TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Y^HH Date: ^h^illb 

Address: I72 0 S 2"7 c'^^V 

Remediation Contractor: _CoastaI Environmental Group_ Year: _2009_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

s r Video of property (DVD) 

XA Executive Summary 

fSl EPA-provided property sketch 

B Signed Access Agreement for subject property 

vA Signed Access Agreement(s) for adjacent property 

&' Restoration Agreement 

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

^ Confirmation data 

N2 Photographs 

Ef As-built sketch 

H Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

• ^ Description ofareas not meeting ROD cleanup criteria 

cf Utility clearances 

cf Property information from Douglas Coimty Assessor's OfiFice 

D 

D 

D 

A. ignature Date 

30217543 

liiniiiniiiii 

Superfund 
Property Access Checklist 

Property ID: j ^ 11 i 4 

D WORK STARTED ON: / 1 

D WORKCOMPELTED ON: / / 1'^'^*•"•"» n7-0 5 7,1,"^-

Renter ^'''''- IjLJmHy^ bJAmfclp. Addrcds: 

Phone: 

Fax: 

Cell/Pager. 

Addfttonol Information: 

Phone: L^ 2 ^S*?, . -4")^ ^ 

Fax: 

Cell/Pager. 

D Notification Letter Sent: / /. By: 

J S| Access Agreement Signed: JL/^Q/CQ By: 

Restoration Agreement Signed: n_'t^/C2Q By: 

D Topsoil Sampling (if applicable) / / By: 

Disposal Sampling (if applicable) By: 

D Garden Sampling (if applicable) By: 

K Utility Clearance Called: li_i2Q/Q9 By:l2.MQq 

{0* Video/Photos (Before) On:J^/J_/i2S By-^io /0(?JtQv/\i:^ 

O Video/Photos (During) On: By: 

O Video/Photos (After) On: / /. By: 

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

Property Completion Agreement Signed; nyiy'HO ^ ^r-^^i/y ^ 

Final Report Issued: / / By: 

Air Monitorine (aa anDlicable) 

I D Commnnity QCrcw On:__ / /_ By: 

Results: 

D Community Q Crew On:. _/ _ /_ B-i'. 

Results: 

D Commnnity QCrcw | On: / / By: 

Results: 

Omaha Lead Stte 
Douglas County Accotmt Infi aaj^t^t Page 1 of3 

Douglas County, Nebraska Property Record - R1240270000 

Print Report 

NEW Feature - Parcel Dimensions available (d) scale 0-50 ft west of 52nd St - VlG W Oi l Ma p Information is valid as of 2009-11 -19 Treasurer's Tax Report 

New Feature -^ •* -^ Auto Sales Search 

Owner 

WRINKLE WALTER L 

ETAL 

1720 3 27 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4027 0000 12 

Account Type: Residential 

Parcel Number: 1240270000 

Parcel Address: 1720 S 27 ST 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 6 BLOCK 20 S 20 FT LT 5 & N 20 FT 40 X 145:8 

Value Informatio n 

Land Improvement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

$63,200.00 

$63,200.00 

$63,200.00 

$55,200.00 

$55,200.00 

$55,200.00 

$67,700.00 

$67,700.00 

$67,700.00 

$59,700.00 

$59,700.00 

$59,700.00 

Sales Informatio n 

Sales Date: 1993-03-11 

Deed Type: D SooAr; 1949 Page: 360 

Price: $31,500.00 

Grantor: 

Grantee: 

Valld/lnvalld: Valid 

Exclusion Reason: 

Sales Date: 1990-08-06 

Deed Type: D SooAr: 1884 Page: 587 

Price: $31,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=Rl... 11/25/2009 
Douglas County Account Infc .^K^gjor Page 2 of 3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Land Information 

Acres 

0.13 

SF 

5880.0 

Units 

1.0 

Depth 

147.0 

Width 

40.0 

Vacant 

No 

Improvement

Building 1 

 Information 

t^&iejr 

atbDertOM 

—ti v 

»»iwtikocfcdr; 

1 1/2 STORY UNFINISHED 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1104.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Stucco Units: 1.0 

Interior: ! Drywall Baths: 1.0 

Roof Cover: i Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 0 0% 1920 88 

Detail Type Detail Description Units 

Add On Fence Wood 1.0 

Add On Unfinished Attic W/floor 864.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 864.0 

http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/25/2009 
Douglas Cotmty Accotmt Infi tom^^ t Page 3 of3 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 200.0 

Porch Slab Roof Ceiling 132.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/25/2009 
• • 

Page 1 of2 

"> 

[ Create AnQtherTicket \ \ _iBackJoJrth jnternet - J [Sen d Email 

• YOUR TICKET NUMBER IS 2414862. 

Original Call Date: 11/30/09 Time: 5:05 pm Op: ELIZABETH18790 


Work to Begin Date: 12/02/09 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1720 Street: S 27TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-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 OF CORNER 


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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/30/2009 
• • 

Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

AU: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/30/2009 
OLS#: 19114 W As-Built Drawing Date Excavated: 12/5/09 

Date USEPA Signed Off: 1/18/09 

COASTA L Omaha Lead Superfund Site Area Sodden: 1032 sa ft ENVIRONMCNTAL 

C R O U r, I N 

Name: ^->^y£^ <j^iyiyt.£ 

Address: m xe 5 a.9 s r 

Phone: 'JBi - VS^ V 

Omaha Lead Site 

Site Sketch 

Date: 

Time: 

y/>o/ci 

1 •-:^o 

North Arrow 

- > 

Team

fHii j 

 PAyt.lAJl^njKICMJA BVID# I ^ yy V XRF Code ^sol 

Sample Number Lead Concentration Confirmation Sample 

^yf)s c ^>A^~ iq/i 4 ppm f^/ Yes No C] (fU9 f J Yes • No 13 /gyp ^AK ^ - i-'f/m ^•g ^ ppm ft' Yes No 13 

3 ^ 8 ppm 

ppm t J Yes 

• No Q '7^(/ ' 

ppm O^'Yes • No ET 

ppm Yes • No CD 

ppm Yes • No • 

RYASCPLA-19114 

Fl =55PPM@>(J^ 


02= 157 PPM @ 13 


Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare 
 Sod ' ' 
 Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
\l \^^i- • • ^,fg 6 5/ 

1 t,.t 

Omaha Lead Site Date: North Arrow 

Address: ;-7 i« . 5 a. 7 5 ~ Site Sketch Time; I -3 0 — ^ Phone: «?3i - V'^S' V 

I'^lA? 

Team ?/ ^ fFlZ/A'K /cM-r c BVID # / f / / Y XRF Code 5SO 

Sample Number Lead Concentration Confirmation Sample 

ppm f i Yes ^ No I ^ 

XIULSL ppm f l Yes 1^ No E /W d QCA'Jcy - \<R\ m ^€4- ppm ft' Yes n No 0

3 " 1 8 

ppm ^g Yes 1^ No S

1^( ^ ppm O^Yes n No ^ 

ppm Yes D No a 

ppm Yes • No n 

RYASCPU\-19114 

Lab 

136ppm 

^RjtL ^ 0 5h<^^ 

y

>.-k kS'lffrfll i. Ji^Lfe2 

I 1 1 ^ ^•••.—J. , jj|,..^.;i.,;=a4 

.-.'^yi»\-..,Ae^i-'-^ !.:^ \\-'A-r- ! r ^^•My< \ 

s a-> 5 T^ T
\l \^^i­

% ^ 

p Name: '^•^>e/?

Address: 1^7 3.6

Phone: <?3A ­

 <iAs<yt«.£. 

5 3. ^ s r 

 V^y v 

Omaha Lead Site 

Site Sketch 

Date: 

Time:

' Ao/c 3 

/ '^c ^ 

North Arrow 

• > 

Team

/^ V 

 r/S(X JFA/frAKJ<r/lAkrc BVID# / I / / Y XRF Code 5SO 

Sample Number Lead Concentration Confirmation Samph 

i^yA)^cpyy^ ~

fJAf^'^CL/'Ky^ -

AWcyieKy ­

(^/iq -

I'^IIM-

 \'^\\^ 

U'5'=i 

JLJJLBP-^^ 

3^=1 2 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

^ / Yes

f 2 Yes

6 ' Yes

^2 Yes

O^Ye s

Yes

Yes

 . E 

 1^ 

n 

 t ^ 

n 

• 

n 

No 1 ^ 

No 0 

No H 

No 13 

No Ef 

No • 

No • 

-^i;£C0l2AT]ve R<OC/C lF+POV)!s\ ANO 
Name: ^^^>€i f *.jXSAjty<.£ Omaha Lead SKe Date: •>/o/ci _ North Arrow 

Address: 1-7 3-0 S a. ? ST^ Sit«Sk«tch Time: i-;x> . Phone: «?3» - V»5- V - > 

Team fAxlFAfi>i)KJcM^X, BVID# / I / / V XRF Code BSOl 

Sample Number Lead Concentration Confirmation Sample 

__L^3- f l Yes El No C ^p.^c.PKy^" mit ^ Jjifl ^ ppm 

ppm F3 Yes D No la ^^4- ppm 6 ' Yes • No la 3 ^ 8 ppm ^a Yes No S n^C/- ppm 02^ Yes • No EI 

ppm Yes • No C3 

ppm Yes No • • 

RYASCPLA-19114 

136 ppm 

^ 

^RI'"- ^'Af^ 

xC } - fcl .2^ ^? t2. ^ 

f/f-ryo 

• ^ 

-f ^ 

(17^4^ 

^ : 

;0«nK 

% 

i

L 

j ^ 

^ ( 

^ - £2 

C323 t>^/><jf\ 

5^ 0-7 S t ­
COASTA l 

•/ y INVIRONKINTA l 

C I 0 U P IH C " t PHO-'t*' 

Consent for Access To PropeFty 

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: V Cl I it I 

Owner's Name: Daytime Phone: 

\Kn-ief uy>rMaeAddress of Property 

covered by this 

Agreement: 

.- z n s-< 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be perfonned, the Grantor will have an 

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

before it begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

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

agrees to: 

Page 1 of 2 
_^>_".V^ 

V ^ COASTA L ^ tNVUOHHEKTAL 

C It O U r I h 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; 

c Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

e 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 (402) 991-1199 

grant access to my properties D I do not grant access to my properties 

^ 

ihAAAz^ 

Signature Date Signature Date ^ 

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

Page 2 of 2 
c:^ 

COASTA L 

C n O h< r • M r 

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 puipose of assuring that restoration 

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

Protection Agency (EPA). 

PropertylD; JC ^ | L \ 

Property Address: \'-]^^ ^ < ^ . 2A~\ ' ^ 

Owner: (.o^py-^^-)C\nU p 

Pt.... ^0|a,a,-u-^^^ 

On the attached diagram(s) indicate area(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 

necessaiy. 

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

The lenoval, storage, oi&posal, and/or return of these itoms is the Owner s responsibility. 

ttem: 

ArMJlfMYVilll plyj/tk 

item: 

ttem: 

Item: 

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

Pagel of. 
€C -%. 

COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced_ 

ttem: 

ttem:

ttem: (_^ 

item: 

Item Quantity 

Pre-existing propeny 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. 

•

Aiint

.pr'i'l^l*.'

h i

! liiv'.ui

l skcicl

; 

i ol lllf k

Number of and size of 

each garden/ flower bed 

area. 

Atiiidi ;i skcirh 1)1 rc!;iii\c \ 

M;'fS nnd loc;iiiiMH 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\c(<- I'li' \Hltic ^\\\\ ni * 

iisi'c' 10 is;ui .1 'jliiii; 

voiiti'io: 1(1 lllf |;rci))crf> 

U" ner. 

Easement Area, to be 

excavated ^0 

, 

Landscape Inventory 

Unit Condition/Type/Species 

Quadrants 

Each 

Each 

Fflrh 

Each 

Square Feet 

$ 

Each Y-OA^y? 

/ 

Page 2 of. 
COASTA L 

O tl O U P . I *• c 

< Addttionai Comments / Instructions: 

^iChec k the tx)X if Owner does not want CEG to document interior foundation walls and possible 

/ pre^lsting damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

I agree Q I do not agree 

•kJ/2^A Ih7/,~t)9 PyfMomh ll/^/ca 

Owner''ss Signatur Signaturee Date Centractor's Signature / Date 

Page 3 of. 
BVID tijAm 

XRF PROPERTY SAMPLE SHEET 


1770 ^ . -zn 5-fam/pm 

30 sec 

Reading Sample area 

5C*''t2­ f\ 

5ti^-l 2 Depth 

6 3 ^-1 ^ 1 3 " 

 ,gc; t l 2 

Reading Sample area 

/ f; ^ i H P^ 

/^•zt z-z. Depth 

75/ ^ ' ^ IV 

if^n trLt 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Date 

Project 

XRF ID# 

Shot# 

^ o o 

H o t 

c(0 ^ 

Average 

Shot# 

"5^^ 

3 3 0 

331 

Average

Shot# 

Average 

Shot# 

Average 

/^'j;-o q 

Omaha Lead ARRA . 

^^012 ^ 

Reading 

/^ t -^ \^ 

l^%t '2-0 

/5G ' '2-0 

/^fc-zo 

Reading 

q i ' )Z 

^ S ^-' 2 

-^5i^-»e 

^ / -^ 1 ^ 

Reading 

Reading 

Sample area 

^(y\ 

Depth 

I " 

Sample area 

F^ 

Depth 

/D" 

Sample area 

Depth 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Signature ^BM - Print i^U^bo-ti^Cnwg/i 

Address 

Sample time 

sample length 

Shot# 

3 2.f: 

•z,Z.G 

3Zn 

Average

Shot# 

^ O ^ 

^OS 

^ 0 6 

Average 

Shot# 

Average 
M 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, I^A 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 157.354 

Supervised By: 

Certificate of Verification 

407 

'-.'.. 'i SOIL 

2010-02-11 17:09 

90.98 

Final 

Avg of 404-406 

1720 S 27 St. 

DZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 20.525 
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 158.362 

Supervised By: 

Certificate of Verification 

404 

SOIL 

2010-02-11 17:08 

30.59 

Final 

19114 

1720 S 27 St. 

DZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 18.982 
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 162.456 

Supervised By: 

Certificate of Verification 

405 

SOIL 

2010-02-11 17:08 

30.17 

Final 

19114 

1720 S 27 St. 

DZ 

13 

O: BARAJAS 

1 

1 

± Error 

± 21.645 
V 

•o 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 406 

Mode SOIL 

Time 2010-02-11 17:09 

Duration 30.22 

Sequence Final 

Flags 

BVID 19114 

ADDRESS 1720 S 27 St. 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 151.244 ± 20.949 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 403 

Mode SOIL 

Time 2010-02-11 16:54 

Duration 90.52 

Sequence Final 

Flags 

AVERAGE Avg of 400-402 

ADDRESS " 1720 S 27 St. 

QUADRANT EM 

DEPHT 1 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 136.372 19.578 

Supervised By :%!Wj!|/tX> 
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 135.744 

Supervised By: 

Certificate of Verification 

400 

SOIL 

2010-02-11 16:53 

30.17 

Final 

19114 

1720 S 27 St. 

EM 

1 

O. BARAJAS 

1 

1 

± Error 

± 19.482 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 401 

Mode SOIL 

Time 2010-02-11 16:54 

Duration 30.19 

Sequence Final 

Flags 

BVID 19114 

ADDRESS 1720 S 27 St. 

QUADRANT EM 

DEPHT 1 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 138.013 ± 19.712 

Supervised By: 
# • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 402 

Mode SOIL 

Time 2010-02-11 16:54 

Duration 30.16 

Sequence Final 

Flags 

BVID 19114 

ADDRESS 1720 S 27 St. 

QUADRANT EM 

DEPHT 1 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 135.359 ± 19.540 

Supervised By: 
Thernno 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 40.794 

Supervised By: 

Certificate of Verification 

332 

SOIL 

2009-12-05 15:47 

92.67 

Final 

Avg of 329-331 

1720 s 27 st 

F2 

10" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 11.721 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 329 

Mode SOIL 

Time 2009-12-05,15:46 

Duration 30.78 

Sequence Final 

Flags 

BVID 19114 

ADDRESS 1720 s 27 st 

QUADRANT F2 

DEPHT 10" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 41.224 ± 11.809 

Supervised By: 
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 42.760 

Supervised By: 

Certificate of Verification 

330 

SOIL 

2009-12-05 15:47 

30.50 

Final 

19114 

1720 s 27 st 

F2 

10" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 11.828 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 331 

Mode SOIL 

Time 2009-12-05 15:47 

Duration 31.39 

Sequence Final 

Flags 

BVID 19114 

ADDRESS 1720 s 27 st 

QUADRANT F2 

DEPHT 10" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 38.398 ± 11.527 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 328 

Mode SOIL 

Time 2009-12-05 15:45 

Duration 91.77 

Sequence Final 

Flags 

AVERAGE Avg of 325-327 

ADDRESS 1720 s 27 st 

QUADRANT Fl 

DEPHT 10" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 54.786 ± 12.041 

Supervised By: ^AC;/]f^O.fPA ^ 
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 56.426 

Supervised By: 

Certificate of Verification 

325 

SOIL 

2009-12-05 15:44 

30.85 

Final 

19114 

1720 s 27 st 

Fl 

10" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.164 
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 55.336 

Supervised By: 

Certificate of Verification 

326 

SOIL 

2009-12-05 15:44 

30.53 

Final 

19114 

1720 s 27 st 

Fl 

10" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.131 
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 52.596 

Supervised By: 

Ceitificate of Verification 

327 

SOIL 

2009-12-05 15:45 

30.39 

Final 

19114 

1720 s 27 st 

Fl 

10" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 11.828 
(A Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTAL • NVIIOmilllTAL 

c lour , m c 

EXECUTIVE SUMMARY: 

BVID #19114-(1720 S 27 ST) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
4

t 

EPA Property Close Out Form 

Property #: 1^ 1/ i

 V^^.'A'^&i^r^^ ^ 

Dnte/Tlme: Owner's Name: ,nj , 

Quads Excavated: Contractor Group. 

Excavation General 

I. If necessaiy, vtrere the correct quadrant(s) excavated and restored? 

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

Grading Sod and Vcgelatton 

I. Does Ihe greding around the perimeter ofthe house in excavaied areas generally slope away 

from the liouse? 

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

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

day time period) 

4. Are sodded areas genetvlly firm and evenly graded? 

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

time period) 

6. Was the property graded such that water will not pool on the propeny? 

7. Was damage to landscaping or plant materials avoided? 

Gates. Fences and Reuining Walls 

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

2. Were all gates or fences taicen down during restoration aclivilies reinstalled? (If applicable) 

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

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

Foundation, Siding aad Gvtters 

I. Was damage to die siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Drivtways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to waOcway surftces avoided? 

Yes No 

/ 

/ 

Yes No 

/ 

i y > 

A 

y 

A 

A 

A 

Yes No 

A 

y 

y 

i / 

Yea No 

J 

J 

A 

A 

A 

Yes No 

/ 

A 
% 

Ort'oers comments: 

[ 

pgnspection notes: 

Removal and resloratlon activates complete including the 30-day sod warranry: 

EPA Representative ^ ^ Date: !:!L* __ 
• 

Property Completion Agreement 

This agreemenl documenls lhe complclion of remedial aclivmes perrorined on my property My signalure 

will designate Ihal I am satisfied wilh lhe restoration of my propeily. and Ihal no items are in questions, 

now, or al any lime in fhe ftilure, excepl Ihose ilems listed below, ifany I 

Property ID: | (^ ) ( ^ 

Property Address: iHOr N S 7 "^ "^^4--

Owner: (jj^^W r Ix^lAJCr Q 

Phone: q^a^q-7C ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Commenls: 

l/\ l Agree ftxtoralion ix completed, except as noted 

[_J I rio not a|>rec restoration is completed 

Owner's Signaturr Date Cb,ontrarlor' i $ Signature Dale 
i^ 

f'ropertv Ov/ner Setisfadion Survey 

Omaha Lead Superfund Sit DEC 29 » 

2008 

Remediation Contractor:. Coastal Environmental Group SUPERFUND DIVISION 

Property Identifier fVumber: ) A \ \'~\ 

Property AriHri>«: P?< 0 .' ^ 2 1 ^ 

Property Owner's Name:(lin[-tfv \Mfi\Ay^(( ^ 

(above information to be filled out by remediation contractor prior to delivery o( form lo Properly Owner) 

Instructions to Property Ow^rier; 1 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the work performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's work by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner) 

[s-ie ^ "excellent" 

7:8 "very good" 

5-6 "acceptable" 

3-4 "poor" i 

1-2 "very poor" 

I 

Property Owner's Satisfaction Rating Regarding Contractor's Work 

5 ^10 

A 9 

3 8 

2 7 

1 6 

Additional Commet^^ fronvPH>fierty^<jmcr(optional: continue to back of page if needed) 

^^P . 

Property Owner's Signature: 3. D.U: / > ^^-^ O "T