m 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \^\a{c Date: 9/^/^ ^ 

Address: \^d 3 ^ "^\ 

Remediation Contractor: Coastal Environmental Group_ Year: _2008_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

5^ Executive Summary 

\J EPA-provided property sketch 

y Signed Access Agreement for subject property 

AM* Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

y Confirmation data 

H' Photographs prg.-oy/^^.)4^.^^ ^y^/^J:rLw ft/Lci^q. 

y As-built sketch 

E^ Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

(ijfr Description ofareas not meeting ROD cleanup criteria 

y Utility clearances 

y Property information from Douglas Coimty Assessor's Office 

y UTAV^kf. (^JC<R S CJMUXM ^ 40316483 

j y tl^tktUX UKI^ llillllllllllll ' "Elino Superfr i und D 

Ignature Date 

%4z^y.Ja^y^ ^H^"i 
Property Access Checklist 

Property ID: V3t2,^ ^ 

Property Address: \e 7 7- ^ 1?S ^ \ 

n

D

 WORK STARTED

 WORKCOMPELTED

 ON: 

 ON: 

_/

/

 /_ 

/ 

Owner: ^t\arA<C x

Address: "^ 

 CtV^e^T ^ Rcnten 

Phone: 

Phone: nrot^-uas ^ 

Fax: 

Fa.\: 

Cell/Pager: 

Additional Information: 

Ce»/Pager. 

D Notification Letter 

0 ^ Access Agreement 

ET Restoration Agi-ecment 

G Topsoil Sampling (if applicable) 

IZI Disposal Sampling (if applicable) 

C] Garden Sampling (if applicable) 

|/J Utility Clearance 

0 ' Vidco/Photos (Before) 

D Video/Photos (During) 

n Video/Photos (After) 

n Vidco/Photos (30-Day) 

n Property Complclion Agreement 

D Final Report 

Sent: / / 

Signed: ^Q/2L'a % 

Signed: iQ l 21' ^ 

1 1 

1 1 

1 1 

ca\\td.]Q.i22JC2i 

On: lO_i,2SIl ^ 

On: / / 

On: / / 

On: / / 

Siencd: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

K\\rlnriin3 

VixrMhVS^ 

io/7.a/os^ 

07iA^ 

1 

Air Monitoring (as applicable 

n Community Q Crew 

Results: 

» 

On: / / By: 

n Community

Results: 

 Cl Crew On: / / By: 

• Community

Results: 

• Crew On: / / By: 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

I Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 )^]2 U 

^'S^T. 1^ ^ 1 

Date Time: Action: 

Date Time: Action:_ 

Date Time: Action: 

Transmit to EPA D Other .Action: D 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R1902900000 

Print Report 

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

New Feature -»->-> Auto Sales Search 

Owner 

CENTENO ALEJANDRA 

4082 PARKVIEW DR 

BLAIR NE 68008-0000 

Property Informatio n 

Key Number: 0290 0000 19 

Account Type: Residential 

Parcel Number: 1902900000 

Parcel Address: 1522BST 

OMAHA NE 68108-0000 

Legal Description: \ OAK HILL -2 LOT 14 BLOCK 0 E 25 FT 25 X 107 

Value Informatio n 

Land Improvement Total 

2008 $2,200.00 $27,400.00 $29,600.00 

2007 $2,200.00 $27,400.00 $29,600.00 

2006 $2,200.00 $27,400.00 $29,600.00 

2005 $2,200.00 $19,800.00 $22,000.00 

2004 $2,200.00 $18,000.00 $20,200.00 

2003 $2,200.00 $18,000.00 $20,200.00 

Sales Informatio n 

Sales Date: 2005-02-22 

Deed Type: QC Book: 2005 Page: 022313 

Price: $30,000.00 

Grantor: ISIDRO ROGEL ETAL 

Grantee: ALEJANDRA CENTENO 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2003-08-21 

Deed Type: QC Book: 2003 Page: 160797 

Price: $30,000.00 

Grantor: Juan D Correa ETAL 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Douglas County Account Information Page 2 of3 

Grantee:

Valid/lnvalid: 

Exclusion Reason: 

 isidro Rogel ETAL 

Valid 

Sales Date:

Deed Type: 

Price: 

Grantor: 

 2000-09-06 

QC 

$30,000.00 

Book: 1351 Page: 635 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Invalid 

Sales Date: 

Deed Type:

Price: 

Grantor: 

1990-10-03 

D 

$16,350.00 

Book: 1890 Page: 471 

Grantee: 

Valid/lnvalid: 

Exclusion Reason: 

Valid 

Land Informatio n 

Acres 

0.06 

SF 

2675.0 

Units 

1.0 

Depth 

107.0 

Width 

25.0 

Vacant 

No 

Improvemen t

Building 1 

 Information 

Ranch 

151! vs t 

B*Miai«k6« 385 IT 

ilf-.-Mi 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 585.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

http://douglasne.mapping-onHne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Douglas County Account Information Page 3 of3 

r 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

Ranch 

Forced Air 

Frame Siding 

Drywall 

Composition Shingle 

Gable 

Allowance 

Year Built 

1895 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

Porch 

Year Percent 

Remodeled Remodeled 

0 0% 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

End Solid Wall 

End Solid Wall 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinlder Square Footage: 

Adjusted Year 

Fair 

0.0 

4.0 

1.0 

1.0 

1.0 

1.0 

0.0 

Physical Age Built 

1895 111 

Units 

1.0 

585.0 

1.0 

1.0 

90.0 

75.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2159965. 

Original Call Date: 10/22/08

Work to Begin Date: 10/24/08

 Time:

 Time:

 3:04 pm 

 3:30 pm 

Op: ELIZABETH187 90 

State: NE 

Address: 1522 

County: DOUGLAS 

street: B ST 

Place: OMAHA 

Twp:

Twp:

 15N Rng: 13E

 Rng:

 Sect-Qtr: 34-SE

 Sect-Qtr: 

-SW 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLtJDING 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 Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


ATTNEBRl CXCATV LEVEL3 MCLEODNE MUD02 OMAHACOF 0PPDGPR6 


QLNNEIF QWEST2 


Service Area Contact Phone Number „ ^ 

Type 

ATTNEBRl ATT/T 

Day: 

Alt: 

Emerg 

80024136249 

80024136249 

CXCATV COX COMMUNICATIONS,

INC 

 ^^^ ^ 

Day: 

Alt: 

Emerg: 

4029340469 

4029340469 

4029329757 

LEVEL3 LEVELS COMMUNICATIONS, ^ ^ 

Day: 

Alt: 

8773668344 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 

Alt: 

8002891901 

Emerg: 8002891901 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/22/2008 
Page 2 of2 

MUD02 

OMAHACOF 

OPPDGPR6 

QLNNEIF

QWEST2

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

 QWEST LONG DISTANCE

SANDY 

RON 

NA 

 NA 

 SARA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Ah: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Ah: 


Emerg: 8887289343 

Day: 8002834237 

Ah: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/22/2008 
D Remote ID: R page of 

To: COASTAL ENVIRONMENTAL SERVICE Attn: ELIZABETH 

Voice: 8776624210 Fax: 8776624211 

Re: Response to Dig Request 

This is an Ixnportant Message from Level 3 Coimnunications (formerly known as 


Broadwing) replying to your request to locate our underground facilities in the 


area described on the One Call Center ticket. 


Ticket: 2159965 


County: DOUGLAS Place: OdAMA 


Address: 1522 B ST 


LEVELS: 


Level 3 Conmunications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


Ticket: 2159975 


County: DOUGLAS Place: OMAHA 


Address: 2214 R ST 


LEVEL3: 


Level 3 Conmunications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


Ticket: 2159986 


County: DOUGLAS Place: OMAHA 


Address: 3322 S 19TH ST 


LEVELS: 


Level 3 Conmunications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


If you have any questions, please contact Level S's Asset Management Teeun at 


1-800-441-0223. 

To:

D Remote ID: R page of •

 COASTAL ENVIRONMENTAL SERVICE 

Attn: ELIZABETH 

Voice: 877-662-4210 

Fax: 877-662-4211 

• 

Re: Locating facilities in the area of your excavation 

This is an inportant Safety Message from QWEST COMMUNICATIONS. 


We are replying to your recjuest to locate our underground facilities 


in aji area where you are planning excavation work. 


The following is the current status of our facility marking in the 


area specified in your notification. 


Ticket number 2159965 is: Your excavation does not p>ose a risk to 


Qwest Worldwide Networks, but may be a risk to Qwest Local 


Networks. If you are in t:he 14 state area previously served by US 


West, and you have questions, please call Qwest Local Networks at 


1-800-833-0825. Qwest Wo. 


County: DOUGLAS 


Place : OMAHA 


Street: 1522 B ST 


Ticket number 2159975 is: Your excavation does not pose a risk to 


Qwest Worldwide Networks, but may be a risk to Qwest Local 


Networks. If you are in the 14 state area previously served by US 


West, and you have questions, please call Qwest Local Networks at 


1-800-833-0825. Qwest Wo. 


County: DOUGLAS 


Place : OMAHA 


Street: 2214 K ST 


Ticket number 2159986 is: Your excavation does not pose a risk to 


Qwest Worldwide Networks, but may be a risk to Qwest Local 


Networks. If you are in the 14 state area previously served by US 


West, and you have questions, please call Qwest Local Networks at 


1-800-833-0825. Qwest Wo. 


County: DOUGLAS 


Place : OMAHA 


Street: 3322 S 19TH ST 


If you have any questions about these responses to your excavation 


notification, please call 1-800-283-4237. 

^ As-Built Drawing ^ 

C

ENvmONHCNTA

O AST A L 

L Omaha Lead Superfund Site G a o u r, IN C 

13126 

461:10 

Legend 

Concret Drxp Zone Excavated e Quadrants Excavated 

Area replaced with Area replaced with Area lef t bare Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
.: ^ 

J 

r1 

^ 

Owner Name: ISIDRO ROGEL 

Address: 1522 B ST 

Phone: H: 402-813-6473

Sample Nunnt)er 

RYASCPXA-13126 

nYDGCPXA-13120 

Omaha Lead Site 

Site Sketch 

 W 402-813-6473 

Lead 

Concentration 

^/7 

13126 

Exterior Paint 

• Geod 

^'^Poor 

{~| Not paint 

North Arrow 

Samples Collected 

^(H loi 

Samples Analyzed 

: -^72 - Book ^ ' 

•• •>kr 
13126 

J 

i 

^ 

Owner Name: ISIDRO ROGEL 

Address: 1522 B ST 

Phone: H: 402-813-6473

Sample Numt)er 

RYASCPXA-13126 Fl 

}GCPXA 

RYCSCPXA-13126 

RYDGCPXA-13120 

RDZSCPXA-13126 DZ 

RGZSCPXA-13126 GZ 

RPZSCPXA-13126 PZ 

Omah a Lead Site 

Site Sketch 

 W: 402-813-6473 

Lead 

Concentration 

:2./7 

Exterior Paint 

• Good 

0Poo r 

[ ] Not paint 

NorthArrow 

Samples Collected 

Firm: mS ^ Ati / 6 H 

Date; U- J (^ (C^j 

Time: ^', ^ ( 

Samples Analyzed 

XRF Unit: ^t'2- ~ Book: 

Date: 7//V^ y 

A 

,yy^<^f C 

\ \ 

-V 

^V 

^ 

^ 

e 

Oiuaha-Lcad-Sitc- 46130 'hy<uA 

* 

. . •••^. ' 
13126 

Owne Omaha Lead Site r Name: ISIDRO ROGEL 

Site Sketch Address: 1522 B ST 

Phone: H: 402-813-6473 W: 402-813-6473 

Sample Numt)er Lead Sample LAB Concentration Collected 

RYASCPXA-13126 Fl 

^/7 ppm D 

RYDGCrXA-13120 F2- ppm D 

RYCSCPXA-13126 Bl ppm D 

RYDGCPXA-13120 -62­ ppm D 

RDZSCPXA-13126 DZ / S'X. ^ ppm 

RGZSCPXA-13126 GZ n SS'? 

RPZSCPXA-13126 PZ 

ppm D

^ B 7 ppm D 

Numt>er of Samples = i ^ 

1|^ = ^ 

ly T^ 

537 

0 • 'V 

-gm : 

•): • 

& • 5"? 5" 

): 4. 

^HJOL Co^v r • , Wflrt 

n!<-,,v : 

y76 ^ ^ ^ v ii> 

31. ^'^r T'l '

r 

V 

fr 

^/7 

^

? ^ l 

•^.fAtvalK 

Exterior Paint NorthArrow 

• Good 

|~1 Not paint 

Samples Collected 

Firm: rn&-> A^/fi U 

Date: i£ J /*/ /c«/ 

Time: 9', W ( 

Samples Analyzed 

XRF Unit ^/2 - Book: ^^ ^ 

Date: 

Time 

Staff: 

ENTERED 

JUN I 1 M 

Omaha Lead Site 46130 

'y^ 5ra6-\ 
COASTA L 

[NVmONHEMTAl 

B • O U f . 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: 

Ale-j^c^^o\r-q Cs_A\eno 

Owner's Name: Daytime Phone: ^</(^ ] 7(Dfo ' ^ ^ ^^ ^ 

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 
V**'*^!*" im '

 COASTAL ^ * _._^«c n«»i«oii«riiT*i 

*^»cn«^ c • 0 u p. INC 

• 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 

>qij I grant access to my properties

 • • do not grant access to my properties 

y^^:^:y^,^olM C^^^^ ^ /O-UD^- ?yy^i^po)\ \oki/rR 

• ^ Signature Date Signature' Date 

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

Restoration Agreement 

The purpose ofthis agreement is to provide a inutual 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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: j' ^ } 'X (^ 

Property Address: j •yJ^'X \ ^ s f ~ 

Owner: /ti p

^ » r v\A A -ecv C -e ^^-V<L ^y o 

[h^fyyioc TH M Phone: 

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

utilities, subsurface features, syrface 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 retum of these items is the Owner's responsibility. 

Item: 

7y.-yy. 7 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

^ Page 1 of 
( ^ ^ 

COASTA L 

CMOUP . IM C 

Items To Be Removed By Contractor Durinq Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: / 

ft ncKi y 6/ 

Item: i /-> 

0 ^ C7( h O'^t cy'> heiAcC 

cK i'\ k d^ 0r/ i /^ {-f^ ht n y^k 

rwi J ^y^^ l .ojcxin ^ er i [r\y>^ lc* 

Kem <1 :

/ 

/ 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

Page 2 of ^ 
C O A S T A L tMVlNOMMCMTA L CMOU P ( N C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

^ o 

Srt c 

1 p ^ 

rz^ 

a; 6-^ 

i^) yy ^ 

'•• N 

/ 

Item: 

/ 

' item: 

(• 

Item: 

Item: 1 

Item: 

/ 

Item: 

/ 

Item: 

/ 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Page 3 of ^ 
— •* » 

COASTA L C N T IRONPI K •» T* l 

C M O W r t M C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

6 ^ 

Pre-existing property area, 

that will be excavated, that Square feet 

is covered wilh grass. 

p y 

Number of trees > 2 inch ,;/ 

Each trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Each 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Each 

Square Feet 

Page 4 of. 
COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

renlaced 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 conn-actor. Be 

very specific and detailed. 

Include a sketcii of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

projjerty 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 

fy 

Each 

SF 

rf If ^ 

^ 

i

b4 

SF 

SF 

^e/ £> 

.V\\ \,M 

Page 5 of. 
C O A S T A L. •MVAKftMM>HTAL «M»W' . IN C 

Additional Comments / Instructions: 

'Zi U^ he y re 

n Check the tx)X if Owner does not want CEG to document interior foundation wails and possible 

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

interior of house, including fourxiation cracks or fissures. 

^ , lagree O I do not agree 

s Signatur•e e Date extractor's Swnatare ^ D^te 

Page 6 of. 
BVID # jli\^lp _ 

XRF PROPERTY SAMPLE SHEET 


Date \\- i a -L:^ B Address i^sas ^ ^to. Project Omaha lead FP 2nd year opllon Sannple time am/pm 

XRFID# 2.Qo8q sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

^/,?)c 3 5Sft.a^2. ii^.ao i^UZ ^ ^1/^.f.in- 3\. i4 G,-^ ^(<x^ 5 laiy.ootvAM u '2y ^ Q(£>^ 0 fSQo.uataK.ia 

^bi> ^ 9a.«^i : u,f\?^ Depth c0(j)<4\ i'-\-i .p,°iio!a.5« Depth 

aus^s gO.,-,,ur,U.-- ^ \ c3b^4Q oJTS o'^'; iq.&o ' )H 

Average R(..Q?. t \2.2. ^ Average ^H^.^^ t c95.6^ \ 

Shot# Reading Sample area Shot# Reading Sample area 

t9L£^'A 

^i^^ ^ 

.a«uv Ci^i\«o i 

ATl..^ot^t i l a ^ \ 

c^(.< ^ 

cC»(^S 

I'm.- as t \'':i,'-jl 

i)3^.'^iH-t l^.SS P^ 

^ty ^ ^i-iCi ;Tv,t,-:55.iM Depth C3LO5I ^ i^cBo t vb.-)P, Depth 

^i.y } tfj-S, \O t m-o w U ci)U?&^ im.Oju t if,.e,s \ D 

Average cPta^^.^Q-L iH.^' H Average XHQ.'^Q t ^^.^^ 8 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

^..^-- ^ ) 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature_ 

Print I^W^ ' MfrnV \ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2632 

Mode SOIL 

Time 2008-11-06 13:21 

Duration 30.56 

Sequence Final 

Flags 

BVID # 13126 

ADDRESS 1522 B st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 58.209 ± 10.400 

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 126.003 

Supervised By: 

Certificate of Verification 

2633 

SOIL 

2008-11-06 13:22 

31.61 

Final 

13126 

1522 B st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.399 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2634 

Mode SOIL 

Time 2008-11-06 13:23 

Duration 30.90 

Sequence Final 

Flags 

BVID # 13126 

ADDRESS 1522 B st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 82.832 ± 11.927 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2635 

Mode SOIL 

Time 2008-11-06 13:23 

Duration 31.55 

Sequence Final 

Flags 

BVID # 13126 

ADDRESS 1522 B st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 80.656 ± 12.583 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2636 

Mode SOIL 

Time 2008-11-06 13:23 

Duration 124.62 

Sequence Final 

Flags 

AVERAGE Avg of 2632-2635 

ADDRESS 1522 B st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 86.925 ± 12.327 

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 316.556 

Supervised By: 

Certificate of Verification 

2639 

SOIL 

2008-11-06 13:30 

30.29 

Final 

13126 

1522 B st 

GZ 

Ventry 

18 

CLEARANCE 

± Error 

± 21.138 
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 550.422 

Supervised By: 

Certificate of Verification 

2640 

SOIL 

2008-11-06 13:31 

30.31 

Final 

13126 

1522 B st 

GZ 

Ventry 

18 

CLEARANCE 

± Error 

± 28.138 
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 347.888 

Supervised By: 

Certificate of Verification 

2641 

SOIL 

2008-11-06 13:33 

30.31 

Final 

13126 

1522 B st 

GZ 

Ventry 

18 

CLEARANCE 

± Error 

± 22.279 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2642 

Mode SOIL 

Time 2008-11-06 13:34 

Duration 30.29 

Sequence Final 

Flags 

BVID # 13126 

ADDRESS 1522 B st 

QUAD/ZONE GZ 

INSPECTOR Ventry 

DEPTH 18 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 275.086 ± 19.804 

Supervised By: 
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 

ppm 

Pb 372.488 

Supervised By: 

Certificate of Verification 

2643 

SOIL 

2008-11-06 13:34 

121.20 

Final 

Avg of 2639-2642 

1522 B st 

GZ 

Ventry 

18 

CLEARANCE 

± Error 

± 22.840 
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 224.250 

Supervised By: 

Certificate of Verification 

2644 

SOIL 

2008-11-06 13:37 

30.29 

Final 

13126 

1522 B St 

61 

Ventry 

6 

CLEARANCE 

± Error 

± 18.207 
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 276.498 

Supervised By: 

Certificate of Verification 

2645 

SOIL 

2008-11-06 13:38 

30.99 

Final 

13126 

1522 B st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 20.135 
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 449.046 

Supervised By: 

Certificate of Verification 

2646 

SOIL 

2008-11-06 13:38 

34.02 

Final 

13126 

1522 B st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 25.139 
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 125.103 

Supervised By: 

Certificate of Verification 

2647 

SOIL 

2008-11-06 13:39 

30.89 

Final 

13126 

1522 B st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 14.059 
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 

ppm 

Pb 268.724 

Supervised By: 

Certificate of Verification 

2648 

SOIL 

2008-11-06 13:39 

126.19 

Final 

Avg of 2644-2647 

1522 B st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 19.385 
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 156.218 

Supervised By: 

Certificate of Verification 

2654 

SOIL 

2008-11-06 14:10 

30.97 

Final 

13126 

1522 B st 

PZ 

Ventry 

10 

CLEARANCE 

± Error 

± 15.512 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2655 

Mode SOIL 

Time 2008-11-06 14:10 

Duration 32.34 

Sequence Final 

Flags 

BVID # 13126 

ADDRESS 1522 B St 

QUAD/ZONE PZ 

INSPECTOR Ventry 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 239.987 ± 18.977 

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 120.795 

Supervised By: 

Certificate of Verification 

2656 

SOIL 

2008-11-06 14:11 

30.94 

Final 

13126 

1522 B St 

PZ 

Ventry 

10 

CLEARANCE 

± Error 

± 13.781 
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 174.664 

Supervised By: 

Certificate of Verification 

2657 

SOIL 

2008-11-06 14:12 

30.97 

Final 

13126 

1522 B st 

PZ 

Ventry 

10 

CLEARANCE 

± Error 

± 15.632 
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 

ppm 

Pb 172.916 

Supervised By: 

Certificate of Verification 

2658 

SOIL 

2008-11-06 14:12 

125.22 

Final 

Avg of 2654-2657 

1522 B st 

PZ 

Ventry 

10 

CLEARANCE 

± Error 

± 15.975 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L INVmOHHENTAL 

G I O U P , INC . 

EXECUTIVE SUMMARY: 

BVID # 13126 - (1522 B ST) 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
sn. EPA 

EPA Property Close Out Form 

Property If: IQVQ.LP^ , 

Date/Tlinc: 

Quads Excavated: g,i, <i=x7r ^ ^7 ^ 

Contractor Group f^/S^ljSbiXiS^ '^f^xJ\\^PTMWy^^ ^ 

Excavatio Yes No n General 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? y 

Grading Sod •nd Vegetation Yes No 

1 Does the grading around the perimeicr 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 evaluale if inspected at a 30 

day time period) 

4. Are sodded areas generally firm and evenly graded? y 

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

time period) 

6. Was the property graded such that water will nol pool on the propeny? y ^ 

7 Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Rctainini! Walls Yes No 

I Do gates open and close freely? (Ifapplicable) y 

2. Were all gates or fences laken down during restoralion activities reinstalled? (Ifapplicable) y 

y

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

A y. Was damage to relaining walls avoided? (Ifapplicable) 

Foundation, Siding and Gutlers 

Yes No 

1. Was damage lo the siding or trim avoided? y 

2. Was damage lo the foundation avoided? l y 

3. Was damage to windows avoided? y 

 Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspoul extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Ves No 

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? y 

4
0>*'Ders comments: 

Inspection notes: 

C9?y^^^X.^^.M^ y^t^^.,7^&cy^ yiOy ^ 

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

EPA Representalive-;2^^^^cl^e^±X^f l Date: AV > X^-r" 
m^ 

Property Completion Agreement 

This agreemenl documents the complclion of remedial activities performed on my property. My signature 

wiil designate that I am satisfied with the restoration of my property, and thai no items are in questions, 

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

>ropertyID: ^2,\^|_ p 

Property Address: y^ ^ B Si 3 > 

Owner: ^W\pkjr\c\<y^ Qj^nyp.no 

I Phone: ^^l^-^Q'^:Q Q 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

y i I agree restoration is completed, except as noted 

 I I do not a}>ree restoration is completed 

//-si{-o? /y y ll W Uy 

Conti^tor' s Signature Date 

I