TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 31A?> ^ . Date: -^^jj^/nQ 

Address: ';^^3^ ^ \-\aV^-\vna n KylP 

Remediation Contractor: _Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

40314801 

Executive Summary iiiili y EPA-provided property sketch Superfund 

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 

y Photographs Prg.- ^^.g^jAovx^ lU/LCjM^lS/l^ \^A£XsoA. I 

As-built sketch 7 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

y Description of areas not meeting ROD cleanup criteria 

Utility clearances 

y Property information from Douglas Coimty Assessor's Office 

* / -pvryu 

D 

A g//^/y Ignature Date" 

(0/^/07 y^fa^AiS:^''^^ 
Property Access Checklist 

PropcmID: ^ ^ C^ ^ q D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON: 

/ / 

|0^vncr:^^^^y^^^ ^ 

Address: 

Renter 

Phone: 

Phonc:^^^\^,^P)^ ^ 

1 Fix: 

Cell/Pager. 

FiLv: 

Cell/Pager: 

Additional Inlormiition: 

•

ffl

^

1 O

[ 3

•

I CS

E '

O

D

 Notincation Letter 

 Access Agrcemcnl 

 Restoration Agreement 

 Topsoil Sampling (if applicable) 

 DisposaJ Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

[ Sent: / / 

Signed: _[i/JJ/i2 & 

Signed: ii/12/. ^ 

/ / 

/ / 

/ / 

Called: jX/I£i/ ^ 

On:U_/X3.'J)3 

On: / / 

On: / / 

By:

By: 

By: 

V^^^^O-OITS*^

\ ^ a PiVO-^

By:

By: 

By:

By: 

By: 

\'\\G^\i'^9, 

x\v va t\

By:

By: 

 T^' G ^ 

 Br't^^ 

1 

1 

1 

\ 

1 

D

D

 Video/Photos (30-Day) 

 Property Completion Agreement 

On:

Signed:

 /

 /

 / 

/ 

By: 

By: 

D Fin"l Report Issued: / / By: 

Air Monitoring (as applicable) 

C ] Community • Crew 

Results:

On: / / 1 

| 

1 1 ComraunitA'

Results: 

 CJ Crew On: /

?i 

/ By: 

• Community

Results: 

• Crvw On: / / By:

-x­ .

 1 

1 

Omaha Lead Site 
Propeny ID #

PropertA' 

Address: 

Inilial Contaci: 

Second Contaci: 

Final Conlact; 

Final Action: 

Comment 

ONvner 

Commeni (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

37^3 ^ 

2^d30_J:krhmnJt^ 

Date. Time: Action: 

Date: Time: Action: 

Dale: Time: Action: 

Transmit to EPA D Other Action: D 
Douglas County Account Inf<^|^tio x|^ t n Page 1 of2 

Douglas County, Nebraska Property Record - R1748010000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w Ofl Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ^ - • -> Auto Sales Search 

Owner 

HILL SHARLET A 

2430 HARTMAN AVE 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 4801 0000 17 

Account Type: Residential 

Parcel Number: 1748010000 

Parcel Address: 2430 HARTMAN AV 

OMAHA NE 68111-0000 

Legal Description: MILLER PARK PLACE LOT 8 BLOCK 0 50 X 128.7 

Value Informatio n 

Land Improvement Total 

2008 $2,600.00 $40,200.00 $42,800.00 

2007 $2,600.00 $30,200.00 $32,800.00 

2006 $2,600.00 $30,200.00 $32,800.00 

2005 $2,600.00 $30,200.00 $32,800.00 

2004 $2,600.00 $27,300.00 $29,900.00 

2003 $2,600.00 $27,300.00 $29,900.00 

Sales Informatio n 

Sales Date: 1994-06-27 

Deed Type: Book: 1981 Page: 587 

Price: $29,590.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6450.0 1.0 129.0 50.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 7... 11 /4/2008 
-nr—niTT^u ;• ^ ~-'W^'^-'^~^'~ 

Douglas County Account Inf J|^tio n Page 2 of2 l ^ t 

Building 1 

2430 HARTMAN AV 

2ff.0 acr r 

b 

cvi 

OettcMed 

2400sq.a Slab Roof Ccamg 

28 Kl* 20.O' 

b First Floor 

HOOOsq tt 

Bsr)ntBiod<8n 

HOOOsq n 

RANCH 2&.0' 

Slab Roof Ceiltng 161 sq.ft 

CLICK TQ ENLARGE jMAQE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1100.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Battis: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

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 

1905 1993 0% 1905 103 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1100.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 240.0 

Porch Slab Roof Ceil 161.0 

Porch Slab Roof Ceil 24.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 7... 11 /4/2008 
.*>•'"' ' Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2177219. 

Original Call Date: 11/18/08 Time: 7:19 am Op: ELIZABETH18790 


Work to Begin Date: 11/20/08 Time: 7:45 am 


State: NE County: DOUGLAS Place: 0M7UIA 


Address: 2430 Street: HARTMAN AVE 


Tv/p: 16N Rng: 13E Sect-Qtr: 33-SE,34-SW ,: . 


Twp: Rng: Sect-Qtr: ' / 


Legal Given: C , , 


Type of Work: Omaha Lead 


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


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


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 


CXCATV 

SPRNTPCS 

MAGELLAN METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number UtiUty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP

" .

 TONYA

 -

Day: 9185747098 

 Alt: 

 Emerg: 9185747098 

METRO METRO COMM. COLLEGE CHRIS

Day: 4024572307 

 Alt: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/18/2008 
Page 2 of2 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNE1C QWEST LOCAL NETWOIOC NA Alt: 

Emerg: 8887289343 

Day: 4025371800 

SPRNTPCS SPRINT SPECTRUM L P Alt: 4025371810 

Emerg: 8005210579 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/18/2008 
As-Built Drawing ^ 

COASTA L Omaha Lead Superfund Site 

934 

Omaha Exterior Paint Lead Site r Owner Name: SHARLET A HILL 

Sit • Good e Sketch Address: 2430 HARTMAN AV 

QPoo r 4

Phone: »-iSI-(>796 W- Q Not paint 

Sampl Lead Sample Samples Collected e Nunnber LAB Concentration Collected Firm: 

RYASCPXA-37934 F1 ___2J^pp m D Date: lo -i-i - o s - RYBSCPXA-37934 F2 2. f 7 PP"' S ' D Time ^ Oo A ^ : 

RYCSCPXA-37934 B1 -gZZ ppm 

B' D Samples Analyzed RYDSCPXA-37934 B2 53 5 PPrn 0' D

RDZSCPXA-37934 DZ 3 1 2-5" ppm IT D XRF Unit: 103 7 Book: /3 3 

RG2SCPXA-37934 GZ H(o3 ppiT^ 0' D Date: ll-lb-oS " 

RPZSCPXA-37934 PZ 2-?5 ppm D Time: f^y l 

Lab RPZSCPLA-37934 Staff: ^A 

Result 400 ppm 

OLS#: 37934 

Date Excavated :11/2^Md^ ^ 

Date USEPA Signed OVfAilUfS^ 

Omaha Lead Site 46130 

Legend 

Concret e Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod ^ ' 

Area replaced with 

Rock/Mulch Area left bare 

Contract #: EP-R7-07-05 Coastal Environmental Grovip Inc. 

4 

^^C> l 

'T H^\ 

Omah Exterior Paint North Ar Owne a Lead Site r Name: SHARLET A HILL • Good Site Sketch Address: 2430 HARTMAN AV (3(='oor 

Phone: »HSl-^79 & W: Q Not paint 

L

Sample Number 

RYASCPXA-37934 F1 

RYBSCPXA-37934 F2 

RYCSCPXA-37934 B1 

RYDSCPXA-37934 B2 

RDZSCPXA-37934 DZ 

RGZSCPXA-37934 GZ 

RPZSCPXA-37934 PZ 

Lab RPZSCPLA-37934 

 Result ^ ^ 400 ppm 

Lead 

Concentration 

2-Ht> ppm 

ZI 7 PPf" 

"^2.2. ppm 

S3 5 ppm 

3 f 2.5* ppm 

^63 ppm 

g.^ 5 ppm 

Sample 

Collected 

IT 

Q 

Number of Samples = \ (o 

LAB 

D 

D 

D 

D 

D

• 

Firm: 

Date . 

Time; _ 

XRF Uni 

Date: _ 

Time: _ 

Staff: 

Samples Collected 

P£ A\T 4 t 

\o in - 05­ ' I 0 0 .A.'vv 

Samples Analyzed 

t: 103 1 Book: 

Prv i 

^A 

Omaha Lead Site 

G.O^S»>i.ilrAt\T~ 
/ / 

q^ol 37934 

r Owner Name: SHARLET A HILL Omaha Lead Site 

Address: 2430 HARTMAN AV Site Sketch 

Phone: H:^g/-^79 g W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-37934 F1 ^^ 3 ppm E^ D 

RYBSCPXA-37934 F2 2.17 ppm D 

RYCSCPXA-37934 B1 •g2Z ppm 0 " D 

RYDSCPXA-37934 B2 53 5 ppm D 

RDZSCPXA-37934 DZ 3 1 2.5* ppm [ ^ D 

RGZSCPXA-37934

RPZSCPXA-37934

 GZ 

 PZ 

^6 3

2.3 5

 ppm 

 ppm 

ET 

D 

D 

[ T 

Lab RPZSCPLA-37934 

ResuJt 4(X}ppm 

Number of Samples 

Exterior Paint North Arrow 

• Good 

gPoo r L 

Q Not paint 

Samples Collected 

Firm: PE M T 4 b ^ 

Date: lo m OS" 

Time; ^ Oo AT^ 

Samples Analyzed 

XRF Unit 10^ 1 Book: /3 3 

Date: ll-iy-OS T 

Time: Pr*1 

Staff: ^ A 

Omaha Lead Site 46130 

fiovS«!.rtTi»n."r 
37934 

Owne Omaha Lead Site r Name: SHARLET A HILL 

Site Sketch Address: 2430 HARTMAN AV 

Phone: ^ *^SI-^79 & W: 

Sample Numtjer 

RYASCPXA-37934 Fl 

RYBSCPXA-37934 F2 

RYCSCPXA-37934 B1 

RYDSCPXA-37934 B2 

RDZSCPXA-37934 DZ 

RGZSCPXA-37934 GZ 

RPZSCPXA-37934 PZ 

Lab RPZSCPLA-37934 

ResuK 400 ppm _ 

Lead 

Concentration 

^*V 3 ppm 

2.17 ppm 

"^22. ppm 

S3 5 ppm 

3 1 2.5 ' ppm 

H(ff 3 ppm 

g.^ 5 ppm 

Sample 

Collected 

ET 

0 -

0 " 

0 " 

[ ^ 

D 

Number of Samples = ; ^ 

LAB 

D 

D 

D 

D 

D 

D 

/ 

• ^ & " " 

:6r ^ 

t: 235 

555 

6i: : o 

S 

5 ^ 

DZ. i=3»45 

C 

dX 

kJ^JK.,. 

Z^3 2/ 7 

— ^ .ik 

UAA-TAAA/J : AV 

Exterior Paint North Arrow 

• Good 

l^p^oor 4 

• Not paint 

Samples Collected 

Firm P£ /v\T 4 b/gDate m OS- Time oo A-'*^ 

Samples Analyzed 

XRF Unit 1037 Book: J_33 

Date: _ ll'tb-os r 

Time: _ 

Staff: 

ENTERED 

:aCT B"» 

Omaha Lead Site 

46130 
» V 

COASTA L fNVltDNMINTAt 

C • O U P . IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

Owner's Name: Daytime Phone: 

^ii4^fp.f l-l-iLi ^0^''LflS-i^<^Df 

Address of Property 

covered by this 

Agreement: ^yjto jf^drriaA /l\7. 

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 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 "^1 — -jjj ^

 [MVrllOPiHriiTtl 

• 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 

"r^ ^ I grant access to my properties D I do not grant access to my properties 

SHgnature Date Signature Date 

O

 1 would like to be present during any sampling that is required. 
COASTA L a ' ' t NONM B NTA l 

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: 3:^^ ^ 

PropertyAddress:^<^3^ /^^/^^. ^ / ^ 

Owner: .^^^^^f//V/// 

I Phone: V ^ -/^^ g 

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

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

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

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

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

^x 

Item: V 

Item: / 

Item: X 

Item: / 

Item: 

/ 

Item: X 

Item: / 

Pagel of i f 
^ ^ ^ 

COASTA L rfMVINOMMflMTAl . 

c n o u p . IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Kem: ' 

Item: 

Item: 

Kem: 

Item: 

Item: 

item: 

Item: 

Item: 

Kem: 

Kem: 

Hem: 

Kem: 

Kem: 

Page 2 \A1J_ 
C O A S T A L 

C « O U P IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

\.;f'CrirS^'b-^ 

Item: 

'.W- r^^-K2'!)? 

Item: 

Item: 

Kem: 

Kem: 

Item: 

Kem: 

Item: 

Item: 

Kem: 

Kem: 

Hem: 

Item: 

Kem: 

Pages oiLo­
-— o 

COASTA L K*«>inONr«K M TA l OHOUP . IM C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that Square feet 

is covered with grass. 

Number of trees > 2 inch 

Each trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. Each 

Attach a sketch of the 

sprinkler layout. 

Number of and size of /^K ^ 

each garden/ flower bed 

area. Each 

Square Feet 

Attach a sketch of relative 

sizes and locations. 

Page 4 of te 
COASTA L (MViJiONrOHTA l 

C H O U P ( M C 

Item 

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. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Uriit Condit'on/Type/Species 

Each 

SF 

u^ 0ra>3 

SF 

^y SF -r^

o 

^Q^ J^Ae/^/^fG^ 

Page 5 of LL 
: O A S T A L M«*«OMMCMT*L « • W r . • M C 

D Chedc the box if Own ^ 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 O I do not agree 

'AAJyM/ //-/7-^ ^ frrA,f>(<?:. wlninx 

^wi

net''ss Signatur Signaturee Date Comractor's Signature bate 

Page 6 of ( C? 
Date 

Project 

XRFID# 

Shot# 

lAL\iA\j > 

^ULVt l

M^aH 

Average

Shot# 

tAfi­ ^ 

^\U^^ \

Average

Shot# 

(PO\ 9 

XoQk ^ 

Average

Shot# 

Average 

lab sample # 

BVID.Xffi^^ 

XRF PROPERTY SAMPLE SHEET 


VX-QVa-O-R Address SB^^jS^^K^v-e - Omana lead FP 2nd year opllon Sample time \l^-.Qis> am/pm 

aQt-^fs,Q sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

:Ci95>A3i^B-\\ HMSi 8SqutU.-) 3 

 ^-i^x-.\:!:\^^0 Jg£L ^A6Q ^T.l,Vi^.X( , &l ^ 

OLin .£»> ^ \R .qr<r Dept^^ <^A^^ r.r> n# Lvn^oft Depth 

-A^^M l«o.,.-^^lz.^ l i ^ 

 ^QtS^.^jU:! : ^ Q .Q ^ Average -y^;^ vc^ ^ \ rn ^ 

Reading Sample area Shot# Reading Sample area 

^<HA?.iio-:ia8 331 lyt.ut^^t i?yi.q 

^ l>r^ .^ftt^P.-O'? .QJ^^ ^ ^Hi/? l«4a . ^tiAt^ - 't>^ • Ha.Mfe^^ia-UJ Depth ^ \a/ ^ .?^^\^8v r Depth ^ M b 

h. ^ .J<>«:i3..^j ^AOlr ^ T • ^O - "^ A J 1 S I. |^ R .R^ b \^.?.- Q Average \?^^.(^ M t | 4 .Q.[ 

Reading Sample area Shot* Reading Sample area 

6t7£> •'^I'^i t .^oTj^ 

^^..f^ 4^^^H^t< - P^ 

Pi\ \ O.P>t.^O-^-s, Depth Depth 

i3U>4 l^^iaoQ^ ^ Zt?' 

 caR?>.feM :L^P.fS ^ Average 

RETEST AREAS 

Reading Sample area Sh0t# Reading Sample area 

Depth ^^.^"-^ ^ Depth 

/ y

 / / 

Average 

Lab result Sample area XRF Avg. ( 

Signature ^/ ^ ^ ^ 

P,)n, ^1V1# ^ M^TT^ ^ 

1 
~t -^T^,-!"^ -

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4450 

Mode SOIL 

Time 2008-11-26 13:29 

Duration 122.92 

Sequence Final 

Flags 

AVERAGE f Avg of 4446-4449 

ADDRESS 2430 hartman 

QUAD/ZONE # 2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE PCPE CLEARANCE 

NOTE 

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 222.915 

Supervised By: 

Certificate of Verification 

4446 

SOIL 

2008-11-26 13:26 

30.58 

Final 

37934 

2430 hartman 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.106 
-y -'yysnf,^-'-" 

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 250.507 

Supervised By: 

Certificate of Verification 

4447 

SOIL 

2008-11-26 13:27 

30.55 

Final 

37934 

2430 hartman 

B2 

Ventry 

6 

CLEARANCE 

± 

± 19.101 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4448 

Mode SOIL 

Time 2008-11-26 13:28 

Duration 30.93 

Sequence Final 

Flags 

BVID # 37934 

ADDRESS 2430 hartman 

QUAD/ZONE B2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 240.208 ± 18.954 

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 306.124 

Supervised By: 

Certificate of Verification 

4449 

SOIL 

2008-11-26 13:29 

30.86 

Final 

37934 

2430 hartman 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 21.001 
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 

Supervised By: 

Certificate of Verification 

4455 

SOIL 

2008-11-26 13:32 

122.31 

Final 

tAvg of 4451-4454 

2430 hartman 

«GZ 

Ventry 

S 

CLEARANCE 
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 83.955 

Supervised By: 

Certificate of Verification 

4451 

SOIL 

2008-11-26 13:30 

30.81 

Final 

37934 

2430 hartman 

GZ 

Ventry 

6 

CLEARANCE 

± Error 

± 11.718 
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 47.613 

Supervised By: 

Certificate of Verification 

4452 

SOIL 

2008-11-26 13:31 

30.51 

Final 

37934 

2430 hartman 

GZ 

Ventry 

6 

CLEARANCE 

± Error 

± 9.364 
"l]fni * *=" ' -"••••ir- •"•=J"; • )!ll S'-'"''-i;i,|-W"' ' 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4453 

Mode SOIL 

Time 2008-11-26 13:32 

Duration 30.77 

Sequence Final 

Flags 

BVID # 37934 

ADDRESS 2430 hartman 

QUAD/ZONE GZ 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 60.160 ± 10.288 

Supervised By: 
~T~W wT^n^' 

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 120.668 

Supervised By: 

Certificate of Verification 

4454 

SOIL 

2008-11-26 13:32 

30.22 

Final 

37934 

2430 hartman 

GZ 

Ventry 

6 

CLEARANCE 

± Error 

± 13.738 
• 'iV-rr" ,'T^-^„-T'^ : J«^ , T'^-T'' " •i-tii' ''rT'"""'^^'^:''*^'"'"*«T:-*~-5^i;?^ii 

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 Pt'PE 

NOTE 

Supervised By: 

Certificate of Verification 

4460 

SOIL 

2008-11-26 13:37 

122.52 

Final 

* Avg of 4456-4459 

2430 hartman 

easement 

Ventry 

a 

CLEARANCE 
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 99.131 

Supervised By: 

Certificate of Verification 

4456 

SOIL 

2008-11-26 13:35 

30.66 

Final 

37934 

2430 hartman 

easement 

Ventry 

1 

CLEARANCE 

± Error 

12.176 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4457 

Mode SOIL 

Time 2008-11-26 13:35 

Duration 30.48 

Sequence Final C 

Flags 

BVID # 37934 

ADDRESS 2430 hartman 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 119.446 ± 13.270 

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 142.450 

Supervised By: 

Certificate of Verification 

4458 

SOIL 

2008-11-26 13:36 

30.53 

Final 

37934 

2430 hartman 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.683 
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 114.245 

Supervised By: 

Certificate of Verification 

4459 

SOIL 

2008-11-26 13:37 

30.85 

Final 

37934 

2430 hartman 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 13.160 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4465 

Mode SOIL 

Time 2008-11-26 13:41 

Duration 122.87 

Sequence Final 

Flags 

AVERAGE fAvg of 4461-4464 

ADDRESS 2430 hartman 

QUAD/ZONE 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By: 
_ 'r;'-r:r-'-^'^yy^\'l^/T' -TTViT^pf^Ty^*^ • 

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 129.677 

Supervised By: 

Certificate of Verification 

4461 

SOIL 

2008-11-26 13:38 

30.73 

Final 

37934 

2430 hartman 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 13.961 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 142.275 

Supervised By: 

Certificate of Verification 

4462 

SOIL 

2008-11-26 13:39 

30.93 

Final 

37934 

2430 hartman 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 14.630 
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 125.316 

Supervised By: 

Certificate of Verification 

4463 

SOIL 

2008-11-26 13:40 

30.63 

Final 

37934 

2430 hartman 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 13.864 
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 137.304 

Supervised By: 

Certificate of Verification 

4464 

SOIL 

2008-11-26 13:41 

30.58 

Final 

37934 

2430 hartman 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 14.398 
~";^^~^it.;'rr'' •jf'^^'rTn^-.rr. •'wry'^'^rwr 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 6016 

Mode SOIL 

Time , 2009-01-20 12:54 

Duration 121.63 

Sequence Final 

Flags 

AVERAGE \Av g of 6012-6015 

ADDRESS 2430 Hartman ave 

QUAD/ZONE iPZ 

INSPECTOR LOPEZ 

DEPTH «6 

SAMPLE TYPE CLEARANCE 

NOTE 

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 275.989 

Supervised By: 

Certificate of Verification 

6012 

SOIL 

2009-01-20 12:52 

30.54 

Final 

37934 

2430 Hartman ave. 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 20.219 
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 250.576 

Supervised By: 

Certificate of Verification 

6013 

SOIL 

2009-01-20 12:53 

30.25 

Final 

37934 

2430 Hartman ave. 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 19.264 
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 341.075 

Supervised By: 

Certificate of Verification 

6014 

SOIL 

2009-01-20 12:53 

30.25 

Final 

37934 

2430 Hartman ave. 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 22.576 
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 264.500 

Supervised By: 

Certificate of Verification 

6015 

SOIL 

2009-01-20 12:54 

30.59 

Final 

37934 

2430 Hartman ave. 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 20.092 
<,tO su . 

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

Coastal Environmental Group Inc. 

V ' ^<? vvww.coastalhazmat.com 

^•"•P^oxt " COASTA L ENVIItONHENTAL 

CROUP , r N C. 

EXECUTIVE SUMMARY: 

BVID # 37934 - (2430 HARTMAN AVE) 

^ No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
.s^EPA 

EPA Propert) Close Out Form 

Proptrty M: '^iQ^l'A -^c^Acxy\lAy<-

Dale/Time: 

Quads E»cav«lfd: "J^'^^^-^^CyT^ ^ ^^^{^i^urAcx X 

Excavation GenenI 

1 If nccessiry, w-ert the correcl quadrant(s) excavated and reslored? 

2 If necessary, were the correcl areas of drip zone excavaied and reslored? 

Gradlog Sod and VrscUlion 

1 Does the grading around ihe perimeter of the house in excavaied areas generally slope away 

from ibe house? 

2. Has sod been laid in all areas thai were excavaied? 

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 generally firm and evenly graded? 

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

time period) 

6 Was the property graded such that water will not pool on the property'' 

7 Was damage lo landscaping or plant materials avoided'' 

Gam , FcDces and Rctainlns Walls 

I Do gates open and close freely'' (Ifapplicable) 

2 Were all gates or fences lakcn down during resloration aciiviiies reinstalled? (Ifapplicable) 

3 Was dam»ge to gales or fences avoided? (Ifapplicable) 

4 Was damage to retaining walls avoided? (Ifapplicable) 

FouDdation, SidioK and Gutters 

1. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? 

3 Was damage to windows avoided? 

4 Was damage lo windows or door screens avoided'' 

5 Was damage lo downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Was damage lo driveway surfaces avoided'!' 

2 Was damage to walkway surfaces avoided'' 

Ye* No 

y 

y 

Ye* No 

y 

t ^ 

i ^ 

t ^ 

y 

^ 

Yes No 

i ^ 

t y 

y 

VA 

Yes No 

y 

y 

y 

y 

y 

Yes No 

y 

y 

1 
O »Ders comments: 

Inspection notes: 

Removal anci resloration aclivales complele including ihe 30-day sod warranty 

EPA Renresent^liv^^^^^^^^^^-^^^'^^'^^ ^ Dale 
4 

Property Completion Agreement 

This agreement documenis the complclion of remedial activilies perlbrmal on my properly. My signaiure 

will designate Ihat I am salislied with the restoralion of my property, and that no items are in questions, 

now, or at any time in the future, except those ilems listed below, ifany. 

Property ID: ^'^Q^C / 

Property Addro.s^^y:^g ^ 't^afi fn^l^r^,) ^ i^e ^ 

Phone 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

J 

/F^ L J ' aRret' rrsl(iralion i.v completed, except as noted 

I 1 do not agree reslomtiun is completed 

I M Q T>wncr\ .Si]>nft(urr Hale ontractor's .Signature 

I