TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA]D#: Wi. Dale: J h n \i 

Addres,s: Wf ] ^ 111 ^ V 

Remediation Contractor: Coastal Environmental Group_ Year: _20]0ARRA_ 

i / 

( / 

J 

J 

</ 

J. 

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i 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject properly 

Signed Access Agreement(s) for adjacent property 

Restoration Agreemenl 

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

Confirmation data 

Photographs \\ < hf ^f(K^ff^ ^ tft^^'^e ^ \ 'TQ'P 

As-buill 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 inftrmation from Douglas County Assessor's Office 

Signature 

30218832 

wm 

Superfund 
Property Access Checklist 

p 

PropertylD: \c^^(^\^ 

Property Address: \«j-^ci _5> Lli _ ."^iTM-,. --^ -

D WORK STARTED 

D WORKCOMPELTED 

ON: 

ON: 

_/ /_ 

/ / 

Owner: 

Address: 

_Vt\vs.\ Ks\ft.V> 

Phone; 

{ Fax: 

Cell/Pager: 

Moi.. -S^\ . °l\M<», 

Renter: 

Phone: 

Fax: 

Ccll/Pager: 

tJSfcSLkk^ 

Additional IiiforroHtion: 

' n Notification Letter 

[yl Access Agreement 

^ Restoration A<j;recment 

1 O Topsoil Sampling (if applicable) 

O Disposal Sampling (if applicable) 

G Garden Sampling (if applicable) 

[^ Utility Clearance 

P Video/Photos (Before) 

D Video/Photos (During) 

1 D Video/Photos (After) 

I D Video/Photos (30-Day) 1 

1 • Property Completion Agreement 

D Final Report 

' Sent; / / 

Signed: \o . /w . Uo . 

Signed: \o/v u /x t 

1 ' ' 

I I 

I 1 

Called: W / 3i, / v^ 

On: \r> / VV. / \r> 

On: / / 

On: / / 

On:' I t 

Signed: / / | 

Lssued: / / 

Bv: 

By: 

By: 

V3^„\. 

V^*\tV 

By: 1 

By: 

By: 

By: 

By: 

By: 

\\l^l\l.-^ Wl..,xrt.^ 

Vj-it V 

By: 

By: 

By: 1 

By: 

,„.J 

Air Monitoring (as applicable) _^^ 

D Community D Crew j On; / / J By 

Results: 

Q ComrounitA' CI Crew On: / " / j B) 

Omaha Lead Site 
Douglas County Account It^Matio i^M a n Page 1 of3 

Douglas County, Nebraska Property Record - R1262690000 

Information is valid as of 2010-8-16 

Print Report 

View Interactive GIS IMao 

Treasurer's Tax Reoort 

New Feature •• -^ ^ Subdivision Sales Search 

Owner 

AYALA PAUL R 

1427 S 17 ST 

OMAHA NE 68108-0000 

Property Information 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

6269 0000 12 

Residential 

1262690000 

1429 S 17 ST 

OMAHA NE 68108-0000 

HARTMANS ADD LOT 31 BLOCK 0 S 33 N 45 FT W 98.5 FT 33 X 98.5 

Value Information 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

$3,600.00 

Sales Information 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

2006-09-12 

QC Book: 2006 Page: 105052 

$750.00 

GALASKA RANDALL 

AYALA PAUL R 

Valid 

1998-10-08 

D Book: 2103 Page: 602 

$18,000.00 

http://douglasne.mapping-online.com/DouglasCoNe/static/accotmtinfo.jsp?accountno=R12... 8/20/2010 
Douglas Cotmty Account Ii^H|atio i^H| a n Page 2 of3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Show All Transactions 

Land Information 

Acres 

0.07 

SF 

3234.0 

Units 

0.0 

Deptti 

98.0 

Width 

33.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 8/20/2010 
Page 1 of2 

"> 

Create Another Ticket 1 Back to Irth Intemet Send Email ] 

• YOUR TICKET NUMBER IS 2632009. 

Original Call Date: 11/02/10 Time: 9:35 am Op: ELIZABETH18790 

Work to Begin Date: 11/04/10 Time: 10:00 am 

State: NE 

Address: 1429 

Covmty: DOUGLAS 

Street: S 17TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 27-NW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

Type of Work: LEAD REMEDIATION 

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

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

: UNSURE IF CORNER LOT. 

Company : COASTAL ENVIRONMENTAL SERVICE 

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

Work Being Done For: COASTAL 

Depth of Excavation: 4 FT Comer Lot: N 

Involves Tunneling or Horizontal Boring : N 

ATTNEBRl CXCATV LEVELS MCINEB 

0PPDGPR6 QLNNEIF QWESTNE SPRINTNE 

Front: Y Rear: Y 

Explosives: N 

METHODIS MUD02 OMAHACOF 

Service Area 

ATTNEBRl ATT/T 

Contact Phone Number 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

UtiUty 

Type 

/-V/-AXX7 COX COMMUNICATIONS, TrcTr,! 

CXCATV p^ p HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCINEB MCI NO CALL PER MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

http://www.(lhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
Page 2 of2 

METHODIS 

MUD02 

OMAHACOF 

OPPDGPR6 

METHODIST HEALTH 

SYSTEMS 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

CONSOLIDATED UTILITY 

SERVICES 

SANDY 

RICH/TRAFFIC 

ELM LOCATING 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING 

QWESTNE QWEST LONG DISTANCE 

SPRINTNE SPRINT COMMUNICATIONS 

CO 

Day: 8888474757 

Alt: 

Emerg: 8888474757 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 8002834237 

Alt: 

Emerg: 8002834237 

Day: 8005210579 

Alt: 

Emerg: 8005210579 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
COASTA L 

i k As-Built Drawing ^ 

Omaha Lead Superfund Site 

OLS#: 19886 

Date Excavated: 11/9/2010 

Date USEPA Signed Off: 12/2/201^ 

Area Sodden: 2020 sa ft ' 19886 

Omaha Lead Site 

Site Sketch 

Sampling Address: 1129 S 17 ST 

Eirtenor Paint 

Q Good 

• Poor 

[ ^ f^ot paint 

Sample Number 

RYASCPXA-19886 Fl 

RYBSCPXA-19886 F2 

RYCSCPXA-19886 Bl 

RYDSCPXA-19886 82 

RPgOCPXA-19000 B? 

Lead 

Concentration 

zn 

2fi l 

122-1 

Cal l 

RGZ6CPXA 10886 

nrzocpxA laees 

-ez 

-pappm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

I 

D 

D 

D 

LAB 

n 

D 

n 

n 

n 

D 

n 

Number of Samples = | V\ | | Q | 

Samples Collected 

Fim, FOft Oft , fl.r 

Date: l2.-l7-f>B 

Time ^••HC (>ft] 

Samples Analyzed 

XRF Unit (BSH O Book: 7 2T 

Dale 0/ • bS- • 0°l 

Time P m 

Staff PTS U 

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

All quadrants are as viewed from ttie street facing propeity 

Pia' 

ENTERED 

DEC 2 3 i m 

Concrete 

Area replaced with 

Sod 

m 

Legen d 

Drip Zone Excavated 

Area replaced with 

Rock/Mulch 

Quadrants Excavated 

Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
Xi 6/^ -r' \ . , \\m 19886 

Omaha Lead Site 

Site Sketch 

Sampling Address: 1429 S 17 ST 

Exterior Paint 

• Good 

• Poor 

3 Not paint 

North Arrow 

Sample Number 

RYASCPXA-19886 Fl 

RYBSCPXA-19886 F2 

RYCSCPXA-19886 Bl 

RYDSCPXA-19886 82 

KDZ3CPXA-19000 BZRCZSCPXA 10886 GZ 

RrZCCPXA.10886 P2-

Lead 

Concentration 

2- 1 1 ppm 

2f? l ppm 

/22 , / ppm 

rp/ 7 ppm 

~ ppm 

~ ppm 

~ ppm 

Sample 

Collected 

i 

D 

D 

D 

LAB 

D 

D 

D 

D 

a 

D 

D 

Number of Samples = I Ll I | Q | 

Samples Colleded 

Date 

Time 

i2r-l7.-f)B 

M'-qo (W 

Samples Analyzed 

XRF Unit; (pS HO Book; ? Z l 

Date 

Time 

Staff 

0 1 • OS- • Q' ^ 

nsu 

Legend; Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pia; 

All quadrants are as viewed from the street, facing property 
19886 

Omaha Lead Site 

Site Sketch 

Sampling Address : 1429 S 17 ST 

exterior Paint 

• Good 

• Poor 

21 Not paint 

North Arrow 

Sample Number 

RYASCPXA-19886 F1 

RYBSCPXA-19886 F2 

RYCSCPXA-19886 B1 

RYDSCPXA-19886 B2 

RDZ3CPXA--19000 BZ" 

RCZSGPXA 19886 SZ 

nPZGGPXA-10886 PZLead 

Concentration 

z n 

2f?7 

122.1 

Col l 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

D 

D 

D 

LAB 

D 

a 

n 

n 

n 

n 

n 

Number of Samples = | V\ | | Q | 

Samples Collected 

Fimi; FD>q DPS, fl.r 

Date: )2.-l7 -r>B 

Time: M'-UO ^ 

Samples Analyzed 

XRF Unit: (Q € H O Book; 9 Z T 

Date 

Time 

Staff: 

O/ • Qg- • 0° \ 

_&n. 

rnsu 

Legend: Fl = Front Left, F2 • Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pia; 

All quadrants are as viewed from the street, facing property 

o"-X 
19886 

Omaha Lead Site 

Site Sketcii 

Samplinq Addrsss ! 1429 S 17 ST 

Exterior Paint 

• Good 

D^Poor 

[ 3 Not paint 

NorthArrow 

Sample Number 

RYASCPXA-19886 

RYBSCPXA-19886 

RYCSCPXA-19886 

RYDSCPXA-19886 

Fl 

F2 

Bl 

B2 

-BZLead 

Concentration 

zn ppm 

RDZSCPXA* 19000 

nOZCCPXA 10886 6Z 

nPgOCPXA 10006 PZ-

/2?T / ppm 

/ff / 7 oom 

— ppm 

"~ Pom 

r ppm 

Sample 

Collected 

D 

D 

D 

LAB 

a 

D 

D 

n 

n 

n 

n 

Number of Samples = | t^ | | Q | 

Samples Collected 

Fimi: FDfl nfl , fl.f 

Date: l2.-l7./sft 

Time: : M'-MQ (W 

Samples Analyzed 

XRF Unit: QiSHO Book: ^Z T 

Date: 01 • Q ^ • Q^f 

Time: ^rr\ 

Staff: rns u 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Lefl. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pia; 

All quadrants are as viewed from ttw street, taclng property 

n 

^ 

1^11 • • • I rf» 

..(p.n.. 

ENTERED 

DEC 2 3 vm 

i^nun^ 

- risc -

f 

2n 

...n 

if' > »' 

"wwTT 

Rev 2008 CrMtol. 05-Nciv*8 

sn ^^ 

M4701 ,01.23 
i^^^l^^'u 

COASTA l 

fHVItONHtNTAl 

C I 0 U f . > M 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 Phonej ^ ^^g) ' ^^ l /fyaU 

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 wili 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, vknil contact 

the Grantor In-person to discuss the woric to be perfomned, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration worl( 

before it begins. Once the wori( 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 
V -'*^* ' COASTAL 

'< PRO"- c « 0 11 r 1 » e 

« 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 

> 

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

(^^p'^^y:^y ^ ^^/y^^^ 

Signature > ^ Difte ' Signature y ^ ^^ ^ Signature Date 

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

Page 2 of 2 
^\ 

C O A S T A L 

BNVIKOMHBNTAL 

C • O U P , INC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe 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 States Environmental 

Protection Agency (EPA). 

PropertylD: [^^( p 

Property Address: / ^^9 -o^ Xl^ t 

Owner wwner: j/^^ \ ^s ^ &^[ : y ^ ^ ^ /y- y ^ yy ^ 

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

access location(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 removal, storage, disposal, and/or retum of these items is the Owner's responsibility. 

Hem: 

yy^ 

Kem: 

Hem: 

Hem: 

Items to be Removed 

Hem: ^ 

/ y 

by the Contractor 

(y*-- ^ 

During Remediation and Not Replaced 

Item: 

Hem: 

Hem: 

Page 1 of. a 
C O A S T A L 

• NVmONHB N T A L 

GROUP , IMC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

Hem: 

^T^^y 

^ h^ 

Hem: 

Hem: 

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. 

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. 

Easement Area, to be 

excavated 

Landscape Inventory 

Quantity 

S'>)S^ 

— • 

J2< 

er 

0^ 

y 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

$ 

Each 

Condition/Type/Species 

^^"^^^ ^2^.=^^ 

Page 2 M 3 
COASTA L 

• NVIROMneNTAL 

O • O U P , INC . 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the cKy of Omaha's Planning Department at (402) 444-5150. 

[~1 Please check this box if you understand the infomiation outlined above. 

t'-< \ Kye^ ZHi^ y 

^ « 

-flee 

I ] 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. 

Q I do not agree 

Owner's Stfnature 

-^y^y^ 

Date 

( ^ ^ . 

•>^'^' y 

Contractor's Signature Date 

Page 3 of. 1 
XRF PROPERTY SAMPLE SHEET 

BviDff nss^ 

Date 

Project 

XRF ID# 

I - Z ^ - ZO U 

Omaha Lead ARRA 

^^o^z: 

Shot# 

4^ 

46 

4^ 

Reading 

/ 5 ^ i /6 

U5 i n 

/^3 i Zo 

Sample area 

£A 

Depth 

/ " 

Average /^ 3 "^ /<5 z 

Address 

Sample time 

sample length 

/^^^ 5 /4 5 r 

am/pm 

30 sec 

Shot# Reading Sample area 

Depth 

Average 

Shot# 

41 

4^ 

43 

Reading 

^ / t zy\ 

3^3 i^ ze 

^>^o i Z^ 

Sample area 

5^ 

Depth 

^ « 

Average 3 ^ ^ •^ ZJ^ y 

Shot# Reading Sample area 

Depth 

Average 

ShGt# 

34 

55 

31 

Reading 

/=?^i e ^ 

/g5i s( 

/^^ i ^ ( 

Sample area 

B( 

Depth 

4" 

Average n^ Z£> 7 

Shot# Reading Sample area 

Depth 

Average 

Average 

RETEST AREAS 

Shot# Reading 

/ ^ 

/ / 

Sample area 

Depth 

Shot# Reading Sample area 

Depth 

Average 

Signature_ 

Print' MftK.^ (l4(mu) 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

48 

SOIL 

2011-01-27 11:27 

91.12 

Final 

Avg of 45-47 

1429 S 17 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

45 

SOIL 

2011-01-27 11:26 

30.66 

Final 

19886 

1429 S 17 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

152.672 

± 

± 

Error 

16.956 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

46 

SOIL 

2011-01-27 11:27 

30.27 

Final 

19886 

1429 S 17 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

165.446 

± 

± 

Error 

19.547 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 173.853 

Supervised By: 

47 

SOIL 

2011-01-27 11:27 

30.19 

Final 

19886 

1429 S 17 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.186 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

44 

SOIL 

2011-01-27 11:24 

90.87 

Final 

Avg of 41-43 

1429 S 17 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

41 

SOIL 

2011-01-27 11:23 

30.30 

Final 

19886 

1429 S 17 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

391.485 

± 

± 

Error 

29.558 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

42 

SOIL 

2011-01-27 11:24 

30.25 

Final 

19886 

1429 S 17 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

343.764 

± 

± 

Error 

28.231 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

43 

SOIL 

2011-01-27 11:24 

30.32 

Finai 

19886 

1429 S 17 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

370.209 

± 

± 

Error 

29.732 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

40 

SOIL 

2011-01-27 11:22 

90.57 

Finai 

Avg of 37-39 

1429 S 17 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

37 

SOIL 

2011-01-27 11:21 

30.18 

Finai 

19886 

1429 S 17 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

172.618 

± 

± 

Error 

20.504 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

38 

SOIL 

2011-01-27 11:21 

30.21 

Final 

19886 

1429 S 17 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

183.813 

± 

± 

Error 

21.331 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Certificate of Verification 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

39 

SOIL 

2011-01-27 11:22 

30.18 

Finai 

19886 

1429 S 17 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Pb 

ppm 

180.394 

± 

± 

Error 

21.052 

Supervised By: 
Omaha Lead Site-Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

EXECUTIVE SUMMARY: 

BVID #19886-(1429 S 17 ST) 

COASTAL 

ENVIRONMENTAL 

GROUP. INC. 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

Quads Excev~trd: 

Property Addrw 

Owner's h'emr I 

Contractor Groul 

Exra~~t-m! __ _ ___ - - _ - --- \t- h~ 

1 If necessq, were the correct quadrant(s) excavated and restored7 - - I - -- - - 4 /A -1 I 

2 If necessary, were the correct areas oldr~p lonr cxcava~cd and rcctored7 - - - - -- - - - - - I JI , J 

2 Has sod been laid in all arcas that were cxcavated? 1'7 i 

4 Am sodded arcas generally Ti and evenly gaded7 ,/I 

, 

. - L -I 

Are thejom~s between rh; sod smps generally trght? (Only c\aluatP 71nz~cctcd at a 711 da\ 

_tlmtpe*) - - ___- - - - - - -- A ' 1 

b Was the property graded such thar ualer w111 not pool on tht propem' - - -- - - - - - - -1 

7 War damage to landscaping or plan1 marcrials avoided7 : / 

, - --- - - -- -. - 

I 7 Was damage to gates or fences avoided? (If applicahlc) - - -- - . . 

1 1 4 Was damage lo retaining walls avoided? (If applicable) - _ - - 

foundation, Sidia~ and Gufttn --. -- _ -~ . -. 

I Was damage to !he siding or trim avoided? I 

, -- - - .- - 

/ 2 Was damage tn the foundation avoided? 

I -- . - 

: Was damage lo wmdows avoidedq I 

I - -- I - 

1 4 Was damage to wmdows or door screens avo~ded'l 

I -- -- - ------ -_ ~ 

. Was damage to dounspou~.c or duwnspou~ extension5 avo~dcd'' - - - __ .- . -- . .. _ ___ .- - 

Sldcwalks and Driveways (Coocs . - - - - -- - - .- .- 

I Was damape 10 drivcwey surfarcs avoided'? -- - 

2. Wa? damage to walkway surfacts avoldcdq .. - -. - - 
OM'pers comnifnls: 

I fn.vr>*'ctir>n no<e«;: 

Removal and resioiatioii ailivalfs t(unpleie iiicluding ihe 30-day scxj wanciiif) 

[-PA Rcprcspniaiive _ _ _ _S'^ M ' Date; u|i|ic 
0:.% 

Property Completion Agreement 

This agieemeni documenls Ihe compiclion ol remedial acliviiies perloimed on my properly My signature 

will designate lliai i am salisfied wilh the restoralion of my properly, and Ihal no iiems are in questions, 

now, or al any tune in the fulure, except ihose items listed below, if any 

Property fP. \€\^^i p 

Property Address: |q ^ g^ ^ |- | ^ 4 

Owner: N^aj^\_{^ytJaJ._ _ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

= 

I ayrcc Ic^tomlion i^ completed, rxccpl as noted 

[ I I rio not gfirtc rcstorittian is completed 

'^.^^^ /^y^^y/n Date (I actor's Signature Dale