TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

Date ^kl 

Remediation Contriictor: Coastal Environmental Group Year: _20]0ARRA 

SOILREMEDIATJON 

PROPERTV FILE FOLDER DOCUMENTS 

1/ Video of property (DVD) 

1/ Executive Summary 

/ EPA-provided properly sketch 

/ Signed Access Agreement for subject propeny 

7 

Signed Access Agreement(s) for adjacent properly 

Restoration Agreement 

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

Confirmation data 

y Photographs |[(T irf'Cfin/fir]^^^ ^ h< CAvifr[\s^ A- 9# ^ 

As-buill sketch 

t/ Satisfactory restoration signed by Property Owner 

6? Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 1/ 

7 Properly information from Douglas County Assessor's Office 

Superfund 
Property Access Checklist 

Property ID: \{jl ^ ZA-Z. ^ D WORK STARTED ON: / 1 . 

Property Addre88:7^i/ ^ ^ 2y > C^^J(_ D WORK COMPELTED ON: l_ J 

Owner •'^IHrvyJiAy Renter ^tM^t ^ 

Address: Phone: 

^C^ f ^ ^^^l^^rJ^.yr^Mir 

Fax: 

CeH/Pager 

Phone: Additional Information: 9-5/ - -^s-^/ 

Fax: 

Cell/Pager 

D Notiflcation Letter Sent: / / By: 

SlffHa:Jj7lZ£2'iO "y= vi.vif 

L ^ Restomtion Agreement Signed: | ^ iJ ^ !/£> 

By: v^^.v 

D Topsoil SampUng (if applicable) 1 1 By: 

D Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if applicable) /__ / By: 

^ Utility Clearance Called; yl 1 ^ U o ^y-W/^oL.:, ^t»Mi.. 

'£1 Video/Photos (Before) OKJI}I2£IIJ O *yj

 V^^LX. 

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

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

D Videoa>hoto8 (30-Day) On: / / By: 

Q Property Completion Agreement Siened: / / By: 

D Final Report Issued: / / By: 

Air Monitorine (as applicable 

n Community D Crew On: / / By: 

Results: 

n Community D Crew On: / / By: 

Results: 

Qcommnnfty QCrcw On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account I •^0P- Page 1 of2 

# > 

Douglas County, Nebraska Property Record - R0743310000 

Print Report 

View interactive GiS IMao Information is valid as of 2010-7-30 Treasurer's Tax Reoort 

New Feature ^ ^ ^ Subdivision Sales Search 

Owner 

JURY JAMES J 

ETAL 

6120 8 48 ST 

OMAHA NE 68117-0000 

Property Informatio n 

Key Numtyer: 4331 OOOO 07 

Account Type: Multiple Res 

Parcel Numtter: 0743310000 

Parcel Address: 2440 S 20 AV 

OMAHA NE 68108-0000 

Legal Description: CAMPBELLS ADD LOT 20 BLOCK 4 W 99 E 111 FT 50 X 99 

Value Informatio n 

Land Improvement Totai 

2010 $500.00 $0.00 $500.00 

2009 $500.00 $0.00 $500.00 

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 

SIlow All Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 4950.0 0.0 99.0 50.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 8/14/2010 
Page 1 of2 

"> 

[ Create Another Ticket ][ Back to Irth Intemet ] Send Email 

YOUR TICKET NUMBER IS 2637698. 

Original Call Date: 11/08/10

Work to Begin Date: 11/10/10

 Time:

 Time:

 5:48 pm 

 6:15 pm 

Op: ELIZABETH18790 

State: NE 

Address: 244 0 

County: DOUGLAS 

Street: S 2OTH AVE 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 27-SW,34-NW 


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 Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


ALTS72 ATTNEBRl CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 


QLNNEIF 


Service Area Contact Phone Nuniber 

UtiUty 

Type 

ALT872 WINDSTREAM COMMUNICATION ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /8/2010 
Page 2 of2 

METROPOLITAN UTILITIES MUD02 SANDY DISTRICT 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

ELM 0PPDGPR6 OMAHA PUBLIC POWER DISTRICT LOCATING 

ELM QLNNE 1F QWEST LOCAL NETWORK LOCATING 

Day: 4025047823 


Alt: 


Emerg: 4025047970 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/8/2010 
As-Built Drawing 

C OASTA L Omaha Lead Superfund Site 

OLS#: 16822 

Date Excavated: 11/15/2010 

Date USEPA Sianed Off: 3/3/2011 1682.2. Area Sodden: 3826 sa ft 

Omaha Lead Site Exterior Paint Owner Islame: J^e ^ JJgft y • Good Address Site Sketch : awf l S JLQ ^j / 

PtHMierH: 731-ass / w. Q'Not paint 

Sannple Numtier 

RYASCPXA­ /6PJiF 1 

RYBSCPXA­ /tr^^ n 

RYCSCPXA-y^^-i i-B1 

Lead 

Concentration 

ZlaCl 

JtLnappm 

ppm 

ppm 

Sample 

Collected 

H 

0-

Ef 

l-AB 

D 

D 

D 

Fhm 

Oate 

Time: 

Samples Collected 

W eS> / AtH O 

(^<///0 /ofa 

4: ;).3 p-^ . 

RYDSCPXA- /fr f a^ > B2 

RDZSCPXA B2-

RGZCCPXA -62 -

^ 7/ ppm 

:ppm 

ppm 

ET 

D 

D 

D 

D 

D 

Samples Analyzed 

XRF Unit 6.3 S Book:

Date t-^ -l<i-Ol A 

 }6 0 

RPZSCPXA -PZ­ rppm D D Time .RtfL 

Numtjer of Samples = | ^ Staff MSvjs) 

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

An quadrants are as viewed from the street, facing propeny 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/biulch Area lef t bare 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 
Omaha Exterior Pain! North Arrow Lead Site Owner Name: >J]7?-Me<> S-Jufi-U • Good Site Sketch 

Address 2^Ht S ^0/4 / : • Poor 

Phone: H: 75/-:iS5 / W; Q^Not paint 

Lead Sample LAB x 

Concentration Collected Sample Number Samples Collecrted 

Firm 

RYASCPXA- /feS'-iiFI ZlaO ppm D

Date ftV//o/o<o 

(RYBSCPXA- /^<f ^^P 2 jfljta. ppm D Time 

0- 4: ;»3 ^w>. (RYCSCPXA-/^<5'-a^ ^8 1 M£L ppm D 

Samples Analyzed 

IR YDSCPXA- / ^ f ^ ^ B2 J O I ppm 

f^OZSCPXA -Qi- n

ppm XRFUnit {p3 _ H Book: 160 

-GZ- ET D

ppm Date: uj -iq-g U 

RPZGCPXA -PZ- D

ppm n Time: P hA D 

D Staff MSVAJ Number of Samples ^rin D 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, facing property 

n 

t<-"". 
1682.2. 

Omah Exterior Paint North Arrow 

Owne a Lead Site r tslame: 0>Me 5 -JZfuR. • Good Site Sketch Address: y!ttb _ S Ji o 17 • Poor 

Phone 7Bl-:iS5 / w: : tl 0^Nol paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: w € 5 / AffHO 

RYASCPXA- /6P..liF 1 ppm 

'>4PO 0' D Date: 6y// 0 (o<o 

RYBSCPXA- ibf^^F l UHC^ ppm 

0- n Time: 4' . 3>3 pvv ^ . 

RYCSCPXA-/^.?'-^ ^8 1 fcIO ppm 

D Samples Analyzed 

RYDSCPXA- / £» S' ^ > B2 HI] _pp m ET 

nDZ6CPya\ 92- D

ppm D XRF Unit: 63S Book: 1 ^ D Rczscpyu\ -62- ppm a D Date: t-l • 19- PL , 

RPZCCPXA -P2- •ppm D Time: P M 

Staff: MSVAJ Number of Samples = i *f 

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 tlie street, facing property 4/iy 

Rev 4 046141.0123 
Ic^Szz. 

Omah Exterior Paint North Arrow a Lead Site Owner Mame: sJ^ei5__J\JitA • Good Site Sketch Address: ^^tft S A o fc D ^°°' Phone: H: 73(-aS5 / w; Q^Not paint 

Sample Numt)er Lead Sample Samples Collected 

Concentration Collected 

LAB 

Firm: fn eb / f^9no 

RYASCPXA- /6P-iiF 1 ?.fao ppm 0' D Date: 6V//o/of a 

RYBSCPXA- l6r^^F 2 Co'1 ^ ppm 0- D Time: 

RYCSCPXA-/^^^ ^B 1 

MA. ppm D 

Samples Analyzed RYDSCPXA- / £, r i > B2 J£LL ppm ET D 

nDZSCRXu^ 02- ppm D n XRF Unit GIH Book: 1 ^

nczccpyvA -GZ- ppm D Date: i^ -iq-Q L 

RPZSCPXA -P2­ D •ppm D Time: P M D 

Staff: MSSA; Number of Samples = i ^ 

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 from the street, facing pro{>erty 

r ; : : 

o 

APR \ 3 2096 

gl •ISA/. 6SL 

(plO ^ 7 / 

a-H'fa 5.-a:o-Ao, 

-4r: 

o 

6 0 0 0 ••• 

r2. 

21,0 (.4^; 

Visi^^lfeS ^ 

5- 2o |i.S. 

Rev 046l4tat23 
jsytoatAr , 

%f COASTA l INVItONKlNTAL 

'" l PHO'*'

/ C I 0 U f INC 

Consent fcf Access Tc 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 environmentai response activities upq3onn ththee 

follov\/ing described premises: Z-T ^ 

Owner's Name: Daytime Phone: 7 " 3 / <£J~J~ /

T -^o'^Y 

Address of Property 

covered by this 77f o y ZO Ay- 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 perfomned 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 perfonmed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the worit is finished, the Grantor wili be asked to review the wori( 

and confinn 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 perfomiing the worit. This access shall 

remain in effect until the worit has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
V

 -'^^'^i * COASTAL 

' "no"-c II0 u r I K c 

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

piles, dog houses, etc; 

e 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 vinth 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 

M \ grant access to my properties Q i do not grant access to my properties 

yi>-j^a yz7 

Signature Date 

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

Page 2 of 2 
COA S T A L 

G fl O U P , INC . 

Restoration Agreement 

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

remediation activities. This will also serve as documentation for the purpose of assiuiag that restoration 

activities are completed to the satisfaction of the property owner and the United States Enviromnental 

Protection Agency (EPA). 

PropertylD; j C S ^Z , 

PropertyAddress; 2^1//-/ Q S ZO Ave 

Owner; s3<x wyes' y <^vjrvy 

Phone; 73-r 7 / / z^ '7 r~rm ^ I I

On the attached diagram(s) indicate aFea(s) to excavate, surface structures and landscaping features and 

access location(s) 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 removal, storage, disposal, and/or retum of these items is the Owner's responsibility. 

Kem: 

A fo ^ ^ 

Kem: 

Kem: 

Kem: 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Kem: 

j<rs yyo/ 

Kem: 

Kem: 

Kem: 

Page lof 5 
COA S T A L 

» U P . INC . 

Items to Be Removed By Contractor During Remediation and Reolaced 

Kem: 

;-a; 

Item: 

r o h 

Kem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter / 

Number of trees <= 2 inch 0

Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, £ f Each Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Attach a sketch of relative # 

sizes and locations. 

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. 

F.asement Area, to be 

excavated 

if «^/ Each ^f^yi^'i, R-e/^/'b 

Page 2 M-? 
<\ 

COASTA L • NVinONH I NTAL O H O U P , INC . 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibK you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underiying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this Is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property Is made legal. To the contrary, you may be cited by the cKy if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the cKy of Omaha's Planning Department at (402) 444-5150. 

O Please check this box If you understand the information outlined above. 

- ^ qy7c^ Z''\ \ y K^^\ C^ 

^ f/o Oip^s hoijsi^ onfl^e f^^hs/de . 

CK VV 

^ Coc^^-^A -JJ\\^ jOo^Y Po<r TJ^-

V^^ V'A\ Co^ ^WJse ?° ^^^^ 

I ] Check the box 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. 

f I agree 0 I do not agree 

"^Owner's Signaliure ^ y ^ Date Contractor's Signature Date 

7 

Page 3 of ^ 
. i6^ZL 

-.c'e i-ze~'Zoi \ ^-'i : .- ^•^-?o_,S._3^.^ci 

P^lz'Z- - • _- - .--- - '^c ,0 e J"""' f; 

./^RFID^ a^o^2 lO ^ p e r; ""• 0 ;,­ . — —— 

,' ShG'ff PeaoTig SaT.O'e area' Peac '.''H I z,a\\•i.Ji^^^hii 

LI^3_ T^ i (6 ^ \ ^ [ \ =Hi (4 _6L 

Y Y ^ 63 i- 13 Depih i zyz % i 16 Der/r, 

I Z^5 J "o^i 15 /'' 1 ^5i_i6_ 6" V"ZA3 

Av'eraqe ' ^ ^ [C y A.'erage ^ f J / 5 • / 

Shot# Reading ) Sample area) Shot# Reading Sample area 

Z-n /6^ .t f6 i F^ 

Depth Dep:h 

.zy?.lA _ 61 i.^H- _J__4'i„..J 

A.e-age _ IZ"^. ^ C^ y '^veraqe 

~c; Reacin: Sample area' I Shot £ i ReaciT I ^?n"?'f' ?'ea 

yY5^ym'__ >^. 

Depth • '- '- r 

3Z^ :^ ^6 ^ " 

Hv-eraae Z^( i Z3 / -..•eraoc 

RETESr .ARE.AS 

Shot a Reanino I Samole dres 

11/!/^^ Mm ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

256 

SOIL 

2011-01-28 16:12 

90.40 

Final 

Avg of 253-255 

2440 S 20 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 253 

Mode SOIL 

Time 2011-01-28 16:10 

Duration 30.17 

Sequence Final 

Flags 

BVID 16822 

ADDRESS 2440 S 20 ST 

QUADRANT EA 

DEPHT 1" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR „ _ 

ppm ± Error 

Pb 97.107 ± 16.110 

Supervised By; 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 63.912 

Supervised By: 

Certificate of Verification 

254 

SOIL 

2011-01-28 16:11 

30.12 

Final 

16822 

2440 S 20 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 13.973 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 50.860 

Supervised By: 

Certificate of Verification 

255 

SOIL 

2011-01-28 16:12 

30.11 

Final 

16822 

2440 S 20 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 13.592 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

252 

SOIL 

2011-01-28 16:09 

90.33 

Final 

Avg of 249-251 

2440 S 20 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 102.877 

Supervised By: 

Certificate of Verification 

249 

SOIL 

2011-01-28 16:06 

30.02 

Final 

16822 

2440 S 20 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 16.340 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 214.722 

Supervised By: 

Certificate of Verification 

250 

SOIL 

2011-01-28 16:08 

30.14 

Final 

16822 

2440 S 20 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.333 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 64.077 

Supervised By: 

Certificate of Verification 

251 

SOIL 

2011-01-28 16:09 

30.17 

Final 

16822 

2440 S 20 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.281 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 248 

Mode SOIL 

Time 2011-01-28 16:05 

Duration 90.68 

Sequence Final 

Flags 

AVERAGE Avg of 245-247 

ADDRESS 2440 S 20 ST 

QUADRANT B2 

DEPHT 6" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 201.719 

Supervised By: 

Certificate of Verification 

245 

SOIL 

2011-01-28 16:04 

30.33 

Final 

16822 

2440 S 20 ST 

B2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.719 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 259.459 

Supervised By: 

Certificate of Verification 

246 

SOIL 

2011-01-28 16:05 

30.32 

Final 

16822 

2440 S 20 ST 

B2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 24.028 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 324.197 

Supervised By: 

Certificate of Verification 

247 

SOIL 

2011-01-28 16:05 

30.03 

Final 

16822 

2440 S 20 ST 

B2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.211 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

244 

SOIL 

2011-01-28 16:03 

90.50 

Final 

Avg of 241-243 

2440 S 20 ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 74.758 

Supervised By: 

Certificate of Verification 

241 

SOIL 

2011-01-28 16:01 

30.12 

Final 

16822 

2440 S 20 ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.714 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 242 

Mode SOIL 

Time 2011-01-28 16:02 

Duration 30.22 

Sequence Final 

Flags 

BVID 16822 

ADDRESS 2440 S 20 ST 

QUADRANT Bl 

DEPHT 6" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 96.380 ± 16.445 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 98.800 

Supervised By: 

Certificate of Verification 

243 

SOIL 

2011-01-28 16:03 

30.16 

Final 

16822 

2440 S 20 ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 16.320 
!> J^ ^ \

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

o ^^^ ^ I Coastal Environmentai Group Inc. >\ 

\~*~! ^ www.coastalhazmat.com 

^"inatt'^ COASTA L INVIRONMENTAl 

CROUP , IH C 

EXECUTIVE SUMMARY: 

BVID #16822-(2440 S 20 AVE) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
» t

iFii 

Property #; 

Datc/Tlrae; : 'HY\^''

Quads Excavated 

EPA Property Close Out Form 

,7MHoSZ£j^^-^ 

Property Address: 

Owner's Name:. /^ 

 , - Contractor Group ravaled; H rSb\ ^b ^ r 

Excavatio Yes No n General 

I. If necessaiy, were the correct qtiadrant(s) excavated and restored? / 

2. If necessary, were the correci areas ofdrip zone excavaled and restored? / 

Grading Sod and Venctatton Yes No 

1 Does the grading around the perimeter ofthe house in excavated areas generally slope away y from the house? 

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

3. Does the sod q>pear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day tune period) 

4. Are sodded areas generally firm and evenly graded? 7 

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

tinte period) ^_ _ y

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

r 7. Was danuge to landscaping or plant materials avoided? 

y 

y 

Gates, Fences and RcUfnlDi! Walls Ves No 

1. Do gates open and close freely? (Ifapplicable) y 

2. Were all gates or fences taken down during restoration activities reinsulled? (If applicable) 7 

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

4. Was damage to reuining walls avoided? (Ifapplicable) y 

Foundation, SidioK and Goiters Yes .No 

t. Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

.^. Was damage to windows avoided? / 

4 Was damage to windows or door screens avoided? / 

5. Was damage to downspouts or downspoui extensions avoided? / 

1 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? "7 

2. W&s damage to walkway surfaces avoided? / 
• t 0>»'Ders comments: 

ninspection notes: 

Removal and restoration aclivales complete including lhe 30-day sod warranty: 

EPA Representative Q*^ j^/y, Date: l^'LlL 
c"k 

Property Completion Agreement 

i his atneemeni documenls. Ihe complclion ol remedial achviiics perloimed on my pioperly My signaluie 

will de.signale ihai I am salisfied wilh lhe restoralion of my properly, and lha( no items are in questions 

now, or al any lime in the future, except those items hsled below, ifany 

Propert y ID: 

Pioptrr) ' Address: lo 

Owne 

Phone 

Restoration Items in Question: 

Item: 

Hem: 

Item; 

Item. 

Item: 

Item: 

Additional Comments: 

J «^rrc ir.^torklion u complclrd, occp l as noltri 

 I I rio nol ii(;ifc rcJioiAdon h cornplclcd 

-y7' ' ^a«€ Conli Dcioi 's Sic/aliiM' 

l