TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: hPliy O Date: l^Xiyi 

Address: t/TpkX tol(^^ M£ > 

Remediation Contractor: _Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

G / Video of property (DVD) 40315415 

y Executive Summary iilliliii l 

Superfund 

\ y EPA-provided property sketch 

S^ Signed Access Agreement for subject property 

fajfi Signed Access Agreement(s) for adjacent property 

\ y Restoration Agreement 

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

W Confirmation data 

y Photographs pn^^p^CAJ^gA ^ ejCCoJrk OA^ ^Cic l -Sdci 

0 As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

Oljl^ Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

W Property information from Douglas County Assessor's Office 

5 /

y

 l^oCteAj^ (uy^jt^

 CiT^uWi^-fi-ytt^ 

 nJirrJcJL&r 

D 

Signature Date 
Property Access Checklist 

Propen^ID: ;:i^^<^: ^ n WORK STARTED ON. / /_ 

• WORKCOMPELTED ON: / / Property Address:^ ^ . V A .V. . ^ iA-X.^ . 

Renter Owner: p^ ^ ^ ^ ^ v-^/^ ; ^C . 

Address: Phone: 

d^n ^ ^ ^t3 . Fa.v: 

Cell/Pager: 

Phone: C^5:2,-a,0C|c i Additionul Information: 

Fax: 

Ccll/Pager. 

D Notification L/Cltcr Sent: / / By: 

^ Access Agreement Signed: il/ii/ci 3 By \o> Golems 

B Restoration Agreement Signed: 11 / !?>/ O B 

^y vO\co\cx,5 

O Topsoil Sampling (if applicable) / / By: 

[H Disposal Sampling (if applicable) / / By: 

• Gnrdcn Sampliag (if applicable) / / By: 

Q ^ Utility Clearance Called:!^/iii/DS. 

B>':l\jlSO^ 

ES Video/Photos (Before) 0n:_a/li/t2g' 

^y•^r-^^rKx^ yy u cyy-^ 

n Video/Photos (During) On: / / By: ^ 

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

D Video/Photos (30-Day) On: / / By: 

1 1 Property Completion Agreement Siened: / / By: 

n Final Report Issued: / / By: 

Air Monitorine (as applicable ) 

D Community • Crew On: / / By: 

Results: 

LJ Community' LD Crew On: / / By: 

Results: 

CU Community O Crew On: / / By: 

Resuiti: 

Omaha Lead Srte 
Property ID ti 

Property 

Address: 

Initial Contacl: 

Second Contacl: 

Final Conlact: 

Final Action: 

Commeni : 

ONvner 

Commen i (s): 

Site 

Coordinator 

Coinmeni (s): 

CONTACT FORM 

3H250 

Z5L9 I f[mJ2S. Av 

Date: Time: Action: 

Date: Time: Aclion: 

Dale: Time: Action; 

Tran.smit to EPA D Other Action: D 
Pouglas County Account Infoouation Page 1 of2 )jB^t 

Douglas County, Nebraska Property Record - R1431450000 

Print Report 

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

New Feature -•-•• • Auto Sales Search 

Owner 

PEREZ JUVENTINO 

2113 J ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 3145 0000 14 

Account Type: Residential 

Parcel Number: 1431450000 

Parcel Address: 2561 AMES AV 

OMAHA NE 68111-0000 

Legal Description: KARRS SUB DIV LOT 4 BLOCK 0 38 X 125.5 

Value Informatio n 

Land Improvement Total 

2008 $400.00 $0.00 $400.00 

2007 $400.00 $0.00 $400.00 

2006 $400.00 $0.00 $400.00 

2005 $400.00 $0.00 $400.00 

2004 $400.00 $0.00 $400.00 

2003 $400.00 $0.00 $400.00 

Sales Informatio n 

Sales Date: 2004-02-10 

Deed Type: WD Book: 2004 Page: 020872 

Price: $1,000.00 

Grantor: Tyneshia Hymes 

Grantee: Juventino Perez 

Valid/Invalid: Valid 

Exclusion Reason: Land Sale 

Sales Date: 2001-03-16 

Deed Type: SWD Book: 2183 Page: 317 

Price: $250.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R14... 11/4/2008 
Pouglas County Account Infooaation Page 2 of2 >jjmt 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Land Sale 

Land Informatio n 

Acres 

0.1 

SF

4750.0

 Units 

 0.0 

Depth 

125.0 

Width 

38.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 11/4/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2175708. 

Original Call Date: 11/14/08 Time: 12:03 pm Op: ELIZABETH18790 

Work to Begin Date: 11/18/08 Time: 12:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2561 Street: AMES AVE 

Twp: 15N Rng: 13E Sect-Qtr: 04-NE-SE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING THE HOUSE ALL THE WAY TO 


: THE STREET. 


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


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC SPRNTPCS 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 

Emerg: 9185747098 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

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

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/14/2008 
Page 2 of2 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

Day: 4025371800 

SPRNTPCS SPRINT SPECTRUM L P Alt: 4025371810 

Emerg: 8005210579 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11 /14/2008 
D Remote ID: R page of 

Magellan 

One-Call 

P.O. Box 3448 

Phone 918/574-7098 

Fax 918/574-7466 

Tulsa, OK 74101 

The followin g One-Call Agency dig ticket s calle d i n by: 

Excavator: COASTAL ENVIRONMENTAL SERVICE 

Fax Number: 8776624211 

Phone Number: 8776624210 

Fax Date: 2008/11/14 

Batchid: 543134 

Wil l be CLEAR o f underground facilitie s for : MAGELLAN PIPELINE 

State Ticke t Number Excavator Contact Dig Address 

NE 2175708 ELIZABETH 2561 AMES AVE 

I f you have any questions , please contac t Magellan OneCall a t 918/574-7098 
Page 1 of2 

'> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2181431. 

Original Call Date: 11/24/08

Work to Begin Date: 12/01/08

 Time:

 Time:

 9:29 pm 

 7:15 am 

Op: ELIZABETH18790 

State: NE 

Address: 2561 

County: DOUGLAS 

Street: AMES AVE 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E

 Rng:

 Sect-Qtr: 04-NE­

 Sect-Qtr: 

SE 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING HOUSE ALL THE WAY TO THE 


: STREET. 


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


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MtJDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 

Emerg: 9185747098 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF 0MAHA-TRAFF1C,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/24/2008 
Page 2 of2 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/24/2008 
D Remote ID: R page of 

Magellan 


One-Call 


P.O. Box 3448 


Tulsa. OK 74101 


Phone 918/574-7098 


Fax 918/574-7466 


The following One-Call Agency dig tickets called in by: 


Excavator: COASTAL ENVIRONMENTAL SERVICE 


Fax Number: 8776624211 


Phone Number: 8776624210 


Fax Date: 2008/11/25 


Batchid: 544646 


Will be CLEAR of underground facilities for: MAGELLAN PIPELINE 


State Ticket Number Excavator Contact Dig Address 


NE 2181431 ELIZABETH 2561 AMES AVE 


If you have any questions, please contact Magellan OneCall at 918/574-7098 

1250 

C O A ST A L ENVmONHiNTAL 

CROUP . INC . 

As-Built Drawing 

Omaha Lead Superfiind Site 

Owne Omaha Lead Site r Name: PEREZ JUVENTINO 

Site Sketch Address: 2561 AMES AV 

Phone: H 4029333899 W: 

Lead Sample 

Concentration Collected 

RYASCPXA-34250 Fl ppm D 

RYBSCPXA-34250 F2 ppm D 

Sample Number LA B 

\3r RYCSCPXA-34250 Bl H32. ppm D 

RYDSCPXA-34250 82 5 0 ppm D 

nD^ccpx;^ MSOO—02 ppm D 0 ' nCZSOPXA 34260 62- D 

RPZSCPXA-34250 PZ 

ppm 

Z ^ ? ppm D D

D 

Numt>er of Samples = 5 

Exterior Paint North Arrow 

• Good 

• Poor ^ 

0 " Not paint 

Firm: 

Date: 

Time 

Samples Collected 

A-awlRs l ftJ11- lf?-o£ . 

IO-. t^«s^». ^ 

Samples Analyzed 

XRF Unit: lOQ- y Book H "^ 

Date: 12. • IH -dj ) 

Time _^CQ 

Staff f>1su; 

Legend Fl = Front Left. F2 = Front Rigfit, B1 = Back Left. B2 = Back Rigfit DZ = Drip Zone, GZ = Garden. PZ = Play 

All Quadrants are as viewed from the street, facing property 

OLS#: 32450 

Date Excavated: 12/8/08 

Date USEPA S gned Off: 1/13/09 

Area Sodded 292^ sq ft 

^3^ . 

4- So\. 

4^-5'^/! AmBy/H) 

.or \ c j 0 r'lcv i 

<0 F2­ . >, 'Z. 

:Z}(o 

vgj' X 

.Awe^ . ftv 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 


Area replaced with Area replaced with 


Area left bare 
 Sod Rock/Mulch 


Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

;4250 

Exterior Paint North Arrow 

Owne Omaha Lead Site r Name: PEREZ JUVENTINO • Good Site SIcetch Address: 2561 AMES AV • Poor 

Phone: H: 4029333899 W: J 0 ^ Not paint 

Sample Numt)er Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: A-S^JIRS I ftX 

RYASCPXA-34250 

RYBSCPXA-34250 

RYCSCPXA-34250 

RYDSCPXA-34250 

F1 

F2 

Bl 

B2 

T 7 

2-lLo 

5XlA

ppm 

ppm 

ppm 

 ppm 

0-

0^ 

D 

D 

D 

D 

Date: 11- 157-OJC 

Time: 10 . M s A»y^ 

Samples Analyzed 

RDZGCPXA 01260 

RCgCCPXA 34260 -Q2­

- ^

"~

 pp m 

 ppm 

D 

D 

D 

D 

XRF Unit: IGQ-y Book: XJ3 -

Date 72 - IH 'CLe 

RPZSCPXA-34250 PZ TS S ppm D Time A ^ 

Staff: ^!vu J Number of Samples = i '5 

Legend F1 = 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 

EiSTTEBED 

NOV 2 7 m t 

3?r6 / \ MBS'IR 

CL.oT\ c j 1^ rictc 

F 2 ­

6. n(p. 

ktijl k 

Rev 4 .Awe;s.. .ft^V 046141 0123 
4250 

Omah Exterior Rami Owne a Lead Site r Name: PEREZ JUVENTINO 

Sit • Good e Sketch Address: 2561 AMES AV • Poor 

Phone: H: 4029333899 W: J \7f Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: A'&wlRsI ftr 

RYASCPXA-34250 F1 1 7 ppm D Date: \±:_ \^-o£ -

RYBSCPXA-34250 F2 

ppm \z D Time: ^o•.^^A ^ 

RYCSCPXA-34250 Bl ^31 . ppm D 

Samples Analyzed 

RYDSCPXA-34250 B2 .^/^I ppm D

RDZGCPXA 04200 &Z ppm D D XRF Unit lOQ-? Book: H "^ 

nOgCCPXA 34260 G2- ppm D D Date: / 2 - IH -CLe 

RPZSCPXA-34250 PZ Z S ^ ppm D Time: ^rt \ 

Staff jA^u ) 

Number of Samples = 5 

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 V^ u« 

1 ^ ': 

; i • ENTERED p^ ... ' ...j... . uni/. .1 > snn*: • WT t . f tVVQ to .....e.«....':... . 

...^.3^...(....32.... 

: l.soA.. . 

; 4 : 

y^y^ryhoBShi 

I 

i 

Cyor s C^l ^ r'icK. 

y....i....y 

y 7/6 

• 

Vi^lK 

Rev 4 046141 ..:-. 7:..:^y^^^i:l^v •,,^^y_.--,.. 
> — *» 

COASTA L INVIItONHINTAI X^o^c ^ e • O U f . IH 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: 

Daytime Phone: 

Address of Property 

covered by this J^^/ AKM 6-5 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 wori<. This access shall 

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

agrees to: 

Page 1 of 2 
i.^^r7 Mi 

S^^ / COASTA L ^

 f NVtRONHENTA l 

•"i«io<* 

c • o u r. IN C 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

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

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (712) 352-0188 

[ZfigI gran i t access to my properties

 D I do not grant access to my properties 

(_/SignaturB / ^ Date Si Signatur i e

 Date 

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

Restoration Agreement 

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

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

activities are completed to the satisfaction of the propei-t\' owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: 1 ^ X fT} 

Property Address: ^Vf/ / A l/v^^f /j-yC 

Owner: ove/1 "f/>ic) JhiyeTs 

Phone: 9?T 7 / s 

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

yuc> /I <_ -^y y 

Item: y 

Item: / 

Item: / 

Item: / 

Item: / 

Item: y 

Item: 

/ 

Page 1 of. 
V 

COASTA L 

CROUP . IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

y /4/L«c i( (7 / . 

( i y 7 yni>^d 

Item: t 

c\A J TU^c^ if de 1P VI r 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: 

/ 

Item: / 

/ 

Item: / 

Item: 

/ 

Item: / 

Kem: / 

Page 2 ^ 0 
( ^ 

C O A S T A L VMVtNONflCMTA L C M D U r IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

<o\ ^ ( -f?2. ^n 

Item: 

/ f&i (/y-^x- Item: ~ / 

1 item: / 

Item: / 

Item: 

/ 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

1

/ 

Page 3 of fe 
COASTA L 

c*«vinoNni M r* i 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

Sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

§l(^^ 

Square feet 

1 

y •^ 

Each 

y Each 

y. Each 

y Each 

Square Feet 

Page 4 o,ii 
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 

voucher 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 ofCity or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

y $ 

Each 

'

y 

<y SF y''^'' 

y SF 

yy , 

SF 

Page 5 of. ^ 
C O A S T A I. 

Additional Comments / Instructions: 

V

1 

y iaAAJ>y]i/0(/y ///^, ­

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 rust responsible for any damage done to the 

interior of house, indudingfoundationcracks or fissures. 

r agree O I do not agree 

ft (^wner' Owner's Signatur Sieoature ' <y^ 'Dat Dae Contractor' Contractor's Sienatnr Signatureate 

Page 6 of 
BVID#.^^Q6N(2) 

XRF PROPERTY SAMPLE SHEET 


Date \S-R-o8 Address y)y^r. \ {\i^i ^ f\ve . 

Project Omaha lead FP 2nd year option Sample time Vl'-O' ^ am/pm 

XRF1D# <5SiDBR sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

A^\(o$ ^ \i o\-a\ t \i :,Ci yQi ^ Q(^Q.y6'yi-o i 

^qin q T2>,, j-7kt U-3 6 '?. \ ^Q-?- 4 .:)a^.•&H^ ^?i.^(.^ ^ 

nq-i D '^^•u'^ \ t lan^ ^ Depth M^I S :}oci.o'-y ll.^-^i> Depth 

• ^qi i ip,<^qs t lu.H i LD ^'l-llf ? 0'4q.2i«', \c,.5^ U 

Average i-2,\.Dp. t i ^ .c^ \ Average ^^ ^ . 11 t \ ^ -B S 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

1 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

S\gnaiure_S£MMyi. 

Print f/)!Li^ib^/\Cc\.i^<iK/^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

4972 

SOIL 

2008-12-08 17:11 

122.86 

Final 

Avg of 4968-4971 

2561 ames ave 

Bl 

Ventry 

6 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 161.017 

Supervised By: 

Certificate of Verification 

4968 

SOIL 

2008-12-08 17:09 

30.85 

Final 

34250 

2561 ames ave 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 16.062 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 73.629 

Supervised By: 

Certificate of Verification 

4969 

SOIL 

2008-12-08 17:10 

30.42 

Final 

34250 

2561 ames ave 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 11.249 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 99.693 

Supervised By: 

Certificate of Verification 

4970 

SOIL 

2008-12-08 17:11 

30.80 

Final 

34250 

2561 ames ave 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 12.664 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 189.991 

Supervised By: 

Certificate of Verification 

4971 

SOIL 

2008-12-08 17:11 

30.79 

Final 

34250 

2561 ames ave 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

16.872 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

4977 

SOIL 

2008-12-08 17:15 

122.21 

Final 

Avg of 4973-4976 

2561 ames ave 

B2 

Ventry 

6 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 262.834 

Supervised By: 

Certificate of Verification 

4973 

SOIL 

2008-12-08 17:13 

30.75 

Final 

34250 

2561 ames ave 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 20.072 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 224.595 

Supervised By: 

Certificate of Verification 

4974 

SOIL 

2008-12-08 17:13 

30.18 

Final 

34250 

2561 ames ave 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.708 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 202.048 

Supervised By: 

Certificate of Verification 

4975 

SOIL 

2008-12-08 17:14 

30.98 

Final 

34250 

2561 ames ave 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 17.409 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 249.366 

Supervised By: 

Certificate of Verification 

4976 

SOIL 

2008-12-08 17:15 

30.30 

Final 

34250 

2561 ames ave 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 19.363 
X 

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

Coastal Environmental Group Inc. 

%. " . ^ www.coastalhazmat.com 

^-iPKo-y COASTA L ENVIItONHENTAL 

CROUP . INC . 

EXECUTIVE SUMMARY: 

BVID # 34250 - (2561 AMES AVE) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
^-^EPA 

EPA Propert> Close Out Form 

Property ft: .^Ao)^:! ^ Property Addrew: Q)6 U j ftj(VV-e.S AT.V P . 

Dalc/Tiroc: Owner's Name: .^ t . ^^p_rA ^ v r^cp. Y^JT^ ^ 

Quads Excavated: RV , fe^ Conlraclor Croup (}tOa<^VrA Q^ 'F^v j .rcsiTM^eM^A 

Excavation General ^//V(^A^i< l-^ ^ Yes No 

1 If necessary, were Ihe correcl quadrant(s) excavaied and restored? y 

2 If necessary, were the correct areas of drip zone excavated and restored'' /(r/3 

GradlDK Sod and Vctctalion 

Ves No 

from tbe house? 

/ 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspecied al a 30 

day lime period) 

/ 

4 Are sodded areas generally firm and evenly graded? y 

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

time period) y 

6 Was the property graded such thai waler will not pool on the property'' y 

7 Was damige to landscaping or plant materials avoided? y 

Gales. Feocea and RcUinln g Walls ^ es No 

I Do gales open and close freely? (Ifapplicable) 

2 Were all gates or fences laken down during restoration acliviiies reinstalled? (Ifapplicable) 

fk 3

 Was damage to gates or fences avoided? (Ifapplicable) 

4

 Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, SidioK and Gutters 

Y es No 

1. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? / 1 1 

3 Was damage lo windows avoided? \ (/­ ^ ! ^ 

\v.(y 4

 Was damage to windows or door screens avoided'^' 1 

5 Was damage to dowTispouts or downspoul extensions avoided? 1 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided'!' y 

2. Was damage lo walkway surfaces avoided? y 
r o •D ers comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty 

EPA Rt^;>x^-,zvs\zyty2yiyyy!^^^y^^^^^yy^^ Dale: y7y^ 7 
f 

^m^ 

Property Completion Agreement 

Tiiis agreemeni documenls the complclion of remedial activities perlbrmecl on my property. My signalure 

will designale Ihat 1 am salislied wilii the resloration of my property, and that no items are in questions, 

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

Propc^t^ID:^^^ ^ 

Property Address: Jjg- ^ 1 ^.rv . 6 C» OsJJL • 

Owner 2"'"" Oai/eni^o 2ex£2_ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

r K LJ I agree rrstoralion i.s completed, except as noled 

 I I do no< agree reslorxtiun is t-onipleled 

bj..^^^-^ ^ qy^^p y ?^AmQ\ \aj/4/Dc: 

M)wncr\ .Signature 1/ Date Contractor's .SiKnatiin- Da 

I