TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: g5^^ ^ Date: ;:^//^/r^.q 

Address: \{oO^ KJ ^ 5 ^- f 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0/ Video of property (DVD) 

y Executive Summary , 40314796 

EPA-provided property sketch 

Superfund 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

y Confirmation data 

Photographs '^CQ^SLJ.C/i^(\h-ii(i^ S.)LC^oko(l^ ^A A Sd d 

As-built sketch 

y Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

Property information from Douglas County Assessor's Office 

y^ 

D 

Ignature • t)ate 
Property Access Checklist 

Property'ID: 2.6'^^' ^ 

PropcnvAddre«:l^n 2 Kl ^ ^ C5^ 

D

D

 WORK STARTED 

 WORK COMPELTED 

ON:

ON:

 / 

/ 

/ 

_/ 

Owner: Zj^ ,,.rAA ) ^S ^ \KK \ 

Add '^"­ 3 5 iO ^-etor. 

Renter 

Phone: 

FJLV: 

Phone:

F«x: 

 ^C^C^^ ^^C^ ^ 

Cell/Pager: 

Additionikl Infnnn»(ion: 

Ccll/Pagen 

D Notification Letter 

B'^Access Agreement 

B'llestonition Agreement 

O Topsoil Sampling (if applicable) 

C] DisposaJ Sampling (K applicable) 

O Garden Sampling (if applicable) 

[^^Utility Clearance 

E2f Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

D Property Completion Agreement 

• Final Report 

Sent: / / 

Signed:/a,/_^/ ^ 

Signed: ^/2_/_ ^ 

/ / 

/ / 

/ / 

Called: 4Z/^/Ii B 

On:j2iyiJ S 

On: / / 

On: / / 

On; / / 

Siencd: / / 

Issued: / / 

By: 

By: 

By: 

Bri^KA 

^C\Q.i \ 

By: 

By: 

By: 

By: 

By: 

)z/^i /y y 

IV/io t IF.•,\a, ^ 

By: 

By: 

By: 

By: 

By: 1 

Air MonitorinK (a* applicable) 

D Communrty D Crc^ 

Results: 

On: / / By: 

D Communitj

Results: 

 C] Crew On: / / By: 

n Comoiunir\

Results: 

• Crew On: ' / 1 By: 

Omaha Lead Site 
# 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

yy^ 

)«D? w y y 

Date: Time: 

Date; Time: 

Date: Time: 

Transmit to EPA D 

Action: 

Action: 

Action: 

Other Action: D 
Douglas County Account InfMjmatio [aama n Page 1 of 1 t 

Douglas County, Nebraska Property Record - R1641390000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w Otl Ma p Information is valid as of 2008-11-5 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner 

YOUNG GERALDINE L 

3510 SEWARD ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 4139 0000 16 

Account Type: Residential 

Parcel Number: 1641390000 

Parcel Address: 1602 N 35 ST 

OMAHA NE 68111-0000 

Legal Description: LOWES ADD LOT 12 BLOCK P S 44 FT 44 X 60 

Value Informatio n 

Land improvement Total 

2008 $500.00 $0.00 $500.00 

2007 $500.00 $0.00 $500.00 

2006 $500.00 $0.00 $500.00 

2005 $500.00 $0.00 $500.00 

2004 $500.00 $0.00 $500.00 

2003 $500.00 $0.00 $500.00 

Sales Informatio n 

Sales Date: 1997-06-20 

Deed Type: Book: 2066 Page: 042 

Price: $662.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.06 2640.0 0.0 60.0 44.0 Yes 

http://douglasne.mapping-online.cotn/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 12/5/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2186899. 

Original Call Date: 12/05/08

Work to Begin Date: 12/09/08

 Time:

 Time:

 3:25 pm 

 4:00 pm 

Op: ELIZABETH18790 

State: NE 

Address: 1602 

County: DOUGLAS 

Street: N 35TH ST 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E 

 Rng: 

Sect-Qtr: 16-NW 

Sect-Qtr: 

Legal Given: C 


Type of Work: omaha lead 


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


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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Mk 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/5/2008 
Page 2 of2 

CITY OF OMAHA- OMAHACOF RON TRAFFICSEWER 

OMAHA PUBLIC POWER 0PPDGPR5 NA DISTRICT 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 4065237717 

Day: 4067289343 

Alt: 4062071494 

Emerg: 4065237717 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/5/2008 
D Remote IDi R page of 

To: COASTAL ENVIRONMENTAL SERVICE Attn: ELIZABETH 

Voice: 8776624210 Fax: 8776624211 

Re: Response to Dig Request 

This is an Important Message from Level 3 CoRHRunications (formerly known as 


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


area described on the One Call Center ticket. 


Ticket: 2186899 


County: DOUGLAS Place: OMAHA 


Address: 1602 N 35TH ST 


LEVELS: 


Level 3 Coontunications has detennined our facilities are clear of the dig site 


described by your One Call Center ticket. Level 3 Communications will not 


have to locate any underground utilities at this dig site. If you have any 


questions, please contact Level 3 Communications at 1-800-441-0223. 


If you have any questions, please contact Level 3's Asset Management Team at 


1-800-441-0223. 

As-Built Drawing 9 

COASTA L Omaha Lead Superfund Site 

-2^*? 3 3 

Name: G-eA»/«<i/»e Vov/J ^ Omaha Lead SKe Date: North Arrow 

Address: /^<s a K> •hS'^f Site Sketch Time: 

Phone: SS^-C>Z'=t9> t:* 

Team <ra /^^ ^ ^a* ^ BVID# •Z.?^'? S i XRF Code /<037 gooK : 13 ^ 

Sample Number Lead Concentration Confirmation Sample 

RY.4 5^^X^-^5-933 J££^ ppm fl Yes C3 No S ^ 

_Z^2^ ppm /^'Yes C: No 3 ^ 

Z'^'1 ppm ^/Yes n No a;; 

l2'iD€CPXA-2S^33 gS 3 

ppm x»AYes 1^ No 2 r 

ppm -rer - B - NO '-— '

ppm -res- NO a 

ppm Tes- O" No • 

3 Bl 

PLS#: 25933 

Date Ekcavated: 12/16/2008 

Date USEF^ Sigried Off:l727/2$08 

i Area Sodded 3255 jsq ft ; E]S|fBB]^E?i. 

Omaha Lead She 46130 

iiegen g 

Concret e Dri-p Zone Excavated Quadrants Excavate d 

Area replace d

Sod 

 wit h Area replaced with 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
a^-'TBS 

Name: frem/<<!/>e yo<//>9 Omaha Lead Site Date: Cf/ac/a c North Arrow 

Address: tit^- s K/ sS-^y Site Sketch Time: lJ'<^ ^ 

Phone; S-g3-6e*? g 

Team er*> /d.* ^ •fa-s / BVID# JUy-T 3 ^ XRF Code /<937 gooKna ^ 

Sample Numt>er Lead Concentratbn Confimiation Sample 

¥g ^ /=^Yes

/^Ye s

^^Yes

^•»-Yes

 ° 

• 

n 

D 

No ^ 

No ^ ^ 

No O ^ 

No 2r 

£<^i^/»1ftrL't' 

Omaha Lead Site !-^<l'' I'S 46130 
^^*?3

 3 

Name: g-ena/flfme ^Qvrtq Omaha Lead Site Date: Cf/Sic/e>€ North Arrow 

Address: Hos ^ K/ 'hS'^'^ Site SIcetch Time: tj'<^ ^ 

Phone; ggS-^Z^ffi 

Team «ra /</ ^ ^^-v / BVID# -2-,?^•? 3 iS XRF Code /<937 ggoKnaa ^ 

Sample Number 

Lead Concentration Confimiation Sample 

^<> ^ ppm /"/Yes n No ^ ^ fZH6^CpyA'2^3 ^ 

_2^Z. /^'Yes • No GT _2.a3- ppm 

ppm ^^Yes a No 2 ^ RHh^cPXA-2.^o\^3 g 5 3 

ppm ^^Yes D No tsr 

ppm ves i-J NO LJ 

ppm Yes D NP Q 

ppm Yes H NtJ • 

3 ^ 

i-JM! TEittEDj. 

OCT 0 5 

2005 i 

-^— 

2?? i 653J .i.. . 

C>/ j ^ 5 I 

• 1 ^ 

E...l£L.i 

^O^ j Z^ Z 

r 

j.'w4*' ­

^ t k - W f 

A^i ^r *! 

Omaha Lead Site 

46130 
> ^ ^ 

(•&- ' COASTA L INVtHONHINTAt ^z> CROUP . IH C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Prbtection 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 Phone: 

frer a loc- rt <f Yo<< ^ 

Address of Property 

covered by this 

Agreement: y % 

/C.OX /t/.jr^^- ^ 

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. 

Tfiis work is being performed under the Omaha Lead Superfund Site remediation 

program. 

A representative of Coastal Environmental Group, contracted by USEPA, \N\\\ 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 ijegins. Once the work is finished, the Grantor will be asked to review the 

work and confirm that it is complete and meets vwth 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 rrotice, 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 
<,.**;«% m\"^***" V

 COASTAL 

' - 1 c • 0 u r. Ih 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 

^ [Zigra I granr t access to my properties D I do not grant access to my properties 

WiAs 

Signature Date 

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

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions of the 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). 

Property ID: ^CHCJ?^ ^ 

Property Address: ^^p ^ M ^^S " 

Owner: Qexfr^Arifne ano/\(j 

Phone: Oc^.Cl.'i. i -i nO" "J ^^5- ^iy\i 

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

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

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

CX^ ^ -S'^r(tO ^vruM<. Vl^ l^^ '^s\\\c^r\^ec\ 

Item 

^ OVw(X.\VULYVk 

item: 

Item: 

item: 

Item: 

Item: 

Item: 

Page 1 of. 
^ ^ ^ 

COASTA L r ^ VI«OHr < ( MTA L 

c A o u r . > M c 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: ^ ' J 

Sii^X^f 

Item 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Page 2 of (y i 
< ^ 

COASTA L CNVlMONnCNTA L 

C « O U P IH C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

.W/-Rp-F[ 

Item: 

•<;^-Ra-ri-FA-BA 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of y . 
•«» 

C O A 5 T A L K N V (HON*' t N TA t C M O U ' ' . IM C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

UsfPre-existing property area, 

that will be excavated, that Square feet 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Each 

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 ^C> 
^ ^ ^ COASTA L 

CMW|«ONr*tMT* 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 contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area{s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

aj-ea (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Specles 

Each 

SF 

^X^jje^QfcyS'^ 

SF 

y SF 

-rh \o^ck^i^ e_ r^ t y\ QjJ) 

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

« « e w r . • M CL 

Additional Comments / instructions: 

O Check the box if Owner does rK>t want CEG to document interior foundation walls and possible 

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

interior of house, including foundation cracks or fissures. 

Q I do not agree 

)( 

Contractor's Stature Date 

Page 6 of. 
Date 

Project 

XRF ID# 

Shot# 

HE 

SSf i 

^l^J ­

5S5: 

Average

Shot* 

^\U 0 

5\U> 

^ti p i 

^1 u^ 

Average

Shot# 

SAS 

^x^M^a­ SJ-klL t?lu>^ 

Average 

Shot# 

Average 

lab sample M 

BVID# 25^3 3 

XRF PROPERTY SAMPLE SHEET 


1XMQ-D5^ Address 1(^0^2 M -Psf^ S.4- Omaha lead FP 2na year opilon Sample time am/pm 

sample length 30 sec 'i^m^Q 

Reading Sample area Shot# Reading Sample area 

^HI.DO 

XZi.n.n £A 

asoaa Depth Depth 

2?>^.2| 

 2M1.D 1 -V'^oH l Average 

Reading Sample area Shot# Reading Sample area n^n^ §\^5.q ^ ba 

O^JL Depth Depth . 

^g^^R i 

Xl7 . ^< ^ "-\"^.^ S Average 

Reading Sample area Shot* Reading Sample area 

IQl . IVr? 

\7.f^. tQ-T Fl 

Depth Depth inq. 7 i 16^. ZH TIT" 

iisH.i q l\^.^s^ ' Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

S ignature C-CLAcgQ^' £ ^ 

Pfinl £li7.r.h(^.4in Or.P^r^^c 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Ceitlficate of Verification 

XL3t-32089 

Reading No 5164 

Mode SOIL 

Time 2008-12-10 16:58 

Duration 122.41 

Sequence Final 

Flags 

AVERAGE Avg of 5160-5163 

ADDRESS 1602 n 35 st 

QUAD/ZONE B2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 212.994 ± 17.852 

Supervised By: z 
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 194.756 

Supervised By: 

Certificate of Verification 

5160 

SOIL 

2008-12-10 16:56 

31.00 

Final 

25933 

1602 n 35 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 17.144 
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 195.953 

Supervised By: 

Certificate of Verification 

5161 

SOIL 

2008-12-10 16:57 

30.60 

Final 

25933 

1602 n 35 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 17.328 
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 232.289 

Supervised By: 

Certificate of Verification 

5162 

SOIL 

2008-12-10 16:58 

30.23 

Final 

25933 

1602 n 35 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

18.546 
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 228.979 

Supervised By: 

Certificate of Verification 

5163 

SOIL 

2008-12-10 16:58 

30.58 

Final 

25933 

1602 n 35 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.388 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5159 

Mode SOIL 

Time 2008-12-10 16:55 

Duration 122.93 

Sequence Final 

Flags 

AVERAGE »Avg of 5155-5158 

ADDRESS 1602 n 35 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 241.026 ± 18.47# 

Supervised By: QJM^VQX 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certific 

XL3t-32089 

Reading No 5155 

Mode SOIL 

Time 2008-12-10 16:53 

Duration 30.61 

Sequence Final 

Flags 

BVID # 25933 

ADDRESS 1602 n 35 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 241.000 18.574 

Supervised By: C , llLjQtJpcJdr^ . IA/IAJUL ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5156 

Mode SOIL 

Time 2008-12-10 16:54 

Duration 30.95 

Sequence Final 

Flags 

BVID # 25933 

ADDRESS 1602 n 35 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 232.278 ± 17.872 

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 257.610 

Supervised By: 

Certificate of Verification 

5157 

SOIL 

2008-12-10 16:54 

30.89 

Final 

25933 

1602 n 35 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 19.182 
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 233.218 

Supervised By: 

Certificate of Verification 

5158 

SOIL 

2008-12-10 16:55 

30.48 

Final 

25933 

1602 n 35 St 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 18.256 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5169 

Mode SOIL 

Time 2008-12-10 17:03 

Duration 121.47 

Sequence Final 

Flags 

AVERAGE Avg of 5165-5JLfia 

ADDRESS 1602 n 35 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 134.198 ± 14.451 

Supervised By: fm^nso\ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5165 

Mode SOIL 

Time 2008-12-10 17:00 

Duration 30.50 

Sequence Final 

Flags 

BVID # 25933 

ADDRESS 1602 n 35 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 107.165 ± 13.128 

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 125.672 

Supervised By: 

Certificate of Verification 

5166 

SOIL 

2008-12-10 17:00 

30.16 

Final 

25933 

1602 n 35 st 

Fl 

Ventry 

13 

CLEARANCE 

± Error 

± 14.120 
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 149.714 

Supervised By: 

Certificate of Verification 

5167 

SOIL 

2008-12-10 17:02 

30.29 

Final 

25933 

1602 n 35 st 

Fl 

Ventry 

13 

CLEARANCE 

± Error 

± 15.018 
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 154.241 

Supervised By: 

Certificate of Verification 

5168 

SOIL 

2008-12-10 17:03 

30.52 

Final 

25933 

1602 n 35 st 

Fl 

Ventry 

13 

CLEARANCE 

± Error 

± 15.536 
\ 

%«c^<^'=^ 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVritONMENTAl 

CROUP , INC . 

EXECUTIVE SUMMARY: 

BVID # 25933 - (1602 N 35 ST) 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

HOMEOWNER RECEIVED FOR THE SUM $35.00 FOR THE REPLACEMENT COST OF 

PLANTS DESTROYED DURING THE REMOVAL OF LEAD IMPACTED SOIL. 
 I 

P^EPA 

EPA Propert> Close Out Form 

Property«: r^SQ?) ^ Property Address: SjpOi; ^ V \ y,S\ ­

D««e/Tlroe: Owner's NaiDt: fajefOVJI X\j^CipT^Yin 

Quads Excavaird: P \ (ViPd. fto Contractor Group CfXmf ? ^Fi ^ u\js}^j^^ ^

Excavation Ctneral Yes No 

I If necessary, were the correct quadrani(s) excavated and restored? y 

2 If necessary, were the correct areas of drip zone excavated and restored'; /^f 

Gradlo

I t

K Sod and Vecetation r ^ . 1 J '

from tbe house? 

J i L ' r I I « .4 I I I 

Yes 

t / 

No 

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

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

{ day lime period) v/ 

4 Are sodded areas generally Firm and evenly graded? / 

5 Are the joints between the sod strips generally tight? (Only evaluate ifinspecied ai a 30 day y time period) 

6 Was Ihe property graded such thai water wil l not pool on ihe propeny'' y 

7 Was damage to landscaping or plani maierials avoided'' ^ j ^ 1 

Gales, FcDces and RcUininc Walls les No 

1. Do gales open and close freely? (Ifapplicable) 

2 Were all gates or fences taken down during restoralion aciiviiies rcinsialled'' (Ifapplicable) 

0^ 

3, Was dam«ge to gales or fences avoided? (Ifapplicable) r 

A. Was damtge to retaining walls avoided? (Ifapplicable) 

Foundalton, Sidiag and Gutters Yes No 

I Was damtge to the siding or trim avoided? 

2 Was damage lo ihe foundation avoided? 

VP^ H ^ i ^ 

3 Was damage lo windows avoided'' 

4 Was damage to windows or door screens avoided'' 

5 Was darrage to downspouts or downspoul exiensions avoided'-

Sidewalks and Drivewtys (Concrete) Ves No 

Was damage lo driveway surfaces avoided' A ) ^ 

2 Was damage lo walkvav surfacei a\oided? tJh 
O »Dens comments: 

Inspection notes: 

> 

Removal and resloraiion aclivales complele including ihe 30-day sod warraniy 

F PA Renrespn1;il,v<*^^'^^*-^2^^^<i-^'S.^^'^^ HQ U /i7 fc^ 
Property Completion Agreement 

Tliis agreement documents the complclion of remedial activilies perfonneci on my properly. My signaiure 

will designaie thai I am salislied willi ihe resloraiion of my property, and thai no items are in questions, 

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

Property IDT 0 3 ^ ^ ~^ 

PropcTtTAddr^ss: ^ Q'Q ^ AJ_IJ^^ ^ 

I'honc: ^-Y~ b C X^ l 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

L 

y \ I ajjret' resturafion is completed, except as noted 

I I I do not agree restoration is completed 

\l\^\jc ^ 

Contractor',s Signature Date 
Property Damage Settlement 

Property ID 25933 

1 Property Address 1602 N 35 ST 

Owner Geraldine Young 

Phone 402.553.6298 | 

I have received a check from the contractor, Coastal Environmental Group Inc. (Coastal), for the sum of 

$35.00 for the replacement cost of plants that where destroyed during the removal of lead-impacted soil 

from the property. 

Compensation Type Check 1687 

Value of Check $35.00 

Check to the Order of Geraldine Young 

Description of Damage 

Coastal Environmental Group will reimburse Ms. Young for the plants destroyed during the remediation for 

Lead at 1602 N 35 ST 

My signature below acknowledges the receipt of the check listed above; further, I acknowledge that 

the compensation amount is fair for the replacement cost of the plants and release Coastal 

Environmental Group, Inc. from further obligations or liability related to this property. 

m.^ ^^Mioi 

Dat/ ^ ntractor's Signature Date 

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