TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ?>nn>MM Date: \7.l^l7T^\\n 

Address: 7^7 ^ /\i 2f) ^ 4 

Remediation Contractor: Coastal Environmental Group_ Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video ofproperty (DVD) • - . 

\y Executive Svunmary 

\Z^ EPA-provided property sketch 

•0 Signed Access Agreement for subject property 

\jff^ Signed Access Agreement(s) for adjacent property 

10^ Restoration Agreement 

'o^L Settlement documents (i.e., for damage or to replace plants, etc.) 

^ Contirmation data 

\ ^ Photographs 

E' As-built sketch 

y Satisfactory restoration signed by Property Owner 

i2f Property close-out check list signed by EPA 

C/V Description of areas not meeting ROD cleanup criteria 

yi Utility clearances 

^ Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

fele ^^^ - ^/',. JLl2j2dO_

,\\ Date 

30217637 

muniH 

Superfund 
^ 

^v 

Property Access Checklist 

PropertylD: 3^L| ^ 

D WORK STARTED ON: __/__/_ 

D WORKCOMPELTED ON:__/__/_

Property Address: ;>q 2 ?> Kl 2 5 5 ^ 

Owner: ^^,^1 ^ U/lVn Q Renter: 

Address: Phone: 

lc3^4^ Read 6 t 

Fax: 

Cell/Pager: 

Phone Additional Information: : Lir>2.fi-7|.q[()lU 7 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / By: 

p ^ Access Agreement Signed: }Z_/2^/CQ. By: 

1^ Restoration Agreement Signed: 12./2£?/03 By: 

D TopsoU Sampling (if applicable) / / By: 

D Disposal Sampling (if applicable) / / By: 

G Garden Sampling (if appUcable) / / By: 

"53 UtiUty Clearance CaUed<SLA /os/vr t ^y- C^/Ofc l\0 VJOtnJlv^ 

Ij^ Video/Photos (Before) On:(Sj>/3i./Afi. By: ' 

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

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

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

'^^^ Property Completion Agreement Siened:^ R M ll O By: fyu^cyy ^ 

• Ffaial Report 

Issued: / / By: ^ 

Air Monitoring (as appUcable) 

n Community D Crew On: / / By: 1 

Results: 

D Conununity Q Crew On: / / By: 

Results: 

n Community Q Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Accoimt InfoniJ^ion Page 1 of 1 rnl^pi 

Douglas County, Nebraska Property Record - R l 144060000 

Print Report 

NEW Fnatura - Parrnl DimRnsinns available (df scale 0-50 ft west of 52nd St - Vle W O n Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->••> • Auto Sales Search 

Owner 

WYNN MARLA M 

6244 READ ST 

OMAHA NE 68152-0000 

Property Informatio n 

Key Number 4406 0000 11 

Account Type: Residential 

Parcel Number 1144060000 

Parcel Address: 2928 N 25 ST 

OMAHA NE 68111-0000 

Legal Description: GISES ADD LOT 105 BLOCK 0 S 30 N 97.35 FT W 107.82 FT 30 X 107.82 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Lancf 

$300.00 

$300.00 

$300.00 

$300.00 

$300.00 

$300.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$300.00 

$300.00 

$300.00 

$300.00 

$300.00 

$300.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.07 3240.0 0.0 108.0 30.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/22/2009 
Page 1 of 1 

"> 

\ .__ CreatejAiriotherJ[icket ^ [ Back^tqjrttt Intemet \ I i ^ Send Email ] 

YOUR TICKET NUMBER IS 2454457. 

Original Call Date: 4/05/10 Time: 8:50 pm Op: ELIZABETH18790 


Work to Begin Date: 4/08/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2928 Street: N 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-NE-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


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


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


: UNSURE IF CORNER LOT. 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/5/2010 
OLS#: 30044 19 As-Built Drawing Date Excavated: 4/13/10 

Date USEPA Signed Off: 4/27/10 

COASTA L Omaha Lead Superfund Site Area Sodden: 1929 sa ft 

30044 

Exterior Paint North Arrow Omaha Lead Site • Good Site SIcetch 

• Poor 

Sampling Address: 2928 N 25 ST Q'Not paint 

Sanipl Lead Sample Samples Collected e Number LAB Concentration Collected Firm 

RYASCPXA-30044 F1 2M 6 ppm D 

Date: U>l2-^i06 

RYBSCPXA-30044 F2 Zl n ppm 

D Time l-'V) ?K 

RYCSCPXA-30044 81 S&° l ppm D 

Samples Analyzed 

RYDSCPXA-30044 82 n (of t ppm D 

'RD2SCPXA-30044 BSr — ppm D D XRF Unit: CS*JO Book: ZOfe 

ROZGCrXA-30044 G2- ~ ppm D D Date 1-/7-0 & 

RPZSCPXA-30044 PS- ~ ppm D D Time 

An. Staff Number of Samples = | ^ | | ( ^ | ^sv/ 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed fmin the street, facing property 

RevJdOX.JA (realcd: l.l-Mar^)S 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
k c\ 50044 eo\.r iA. n^/o^ 

Omah Exterior Paint North Arrow a Lead Site • Good Site SIcetch • Poor 

Sampling Address. 2926 N 2b : Q'Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: FE In o Pf>r, \ 

RYASCPXA-30044 Fl 2H6 ppm 

D Dale (fili-JlOU 

RYBSCPXA-30044 F2 2.1^) ppm D Time 

'•••v> fl"- RyCSCPXA-30044 B1 /»aq oom D 

Samples Analyzed 

RYDSCPXA-30044 B2 ^fpfi ppm D 

r^DZSCPXA-30044 Bir — ppm D D XRF Unit: GSH O Book: ZOf t 

RO2CiCPXA-30044 ^ - ~ ppm D D Date: "7-/ 7 •<?& 

RPZGCPXA-30044 Pg- ~ ppm D D Time: An. Staff: Number ot Samples = | ^ [ | ( ^ \ ^s\/ 

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

All quadrants are as viewed from the street, facing property 

'0^^^^ 
• • # • 

30044 

Omaha Lead Site Exterior Paint 

Site SIcetch • Good 

• Poor 

Sampling Address: 2928 N 25 ST QNo t paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: PE Irt c PftT A 

RYASCPXA-30044 Fl 2.H& ppm D Date; iffl^-^iOH, 

RYBSCPXA-30044 F2 2.l n ppm D Time: l-^V) F H 

RYCSCPXA-30044

RYDSCPXA-30044

'RDZSCrXA-30044

ROZOCPXA-30044

RPZOCPXA-30044

 B1 

 82 

 B2­

 SZ­

 PSS&° l

H(pft

 ppm 

 ppm 

ppm 

ppm 

, ppm 

D 

D 

D 

n 

D 

D 

D 

D 

Samples Analyzed 

XRF Unit: GSH O Book:

Date: 1-/ 7 -gf e 

Time: /1A 1 

 Zo9 i 

Number of Samples = | *-) | | ^ [ Staff: /^S W 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

1^1^-' y% T^ v^* 

JUL 0 7.. ; 

er-es a V^oo 

'€^'^ 

Rev 2(»)S„1,A frcnlnl: l.!-M.ir 
30044 

Omah Exterior Paint North Anow a Lead Site • Good Site Sketch 

a Poor 

Samollna Address: 2928 N 25 ST 04jo t paint 

Sample Numt}er 

RYASCPXA-30044 F1 

Lead 

Concentration 

2H& oom 

Sample 

Collected LAB 

D 

Samples Collected 

Firm: fgJnC P6T: > 

Date: talz^JQ^ 

RYBSCPXA-30044 F2 2-ir) Dom a Time: l^TjQ m 

RYCSCPXA-30044

RYDSCPXA-30044

 Bl 

 B2 

gft^

H(pft

 Dom 

 ppm 

a 

n Samples Analyzed 

T^DZOCPXA-30044 B2­ - ppm D n XRF Unit: GS^ O Boole: ZOf t 

ROZOCrXA-30044 SZ­ ppm D a Date: 1-/ 7 • O ^ 

RPZOCPXA-30044 PS­ ppm D D Time: /1A1 

Numi}er of Samples = | *-) | | ^ | Staff: AISW 

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

All quadrants are as viewed from the street, facing property 

. ' f 

k ' U c f 

JUL 0 7c.:3 

/ • : 

?>\ ^z 

2*^23 : 

Vi%. 

.fl. I F2 

I

IU 

J. ^amry^::%'5. .5.t. Rev2008.3A Created l3-Mar-08 0447UI 01.2.1 
»*>'*!r'v 

COASTA l ENVIItONfllKTAt 

C R O U r t H C 

Consent for Access To Froperty 

RIGHT OF ENTRY TO PREI\/IISES 

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

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

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

following described premises: 

Daytime Phone: 

402^71' 

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 v/ill 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 vmtten 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 
COASTA L ^ > ^ ^ IttVtROHKIftTAL 

<l BROl* C « O U » 1 « C 

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

piles, dog houses, etc; 

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

to save; 

e 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. 

c 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 (402) 991-1199 

JQLI grant access to my properties D ' do not grant access to my properties 

^Jykyjjiu^ /^/^^A^ 

signature (/ Date Signature Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

The purpose of this agreement is to provide a mutual 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 satisfi&ction ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: SCOf f 

Property Address: ^f^^ ^ ^ ^ ^ T 

Owner: "3^.^/ ^ t\) 

Phone: ^92 ^ ) •/W^4-W( ^ 

On the attached diag[am(s) indicate area(s) to excavate, surface stmctures and landscaping features and 

access location(5) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

items to be Removed by the Owner before Start of Remediation: 

The tenoval. storafie, di&posal, and/or return of these items is the Owner's responeibiiity. 

V^yv^K ~^UvU 

Item: 

Item: 

items to iae Removed by the Contractor During Remediation and l^ct Replaced 

Kem: 

w yy ynj- ji^yr (~UiM'\inA 

Item-^^ / 

Item: 

Item: 

Page 1 of ' 
COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

item: 

Sod t SoO- t>{ , ^ y 

item: 

Item: 

Kem: 

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. 

Aiinth n sketch ol the 

•.ri'i'klci liiNoui 

Number of and size of 

each garden/ flower bed 

area. 

All;\th w skL'lcii DI' rt-Iritivi.' 

*i/cs niid loc;iiioMN 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

N'CIc l!ii" \HIIIC vvill tit 

USI'L' 10 is;uv .1 fjlKii! 

\oin.;uT, Id lhe |iropcil> 

ow ner;-

Easement Area, to be 

excavated 

Ljindscape Inventory 

Quantity Unit Condition/Type/Species 

Quadrants ^\^Z 

Each 

\ 

1 Each 

Each 

F ^ h 

Square Feet 

S 

Pjich 

Page 2 of. 
C O A S 1 A L 

n h o w ' . IN C 

y Additional Comments / Instructions: 

^ 'Z- 3 ^>y Nor\C& B>^^y^ ^^^^ 

[/T Check the tx)X if Owner does not want CEG to document interior foundation walls and possible 

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

interior of house, including foundation cracks or fissures. 

X' J agree I l l do not agree 

MJI(J 

Owner's Signature Datee Contractor'ss Sienatur Signaturee Date 

Page 3 of 
BviD# P)nry-/q 

XRF PROPERTY SAMPLE SHEET 


Date .^':^--M Address 

Project Omaha Lead ARRA Sample time am/pm 

XRF 1D# -^py??^^ sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

2%CL 'hW^^ttp B. ^Hk. ±M ^ ^ ^ 

.^£L Depth a^?- ^»V/ t ^3^ Depth ^In^^-^lf dk2^ "bfiot'dii; ^ ^ ^W£^'/ 7^ 

Average ?)9S' ^ ; 3 ( ^ Average / ^ ^ g X> ^-^ ^ 

Shot# 

a^a. .^ii 2a. Average

Reading 

3^ik±yb±_ 

^^t^, 2z/^i ^ 

Sample area 

ill 

Depth 

BZL 

^^ ^ ^ 3(f i 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Average 

y^

^ ^ 

y 

Depth 

Average 

Depth 

Signature 

Print MAf6, H^nv s 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 283 

Mode SOIL 

Time 2010-05-07 14:53 

Duration 90.31 

Sequence Final 

Flags 

AVERAGE yg-of-280-282-

ADDRESS 2928 N 25 St 

QUADRANT B2 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo 8.389 

Zr 16.710 

Sr 9.026 

U 15.255 

Rb 6.917 

Th 14.867 

-Ptr- 253m} 

~Se" 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

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 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

496.623 

172.008 

< LOD 

77.640 

< LOD 

379.861 

< LOD 

< LOD 

< LOD 

511.840 

< LOD 

86.706 

< LOD . 

227.361 

22954.912 

596.810 

Supervised By: 

Certificate of Verification 

280 

SOIL 

2010-05-07 14:52 

30.10 

Final 

30044 

2928 N 25 St 

B2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.512 

± 16.732 

± 9.186 

: 15.032 

± 7.050 

J 14.735 

dk 26.214 

: 6.592 

: 34.338 

; 13.969 

± 37.718 

; 99.700 

± 25.573 

: 79.689 

± 140.387 

± 447.294 

± 105.990 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

502.710 

165.433 

< LOD 

66.964 

< LOD 

369.449 

< LOD 

< LOD 

< LOD 

452.379 

< LOD 

62.598 

< LOD 

< LOD 

22600.639 

568.974 

Supervised By: 

Certificate of Verification 

281 

SOIL 

2010-05-07 14:52 

30.10 

Final 

30044 

2928 N 25 St 

B2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.364 

± 16.676 

± 8.955 

: 15.022 

± 6.630 

\ 14.715 

± 25.652 

: 6.201 

: 32.644 

: 14.700 

± 35.405 

: 100.593 

± 23.712 

: 77.692 

: 204.148 

± 440.472 

± 103.558 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

498.976 

162.447 

< LOD 

76.532 

< LOD 

376.457 

< LOD 

< LOD 

< LOD 

456.291 

< LOD 

60.147 

< LOD 

< LOD 

22455.848 

582.903 

Supervised By: 

Certificate of Verification 

282 

SOIL 

2010-05-07 14:53 

30.11 

Final 

30044 

2928 N 25 st 

B2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

; 8.291 

± 16.721 

± 8.936 

: 15.710 

± 7.070 

I 15.152 

± 26.074 

: 6.165 

; 33.406 

: 13.381 

± 35.516 

• 89.374 

± 23.658 

I 79.612 

I 205.191 

± 441.748 

± 104.188 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 275 

Mode SOIL 

Time 2010-05-07 14:45 

Duration 90.32 

Sequence Final 

Flags 

AVERAGE :^ygJb£-27-2=27-4-

ADDRESS ^^928 N 25 st 

QUADRANT Bl 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD ; 8.392 

Zr 449.451 ± 16.299 

Sr 173.050 ± 9.342 

U < LOD : 15.951 

Rb 74.565 ± 7.142 

Th <: LOD- . • 19.192 

CsPti—" 726.482 ± 36.283 -> 

Se < LOD : 7.455 

As < LOD : 46.971 

Hg < LOD ; 14.400 

Zn 640.829 ± 42.567 

W < LOD ; 103:63^ 

Cu 256.657 ± ^ ^'ysyi Ni < LOD ^y y.i\2 Co < LOD . /^21.35 0 

Fe 25566.791 X y : l 477.635 

: ^ y Mn 628.293/ •^ 110.496 y 

Superv ised By: y^ j 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

458.786 

176.684 

< LOD 

75.146 

22.499 

735.649 

< LOD 

< LOD 

< LOD 

632.131 

< LOD 

174.148 

< LOD 

< LOD 

26529.217 

620.777 

Supervised By: 

Certificate of Verification 

272 

SOIL 

2010-05-07 14:44 

30.11 

Final 

30044 

2928 N 25 St 

Bl 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

; 8.447 

± 16.479 

± 9.443 

: 15.503 

± 7.123 

± 13.143 

± 36.545 

7.199 

47.562 

14.325 

± 42.270 

: 103.307 

± 31.198 

: 78.095 

: 224.// / 

± 486.983 

± 110.455 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Dut'ation 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

446.037 

174.673 

< LOD 

74.996 

< LOD 

727.300 

< LOD 

< LOD 

< LOD 

664.755 

< LOD 

345.759 

< LOD 

< LOD 

25707.148 

617.898 

Supervised By: 

Certificate of Verification 

273 

SOIL 

2010-05-07 14:44 

30.10 

Final 

30044 

2928 N 25 st 

Bl 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.479 

± 16.326 

± 9.424 

: 16.396 

± 7.233 

: 19.027 

± 36.494 

: 7.899 

I 46.780 

: 14.585 

± 43.656 

: 109.277 

± 39.728 

: 80.912 

: 222.275 

± 481.289 

± 110.571 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

443.528 

167.794 

< LOD 

73.553 

< LOD 

715.599 

< LOD 

< LOD 

< LOD 

625.602 

< LOD 

250.064 

< LOD 

< LOD 

24464.012 

646.204 

Supervised By: 

Certificate of Verification 

274 

SOIL 

2010-05-07 14:45 

30.11 

Final 

30044 

2928 N 25 St 

Bl 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

I 8.249 

± 16.093 

± 9.158 

: 15.953 

± 7.069 

: 18.833 

± 35.811 

I 7.268 

\ 46.571 

; 14.291 

± 41.775 

J 98.294 

± 34.769 

; 77.131 

; 216.997 

± 464.631 

± 110.461 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 279 

Mode SOIL 

Time 2010-05-07 14:48 

Duration 90.33 

Sequence Final 

Flags 

AVERAGE FSfc278— ^ 

ADDRESS 28 N 25 st 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 7.792 

Zr 339.345 ± 13.870 

Sr 196.723 ± 9.454 

U < LOD : 14.328 

Rb 64.369 ± 6.318 

Th < LOD : 12.439 

C2b__ 237:517 ± 207333. _ Se- < LOD : '5:886' 

As < LOD : 26.731 

Hg < LOD ' 12.472 

Zn 231.179 ± 25.317 

W < LOD -—T83.475 

Cu 47.434 y21.563 

Ni < LOD / / 74.158 

y : Co < LOD / 188.735 

Fe 20640.285^ 410.193 

y ± y 

Mn 443.072 y 91.589 

1 y ^ ' 

Supervised By: x - ^ 'y^ —
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 276 

Mode SOIL 

Time 2010-05-07 14:47 

Duration 30.11 

Sequence Final 

Flags 

BVID 30044 

ADDRESS 2928 N 25 st 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 7.831 

Zr 347.943 ± 13.891 

Sr 188.479 ± 9.211 

U < LOD : 14.130 

Rb 63.861 ± 6.245 

Th < LOD : 11.910 

Pb 227.162 ± 19.799 

Se < LOD • 5.986 

As < LOD • 26.009 

Hg < LOD ; 13.011 

Zn 213.483 ± 24.368 

W < LOD I 84.510 

Cu 44.757 db 21.245 

Ni < LOD : 73.982 

Co < LOD : 186.119 

Fe 20830.859 ± 409.628 

Mn 463.727 ± 92.659 

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 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

334.639 

199.677 

< LOD 

65.364 

15.356 

241.293 

< LOD 

29.964 

< LOD 

233.660 

< LOD 

60.820 

< LOD 

< LOD 

20657.785 

385.529 

Supervised By: 

Certificate of Verification 

277 

SOIL 

2010-05-07 14:47 

30.11 

Final 

30044 

2928 N 25 st 

EA 

1" 

CONFIRMATION 

N. LOPEZ 

Error 

\ 7.804 

± 13.877 

± 9.559 

: 13.974 

± 6.341 

± 8.851 

± 20.591 

; 5.882 

± 18.320 

: 12.117 

± 25.544 

: 83.331 

± 22.631 

: 74.212 

: 189.281 

± 412.035 

± 88.182 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

335.451 

202.011 

< LOD 

63.882 

< LOD 

244.096 

< LOD 

< LOD 

< LOD 

246.394 

< LOD 

36.725 

< LOD 

< LOD 

20432.211 

479.959 

Supervised By: 

Certificate of Verification 

278 

SOIL 

2010-05-07 14:48 

30.11 

Final 

30044 

2928 N 25 St 

EA 

1" 

CONFIRMATION 

N. LOPEZ 

Error 

: 7.742 

± 13.841 

± 9.591 

: 14.881 

± 6.368 

: 12.129 

± 20.609 

5.790 

: 26.705 

: 12.286 

± 26.039 

: 82.585 

± 20.813 

: 74.279 

: 190.805 

± 408.915 

± 93.925 
.*•'*"'''> . 

f ^A ^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I

^ ­ j ^ '^tPBoT*^"

 Coastal Environmental Group Inc.

 vvvvw.coastalhazmat.com 

 vl 

 COASTA L • NVIIONHCHTAL c lo u r, IN C 

EXECUTIVE SUMMARY: 

BVID #30044-(2928 N 25 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

S S^ Property #:.200^i£L x 

Property 

Date/Time; Owner' 

Qiifldi Excavated: 

Contractor TTT^ 

Eicavatton Yes No Ceneral 

I. If necessaiy, were the correct quadrant(s) excavated and restored? 0 - ' 

2. If necessary, were the coneci areas of drip zone excavated and restored? 

GradJDK Yes No Sod awd VegetatioB 

1. Does the gnuling around the perimeler ofthe house in excavated areas generally slope away 

from the house? 

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

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 genet«lly firm and evenly graded? y 

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

time period) y 

6. Was the property graded such that water will not pool on the propeny'' t^- ^ 

7. Was damage to landscaping or plant maierials avoided? i^ ^ 

Gates, Fences and Retnfailng Walls Yes No 

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

Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 

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

( / ^ 

A. Was damagie to retaining walls avoided? (If applicable) 

t/^ 

Foupdatloa, SldUiK and Gatlefs 

Yes No 

I. Was damage to tltt siduig or trim avoided? 

2. Was damage to the foundation avoided? ^ ^ 

Was damage to windows avoided? 

A Was damage TO windows or door screens avoided? 

y_ 

S. Was damage to downspouts or downspout extensions avoided? 1 / 

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage to driveway surfaces avoided? y 

2, Was damage to walkway surfaces avoided? ly^ 
OM'oers comments: 

lln.spection notes: 

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

EPA Representative TU U L o...i(JrLl^^y 
Property Completion Agreement 

This agreement documenls lhe completion ol remedial acliviues perloimed on my property My signature 

will designate ihat I am satisfied wilh the restoraiion of my propeily. and that no items are in questions, 

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

PropertylD: rj^^/L ^ 

Property Address: ;7^2.f ^ A/ 2J>. ^S^ ^ 

Q""^'= Mr^rlO V\\lY\r\ 

i::^!: ^oi-57/-^b-i( ^ 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

Jr \ I agree rcttoralion \s complcled, except as noted 

[_J I do not «i;rec restoration is rompleteri 

OwnW' s Signatiire JJ Date Contrarlor' s Signamre Dale 
Property Owner Assessment of Performance fmfS/^ 

American Recovery and Reinvestment Act (ARRA) ^ KJ ^ 

Omaha Lead Superfund Site ^p^ 

2009/2010 „ ^^9 % 

SUPt 

Remediation Contractor: Coastal Environmental Group - EP-R7-09-06 ^'y U 

Property Identifier Number: 5on*A^ '-^/O/j/ 

Property Address: Z<^ ^9 . k) 2FS '^ ^ 

Property Owner's Name: \Jnr\ n \/\\\i)f\V\ 

Instructions to the Property Owner; 

This form serves to record the Property Owner's assessment of performance (hicentive 1 

- Quality Assurance Surveillance Plan) involving the listed remediation contractor, as applicable 

to the Omaha Lead Site. This form documents the timeliness of punch list resolution, business 

relations, complaint resolution and the overall quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Performance Work Statement. 

The Property Owner will indicate his/her assessment of performance with the contractor's 

work by checking a numerical rating on the table below using the ntmierical definitions from 

the rating scale below, then sign & date the form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 . "poor" 

1-2 "very poor" 

Property Owner's Assessment of Performance Regarding the Contractor's Work 

10 ^ 5 

8 3 

7 2 

6 1 

Property Owner Additional Comments from (optional; continue on back page if needed) 

Property Owner Signature: yi/ l y^lyh^"^ ^ _Date: ^y^ly^l'^