TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: i'll ^ Date: Itj^fc ^ 

Address: ^^1 ^ O^h ^ f 

Remediation Contractor: Coastal Environmental Group_ Year: 2001 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

/ 

^

0

-E­

(/

u

~&

^

sy

M

tz

-5

u

U

C. 

Video of property (DVD) 

Executive Summary 

 EPA-provided property 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 

 As-built sketch 

 Satisfactory restoration signed by Property Owner 

 Property close-out dieck list signed by EPA 

 Description ofareas not meeting ROD cleanup criteria 

 Utility clearances 

 Property infonnation from Douglas County Assessor's Office 

D 

D 

Date / 

30054526 

HIMI 

Superfund 
Property Access Checklist 

Property ID: 2.'^^^ ^ 

D WORK STARTED

Property Address: ^ ' 5 y ^ QJ^^SS S ^ D WORK COMPELTED

Renter Q^^"'"-^ [)a^/^A \Z>j\her-4^o<-d 

Address: 

Phone: '*''• H'^70 <^^35 s^ 

Fa.\: 

Cell/Pager: 

Additionul InfomiMtion: ''''°"'- f^5\(?-^0U 

Fax: 

Ccll/Pager. 

1 D Notification Letter Sent: / / Bv: 

I Ef Access Agreement Signed: Je./_2:/4L By:/T. e

[Q' Restonttion Agreement Siened: ^ / ^ / ^ By:p,C 

1 D Topsoil Sampling (if applicable) / / By: 

CD Disposal Sampling (if applicable) / / By: 

1 G Gnrdcn Sampling (if applicable) / / By: 

^ Utility Clearance Called: U / iZ / C^ By=U/fe>/D«i 

1 ^ Video/Photos (Before) On: J£_l JOl ^ By: A/)0± 

1 D Video/Photos (During) On: / / By: 

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

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

Q Property Completion Agreement j Signcd:^/'l^ JC^ By:

D Pinal Report Issued: / > \ By: 

Air Monitorine (iU ai>plicable ) 

1 n Communrty D Crew On: / / By : • 

RciiuJts: 

1 Q ComraunitA' Q Crew On: / / By: 

Results:

1 Q Community D Crew On: / / 

Results: 

 ON: _/ /_ 

 ON: / / 

1 

1 

1 

1 

Omaha Lead SHe 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

l-^9i^U 

M1M7 ^ft^3 ^^ 

 Date: 

 Date: 

 Date: 

 Transmit to EPA D 

Time: 

Time: 

Time: 

Action 

Action 

Action 

Other Action: D 
Douglas County Account tion Page 1 of2 

Douglas County, Nebraska Property Record - R2018400000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w OH Ma p Infonnation is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature ••-•• • Auto Sales Search 

Owner 

RUTHERFORD DAVID R 

4320 CASS ST 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 1840 OOOO 20 

Account Type: Residential 

Parcel Number: 2018400000 

Parcel Address: 

Legal Description: 

4312 CASS ST 

OMAHA NE 68131-0000 

POPPLETON PARK LOT 18 BLOCK 12 50 X 122.85 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$79,600.00 

$79,600.00 

$75,400.00 

$75,400.00 

$75,400.00 

$54,700.00 

Total 

$86,000.00 

$86,000.00 

$81,800.00 

$81,800.00 

$81,800.00 

$61,100.00 

Sales Informatio n 

Sales Data: 1995-04-23 

Deed Type: 

Price: 

Grantor: 

$52,900.00 

Book: 2005 Page: 551 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.14 

SF 

6150.0 

Unlta 

1.0 

Depth 

123.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201... 6/6/2009 
Douglas County Account y|||fl^tion Page 2 of2 

Building 1 

1 1/2 Story 4312 Cass st 

Fnt Ftow TSeOx) « 

BwrtBlocHII ns v 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1252.0 Percent Complete: 100.0% 

Perimete 0.0 Quality: Average r 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 88 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 756.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch Slab Roof Geil 128.0 

User Fence.dog 1.0 

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accovmtno=R201... 6/6/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2311570. 

Original Call Date: 7/07/09 Time: 12:43 pm Op: ELIZABETH18790 


Work to Begin Date: 7/09/09 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4312 Street: CASS ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT 


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 MUDOl OMAHACOF 0PPDGPR5 PAETEC QLNNEIC 


Service Area Contact Phone Niunber Utility 

Type 

CXCATV ^° ^ COMMUNICATIONS, 

INC 

HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC.SEWER 

RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER 

DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
Page 2 of2 

Day: 8002891901 

PAETEC PAETEC COMMUNICATIONS £2^00^^"^^^ ^ ^*-

Emerg: 8002891901 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
^ As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

23844 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch i • Poor 

Samollna Address: 4312 CASS ST rO'Not paint 

Sample Number Lead Sample Samples Collected 

i LAB Concentration Collected Firm: ? £ lo c Ccc - ^ K ) 

RYASCPXA-23844 F1 I Co 5 ppm n Date: S-L , - <2r« 

RYBSCPXA-23844 F2 2 3 3 ppm n Time: 9:/ 3 c- l 

RYCSCPXA-23844 81 3 3 a 

ppm a Samples Analyzed RYDSCPXA-23844 B2 ^ 1 3 ppm D 

RDZSCPXA-23844 DZ C 3 0 

ppm D XRF Unit : CnSH o Book: 2 0 1 

nCZCCPXA-23044 Q ^ ppm D Dafe: Ai'7.-\ o e RPZSCPXA-23844 PZ 1 5 / ppm Time: AM n 

Staff: M S W Number of Samples <o 

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

All qu.-idrants are as viewed from the street, facing property 

Legen d 

Concrete Drip Zone Excavated /:A i<'^AQ Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area lef t bar e 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc , 
23844. 

Omah Exterior Paint Nortti Arrow a Lead Site 

Sit • Good e SItetch • Poor 

Sampling Address: 4312 CASS ST \ j Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected 

i Firm: ? £ I»c Ccc -S O 

RYASCPXA-23844 Fl l(c5 ppm D Date: 5-l o - (2iZ 

RYBSCPXA-23844 F2 933 

ppm D Time: 9 T / 3 c^*^! 

RYCSCPXA-23844 B1 33fi ppm 

n Samples Analyzed RYDSCPXA-23844 82 "M ^ ppm 

RDZSCPXA-23844 DZ &30 ppm XRF Unit: G6H o Book: 20 1 

nCZCCPXA 23044 6?­ ppm • Date: ^5-210 $ 

RPZSCPXA-23844 PZ \$ l ppm r Time: AM 

n 

D 

Staff: M S W Number of Samples = I (o 

Legend: F1 = Front Left, F2 = Front Rigtit, B1 = Bacl^ Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

CA>.>.. .^T . AA-rry^.o..;e.-'^A y. Rev 2008.N Created: 26-Fet)-08 044701 01 2.1 
23844. ^ 

Omah Exterior Paint North Arrow a Lead S... 

Site • Good Sketch i • Poor 

Samplina Address: 4312 CASS ST [ J Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Coilectad Firm: P £ In c fee - BKi 

RYASCPXA-23844 F1 

ppm n Date: S'L, ' (3's 

RYBSCPXA-23844 F2 233 ppm n Time: 9 r /3 cv"*i 

RYCSCPXA-23844 Bl 33a ppm a 

Samples Analyzed RYDSCPXA-23844 B2 it 3 ppm D 

RDZSCPXA-23844 DZ C>30 ppm D XRF Uni t: GiBH o Book: 101 

nCZCOPXA 20044 8Z­ ppm D Date: -^-21-oe RPZSCPXA-23844 PZ 1S± ppm 

°Y D Time: 

AM 

Staff: MSW 

Number of Samples = ia 

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 ttie street, fedng property 

Irl'^.T'T'' k\ ^er .r..y- y A P ' 'RED 

MAV f '6 im ' 

C0(^& ;H_J (^ro^s^^ 

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5Ke^ •*—* ( tz r^—¥ ­

1 

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Cc^5 5t: Rev 200S.N Created: 26-Feb-OS 044701.01.23 
COASTA L INVIIOMHIHTftl ^ ^ ' « • o u r. INC 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner's Name: 

Address of Property 

covered by this 

Agreement: 

Ll^\^

PURPOSE OF RESPONSE ACTIVITIES 

Daytime Phone: 

 Qjas^ %< 

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 tb 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 Environmentai Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the worlc to be perfomned, 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 

worl< 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-

COASTA L 

iiKiieiiKriii*! 

• 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 vynth 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 

[^1 grant access to my properties 

• I do not grant access to my properties 

Signature 

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 mutual agreement as to conditions ofthe property prior to 

remediation activities. This wili 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: ^gg'^JH 

Property Address: t|5\ 2 Oa< S fiV 

Owner: ^g^/ ^ \?o W ^^vA 

Phone 

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

utilities, subsurface features, siirface 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 ofthese items Is the Owner's responsibility. 

Item: 

An/1 - > .Symll ninfiK An top-^^.u^W Item: J ' ' ' " ' ^ ^ 

Item: ^ ^ 

Item: ^ A 

Item: A 

Item: 

1 

/ 

Item: 

Item: 

Page 10,: ^ 
 7 

COASTA L 

O R O U » , • N C 

Items To Be Removed By Contractor Durina Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

OldJAK Ipt-l-bfU'i^rl -N Item: Q ' ' ' ""

Item: A 

Item: A 

Item: A 

Item: 

/ 

Item: 

/ 

/ 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

Item: 

Page 2of fe' 
C p A S T A L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

so; I -D^ f ^7. Item: 

^fvl A)7.'^ P.9, 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Pages of (O 
COASTA L INvlRONMiHTAI . o n o u r . IN C 

Item 

Pre-exisiing property area, 

lhat 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 

Square feet 

•, 

t Each 

1 

Each ^/fl 

Each 

^0 

Each 

\ Square Feet 

Page 4of_k 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

renlaced bv contractor. 

Note this value wili be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by connector. Be 

very specific and detailed. 

/ 

/ 

/ 

$ 

Each 

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. 

SF 

Area ofCity or County 

proper^ to be landscaped 

per their requirements. 

Include a sketch of the 

aiea (s) 

^ 

SF 

To Voe d^t\ccmued 

Easement Area, to be 

excavated SF 

Pages of Y 
# 

G OAST A I. •«««» • MMC MTAL 

« » • w r. • H C 

D Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damaga By cheddng this box CEG is not responsible for any damage done to the 

interior of house, induding foundation cracks or fissufes. 

lagree QLd o not agree 

C±a7 ^CawiiA lojf^lA ^ * - - -* - J _ • * - O i A ' " BV _ J Owner's Signature Contractor's Signatere 

Page 6 *A 
BVID #2 5 8 H ^ 

XRF PROPERTY SAMPLE SHEET 

Date -7-\i^-m Address H?>I7 C.as:9>~sF 

Project Omaha lead PP 2nd year option Sample time y^^rsn. am/gj 

XRFID# ?iZV>?,<^ sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

T5qo 

Ami % JM I 

t'i{>,1l?{±2\.Zfi 

i^HDiin.^^ 

\i4U.n ± r^H U

»M2.n±f«=^.o2 

 Depth 

-QX 

n: m\f 3 H 

L>0/^\X\^.ll 

Tcii.5JI\:o>^ 

9>H^'M[^.^i 

52 

Depth 

Average \%,1 ^ ± H ,2[f l Average Th.^s l ± l\.Mf S 

Shot# Reading Sample area Shot# Reading Sample area 

JltCi. iiallH 

IWO ^ 

y?y.qu.i-2M.2«^ 

^i^nn t w. ^ 

HlU^ntT^.'*! 

^'i^^' ' 

Depth Depth 

ikf^ifl lM«^-t^?»±2M<»sl 1 

Average Hl U 5^ ± 1H.% \ Average 

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. 

Sianature ^iajQMa> A 

Print Pii^Jne^r/rrr^^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1593 

Mode SOIL 

Time 2009-07-18 15:02 

Duration 122.23 

Sequence Final 

Flags 

AVERAGE ^vg:^f;i58i9rl5p^ 

ADDRESS 4312 cass st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb ^17;255 f ^190.779 f ± 

Supervised By: (AY'/MWLA ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 290.828 

Supervised By: 

Certificate of Verification 

1589 

SOIL 

2009-07-18 15:00 

30.65 

Final 

23844 

4312 cass st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 21.254 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 184.009 

Supervised By: 

Certificate of Verification 

1590 

SOIL 

2009-07-18 15:01 

30.60 

Final 

23844 

4312 cass st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 17.287 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 146.172 

Supervised By: 

Certificate of Verification 

1591 

SOIL 

2009-07-18 15:01 

30.56 

Final 

23844 

4312 cass st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 15.457 
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 142.109 

Supervised By: 

Certificate of Verification 

1592 

SOIL 

2009-07-18 15:02 

30.42 

Final 

23844 

4312 cass st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 15.022 
f f 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certlfic 

XL3t-32089 

Reading No 1598 

Mode SOIL 

Time 2009-07-18 15:06 

Duration 121.29 

Sequence Final 

Flags 

AVERAGE flvg of 1594-1597^ 

ADDRESS *43T2xa5S-st 

QUAD/ZONE B2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb fTb.sisj ± 

Supervised By: (AQiMllJ ) 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 60.911 

Supervised By: 

Certificate of Verification 

1594 

SOIL 

2009-07-18 15:04 

30.20 

Final 

23844 

4312 cass st 

B2 

Nicolas 

6 

CLEARANCE 

± Error 

± 10.765 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 87.875 

Supervised By: 

Certificate of Verification 

1595 

SOIL 

2009-07-18 15:05 

30.51 

Final 

23844 

4312 cass st 

B2 

Nicolas 

6 

CLEARANCE 

± Error 

± 12.602 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 79.645 

Supervised By: 

Certificate of Verification 

1596 

SOIL 

2009-07-18 15:06 

30.14 

Final 

23844 

4312 cass st 

B2 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.930 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1597 

Mode SOIL 

Time 2009-07-18 15:06 

Duration 30.44 

Sequence Final 

Flags 

BVID # 23844 

ADDRESS 4312 cass st 

QUAD/ZONE B2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 54.840 ± 10.519 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1607 

Mode SOIL 

Time 2009-07-18 15:16 

Duration 121.55 

Sequence Final 

Flags 

AVERAGE Avg of 1603-1606] 

ADDRESS ^raT2 cass st 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 416.802 ± 24.811 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 398.957 

Supervised By: 

Certificate of Verification 

1603 

SOIL 

2009-07-18 15:14 

30.31 

Final 

23844 

4312 cass st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 24.290 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 425.999 

Supervised By: 

Certificate of Verification 

1604 

SOIL 

2009-07-18 15:15 

30.33 

Final 

23844 

4312 cass st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

24.558 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 426.574 

Supervised By: 

Certificate of Verification 

1605 

SOIL 

2009-07-18 15:16 

30.27 

Final 

23844 

4312 cass st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 25.442 
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 415.680 

Supervised By: 

Certificate of Verification 

1606 

SOIL 

2009-07-18 15:16 

30.64 

Final 

23844 

4312 cass st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 24.952 
>^' Q A Omaha Lead Site—Fixed Price EP-R7-07-05 

3 ^^^^ ^ I Coastal Environmental Group Inc. M ^ ^ ^^^^Tt ? ^tPBO**' www.coastalhazmat.com COASTA L ENVI>ONNENT*l 

S t o U r . IN C 

EXECUTIVE SUMMARY: 

BVID # 23844 - (4312 CASS ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
4

^ EPA 

EPA Property Close Out Form 

Property #: 7^Vi ^ Property Address:-

Datemme: -JfT^CfiK Owncr*s Name: / ^ 

Quads Excavated: uL . y>7 Contractor Group 

Excavation Yes No General 

I. If necessary, were the correct quadrant(s) excavated and restored? 

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

Grading Yes No Sod and Vegetation 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away 'AT from the house? 

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 at a 30 

day time period) 

4. Are sodded areas genetally finn and evenly graded? 

5. Are the joints t>etween 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 thr propeny? 

7. Was damage to landscaping or plant materials avoided? AY-' 

Gates, Fences and Retaining Walls 

Ves No 

I. Do gates open and close freely? (Ifapplicable) YAA 

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

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

4. Was damage to retaining walls avoided? (Ifapplicable) 17" 

Foundation, Sidiag and Gmttrt Yes Jja 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foiuidation avoided? A 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage lo dov^spouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

Ves Wb 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
0>*'Dcrs comments: 

Inspection notes: 

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

EPA Representative jUgVy UcJLl ^ Date: 11 ^10 ^ 
Property Completion Agreement 

I his agreemeni documenls the complclion of remedial acliviiies perloimed on my properly My signature 

will designate that 1 am satisfied with the restoralion ofmy properly, and lhat no Hems are in questions, 

now, or al any lime in fhe future, excepl ihose ilems listed below, ifany 

Propert)'ID: 2.*5^HL \ 

Property Address: ^a^^>^ (»^^ ^ ^ ^ 

Owne.: ^^^j ^ ^Q^flffecA . 

Phone: (H02^^f^lo-<HQt.- & 

Restoration Items in Question: 

I Item: " 

Item: 

I •• « I • I LJ L 

Item; 

Item: 

Item: 

Item: 

Additional Comments: 

^K l 1 tt^rce rcntoralion is compleied, excepl as noteri 

[ I I rlo nni Dtrree restoralion is completed 

7 U-A A^Mph -^hAM 

Owner's Sicnahirr Dat Dat ff ee Sen Centrarlor' d arlor's Sicnalurc s Sig Dale 
(0 4^ 

Property Damage Settlement 

Property ID 23844 

Property Address 4312 Cass St. 

Owner Dave Rutherford 

Phone 402-556-9068 

Coastal Environmental Group Inc. (Coastal), has agreed to pay Mr. Dave Rutherford tfae stun of $1000.00 

as compensation for all property damages including but not limited to basement water damages which 

occurred at: 4312 Cass St. Omaha, NE. Mr. Rutherford accepts this as 'Tayment In Full" in lieu of any 

and all repairs and/or any and all replacement inaterials required. 

Coastal Environmental 1783 Group Inc Checks 

Value of Check $1000.00 

Made Out To Dave Rutherford 

DescriDtion of Miscellaneous Prooertv Damaoe 

• All damages are "Pakl in Full' to include any and all uncollected rent 

My signature below is acloiawtot^ment of ttie receipt of ttie sum listed alxive, whicti I further 

acknowledge to lie fair compensation for the mlscailaneous property damage described above and 

release Coastal Environmental Group inc from further oliligations or liability related to this pipperty 

damage. 

Witness Signature Date 

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