TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \00 O Date: ^/!2^)Q 1 

Address: g^l Q ^]br)C S St " 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video of property (DVD) 

 Executive Summary 

 EPA-provided propeily 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.) 

 Confirmation data

 Photographs pre,-£^_/iJ^tV|^ ^JTyiJlltll^, \i/u 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 

i 

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40318144 

Superfund 

^^tef ^^ ^ ^^^§3fy 
Property Access Checklist 

Property ID: \(>£) Q 

PropertyAddress:Q^q^^ yy,p<; > 

owneni;^^;^^ ConVTeTCv^^ 

Address: 

Phone: • ^?)H"X5 ^ 

Fax: 

Cell/Pager. 

n Notification Letter 

jyf Access Agreement 

0 ^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

0 ^ Utility Clearance 

JEf Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

n Video/Photos (30-Day) 

O Property Completion Agreement 

D Final Report 

n Community • Crew 

n WORK STARTED ON:. _/ l_ 

D WORKCOMPELTED ON: / / 

Renter: 

Phone: 

Fax: 

Cell/Pager. 

Additional Infonnation: 

Sent: / / By: 

Signed: [0 / 3 /fej? By=|^\\rVr^n<J 

Signed: IQ_/X//D £ ^r'%ySr\!\C\0^ 

/ / By: 

/ / By; 

/ / By: 

Called: in/3:_/C ^ ^r.\(^lOilO& 

On:^ / ? / ^J ' ^y- .Mck'/1.^)1 /-^v 

On: / / ' ^ 

On: / / By: 

On: / / By: 

Signed: J 1 By: 

Issued: / / By: 

Omaha Lead Site 
CONTACT FORM 

Property ID jf/ 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

jnnn 

3H10 \?Y^^\ 

Date: Time; 

Date: Time: 

Date: Time: 

Transmit to EPA D 

?^-T 

Action: 

Action: 

Action: 

Other Action: D 
Douglas County Account Infonnation Page 1 of3 

Douglas County, Nebraska Property Record - R1419260000 

Print Report 

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

New Feature -•-•- • Auto Sales Search 

Owner 

CONTRERAS PEDRO R 

3410 JONES ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1926 0000 14 

Account Type: Residential 

Parcel Number: 1419260000 

Parcel Address: 3410 JONES ST 

OMAHA NE 68105-0000 

Legal Description: ISAACS & SELDENS ADD LOT 7 BLOCK 10 W 1/2 33 X 124 

Value Informatio n 

Land Improvement Total 

2008 $5,400.00 $62,600.00 $68,000.00 

2007 $5,400.00 $62,600.00 $68,000.00 

2006 $5,400.00 $54,600.00 $60,000.00 

2005 $5,400.00 $54,600.00 $60,000.00 

2004 $5,400.00 $54,600.00 $60,000.00 

2003 $5,400.00 $54,600.00 $60,000.00 

Sales Informatio n 

Sales Date: 2002-04-18 

Deed Type: WD Book: 2211 Page: 188 

Price: $60,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2002-01-25 

Deed Type: WD Book: 2201 Page: 737 

Price: $32,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 9/27/2008 
Douglas County Account Information Page 2 of 3 ormal 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Land Informatio n 

Acres SF 

Valid 

2001-09-27 

SHD 

$34,158.00 

Book: 2199 Page: 38 

Invalid 

Foreclosure 

Units Depth Width Vacant 

0.09 4092.0 1.0 124.0 33.0 No 

Improvemen t Informatio n 

Building 1 

Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

tuss q t 

•HT 

SmrtBuactt tiiO M • 

CLICK TO ENLARGE IMAGE 

832.0 Percent Complete: 100.0% 

0.0 Quality: Average 

Condition: Good 

Ranch Condo Square Footage: 0.0 

Central Air to Air Rooms: 5.0 

Frame Aluminum Units: 1.0 

Drywall Baths: 1.0 

Composition Shingle Bedrooms: 2.0 

Hip Stories: 1.0 

Allowance Foundation: Block 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 9/27/2008 
Douglas County Account Information Page 3 of 3 ormal 

Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

1890 0 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Percent 

Remodeled 

0% 

Detail Description 

Fence Chain Link 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Detached 

End Screen 

Adjusted Year 

Built 

1890 

Physical Age 

118 

Units 

1.0 

1.0 

832.0 

1.0 

1.0 

330.0 

135.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 9/27/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2149512. 

Original Call Date: 10/07/08

Work to Begin Date: 10/09/08

 Time: 12:29 pm 

 Time: 1:00 pm 

Op: ELIZABETH18790 

State: NE 

Address: 3410 

County: DOUGLAS 

Street: JONES ST 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E

 Rng:

 Sect-Qtr: 21-SW 

 Sect-Qtr: 

Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY STARTING AT 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: 4 ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MCLEODNE MUDOl OMAHACOF DGPR5 QLNNEIC 

Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 

Alt: 

Emerg 

4029340469 

4029340469 

4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day: 

Alt: 

Emerg: 

8773668344 

8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 

Alt: 

Emerg: 

8002891901 

8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 

Alt: 

Emerg: 

4025047823 

4025047946 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2008 
Page 2 of2 

CITY OF OMAHA- OMAHACOF RON TRAFFIC,SEWER 

0PPDGPR5 SI^^^T"'^"^''' TM NA 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2008 
f 

^ 

As-Built Drawing 

C OASTA L Omaha Lead Superfund Site 

1000 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: 

Sit • Good Address e Sketch : 3410 JONES ST • Poor Phone: H: W: (S) r~1 Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: _ Sverdrup 

RYASCPXA-1000 YA 373.4 _pp m D Date: _ 

RYBSCPXA-1000 YB 135.1 _ ppm Time: _

RYCSCPXA-1000 YC 112.6 a

_pp m n Samples Analyzed RYDSCPXA-1000 YD ppm D 

RD2SCPXA-1000 DZ 2400 ppm n XRF UnH t: Book: 

RGZSCPXA-1000 GZ ppm a n Date: _ 12/5/1999 

RPZSCPXA-1000 PZ 431.6 ppm 0 0 Time: _ 10:27 

Staff: Numtser of Samples = 5 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

OLS#: 1000 

Date Excavated: 10/14/2008 

Date USEPA Signed Off: 

12/03/2008 

Area Sodded 607 sq ft 

PZ = 338 PPM ( 

DZ = 245 I 

EA=168PPM( 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare 
 Sod ' ' RocJt/Mulch 


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

1000 

Exterior Paint North Arrow ni^,..»-*i

 Omah a Lea d Site 

• Good Address: 3410 JONES ST

 Sit e Sketc h • Poor 

Phone: H: W (D Q Not paint 

Sample Lead Sample Samples Collected Number LAB '( Concentration Collected Firm: Sverdrup 

RYASCPXA-1000 YA 373.4 Dom 

M D Date: 

RYBSCPXA-1000 YB 135.1 DPm 

0 D Time: 

RYCSCPXA-1000 YC 112.6 Dom D 

Samples Analyzed 

RYDSCPXA-1000 YD 

ppm D D 

RDZSCPXA-1000 DZ 2400 ppm 0 0 XRF Unit: Book: 

RGZSCPXA-1000 GZ DDm 

D D Date 12/5/1999 

RPZSCPXA-1000 PZ 431.6 DPm 

0 0 

Time; 10:27 

Staff: Number of Samples = , 5 , 2 

Legend; YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

f 

Rev 4 

046141,0)23 
• 

1000 

Omah Exterior Paint North Arrow Owne a Lead S te r Name: • Good Site Sketch Address: 3410 JONES ST 

Phone: H: W: n ^°^ (D 

Q] Not paint 

Sample Number Lead 

Concentratior 

Sample 

Collected LAB 

Firm:

Samples Collected 

 Sverdrup 

1

RYASCPXA-1000 

RYBSCPXA-1000 

RYCSCPXA-1000 

 RYDSCPXA-1000 

YA 

YB 

YC 

YD 

373.4 

135.1 

112.6 

ppm

ppm

ppm

ppm

 0 

0 

0 

n 

a 

n

a 

a 

Date: 

Time: 

Samples Analyzed 

RDZSCPXA-1000 DZ 2400 ppm 0 0 XRF Unit: Book: 

RGZSCPXA-1000 

RPZSCPXA-1000 

GZ 

PZ 431.6 

ppm

. ppm

 • 

0 a 

=E 

Date:

Time:

 12/5/1999 

 10:27 

Numtjer of Samples = 5 2 Staff: 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

046I4I.0I23 
n 

1000 

Omah Exterior Paint North Arrow a Lead Site Owner Name: 

Site • Good Sketch Address: 3410 JONES ST • Poor 

Phone:_H; W; (D Q Not paint 

Sample Number 

RYASCPXA-1000 YA 

Lead 

Concentration 

373.4 Dom 

Sample 

Collected 

0 

LAB 

• 

Firm:

Date: 

Samples Collected 

 Sverdrup 

RYBSCPXA-1000 YB 135.1 oom 0 n Time: 

RYCSCPXA-1000 

RYDSCPXA-1000 

RDZSCPXA-1000 

RGZSCPXA-1000 

YC 

YD 

DZ 

GZ 

112.6

2400

 Dom 

Dom 

 Dom 

Dom 

0 

a0

• 

a 

a 

0 

a 

Samples Analyzed 

XRF Unit: Book: 

Date: 12/5/1999 

RPZSCPXA-1000 PZ 431.6 Dpm 0 0 Time: 10:27 

Number of Samples -\ 5 1 ; 2

1 

i 

Staff: 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

RCT4 046141.0123 
\T*'TJ f COASTAL ^ , _-fe'r tNvmOWHfNTAl ^t^OT * fl • 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: 

ner's Name: Daytime Phone: 

Address of Property 

covered by this :^yO Javxes f t 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 
8 , ,

 • „- COASTA L • ^

 ENVIItONHrMTA t 

c I 0 u r. IM 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 

^ I grant access to my properties n • do not grant access to my properties 

f W ^ /C^^i^ , ^yu^mj/ ^ 

Signature Date Signature Date 

Q

 J would like to be present during any sampling that is required. 
COASTA L • : ' (MOMmaNTA i 

C N O O P IN C 

Restoration Agreement 

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

remediation activities. Tliis wilt 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 Environmental 

Protection Agency (EPA). 

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 return of these items is the Owner's responsibility. 

Page 1 of. £ 
^ ^ ^ 

COASTA L f »« V I AOHM « WTA L 

C fl O U P . IN C 

Items To Be Removed By Contractor During Remediation An d Not Replaced 

(Use additional sheets as necessary) 

Item: 

^ ^M-CK. II Cc yt •^5 l-^r ^ )p<.L > n J 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 7 

Page 2 Of / 
C p A S T A L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

^ Page 3 of 
- —* > • 

COASTA L CVvlHONHtf * TAL 

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 

•pz. 

Square feet 

y •^ 

Each 

yy Each 

0 Each 

y Each 

Square Feet 

Page 4of ^ 
COASTA L [NVIKONHtNTA I 

Item Quantity Unit Condition/Type/Species 

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 conn-actor. 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 

aiea (s) 

Easement Area, to be 

excavated 

y $ 

Each 

^ 

SF 

j ^ SF 

SF K. \^,.. y 

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

Additional Comments / Instructions: 

• Check the box if Owner does not want CEG to document interiorfoundation walls and possible 

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

interior of house, includingfoundation cracks or fissures. 

W'' agree O I do not agree 

Owner's Signature Date CSntractoi^s S^ator e Date 

Page 6 of 
BVID # 1^^ ' 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRFID# 

Shot# 

\ni 

UOl 

l^i^ 

\'l-'^o 

Average

Shot# 

w

®tHv 

ML 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

\<^^\^ h i 

Omaha lead FP 2ncl year option 

''y-U?^'^ 

Reading Sample area 

ii^i-M/J^ \<•^^ yhfyt^ii^r n^.i^ t ifSb 

1^^ L-^ t Ko^ Depth 

nip-^r- ('--"^ 

 l^'^.pH t K-J?) 

Reading 

'^I-'IN-J ii.. ^ 

"^Ll•a^^^.^^ 

tl2.-^.oi: z^.U 

M->Z,.SP^ '^~K 

 T^Y-^"^ ^

Reading 

Reading 

Lab result 

Sample area 

h 

Depth 

ttj ^ 

Sample area 

Depth 

RETEST AREAS 

Sample area 

Depth 

Address 

Sample time 

sample length 

Shot# 

IM 

iM. I K 

nu. Average

Shot# 

Average 

Shot# 

Average 

Shot# 

Average 

Sample area XRF Avg. 

Signature_ 

^^\P Tou ^ 

UHC *C, 

(irp^/pm 

30 sec 

Reading Sample area 

iin.^<rt I(..IV 

Mii-iu V ^ t 'z.iY.f,^ 

^t?-'r<? 111 - u Depth 

i(.i.-^^t i^.^> 4 ^ 

 'IH < . 0 ^ t |j(.1 | 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

^^^-^ - ^ y 

7 Depth 

/ / 

Print Vn-O n WlW^ V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1281 

Mode SOIL 

Time 2008-10-14 11:35 

Duration 120.81 

Sequence Final 

Flags 

AVERAGE |Avg of 1277-1280_ 

ADDRESS 3410 Jones st 

QUAD/ZONE ieasemerjt 

INSPECTOR jVentry 

DEPTH •1 

SAMPLE TYPE J.CLEARANCE"P 

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 161.484 

Supervised By: 

Certificate of Verification 

1277 

SOIL 

2008-10-14 11:32 

30.29 

Final 

1000 

3410 Jones st 

easement 

ventry 

1 

CLEARANCE 

± Error 

± 15.449 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1278 

Mode SOIL 

Time 2008-10-14 11:33 

Duration 30.29 

Sequence Final 

Flags 

BVID # 1000 

ADDRESS 3410 Jones st 

QUAD/ZONE easement 

INSPECTOR ventry 

DEPTH 1 

SAMPLE TI'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 174.194 ± 15.860 

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 159.638 

Supervised By: 

Certificate of Verification 

1279 

SOIL 

2008-10-14 11:34 

30.22 

Final 

1000 

3410 jones st 

easement 

ventry 

1 

CLEARANCE 

± Error 

± 15.093 
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 176.880 

Supervised By: 

Certificate of Verification 

1280 

SOIL 

2008-10-14 11:35 

30.01 

Final 

1000 

3410 jones st 

easement 

ventry 

1 

CLEARANCE 

± Error 

± 16.059 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1287 

Mode SOIL 

Time 2008-10-14 11:40 

Duration 121.56 

Sequence Final 

Flags 

AVERAGE |Av g of 1283-1286 

ADDRESS 3410 jones st 

QUAD/ZONE 

INSPECTOR j ^ ventry 

DEPTH 

SAMPLE TYPE I 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 197.955 

Supervised By: 

Certificate of Verification 

1283 

SOIL 

2008-10-14 11:37 

30.31 

Final 

1000 

3410 jones st 

DZ 

ventry 

13 

CLEARANCE 

± Error 

± 16.987 
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 419.165 

Supervised By: 

Certificate of Verification 

1284 

SOIL 

2008-10-14 11:38 

30.67 

Final 

1000 

3410 jones st 

DZ 

ventry 

13 

CLEARANCE 

± Error 

± 24.667 
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 200.502 

Supervised By: 

Certificate of Verification 

1285 

SOIL 

2008-10-14 11:39 

30.31 

Final 

1000 

3410 jones st 

DZ 

ventry 

13 

CLEARANCE 

± Error 

± 17.666 
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 162.465 

Supervised By: 

Certificate of Verification 

1286 

SOIL 

2008-10-14 11:40 

30.27 

Final 

1000 

3410 jones st 

DZ 

ventry 

13 

CLEARANCE 

± Error 

± 15.539 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1292 

Mode SOIL 

Time 2008-10-14 11:45 

Duration 121.18 

Sequence Final 

Flags 

AVERAGE lAvg of 1288-1291 

ADDRESS 3410 jones st 

QUAD/ZONE |P2 

INSPECTOR ventry 

DEPTH 

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 287.254 

Supervised By: 

Certificate of Verification 

1288 

SOIL 

2008-10-14 11:43 

30.34 

Final 

1000 

3410 jones st 

PZ 

ventry 

6 

CLEARANCE 

± Error 

± 20.509 
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 361.462 

Supervised By: 

Certificate of Verification 

1289 

SOIL 

2008-10-14 11:44 

30.29 

Final 

1000 

3410 jones st 

PZ 

ventry 

6 

CLEARANCE 

± Error 

± 22.940 
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 272.406 

Supervised By: 

Certificate of Verification 

1290 

SOIL 

2008-10-14 11:45 

30.23 

Final 

1000 

3410 jones st 

PZ 

ventry 

6 

CLEARANCE 

± Error 

± 20.187 
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 432.901 

Supervised By: 

Certificate of Verification 

1291 

SOIL 

2008-10-14 11:45 

30.32 

Final 

1000 

3410 jones st 

PZ 

ventry 

6 

CLEARANCE 

± Error 

± 25.025 
V • .ci^ ^•".PHO ^

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

Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L fNVmONMENTAL 

0 > 0 U P. IN C 

EXECUTIVE SUMMARY: 

BVID # 1000 - (3410 JONES ST) 

~x\ No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
EPA 

EPA Property Close Out Form 

Property #: [CPC^Q , , 

Property Addrr^:-^-"^^^ ^ ^S^r^ ^ S ^ 

Dfltc/Tlme: 

Owner's Name: /i^.,4rtt > ^^^^'^^^:c> ^ n 

Quad Contractor Group O^ n <:.-W-la "£.yNv/ ^ rorx^'-^-J^^'^^^^ s Excavated: 1^ ^ ^ "PT ^ 

Excavation Yes No Geoerel 

1. If necessary, were the correct quadrant(s) excavated and restored? i ^ 

2. If necessary, were the correct areas of drip zone excavaled and restored? ^ 

Grading Yes No Sod and Vegetation 

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

from the house? 

2. Has sod been laid in all areas that were excavated? t - ^ 

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

day time period) 

4. Alt sodded areas generally Firm and evenly graded? 

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

time period) 

6. Was the property graded such that water will nol pool on the property'^ • ^ 

7. Was damage to landscaping or plant materials avoided? i X 

Gates, Fences and ReUinlne Walls Yes No 

1. Do gates open and close freely? (If applicable) t y 

2. Were all gates or fences laiien down during restoration aclivities reinstalled? (If applicable) j _ ^ 

3. Was damage to gates or fences avoided? (If applicable) i ^ 

4, Was damage to retaining walls avoided? (If applicable) y ^ 

Foundation, SidiDKand Gudcrs 

Yes No 

1. Was damage to the siding or trim avoided? 

o.^ 

2. Was damage to the foundation avoided? u y 

3. Was damage to windows avoided? t^ ­

 Was damage to windows or door screens avoided? . ^ 

5. Was damage to downspouts or downspout extensions avoided? l y 

Sidewalks and Driveways (Concrete) Vcs No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

4
» • 

0>^'ners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: .jiuiauuii aciivciLCi Lumpictc iDCJuuing IHC ju-uay suu wairuiiiy; 

EPA Representalii 

^live^^^^^L^^^^^^.^^X ^ Date: /yysA ^ 
Property Completion Agreement 

Tiiis agreement documents the complclion of remedial activilies perlbrinal on my property. My signature 

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

now, or at any time in the fiiUire, except those itenxs listed below, if any. 

Property ID: I OOO 

Property Atidrcss: _ J> IfJ ^ J ^n-e.-^ _ ,-r 

Owner: 

Phone: 

rr^i ^i5c) 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Kern: 

Item: 

Additional Comments: 

STTagre K e restoration i.v conipletcil, except as noted 

 I I tlo not agree rcsloralion is completed 

w h^ n 

Owner's .Si)>nalure ©•to yX"oDtractor's Sij^nature Date 

I