f 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#:_SMSL _ Date: ;x]^^\t>^ 

Address: ^ U ^ t^ 5 0 h\/<2 ^ 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 prg.-.^r.iJ/?Jieyi^ {yYCaJAMm^ fKLcJ Sd d 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

D 

&Cajf^ ^ m 

"Signature" ^ % / 

^<^^fij^ ^ Wimi 
% 

Property Access Checklist 

Property ID: £^|q^g > D WORK STARTED ON: / /_ 

Property Address: QAT - hsic 

n WORK COMPELTED ON: / /_ 

L^"i:lcYxJBDCclarr Renter: 

Address "^PrmC Phone: 

Fax: 

Cell/Pajjer: 

Phone: ^^^ - jg^ ^ Additional Information: 

Fax: 

Cell/Paser 

1 n Notification Letter Sent: / / By: 

1 0 Access Ajjrecnicnt Signed: ^/i/O S By:^C 

j 0 ^ Re.storation A<«reement Signed: X/fi_/a ^ By: ^ 

1 1 Topsoil Samplin<; (ifapplicable) / / By: 

O Disposal Sampling (if applicable) / / By: 

• Garden Saniplin» (if applicable) / / By: 

n Utility Clearance Called: / / By : II 

0

n

 Vi<leo/Photos (Before) 

Video/Photos (During) 

On:

On:

 °\ /

 /

 t / (K 

/ 

B.v:llt^l/t6 

By:

/^'^ II 

1 

n Vi<lco/Phot<)s (After) On: / / By: 

n Video/Photos (3(>-Day) On: / / By: 

n Pi*opei-ty Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air IVIonitoring (as ap|)licable) 

I I Community CH Crew On: / / Bv: 

Results: 

I I Community LJ Crew On: / / Bv: 

Results: 

d l Community [U Crew On: / / Bv: 

Re.sults: 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

g-onaU

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 51^?; ^ 

^0 > M "^D (\^^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

 M5\ - \?.-^^ ^oe, I-TM - 7^7.f^<v 
Douglas County Account I nilMai ation Page 1 of 3 

Dougla s County , Nebrask a Propert y Recor d - R075340000 2 

Print Report 

NEW Feature - Parcel Dimensions available ( > scale 0-50 ft west of 90tti St - Vie W OP Ma p Information is valid as of 2008-6-19 Treasyrer!s Tax Report 

New Feature Auto Sales Search 

Owne r 

BOECKER RONALD F 

ETAL 

10910 JOHN J PERSHING DR 

OMAHA NE 68112-0000 

Propert y Informatio n 

Key Number: 5340 0002 07 

Account Type: Residential 

Parcel Number: 0753400002 

Parcel Address: 907 N 50 AV 

OMAHA NE 68132-0000 

Legal Description: CARTHAGE ADD LOT 12 BLOCK 17 LTS 11 & 12 100 X 126 

Valu e Informatio n 

Land Improvement Total 

2008 $9,300.00 $92,200.00 $101,500.00 

2007 $9,300.00 $92,200.00 $101,500.00 

2006 $9,300.00 $70,000.00 $79,300.00 

2005 $9,300.00 $70,000.00 $79,300.00 

2004 $9,300.00 $70,000.00 $79,300.00 

2003 $9,300.00 $70,000.00 $79,300.00 

Sales Informatio n 

Sales Date: 2005-06-15 

Deed Type: WD Book: 2005 Page: 070916 

Price: $106,500.00 

Grantor: MICHAEL G GOLTER 

Grantee: RONALD F BEECHER ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1998-04-29 

Deed Type: Book: 2091 Page: 130 

Price: $77,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 7/17/2008 
Douglas County Account Information Page 2 of 3 rorma 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.28 12600.0 1.0 126.0 100.0 No 

Improvemen t Informatio n 

Building 1 

Verified ;^ ^ Ra^ch 

> 

l>120-S<| Ft 

r^r' 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 912.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Ranch 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: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 0% 1920 87 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 888.0 

Fixture Base Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 7/17/2008 
Douglas County Account Infonnation Page 3 of 3 

Fixture Bath Full 1.0 

Porch End Screen 96.0 

Porch Slab Roof Ceil 'i

 128.0 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 7/17/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2098688. 

Original Call Date: 

Work, to Begin Date: 

8/04/08 

8/07/08 

Time:

Time:

 7 

7 

11 pm 

15 am 

Op: ELIZABETH187 

State: NE 

Address: 907 

County: 

Street: 

DOUGLAS 

N 50TH AVE 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 18-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY ALL THE WAY TO THE STREET. 


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

: tJNStJRE 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 

Involves Tunneling or Horizontal Boring : N 

Front: Y

Explosives: N 

 Rear: 

ALT872 ATTNEBRl CXCATV MCLEODNE 
 MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number 

UtiUty 

Type 

ALT872 WINDSTREAM 

COMMUNICATION NA 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

/-v/- A T^/

CXCAIV

 COX COMMUNICATIONS, 

 ^ ^ HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/4/2008 
Page 2 of2 

MUDOl 

OMAHACOF 

OPPDGPR5 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

EDWINA 

RON 

NA 

 NA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/4/2008 
As-Built Drawing 

COASTA

ENVIRONMI NTA

L 

L Omaha Lead Superfund Site CROUP . IN C 

$«=^8S 

Omaha Exterior Paint Nkjrth Arrow Lead Site Owner Name: RcnQ/cj f OoQcJ/^ T 

Site • Good Sketch Address: '=^q2_l± . ^ 9 .:^15i:. 0 Poor Phone: H; y^/ - fSJSy^JSJ-Qa^ G r~| Not paint 

Sampl Lead Sample Samples Collected e Numbe r LAB Concentration Collected Firm: »V\<-S c>t^f(^C 

RYASCPXA .57^5 8 Fl IWO ppm 0 Date: ^(bjo^ -

RYBSCPXA-57^5aa F2 _LTa__Pp m a Time: '2 : $ S r»yv^. 

RYCSCPXA-^-/^8a Bl R 5 ppm uar n Samples Analyzed RYDSCPXA-tf-Z^ag 82 9fil ppm D 

RDZSCP-KA-Pf ISQ Q DZ 11 y>o ppm nr D XRF Unit: lOO V Book: ILo' ^ 

«eZS€PJ<A- -G2 ppm n n Date: /?-/$ • - d37 

RPZSCPXA. -E2 ppm D Time: /^r m 

Staff: /^hty ^ Number of Samples • 

OLS#:S1988 

[ late Excavated: 9/16/08 

Date USEPA Signed Off: 1/28/09 

Area Sodded 2119 sq ft 

Omaha Lead Site 46130 

Legend 

Concrete '/jf 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 Environmental Group Inc . 
5<^SS 

Omaha North Arrow Lead Site Exterior Paint 

Owner Name: Ronal d OOQCMe r • Good Site Sketch Address: ^O l »^ "SO AVJt­ ( 3 Poor 

Phone: ^:Mi-133 5 ^v T^I'QaZ Q Q Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: 

RVASCPXA-S'/SdQ F1 ISO ppm Ef Date: ^(b|ot» . 

RYBSCPXA-37^555 1^2 I I H ppm D Time; I2-. $s rio^. 

RYCSCPXA-^7^3a B1 R6 ppm D Samples Analyzed RYDSCPXA-5"/^<9g B2 9?M ppm n RDZSCPXA- ^/ ^ 5 ^ DZ iL-^O ppm XRF Unit: i00 7 Book: n /o? ^ 

RGZSePXA- G2 ppm D n Date: R - J i - 0 7 

RPZSCPXA. -EZ ppm D Time: i^/ O D 

Staff: /^ri*^ Number of Samples = ' ^ 

r'wjieef^c^ 

Omaha Lead Site -tite ^ur6 

tft^mC-viY 

46130 
^I^SS 

Omaha Lead Site Owner Name: 

Site SItetch Address:, ^0" 7 eo 

Phone: 

^¥Shi33S w: TSf'OC^G 

Sample Number Lead 

Concentration C 

Sample 

Collected LAB 

RYASCPXA- S-/3QQ F1 14 O Dom 

RYBSCPXARYCSCPXA 

RYDSCPXA 

RDZSCPXARGZSCPXA­

£'/36a 

f/saa 

s'/saa 

£r/3ae 

F2 

81 

82 

DZ 

« 2 

II H 

A6 

qfti 

I130 

.ppm 

.ppm 

.ppm 

ppm 

ppm 

cr 

wr 

D 

D 

D 

n 

D 

RPZSCPXA. -EZ Dom n D 

Number of Samples = 5* I n

Exterior Paint North Arrow 

• Good 

0 Poor 

• Not paint 

Samples Collected 

Firm 

Date 

Time '2: $ S if?yv^. 

Samples Analyzed 

XRF Unit: /00 7 Book: /(o ^ 

Date: R-/i'0 7 

Time: Ah n 

Staff: Wru ^ 

Omaha Lead Site 46130 
A 

COASTA L fMVJtONNlMTAl 

Consen t For Acces s T o Propert y 

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: Daytime Phone: 

Address of Property K)^ 5 0 y/v 

covered by this 

Agreement: milPURPOSE 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 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 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 
COASTA L tHVIIONHfNTi t 

e V o u r in c 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• if the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (712) 352-0188 

I ^s l grant access to my properties 

Q I do not grant access to my properties 

h/ii::>-^ 

Signature Signature Date 

Q I would like to be present during any sampling that is required. 
C O A S T A I 

Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: s w 

Property Address: qfy-) |^\ ^ ' ^ l ^ j 

Owner: f-oh Uic\^ 

Phone: (^^^- i ^ f­ On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

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

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

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

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these iiens is the Owners responsibility 

Item: 

^^^c^Mit i \ \T^c ' ^ 

Item: / 

Item: ^ ^ 

Item: ^ ^ 

Item: 

/ 

Item: y ^ 

Item: ^. ^ 

Item: ^y ^ 

^ 

Page 1 of. 

L 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

tfimif^ f//t^r> li ^ Umn^ 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of c
C O A S T A I. 

Items To Be 1Remove 

dBy ( [Contractor Durinq Remediation And Replaced 

(Use a( jditional sheets as necessary) 

Kem: 

)V)\;L ^ 

rtem: 

^01 L 1?^ 

y ^^' ^ 

Item: 

^<7l ^ \ ^ ^ ^ 

Item: 

1 ) 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

rtem: / 

Item: / 

rtem: / , 

Item: / 

rtem: 

/ 

Page 3 of k 
1 

COASTA L 

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. 

Attach a sketch of the 

sprinkler laxout. 

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 

Each 

^ 

'h 1 Each 

i 

Each 

\^0 t? 

Each 

Square Feet 

> 

Page 4 of. 
COASTA L 

Item 

Agreed upon value of 

plant inaterials nol to be 

reolaced bv contractor. 

Note this \alue will be 

used to issue a plant 

\oucher to the propert> 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of s^ere 

each plant will be placed 

b> the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced \^ ith 

grass sod. 

Area of Cit) or County 

property to be landscaped 

per their requirements. 

Include a -keiclr ol' tlie 

area (si 

Easement .Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

t s 

\^Jl(^)^ 

Each 

H 

SF 

%UKb\i 

SF 

i 

SF 

1 

Pages ».-t 
C O A S T A t. 

Additional Comments / Instnictions: 

l(A\ 

k^f^h ph^'w (^m^t 

Q Check the box if Owner does not want CEG to documerrt interior foundation walls and possible 

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

interior of house, induding fourxlation cracks or fissures. 

agree Q I do not agree 

^ ^C^ffi^A^ :s/n 

:f*sSigiuiture Date Contractor's Signatare Date 

PageSof. 
Date 

Projecl 

XRFID* 

Shot# 

(j> 

W 

M 

Average

Shot* 

l / p 

' 7 

1 / ^ 

(^^ 

Average

Shot* 

Average 

Shot* 

Average 

lab sample * 

BVID#5J3SS 

XRF PROPERTY SAMPLE SHEET 


q-ii^-os ^ Address qo n K^. -H^)-^ Au-p, Omaha lead FP 2nd year opilon Sample time am/pm \'^\^' ^ 

r-SQr^Aq sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

pA-BS i lo-i-7^ i \ 4^.<Q| ± q n ^ 

Z-O./.i i)»,^ ^ ^ 4?3.Aeh^.S' ^ 

' ^ b^ 

i?^.a« l l\V O Depth 15 ^3-^0^^9.7 ^ Depth 

^'^•HfttlO--?'^ — ^ n ^.c^ t p.q i l< ^ 

 {o l ^^ ± llOQ ^ Average ^ \ .0<=i t ^ .^S Q 

Reading Sample area Shot* Reading Sample area 

a^qitsas 

-VJ r>';* q.q ^ ^oJ^* ^ 

[ai <^b>t iD-^ a Depth Depth 

^TUSi l ---t.^iD I 

 ^\Jp8 t ^..Lg< 9 Average 

Reading Sample area Shot* Reading Sanrtple area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg 

Signature, 

Prinl AJ' i cofcL.^ / ^yye-Z ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 6 

Mode SOIL 

Time 2008-09-16 13:55 

Duration 30.05 

Sequence Final 

Flags 

BVID # 51988 

ADDRESS 907 N 50 ave. 

QUAD/ZONE B2 

INSPECTOR lopez 

DEPTH 6 

SAMPLE Pr'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 64.849 ± 10.641 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 72.606 

Supervised By: 

Certificate of Verification 

7 

SOIL 

2008-09-16 13:55 

30.53 

Final 

51988 

907 N 50 ave. 

82 

lopez 

6 

CLEARANCE 

± Error 

11.233 
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 68.479 

Supervised By: 

Certificate of Verification 

8 

SOIL 

2008-09-16 13:56 

30.36 

Final 

51988 

907 N 50 ave. 

B2 

lopez 

6 

CLEARANCE 

± Error 

± 11.103 
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 63.483 

Supervised By: 

Certificate of Verification 

9 

SOIL 

2008-09-16 13:57 

30.47 

Final 

51988 

907 N 50 ave. 

B2 

lopez 

6 

CLEARANCE 

± Error 

± 10.741 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 10 

Mode SOIL 

Time 2008-09-16 13:57 

Duration 121.41 

Sequence Final 

Flags 

AVERAGE * Avg of 6-9 » 

ADDRESS 907 N 50 ave. 

QUAD/ZONE 

INSPECTOR lopez 

DEPTH •.6 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 11 

Mode SOIL 

Time 2008-09-16 13:58 

Duration 30.04 

Sequence Final 

Flags 

BVID # 51988 

ADDRESS 907 N 50 ave. 

QUAD/ZONE DZ 

INSPECTOR lopez 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 46.208 ± 9.793 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 42.421 

Supervised By: 

Certificate of Verification 

12 

SOIL 

2008-09-16 13:59 

30.59 

Final 

51988 

907 N 50 ave. 

DZ 

lopez 

12 

CLEARANCE 

± Error 

± 9.536 
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 42.692 

Supervised By: 

Certificate of Verification 

13 

SOIL 

2008-09-16 13:59 

30.38 

Final 

51988 

907 N 50 ave. 

DZ 

lopez 

12 

CLEARANCE 

± Error 

± 9.787 
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 33.048 

Supervised By: 

Certificate of Verification 

14 

SOIL 

2008-09-16 14:00 

30.33 

Final 

51988 

907 N 50 ave. 

DZ 

lopez 

12 

CLEARANCE 

± Error 

db 8.969 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

15 

SOIL 

2008-09-16 14:00 

121.34 

Final 

TAVJ of ll-14i«i j 

"907 N 50 ave. 

wz 

lopez 

12 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 16 

Mode SOIL 

Time 2008-09-16 14:01 

Duration 30.41 

Sequence Final 

Flags 

BVID # 51988 

ADDRESS 907 N 50 ave. 

QUAD/ZONE easement 

INSPECTOR lopez 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 43.966 ± 8.926 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 54.065 

Supervised By: 

Certificate of Verification 

17 

SOIL 

2008-09-16 14:02 

30.40 

Final 

51988 

907 N 50 ave. 

easement 

lopez 

1 

CLEARANCE 

± Error 

± 9.922 
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 61.260 

Supervised By: 

Certificate of Verification 

18 

SOIL 

2008-09-16 14:02 

30.48 

Final 

51988 

907 N 50 ave. 

easement 

lopez 

1 

CLEARANCE 

± Error 

± 10.442 
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 47.425 

Supervised By: 

Certificate of Verification 

19 

SOIL 

2008-09-16 14:03 

30.42 

Final 

51988 

907 N 50 ave. 

easement 

lopez 

1 

CLEARANCE 

± Error 

± 9.200 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

20 

SOIL 

2008-09-16 14:03 

121.71 

Final 

Avg of 16-19 

907 N 50 ave. 

easement—, 

lopez 

1 

CLEARANCE 
^ - ^ ST^^ 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMENTAL 

CROUP . INC . 

EXECUTIVE SUMMARY: 

BVID # 51988- (907 N 50 AVE) 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

HOMEOWNER RECEIVED COMPENSATION FOR THE SUM OF $300.00 FOR PLANTS 

REMOVED DURING THE REMOVAL OF LEAD IMPACTED SOIL. 
1

.^EPA 

EPA Propert) Close Out Form 

Property «: ^\Q . ?0?^ Property AddrcM: ^Q l XT) ^Q^- ^ /^V^ ­

Datc/Tlroc: Owner's Namt: ^-g n ISoflCVgr " 

Quads Excav.ud: ^ ^ ^ VT^ ^ Coniracior Croup T-r^n. '/-^u'LV: r\y\ rnAVUL/V^ ^ 

Excavation General 

Ye* No 

 If necessary, >vere the correct quadrant(s) excavated and restored? 

^ 

2 If necessary, were Ihe correct areas of drip zone excavated and restored*^ y 

CradloK Sod and VcsctalioD Yes No 

I Does the grading around the perimeter of the house in excavated areas generally slope away 

^

from tbe house? 

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

< ^ 

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

day lime period) iy ^ 

4 Are sodded areas generally rirm and evenly graded? t ^ 

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

U ^ 

time period) 

6 Was the properry graded such thai water wil l not pool on ihe property'' U ^ 

7 Was damage to landscaping or plant materials avoided'' 4 ^ 

Gam , FeDccs and RCUIDID K Walls > es No 

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

2 Were all gates or fences taken down during resloration aclivilies rcinsialled? (Ifapplicable) rl 

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

4 Was damige to retaining walls avoided? (Ifapplicable) 

FouDdalioD, SidioK and Gutters Yes No 

1, Was damage to the siding or trim avoided? l / 

2 Was damage lo the foundation avoided'' 

l y 

3 Was damage lo windows avoided? 

L-^ 

4. 

Was damage to windows or door screens avoided'' i.- ^ 

5 Was damage to downspouts or downspoul extensions avoided'' 

X ^ 

Sidenalka and Driveways (Concrete) Yes No 

Was damage to driveway surfaces avoided'' 

2 Was damage to walkvay surfaces avoided'/ ^ 

l . i i- \ i\\ . ly i V :5^iii.a i I V >. /

1 
Property Completion Agreement 

This agreemenl documenis Ihe complclion of remedial aclivilies perloimed on my properly. My signaluie 

will designate ihal I am salisfied wilh Ihe restoration of my properly, and ihal no items are m questions, 

now, or al any lime in ihe fuluie, except Ihose items listed below, ifany 

Property ID ^- j C^i^t^ 

Property Address: q Q ^ ^yj ^^•U . ,|<\ ^/ ^ 

Q-""^c.o i^r^e r" 

^^°-^9^-/9^-<;-

Restoration Items in Question 

Item; 

Item: 

Item: 

Item: 

Item: 

Item; 

Additional Comments: 

-j ^ If^J I ayrec r c,<;roralion i.s completed, except us noted 

 I I do np)-imiec restoration is compleled 

'Jh/M 

iici 's Si^n*rrtre m\fi' Cond actor's Sipnahirc Date 

I
Property Damage Settlement 

Property ID 51988 

Property Address 907 S 50'" St 

Owner Ron Boecker 

Phone 402-699-1955 

I have received from the contractor, Coastal Envirorunental Group Inc. (Coastal), the sum of $ 300.00 as 

compensation for plants removed from the drip zone while removing lead impacted soil from the 

property. 

Check Number 1518 

Value of Check $300.00 

Made Out To Ron Boecker 

Description of Miscellaneous Settlement 

Coastal accessed the property at 907 S 50'^ St. to removed lead impacted soil. During excavation at this 

property all the small plants that were lotDated inside the Drip Zone were removed and discarded. Coastal 

and the PO have agreed that $300.00 is fair and sufficient compensation for these plants. The PO will 

replace the plants to pre-existing conditions at his/her own leisure. 

My signature below is acknowledgement of tlie receipt of the suin listed above, which I further 

acknowledge to be fair compensation for the miscellaneous settlement described above and release 

Coastal Environmental Group Inc from further obligations or liability related to this settlement. 

31910^1 

L.- ^ wrier's Signature Contractor's Signature Date 

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