TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: '^^^t ^ Date: ? P 1 

Address: 

. hi i Y[ ^^^ ^ r 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (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.) 

y Confirmation data 

Photographs 'i^ZerSLj.riiJckn/i^ CiP^atiyi j 30'cLuSd<:ij jiru J Sd d 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

• 

D 

D 
(p^ 

Property Access Checklist 

Property ID: 3^<~S ^ 

n WORK STARTED ON: / / j 

Property n WORKCOIMPELTED ON: / / Address: f^/^ A / 3^ ^ S h 

Owiiei 

Renter: ~^>?l Ry^sr f^yH 

Address Phone: yy^% Uk^^lttM^vt 

Fax: 

Otn^h^^NB Q7il3\ Cell/Pa<£er: 

Phone: d/^^ - -^g^f^. %Lf^ Additional Information: 

Fax: 

Cell/Pa«iei 

I I Notification Letter Sent: Bv: 

iM Access Ajjrecmcnt Siirned: S / f^/° 2 B.v: ^ .OoJf/cL 

1X1 Restoration A<>recment Signed: ^ / 1^1 ^ H B.v: fi.D6/y;(jU 

CU Topsoil Samplinji (if applicahle) Bv: 

CD Disposal Sampling (if applicahle) Bv: 

CU Garden Sampling (if applicahle) Bv: 

l^f'- l - ^

 ^oH^1%T Called: b I 1 / t' j m IJtility Clearancx^2C' m^' ^ ^y£[m:s^y^k^i^L^iein 

[^ Video/Photos (Before) 

On: S^/1:^/0 % y - /^./3r6UKj 

n Video/Photos (During) On: Bv: 

n Video/Photos (After) On: 

Bv: 

D Video/Photos (30-Day) On: 

Bv: 

I I Property Completion Agreement Signed: 

Bv: 

CU Final Report 

Issued: Bv: 

Air Monitoring (as applicable) 

j CU Community CU Crew On: / / By: 

Results: 

j CJ Communit} CD Crov On: / / 

B.v:. ll 

Resulls: 1 

CU Community CU Crew On: / ,/ By: 1 

Results: 1 

Omaha Lead Site 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact;

Final Action:

Comment: 

Owner

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

/<v/3 /y. j y y . 

 Date:S-)3>-0S Time: j'^prv Action: o-HeA ^ ci^| /yicA 

 Date:^^i'^-£)f Time:M"'prn Action: <>/yeri.. 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

' 

^'\a-o- b SfoJ^e U>/ owner, d ^ UrJ c o n U^^nesck^' 

^"tq-o^ ^ 0^ ^ p<-^p<^,-s;cj^^(ui 

^/z/oS' - e-aiiai left mcsscvop. abcii+usNin 

1 
Douglas County Account Information Page 1 of 3 lunt inrorma 

Dougla s County , Nebrask a Propert y Recor d - R164210000 0 

Print Report 

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

New Feature -*-*- • Auto Sales Search 

Owne r 

MEYER RODGER 

ETAL 

3648 LAFAYETTE AVE N E 

OMAHA NE 68131-0000 

Propert y Informatio n 

Key Number: 4210 0000 16 

Account Type: Residential 

Parcel Number: 1642100000 

Parcel Address: 1412 N34ST 

OMAHA NE 68131-0000 

Legal Description: LOWES ADD LOT 2 BLOCK U N 34.5 FT LOT 1 & E 20 N 34.5 FT 34.5 X 80 

Valu e Informatio n 

Land Improvement Total 

2007 $1,700.00 $43,200.00 $44,900.00 

2006 $1,700.00 $43,200.00 $44,900.00 

2005 $1,700.00 $43,200.00 $44,900.00 

2004 $1,700.00 $16,900.00 $18,600.00 

2003 $1,700.00 $16,900.00 $18,600.00 

2002 $0.00 $0,00 $0.00 

Sales Informatio n 

Sales Date: 2006-09-11 

Deed Type: WD Book: 2006 Page: 110262 

Price: $34,500.00 

Grantor: CENTEX HOME EQUITY COMPANY LLC 

Grantee: MEYER RODGER ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2005-12-07 

Deed Type: TRD Book: 2005 Page: 155392 

Price: $52,850.00 

Grantor: Eric H Lindquist 

http://douglasne.rnapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R164... 5/7/2008 
Douglas County Account Information Page 2 of 3 3unt intorma 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Centex Home Equity Company 

Invalid 

Sale to Mortgage - Bank 

Lan d Informatio n 

Acres 

0.06 

SF 

2800.0 

Units 

1.0 

Depth 

80.0 

Width 

35.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

No 

Sketch 

Available 

CLICK TO ENLARGE IIWIAGE 

Square Footage: 1117.0 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: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1910 0 0% 1910 94 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 665.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Screen 154.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R164... 5/7/2008 
 1.0 

Douglas County Account Infonnation _ ^ Page 3 of 3 ount iniormation ^_^ ^^ 

User NEW ROOF

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R164... 5/7/2008 
25585 

w As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Omah Exterior Paint a Lead Site 

Sit n Good e Sketch 

[ ^ Poor 

Sampling Address: 1412 N 34 ST n Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected 

I Firm: 

RYASCPXA-25585 Fl 3 IQ ppm n 

Date: 17.--7-0-7 

RYBSCPXA-25585 F2 

ppm n Time: '>:'^4. A M 

RYCSCPXA-25585 Bl 

ppm D 

RYDSCPXA-2558 Samples Analyzed 5 B2 ppm n 

nOZeGPXAI!S585 Be ppm D n XRF Unit: ^6H 0 Book: ICil. RCZSCPXA 36688 Oi ­ ppm D D Date: J 2 - l9> - O T 

RPZSCPXA asses P2­ ppm D Time n 2t± Staff Numbe i^^\y r of Samples = L| 

Legend Fl = Front Left. F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play AN quadrants are as viewed trom ttie street faang property 

'"rcalej ]2-\'m 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare Sod ' ' Rook/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
• 

25585 

Omah Exterior Paint North Arrow a Lead Site 

Q Good Site Sketch 

Sampling Address: 1412 N 34 ST [ J Not paint 

Sample Numtier 

RYASCPXA-25585

RYBSCPXA-25585

RYCSCPXA-25585

RYDSCPXA-25585

 F1 

 F2 

 B1 

 B2 

Lead 

Concentration 

3 10 ppm 

ppm 

ppm 

ppm 

Sample 

Collecled 

I 

LAB 

D 

n 

D 

n 

Fimi:

Dale:

Time:

Samples Collected 

 r^f ^ gu v LC 

 \').-l-O l 

 11:54? A M 

Samples Analyzed 

nogoorxA jsses—BJ» ppm n D XRF Unit ^5H 0 BooK: ICil. RGI&C9XA 36686 « ^ ppm D D Date: II - J9> - Q 7 

RPZSCPXA 26586 F^ ppm a D Time 2lXL 

Number of Samples = L| Staff: nswL 

Legend: Fi = Front Left. F2 = Front Right. Bl = Back Left B2 = Back Right DZ = Dnp Zone, GZ = Garden. PZ = Play 

All quadianis are as viewed from the streel facng property 

Wfui/nr 
>5585 

Omaha Lead Site Exterior Paint hJorth Arrow 

Site Sketch • Good 

[Vf Poor 

Sampling Address: 1412 N 34 ST [~~| Not paint 

Sample Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm: T^ ^ Zxi^. LC 

RYASCPXA-25585 Fl 

3 10 ppm D Date: )l-l'O l 

RYBSCPXA-25585 F2 3^q 

ppm n Time: U : 5<^ A M 

RYCSCPXA-25585 Bl ^ 2 g ppm n 

Samples Analyzed 

RYDSCPXA-25585 B2 ppm D 

nDZCGPXA-25585 B2 

ppm D D XRF Unit: ^6H 0 Book: 2C) 3 

•RGZSCPXA 25686 GZ­ ppm D D Date: ^-^'0 7 

RPZSCPXA 26586 P * ppm D 

Time 27± 

Staff: n'^w Number of Samples • 

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 from the street, facing property 
25585 

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

[^Poor r 

Sampling Address: 1412 N 34 ST Q Not paint 

Sample Number 

RYASCPXA-25585

RYBSCPXA-25585

RYCSCPXA-25585

RYDSCPXA-25585

 Fl 

 F2 

 Bl 

 B2 

Lead 

Concentration 

3 } 0 PPnn 

3^ ^ ppm 

^28 

J5ZC_ 

ppm 

ppm 

Sample 

Collected 

I 

LAB 

D 

D 

D 

D 

Firm:

Date:

Time:

Samples Collected 

 F>.A> gin , (LC 

 \7-l'O l 

 li:S4 ^ A M 

Samples Analyzed 

RDZGCPXA 25585 BS ppm n D XRF Unit: ^6H 0 Book: 2C>3 

RCZSCPXA 26686 GZ­ ppm D D Date: J 2-/f i ' O l 

RPZSCPXA 26686 PS­ ppm n D Time: 2f± 

Number of Samples = ^ Staff: n M 

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

All quadrants are as viewed from ttie street, facing property 

DEC 1 3 20C7 

*<­

?>l 

t)»v)^ O?*^ 

&s 9>'i 

56/ ^2£>J- -a 

% 

62 

-i £ 

Do 3°\'^ 

Fl ft 

1^-v^ -v^ 

n rz •AZ-tttX^ 

AT 3 ^ 5 t Rev-5 rrcalcJ i:-Nnv-07 
.y^ <;p 

^ 

% "I " o* COASTA L *•'<, , y J / ENVIRONMENTAL 

^ ""0^ ^ / / CROUP , INC, 

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: 

^t ^ ifiVy^ Owner's Name: Da,.imePhona:^^ ^ -^2^_^^ ^ 

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 
.^^tD ST, - * 

COASTA L ENVIRONMENTA L 

CROUP , IHC . 

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. 

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

cp.^ ^-/H-0 ^ 

Signature Date 

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

Page 2 of 2 
COASTA L E N V I K O N»M F N T A L 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe propei1>' 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 propert>' owner and the United States Hnvironmental 

Protection Agency (EPA). 

Property ID: '^^'S ^"^ ^ 

Property Address: \Lf| ^ kl '^'-H ^ *^-vk 

Q^""'"= ila ^ Wyjiy 

Phone: ^t.^.'\')p--%Hei y ­

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

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

contractor, and the direction of North. Indicate distances, depths, material 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: 

miAi_ 1 

Item: 

Item: «. 'i, 

Item: 

Item: 

Item: 

I 

Item: 

Item: 

Page 1 of C^ 

1 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

^^^"^-'^^\^\(\<\ ^^n^ S oy\rU M ^^^U "H hoo<^ 

p)a/vi-5 o^t>y^^ Uo\ c ^^ ^ ^"^ ^ ' ^^^^^^^^^" ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 6
C O A S. T A L 

Items To Be Removed By Contractor Durinq Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

\ix\cy. , OUrf ]c^ck (y^^ fe.^ic^{^yA'y^<to 

Item: ' 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 6 
COASTA 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 Unit Condition/Type/Species 

B/,6Sl 

Square feet 

Itf-f C-ud^r 

1 Each 

^ Each 

1 

Each 

^ 

X Each Square Feet 

Page 4 of. 6 
COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

\oucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch 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 Uriit Condition/Type/Species 

' 0 

^ 

A Each 

^ly^ j 

SF 

0 SF 

SF 

- -f rO) ^ VVi'ljl?. 

' Page 5 of C
C O A 5 T A L • NVIROMMCMTAL C « O U P . IM C 

Additional Comments / instructions: 

- \^ockK - W c^a ^ Totals cUovoY^ »«^^ C-tJ^ ^iy^CJL 

n 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. 

M I agree Q I do not agree 
BVID# 'Kd^ 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF 1D# 

Shot# 

W1T 

Wo 

M 

Average 

Shot# 

m^10 

"TU 

lilt 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

zm 

Address 

Omah a. a lead FP 2nd year option 

Sample time 

Reading 

xm 1% 

^it>t n.H 

1^-02 t L-l 

sample length 

Sannple area Shot# 

^H ^1 

To5 

Depth 

%fc 

<roi 

lC.Cii1.o> 

Average

Reading 

lA^.nt Z^.U 

y]7\bt fi-iz 

Hi.x-tN.qi 

Uo.hi \f)k 

Sample area Shot# 

X\^ 

<^\<, 

Depth 

1" 

QV 

m 

 tlO-^'^ J l^-P j Average

Reading Sample area Shot# 

Depth 

Average 

Reading 

RETEST AREAS 

Sample area Shot# 

Depth 

Lab result Sample area XRF Avg, 

Average 

Signature 

m K ^'{ ^ ^ < 

lo'H^ §in)lpm 

30 sec " 

Reading 

!b4 (.Hi K.tl 

p^Si \\.^'\ 

P'li l K.li 

Itl-^l J K.^S 

Sample area 

^en^Hf 

Depth 

r 

 l'!; ^ (f^ ^ j j l' ^ 

Reading 

H'isMCi '^TH 

m.:^it 2!o.&^ 

>n.1Li 2.1-71 

t'^b-iii tvAz 

% Z X' h 1

Reading 

Reading 

^ ^ 

y ^ / 

Sample area 

t\ 

Depth 

U ' 

 22^.(1 

Sample area 

Depth 

Sample area 

Depth 

V\^(y i P\)hn^c^ Print 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 518 

Mode SOIL 

Time 2008-07-08 11:03 

Duration 121.57 

Sequence Final 

Flags 

AVERAGE Avg of 514-517 

ADDRESS 1412 N 34 ST 

QUAD/ZONE 

INSPECTOR 

DEPTH 

|B I 

MATEUS I* 

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 495.466 

Supervised By: 

Certificate of Verification 

514 

SOIL 

2008-07-08 11:00 

30.57 

Final 

25585 

1412 N 34 ST 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 27.140 
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 PI'PE 

NOTE 

ppm 

Pb 286.321 

Supervised By: 

Certificate of Verification 

515 

SOIL 

2008-07-08 11:01 

30.71 

Final 

25585 

1412 N 34 ST 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 20.848 
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 Pi'PE 

NOTE 

ppm 

Pb 311.746 

Supervised By: 

Certificate of Verification 

516 

SOIL 

2008-07-08 11:02 

30.06 

FiBal 

25585 

1412 N 34 ST 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 21.775 
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 355.015 

Supervised By: 

Certificate of Verification 

517 

SOIL 

2008-07-08 11:03 

30.23 

Final 

25585 

1412 N 34 ST 

Bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 22.929 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 502 

Mode SOIL 

Time 2008-07-08 10:25 

Duration 123.35 

Sequence Final 

Flags 

AVERAGE Avg of 498-501 1 

ADDRESS 1412 N 34 ST 

QUAD/ZONE B2 

INSPECTOR MATEUS 

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 18.489 

Supervised By; 

Certificate of Verification 

498 

SOIL 

2008-07-08 10:22 

30.84 

Final 

25585 

1412 N 34 ST 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 7.325 
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 13.892 

Supervised By: 

Certificate of Verification 

499 

SOIL 

2008-07-08 10:24 

30.38 

Final 

25585 

1412 N 34 ST 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 6.836 
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 19.962 

Supervised By: 

Certificate of Verification 

500 

SOIL 

2008-07-08 10:25 

31.23 

Final 

25585 

1412 N 34 ST 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 7.262 
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 14.027 

Supervised By: 

Certificate of Verification 

501 

SOIL 

2008-07-08 10:25 

30.90 

Final 

25585 

1412 N 34 ST 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 6.709 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Supervised By 

Certificate of Verification 

508 

SOIL 

2008-07-08 10:45 

120.96 

Final 

.Avg of 504-507

•^^1412 N 34 ST

* easement 

MATEUS 

1 

CLEARANCE 

i 

' 
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 PT'PE 

NOTE 

ppm 

Pb 164.642 

Supervised By: 

Certificate of Verification 

504 

SOIL 

2008-07-08 10:42 

30.26 

Final 

25585 

1412 N 34 ST 

easement 

MATEUS 

1 

CLEARANCE 

± Error 

± 15.641 
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 PI'PE 

NOTE 

ppm 

Pb 81.853 

Supervised By: 

Certificate of Verification 

505 

SOIL 

2008-07-08 10:43 

30.25 

Final 

25585 

1412 N 34 ST 

easement 

MATEUS 

1 

CLEARANCE 

± Error 

± 11.249 
f 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 506 

Mode SOIL 

Time 2008-07-08 10:44 

Duration 30.01 

Sequence Final 

Flags 

BVID # 25585 

ADDRESS 1412 N 34 ST 

QUAD/ZONE easement 

INSPECTOR MATEUS 

DEPTH 1 

SAMPLE PT'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 150.922 ± 15.128 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 507 

Mode SOIL 

Time 2008-07-08 10:45 

Duration 30.44 

Sequence Final 

Flags 

BVID # 25585 

ADDRESS 1412 N 34 ST 

QUAD/ZONE easement 

INSPECTOR MATEUS 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 161.141 ± 15.435 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 513 

Mode SOIL 

Time 2008-07-08 10:55 

Duration 122.77 

Sequence Final 

Flags 

AVERAGE i Avg of 509-512 

ADDRESS 1412 N 34 ST 

QUAD/ZONE easement B 

INSPECTOR MATEUS """ 

DEPTH 1 

SAMPLE PCPE 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 295.038 

Supervised By: 

Certificate of Verification 

509 

SOIL 

2008-07-08 10:52 

30.53 

Final 

25585 

1412 N 34 ST 

easement B 

MATEUS 

1 

CLEARANCE 

± Error 

± 20.204 
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 377.138 

Supervised By: 

Certificate of Verification 

510 

SOIL 

2008-07-08 10: 53 

30.65 

Final 

25585 

1412 N 34 ST 

easement B 

MATEUS 

1 

CLEARANCE 

± Error 

± 22.727 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 511 

Mode SOIL 

Time 2008-07-08 10:54 

Duration 30.73 

Sequence Final 

Flags 

BVID # 25585 

ADDRESS 1412 N 34 ST 

QUAD/ZONE easement B 

INSPECTOR MATEUS 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 149.253 ± 14.465 

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 260.802 

Supervised By: 

Certificate of Verification 

512 

SOIL 

2008-07-08 10:55 

30.86 

Final 

25585 

1412 N 34 ST 

easement B 

MATEUS 

1 

CLEARANCE 

± Error 

± 18.985 
Omaha Lead Site—Fixed Price EP-R7-07-05 

<yy 

Coasta

www.coastalhazmat.co

l Environmental Grou

m 

p Inc. 

COASTA

m

L ENVIRONHENTA L 

CROUP . INC . 

EXECUTIVE SUMMARY: 

th BVID # 25585 - (1412 N 34"' St.) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
^ -^^EPA 

EPA Property Close Out Form 

Property # 

i^y.. Property Address:

D«ten"lme Owner's Name y M

Quads Eicav^ated: ^ \ KyflX 

Contractor Grouup

p L- Co^^TTT © L

Excavation General Yes No

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

2. If necessary, were the correcl areas of drip zone excavated and restored? l y 

Grading Sod and Vegetation Yes No

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

from the house? 

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? y 

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

time p)eriod) 

6. Was the properry graded such that water will not pool on the propert)'' 

7 Was damage to landscaping or plant materials avoided'' 

Gates, Fences and Retaining Walls 

Yes Nc 

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

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

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

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

Foundation, SidiDg and Gutters Yes No 

1. Was damage to the siding or trim avoided? £-' 

2 Was damage to the foundation avoided? i ^ 

3. Was damage to windows avoided? 1 - ^ 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 
Owo«?rs comments: 

Inspection notes: 

So d ^^ Su.A«vci Q.rejis ^C-S> ^KiHpcc^4 bnD(JncAX. ^/<^JL | Grt^ s 

VU 

CD(l\i |\JWJ L U^-lc r cf M-Oxif iV" ^ ' ci 

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

EPA RQprestnmw^yy^^ ^ Dale;_^A^-^_ 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My signature 

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

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

Property ID: ^ J SS ^ 

Property Address: \ '-f IQ^ 7^ '}H f f 

Owner: H . y ^ r M e^Y JL-V­ '-^ 

Phone: 7A<!P FjO Q 

Restoration Items in Question: 

Item: 

X g .^^^ 4-c. yetv^cj^r^ * J hufV<s.'> " h (31 VJ^ v'^V^^v firrv V g.»-v5 

Item: 

S^^cie ^ r «r\s; e V c\,^ ^ \< a »VO. I- < v\ «- I 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

^i^-* ! (s^f{j((bf ^yjo y 

I AJ I agree restoration is completed, except as noted 

I I I do not auree restoration is completed