JKI^J Number of Samples • 

Legend Fl = Front Left, F2 = Front Right, 81 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

T 

Rev 4 046141 U)^3 
25191 

Exterior Paint North Arrow Owner Name: OMAHA ECONOMIC DEVELO Omaha Lead site Q Good 

Address: 2424 INDIANA ST ^'*® Sketch • Poor 

Phone: H 402453930 W: 0^Not paint 1 

Sample Number 

RYASCPXA-25191

RYBSCPXA-25191

RYCSCPXA-25191

RYDSCPXA-25191

RDZGCPXA 20101

ROZSCrXA-2S101

r;PZOCrXA-25191

 F1 

F2 

81 

82 

DZ 

SZ 

P2 

Lead 

Concentration 

fjQS ppm 

3 0 5 ppm 

:Llll_Ppm 

I OTS* ppm 

• " ppm 

ppm 

ppm 

Number of Samples 

Sample 

Collected 

B­

\ET 

D 

D 

D 

LAB 

Firm; 

D Date; 

D Time; 

D 

n 

Samples Collected 

A<;w>lP«. l A T 

H-f^-t - ofe 

1 •• ^ ^ p^^ 

Samples Analyzed 

n XRF Unit; tCJOy Book; IT ^ 

D Date; // - t ^ - O C> 

Time; P/n n 

Staff; ^^(u y 

Legend: Fl = Front Left, F2 = 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 

1 

i 

: I ' 

1 

1 

iB\... ( iB>2... 

I 

i 

.7.^2 

1 

1 

1 

• 4i ; 

Fl : 1 F2. 

.m !, jo^ . ... 

- -W PT?"!?T \ 

JD. 

NOV 1 4 2Q05 

Rev 4 3/vi.i*Ka ^. r 046141 
y " "if f 

COASTA L ENVIRONMENTfc l 

"1 PBo-rt^^ C B 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: 

(s^yY\Oi\y< ^C-or^r^)(L 

Owner's Name Daytime Phone 

S^ ^ -^^^ 0 

Address of Property ^V^-^ y ^Jndia^-Qi, y- ^ 

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 
,^v1« St.,, 

> - * 

V**'*'^n * COASTAL *^ , ,0^ ' ENVIRONMENTA L 

^ < PSOT ^ CROU 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 T O 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 

^^ ^ ^oA^/^-s 

91grnture ' V TOate Signature 

O 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 ofthe property' prior to 

remediation activities. This v\ill also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property ouner and the United States Environmentai 

Protection Agency (EPA). 

Property ID: "2^ j ^ ^ I 

Property Address: :^c/ ^ c/ -^^Ji^^^ ^ 

^'""'""^ QnnaW?^ ^r^^onomjC'boeiop^TYvtvtJ' C/^ 

Phone: L|()^ , 34 ^ , ^a^f^p 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e,\ca\ation. location of ali 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 t>pes, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicaling direction of \ iew. 

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. 

Page 1 of. t 
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 

1 MVlNONrs f ^T* l 

Q II O U ' > N C 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

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 Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diaineter 

Number of trees • = 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Vah'es. 

Timers. Heads, etc. 

•\iuiL-h a sketcli u!' inci)iri;;kle;- k'.v oul. 

Number of and size of 

each garden- flower bed 

area. 

••.;..i<_;, ;-. sr.eii.;: ^'i .^ .-..i-. c 

-i;'eN ;inJ. locaiiop.s. 

S2 Square feet 

1 

Each ^ 

1 

Each 

^ 

1 

1 

Each 

^ 

-fi- Each 

Square Feet 

li 

G7 

Page 4 of 
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 propertx 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of \\ere 

each plant \\il l be placed 

h_\ ihe comracioi". 

Agreed upon area of 

propem to be replaced 

v\ ith grass sod. 

''U'li:(.ie :; sl,(,'U-|| ,);' ;hc 

.i:eu(S! U-. be :epl.K't.-J -.^ 'ri 

.-•-.^.s so d 

.^rea of Cir> or Countv 

property lo be landscaped 

per Iheir requirements. 

.;:c', : IS ! 

Easement .Area. lo be 

excavated 

Quantity Unit Condition/Type/Species 

^ 

-•-a Each 

SF 

^ SF 

SF 

Page 5 of f­
C O A S T A L • HVIHOMHIMTA L CHOUP . IM C 

Additional Comments / Instructions: 

-; - ... -^m:^ / ^-f 

a.(-eyK<^ ' 

• 

y 

• • '. ' . ; .­

• 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. 

O I do not agree 

/ / y^ - ^ g ^ 4 (0-/6-Q ^ 

Date Contractor's Signature Date 

Page 6 of 
Date 

Project 

XRF ID# 

Shot# 

3Z 

j ^ ^ 

^i^ 

Average 

Shot# 

T7a '"yrr 2E 

T73 

Average

Shot# 

Average 

Shot# 

S

^ L 

1 

2S. 

Average 

lab sampl nph e #

TWOo ^ 

y, 

4 

BVID# p.r/f/ 

XRF PROPERTY SAMPLE SHEET 


Ip'f^yD ^ Address mM2^Sk^ ^ 

Omaha lead FP 2nd year option , Sample time T3o (^^g^/pm 

'^0^^ sample length 30 sec 

Reading Sample area 1 Shot # Reading Sample area 

oJi*^ ' Fl 

in^^^-^ 8/ 5/"^ j-- ^ ^ ;ix> • m i 

Depth iun JlJB^-^ ;i ^ Depth 

ol<i.1? J<i'S'^-a_? 1 ^ 

4­ bo3 

Average 34/^ t ,33 

Reading Sample area 

Shot # Reading Sample area 

w Ba '^UK­

- ^ > i Depth Depth 

K0 4:; i 

 1) ^ ^ 1 ^ Average 

Reading Sample area 

Shot# Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

i4n>( y B l 

D ^ ^ 1 ^ 

Depth Depth 

1^ j ^ ' ^ ts 

ll^l 11< 

Average 

Lab result Sample area XRF Avg. 

y JiJ 1^'Mi K Signature, _iJ 

n i hV ll'^i: 1^ 

fl yoyt tl Print Mx ^ DfA>'cl . 

lli_ 
/[ \ Midwes t 

SJ ^ Laboratories, Inc 

13611 B Street • Omaha, Nebraska 68144-3693 • (402) 334-7770 • FAX (402) 334-9121 • www.midwestlabs.com 

ACCOUNTNUMBER obifi b I p 

CHAIN OF CUSTODY RECORD: Yes No 

PURCHASEORDERNUMBERREPORT&BILLTO IDENTIFICATION COPYTO 

^(^iUi^eO ^V^foY^lrWbv f 

^ ^ W W\af^^ . 

Hr^Vvx^Ug ^'Pb>^lQ^ ZIP 

PHONE q;^g,)t^Qj_H^C^ PHONE ( 

SAMPLE C/LOCATON 

1440093 as'/'}/-fe/-^ac^­ , 1440094 

lAOA-UJ-^. ^^40095 y u g-g^fof 

O'??o 

Dale/Time 'R^eiv/5^ by: (^jgipture) liooler arrived intact; Yes. 

Kehrtc^uiShfed by: (Hi^nalurij uaie/11 me eceived ty : (bigfaiure) remperalureonArrival('/4C); Mi 

^reserved in Field: Yes _No 

Relinquished Remarks: by: (Signature) Date/Time Received in Lab by: (Signature) 

Chain-of-Custody will have a signature upon receipt but no subsequent signatures Rev 02/02 

Distribution: Original accompanies shipment; copy to Coordinator Field Files 

•Matrix CcKJe: SO - Soil, WA - Water. SL - Sludge. OT - Other Our reports ano letters Ere for the exclusive ?nd confidential use of our clients and may not be reproduced in whole or in psrl, nor mov eny reference be made 

to the worli, the results, or ttie company in any advertising, news relesse, or other public anriomcements ft#ioui obtaininc ou! prior written EuthoritEfion. 
Report Number: Date Reported: 

08-182-2378 /l \ Midwest 06/30/08 

Account: Date Received: 

20666 V | 06/26/08 / Laboratories, incl 

Page: 1 of 1 

13611 B Street • Omaha, Nebrasl<a 68144-3693 • (402) 334-7770 • FAX (402) 334-9121 • www.midwestlabs.com 

COASTAL ENVIRONMENTAL GROUP 

MARCOS MATEUS 

2411 MARTHA ST 

OMAHA NE 68105 

LEAD ANALYSIS 

PO/Project #: OMAHA LEAD 

Analysis As Detection Analyst Verifier 

Perfonned Received Units Limit Metiiod Date Date 

Lab number: 1440093 Sample ID: 25191-B1-062508-QC 

Lead (total) 155 mg/kg 5 EPA 6010 al<j/06-30 bab/06-30 

Lab number: 1440094 Sample ID: 25191-B2-062508-QC 

Lead (total) 132 mg/kg 5 EPA 6010 akj/06-30 bab/06-30 

U b number: 1440095 Sample ID: 25191-F1-062508-QC 

Lead (total) 282 mg/kg 5 EPA 6010 akj/06-30 bab/06-30 

For qjtj^^tions copf&ct C^/ ^ 

Sue Ann Seitz 

Client Service Representative 

sueann@midvtfestlabs.com (402)829-9892 

The result(s) issued on this report only reflect the analysis of the sample(s) submitted. For applicable test paramaters, Midwest Laboratories is in compliance with NELAC requirements. Our reports and letters are for the exclusive and confidential use of our clients and may not be reproduced in whole or in part, nor may any reference be made 

to the work, ttie results, or the company In any advertising, news release, or other public announcements without obtaining our prior written authorization. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 264 

Mode SOIL 

Time 2008-06-25 12:36 

Duration 121.56 

Sequence Final 

Flags 

AVERAGE Avg of 260-263 

ADDRESS 2424 Indiana 

QUAD/ZONE F l 

INSPECTOR DETRICH 

DEPTH 10 

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 270.154 

Supervised By: 

Certificate of Verification 

260 

SOIL 

2008-06-25 12:33 

30.70 

Final 

25191 

2424 Indiana 

Fl 

DETRICH 

10 

CLEARANCE 

± Error 

± 19.762 
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 235.487 

Supervised By: 

Certificate of Verification 

261 

SOIL 

2008-06-25 12:34 

30.31 

Final 

25191 

2424 Indiana 

Fl 

DETRICH 

10 

CLEARANCE 

± Error 

± 19.468 
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 274.208 

Supervised By: 

Certificate of Verification 

262 

SOIL 

2008-06-25 12:34 

30.26 

Final 

25191 

2424 Indiana 

Fl 

DETRICH 

10 

CLEARANCE 

± Error 

± 19.877 
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 431.968 

Supervised By: 

Certificate of Verification 

263 

SOIL 

2008-06-25 12:36 

30.29 

Final 

25191 

2424 Indiana 

Fl 

DETRICH 

10 

CLEARANCE 

± Error 

± 24.421 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 269 

Mode SOIL 

Time 2008-06-25 12:40 

Duration 123.03 

Sequence Final 

Flags 

AVERAGE •^Avg of 265-268 

ADDRESS 2424 Indiana 

QUAD/ZONE B l 

INSPECTOR DETRICH 

DEPTH 110 

SAMPLE TYPE f 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 371.915 

Supervised By: 

Certificate of Verification 

265 

SOIL 

2008-06-25 12:37 

30.39 

Final 

25191 

2424 Indiana 

Bl 

DETRICH 

10 

CLEARANCE 

± Error 

± 23.186 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 266 

Mode SOIL 

Time 2008-06-25 12:38 

Duration 30.99 

Sequence Final 

Flags 

BVID # 25191 

ADDRESS 2424 Indiana 

QUAD/ZONE Bl 

INSPECTOR DETRICH 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 306.485 ± 21.727 

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 335.462 

Supervised By: 

Certificate of Verification 

267 

SOIL 

2008-06-25 12:39 

31.03 

Final 

25191 

2424 Indiana 

Bl 

DETRICH 

10 

CLEARANCE 

± Error 

± 21.757 
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 367.872 

Supervised By: 

Certificate of Verification 

268 

SOIL 

2008-06-25 12:40 

30.62 

Final 

25191 

2424 Indiana 

Bl 

DETRICH 

10 

CLEARANCE 

± Error 

± 22.895 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 274 

Mode SOIL 

Time 2008-06-25 12:44 

Duration 122.53 

Sequence Final 

Flags 

AVERAGE Avg of 270-273 

ADDRESS 2424 Indiana 

QUAD/ZONE B2 

INSPECTOR DETRICH 

DEPTH 10 

SAMPLE TYPE I CLEARANCE 

NOTE 

— ^ 

pprp 

± / Error 

/ 

Pb 'X y 

119.181 ± 13.994 

y 

y . 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 111.158 

Supervised By: 

Certificate of Verification 

270 

SOIL 

2008-06-25 12:41 

30.20 

Final 

25191 

2424 Indiana 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 13.963 
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 130.751 

Supervised By: 

Certificate of Verification 

271 

SOIL 

2008-06-25 12:42 

30.79 

Final 

25191 

2424 Indiana 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 14.876 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 272 

Mode SOIL 

Time 2008-06-25 12:42 

Duration 30.60 

Sequence Final 

Flags 

BVID # 25191 

ADDRESS 2424 Indiana 

QUAD/ZONE B2 

INSPECTOR DETRICH 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 84.388 ± 12.137 

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 150.429 

Supervised By: 

Certificate of Verification 

273 

SOIL 

2008-06-25 12:44 

30.94 

Final 

25191 

2424 Indiana 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 15.000 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 279 

Mode SOIL 

Time 2008-06-25 13:52 

Duration 121.42 

Sequence Final 

Flags 

AVERAGE I Avg of 275-278 

ADDRESS 2424 Indiana 

QUAD/ZONE 

INSPECTOR DETRICH 

DEPTH 13 

SAMPLE TYPE RETEST 

NOTE 

^ 

ppnTM/' ± / Error 

/ ' 

Pb 134.129 ± 14.636 

y^^y . Supervised By: 

y y 
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 146.723 

Supervised By: 

Certificate of Verification 

275 

SOIL 

2008-06-25 13:50 

30.84 

Final 

25191 

2424 Indiana 

B l 

DETRICH 

13 

RETEST 

± Error 

± 15.484 
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 104.426 

Supervised By: 

Certificate of Verification 

276 

SOIL 

2008-06-25 13:50 

30.19 

Final 

25191 

2424 Indiana 

Bl 

DETRICH 

13 

RETEST 

± Error 

± 13.099 
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 161.969 

Supervised By: 

Certificate of Verification 

277 

SOIL 

2008-06-25 13:51 

30.20 

Final 

25191 

2424 Indiana 

Bl 

DETRICH 

13 

RETEST 

± Error 

± 16.033 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 278 

Mode SOIL 

Time 2008-06-25 13:52 

Duration 30.19 

Sequence Final 

Flags 

BVID # 25191 

ADDRESS 2424 Indiana 

QUAD/ZONE Bl 

INSPECTOR DETRICH 

DEPTH 13 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb 123.399 ± 13.927 

Supervised By: 
^ito sr<. 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIKONMENTA L 

C R O U r . INC -

EXECUTIVE SUMMARY: 

BVID # 25191 - (2424 Indiana) 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
S30L EPA 

EPA Property Close Out Form 

Property #: iC\^ Property Address: l/^ y \AK'lAy]A 

Date/Time: Owner's Name: (f/lMr^m ffgy^^iC HVdlofMt^ f 

Quads Excavated: f | ^ U < ^ t Contractor Group O/A'^'P^u 

Excavation General N ACA-M T Lo T Yes No 

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? y 

Grading Sod and Vecetation Yes No 

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

from the house? y

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

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? ^ 

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

time period) 

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

7. Was damage to landscaping or plant materials avoided? fX^ 

Gates, Fences and Retaining Walls Ves No 

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

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

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

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

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

< A/A 

2. Was damage to the foundation avoided? lA J ^ 

^ 

3. Was damage to windows avoided? UA 

4. Was damage to windows or door screens avoided? (0^ 

5. Was damage to downspouts or downspout extensions avoided? Ki 

Sidewallu and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? AJA 

2. Was damage to walkway surfaces avoided? y 
O vners comments: 

Inspection notes: 

cu^.. CU., 7 

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

EPA Representati; yU^yc^W^ ^ Date: 7^f/(}/^, 
(P> 

Property Completion Agreement 

This agreement documents the completion of remedial activities perfonned on my property. M> 

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

questions, now. or at any time in the fulure. except those items listed below, ifany. 

Property ID: ^^/( j / 

Property Addres.s: g^l/-^i / ^^^'Q^ ^ S/ . 

Owner: Q^/ ^ ^C^ytCM y btl/drp p ^^^ d ^ C 

pii^tno- 11. n Try. y~y^. < 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

l*n I iiKi'oe restonition is completed, except as noted 

 I I do not iigree restoiiition is completed 

vyj> 

Owner's Signature iJDate Contractor's Signature Date 

I