TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID.-. ^^y^ll_ Date: 

^ yit 

Address l/tPW t-\ t ^ ^ ^ f 

Remediaiion Conliactor: Coaslal Enxironmenlal Group Year: JOIOARRA 

SOILREMEDIATJON 

PROPERTV FILE FOLDER DOCUMENTS 

(/ Video of properly (DVD) 

/ Executive Summary 

A EPA-provided properly sketch 

A Signed Access Agreemenl for subject properly 

7 Signed Access Agreement(s) for adjacent properly 

Resloration Agreement 

Selllenient documents (i.e,, for damage or lo replace plants, etc) 

Confinnation data 

A Photographs f^6r)c<^^rU ^ Y ^tASfr^w \ \ ^Oxj 

y As-buill skelch 

/ Salisfaclory restoralion signed by Properly Owner 

/ Property close-oul check lisl signed by EPA 

Description of areas not meeting ROD cleanup criteria 

A Utility clearances 

y Properly infonpati^from Douglas County Assessor's Office 

Signature 

30218827 nil 

Superfund 
VV 

Property Access Checklist 

PropertylD: ^^^/ ^ 

Property Address: ;^, , j ^ ^ ^ ^ ^ 

n

n

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner: ' ^ ^ ^ ^ ^ ^ 

Address: 

Ow\alAPi, ^« . (^Sdoy[ 

Phone 

Fax: 

3^5-^ ^YP ^ 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Infomiation: 

D

Q

Q

G

D

[^

Q

^

D

D

D

Q

n

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 TopsoU SampUng (if appUcable) 

 Disposal Sampling (if appUcable) 

 Garden SampUng (if applicable) 

 UtiUty Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Siened: Vi / v m / vo 

Siened: vo /vw U n 

I I 

I I 

I I 

CaUed: Ax /fe^/v o 

On: \o / vto / V 0 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

Vi^^-VC 

V»^O t 

\v|\o/v O

^\Oi , 

 \A^rA ^ 

Air Monitoring (as appUcable) 

r~l Conununity H] Crew 

Results: 

On: / / By: 

[~~l Community

Results: 

D Crew On: / / By: 

• Conununity

Results: 

 CD Crew On: / ' / By: 

Omaha Lead Stte 
Douglas County Account I i^^i^tion Page 1 of2 

Douglas County, Nebraska Property Record - R0747590000 

Print Reoort 

View Interactive GIS Mao Information is valid as of 2010-8-30 Treasurer's Tax Reoort 

New Feature ^ -^ •* Subdivision Sales Search 

Owner 

STIGGER ROBERT 

ETAL 

4722N61ST#D-1 

OMAHA NE 68104-2039 

Property Informatio n 

Key Number: 4759 OOOO 07 

Account Type: Residential 

Parcel Number: 0747590000 

Parcel Address: 2011 N27ST 

OMAHA NE 68111-0000 

Legal Description: CARLBERG SUB DIV LOT 7 BLOCK 1 W 100 FT 37 X 100 

Value Informatio n 

Land Improvement Total 

2010 $300.00 $0.00 $300.00 

2009 $300.00 $0.00 $300.00 

2008 $300.00 $0.00 $300.00 

2007 $300.00 $0.00 $300.00 

2006 $300.00 $0.00 $300.00 

2005 $300.00 $0.00 $300.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.08 3700.0 0.0 100.0 37.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R074... 9/2/2010 
Page 1 of2 

"> 

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

YOUR TICKET NUMBER IS 2637700. 

Original Call Date: ll/08/lO Time: 5:50 pm Op: ELIZABETH18790 

Work to Begin Date: 11/10/10 Time: 6:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2011 Street: N 27TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 09-SE,16-NE 

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 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

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

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

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

COASTA L Omaha Lead Superfund Site CNVIKONHtNTAL CROUP . IN C 

OLS#:27318 

Date Excavated: 11/15/2010 

'ii.t.Te.n... .k^nTM.iM<iun.tncA-ivJir Pate USEPA Signed Off: 12/7/2010 .\\fffAX>j!?AiMMtMixSfaxfXi9fWMtliM^^ 

Area Sodden: 2990 sa ft 

2.13 Ig 

I Name: JPofagz-f gfitie> - Omaha Lead Site Date fA/tAa'T 

I Address ^r>j / »v/ g > » ' Site Sl(etch Time: / -Sti 

Omaha Lead Site 46130 

Legen d 

Concrete Dri p Zone Excavate d Quadrants Excavatied 

Area replaced wit:h Area replace d wit h 

Area lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
..:AV-^M•J.•^•;:i•3;:i*.i,t^t>'>.;i,*c&.i;>>>.'>>S^>.^».^svi^•.•'>>'.^"•X^>.•>.•^ m '.»>X*.».C*.»,-,?Si,''.*.v\»,'?i%V.*.v 

Z'73JS 

Name: ^ofee/-f ^-hi^'^t.r Omaha Lead Site Date: 'f/ft ^ <- North Arrow —i 

Address: p o J / A / g > ^ J^ Site Sketch Time: / 'Se> 

Phone: g^ 5 g'Vfl? 

~STA?^ST M V^ie•.ic-2.k-GS' nn^e: />/*i 

Team /^^ u cj,/^ ^ BVID# ^. 7 3/ g XRF Code /g3 7 -^2S^.- /3 3 

Sample Number Lead Concerrtration Confinnation Sample 

F' Yes ^ No O , 

S ppm ^Yg^^/^X A -273/ g _ ^ f a Yes D f^o S 

ppm 6/ Yes n No ^ 

ppm 

S^Z? 63 Yes CD No ^ 

ppm 

ppm 

Veh P Nc D 

ppm Nu D 

YCA • Nu a 

Lab RYASCPLA-27318 

ppm 

CD IE 

Result . 304f)pm .rrv 

ipyyA yiziy^'l ttf-Trimy 

i M ^ i 

r^r^-i 

j-"M-^^^^ 

^ .!iv.„....|..„t...;„..., 

r#l I 

Omaha Lead Site 46130 
.>.i«i...;<w..i-.i>ri>...i.vir....»..-»-;*. ivijv-...i...:s«.ii.i«Vi...it«..v..<»S'^^ 

Z73JS 

Name: ^ober f g^tgja r Oinaha Lead Site Date: %Z/^/(i<r North Arrow 

Address: Jinj / f^ ^' > ^* Site Sl(etch Time: / 'S<^ 

Phone: ?Mg 8Wfl 7 

Team A.5U e.sy^ ^ BVID# ^73/ g _ XRF Code /g3 7 &^J^: 1^3 

Sample Number Lead Concentration Confirmation Sample 

ft Yes ^ No 2 ^ ppm ^Yg>S^/OXA -273i a ;^pp m fa Yes [^ No 2 ppm 

fe7r.5<^<<>;<;/i^~2.7^>8 6/ Yes n No o r 

^^bSCpy^'2.731 8 5^^ ppm 

ea Yes CD No ^ 

•Yes P NO D 

Omaha Lead Site 46130 
(*l)6WV»iViVW»:s>W»>->*Vi-'i>-V.«V.-i««Vi'»ii»SVi»i«i<Wi"ii"«>^ 

2.13lg 

Name: ^gfee^t gfjgj^* ^ 

Address: p^t f ^ o > *>* 

Phone: ^Hg gfg ? 

Omaha Load SKe

Sits Sketch

 Date:

 Time:

 f/^»^< -

 f •i'6 

NorthArrow ­ i 

Team >to u c.</^ ^ BVID# ^ 7 3/ g 

S+«if^:M ^><vfe\lo-'Zt-oS TtmA-. pn[ 

XRF Code /g3 7 jgfi2^*/5 3 

Sample Number 

/gYgSg/>XA -273/ g 

Lab RYASCPLA-27318 

Result;^. :. . 3 ^ 

Lead Concentration 

312. . ^fi: 

5ifi O 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Confirmation Sample 

f' Yes GB^ 

fa Yes a 

6/ Yes n 

&» Yes D 

Yea P 

Yea O 

Y M • 

No B' 

No 5 

No » 

No I^^ 

NO D 

Mu Q 

Nu • 

Q H 

—« ­

"••••SENTW" 

i. 

UL 

'^79ij5,|^. H 

£/ ^ P 

-J^ 

r/ ' d 

I3I^ ^ ' ^ F 

ll COH*­

i, w^tj ^ "* • 

t - %

n/5->» 

Omalia Lead Site 46130 
\ \A/^ -' ^ c? C C A- S "1 /t 1 

c I 0 u ^ . • c 

C:()iii:t^iil fl)' /\(v(.iV!i- 'i(i ! i()|)c-^(iy 

RiGHi OF ENTRY TO PREMISES 

Granloi (the property' ownei) consents tc snd authorizes the United States 

Environmental Protection Agency (FPA) oi its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental lesponse activities uport the 

following described premises: 

Owner's Name; i Daytime Phone: 

Address of Property 

covered by this - y oil Z ^y s t 

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 performed under the Omaha Lead Superfund Sile 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 rt 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 ttiis Access Agreement, the Grantor is granting the EPA, its employees, 

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

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

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

agrees to: 

Page 1 of 2 
C CAS 1 A i i^-vl»o^'K^ ^ TAI 

c n 0 u » 1 (. c 

I Remove obstructions including hosts, tiaileis, vehicles, pleyscape ilftm.'^, wo

piles, rioo houses, etc; 

od 

< Remove flov^'er bulbs oi piaiits ttial the Giantoi or the Grantni's lenEnt

to save; 

may wish 

Water and maintain leplacement vegetation, including fertilizer applicstion,

necessary' subsequent to sn initial watering period by EPA; 

 as 

< Abide by health and safety guidance provided by EPA; 

« If the property' is rented, assist EPA in obtaining tenant approve! foi

the property' to perform the work 

 access to 

I Allow videotaping and/or photographing of the properly. 

AGREEMENT NOT TO INTERFERE 

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

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

/^^/^-/^. _ . _. 

Signature Date 

Q I wouid like to bt preieitt duficp any sampllno U^E\ is reqi'iied. 
'COASTA 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 dociimentation 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: iri2Jl 

Property Address: zl P Z.7 sf 

Owner: lAZi m Z nM- Phone: 7 Hr^y?z 

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 

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: 

J(J O JU ^ 

Kem: 

Item: 

Kem: 

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

Kem: z- Aje.^ 

Kem: 

Kem: 

Kem: 

Pagel of / 
v^ 

C O A S T A L • NVI«ONHI N T A L OROUP , INC . 

Items to Be Removed Bv Contractor Durina Remediation and Replaced 

Item: 

so\ \ 

Kem: 

^o i 

Kem: 

Item: 

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 

2^nes, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

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. 

Easement Area, to be 

excavated 

Quantity 

rr 

lot 

z 

y 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

yz $ 

\ f av^y Each 

Condition/Type/Species 

r e z)(^ ^^^j K^^uihj 

Page 2 cA 
C O A S T A L • NVmONHKNTA L OROUP , 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 city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding 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. 

fl I ^ c" ct H (3* ^ ^ 

G 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. 

[^ I agree Q I do not agree 

Owner's Sigi^iure M/Bate Contractor's Signature Date 

Page 3 of ? 
BVID# Z33[8 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

Shot# 

131 

I3Z 

133 

Average 

Shot# 

13^ 

13^ 

13^ 

Average 

Shot# 

( 3 1 

m 

1 ( 

Average 

Shot# 

Average 

Signature 

Print 

Zni l Ai Z^ 3 T 

am/pm 

30 sec 

Reading Sample area 

zeo i z4 BA 

^ ^ i ZL Depth 

Z04i Zl / " 

Z34 t ZX. A 

Reading Sample area 

Depth 

Reading Samplearea 

Depth 

Reading Sample area 

Depth 

)-Z [ ' zol \ 

Omaha Lead ARRA 

P.'^^OZF 

Reading 

3BL i ze 

3"^! ± ZS 

4(5 i zn 

ZZS'^ i Z'^

Reading 

14 t ^ 

/ 5 i ^ 

ZSt u 

Sample area 

51 

Depth 

/3" 

^ 

Sample area 

6Z. 

Depth 

13 

Address 

Sample time 

sample length 

n t 10 ^ 

Reading Sample area 

45 i i 3D FZ 

45-^ i Z^ Depth 

560 t ZA /3" 

4^6 '- 3b y 

Average 

(H ^ Ufrdyj 

RETEST AREAS 

Reading Sample area 

—-— ^ y Depth > 

y A 

Shot# 

143 

m 

/ ^ ^ 

Average 

Shot# 

Average 

Shot# 

Average 

Shot# 
Thermo 

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 

Supervised By 

Certificate of Verification 

134 

SOIL 

2011-01-21 13:24 

90.75 

Final 

Avg of 131-133 

2011 N 27 ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpil<e 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 382.497 

Supervised By: 

Certificate of Verification 

131 

SOIL 

2011-01-21 13:23 

30.20 

Final 

27318 

2011 N 27 ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 28.618 
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 399.360 

Supervised By: 

Certificate of Verification 

132 

SOIL 

2011-01-21 13:23 

30.26 

Final 

27318 

2011 N 27 ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 28.744 
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 415.291 

Supervised By: 

Certificate of Verification 

133 

SOIL 

2011-01-21 13:24 

30.29 

Final 

27318 

2011 N 27 ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 29.794 
Thermo 

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 

Supervised By 

Certificate of Verification 

138 

SOIL 

2011-01-21 13:27 

90.71 

Final 

Avg of 135-137 

2011 N 27 ST 

B2 

13" 

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 14.753 

Supervised By: 

Certificate of Verification 

135 

SOIL 

2011-01-21 13:26 

30.20 

Final 

27318 

2011 N 27 ST 

B2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 9.781 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 136 

Mode SOIL 

Time 2011-01-21 13:27 

Duration 30.22 

Sequence Finai 

Flags 

BVID 27318 

ADDRESS 2011 N 27 ST 

QUADRANT B2 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 15.086 ± 9.907 

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 28.285 

Supervised By: 

Certificate of Verification 

137 

SOIL 

2011-01-21 13:27 

30.29 

Final 

27318 

2011 N 27 ST 

B2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 11.032 
Thermo 

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 

Supervised By 

Certificate of Verification 

142 

SOIL 

2011-01-21 13:31 

91.33 

Final 

Avg of 139-141 

2011 N 27 ST 

F2 

13" 

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 451.879 

Supervised By: 

Certificate of Verification 

139 

SOIL 

2011-01-21 13:28 

30.31 

Final 

27318 

2011 N 27 ST 

F2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 30.453 
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 457.524 

Supervised By: 

Certificate of Verification 

140 

SOIL 

2011-01-21 13:30 

30.69 

Final 

27318 

2011 N 27 ST 

F2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 27.270 
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 550.697 

Supervised By: 

Certificate of Verification 

141 

SOIL 

2011-01-21 13:31 

30.33 

Final 

27318 

2011 N 27 ST 

F2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 34.973 
Thermo 

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 

Supervised By 

Certificate of Verification 

146 

SOIL 

2011-01-21 13:38 

90.70 

Final 

Avg of 143-145 

2011 N 27 ST 

EA 

1" 

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 280.503 

Supervised By: 

Certificate of Verification 

143 

SOIL 

2011-01-21 13:36 

30.25 

Final 

27318 

2011 N 27 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 24.239 
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 219.253 

Supervised By: 

Certificate of Verification 

144 

SOIL 

2011-01-21 13:37 

30.21 

Final 

27318 

2011 N 27 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.504 
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 204.006 

Supervised By: 

Certificate of Verification 

145 

SOIL 

2011-01-21 13:38 

30.24 

Final 

27318 

2011 N 27 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

21.542 
/ ^A/' %

o ^^^ZI

\y^y^

^'IPBOT*'^

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

 Coastal Environmental Group Inc. 

 www.c0astaiha2mat.com 

 COASTA L INyiaONMINTAl 

c ao u r, INC ' 

EXECUTIVE SUMMARY: 

BVID #27318-(2011 N 27 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
^L> 

EPA Property Close Out Form 

Property #: 2'^'^ l SZ PropertyAddre«: 7fftJ A l ZK^T^V T 

Date/Time: Owner's Wame; Name:,/. /^, . . [ij&ijftfZ^.^ ^ ^ / V 

Quads Excavattd: p ( Z\Z^ ^ Y yi y Contractor Croup ZJDO^ 

Excavation General Yes ISo

1. If necessBiy. were tiie correct quadrant(s) excavated and restored? J 

2. If necessary, were (lie correct areas ofdrip zone excavaled and restored? / 

Grading Sod and Vegetettow Yes No 

I Does the grading around the perimeter of ttie liouse in excavated areas generally slope away / from the house? 

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

3. Does the sod appear to be generally IteaJlliy and growing? (Only evaluate ifinspected at a 30 /

day time period) ____ ^ ­

4. Are sodded areas generally llrm and evenly graded? / 

5. Are thejoints t>etween the sod strips generally tight? (Only evaluate if inspected at ^ 30 day 

time period) y 

6. Was the property graded such that waler will not pool on the property? / 

7. Was damage lo landscaping or plant materials avoided? / 

Gates. Fences and Retaining Walb 

Yes No 

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

7

/ 

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

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

4. Was damage to teuiining walls avoided? (Ifapplicable) / 

Foundation, Siding and Gutlera 

Yes .No 

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

2. Was damage to Ihe foundation avoided? / 

.*. Was damage to windows avoided? / 

4 Was damage to windows or door screens avoided? / 

5. Was damage lo downspouts or downspoui extensions avoided? J 

Sidewalks and Driveways (Concrete) Yes. No 

I. Was damage to drivevray surfaces avoided? 

-A 

2. Was damage to walkway surfaces avoided? 

T 
Ort'Ders comments: 

[inspection noies: 

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

EPA Representiitive Bun^ ^ Date: IZ/J/JQ 

" ^ 
Property Completion Agreement 

ihis agreement documenls the compiclion ol remedial activities perloimed on my properly My signature 

will designate ihal I am satisfied with tlie restoralion of my properly, and thai no ilems are in questions, 

novi', or al any lime in the fuluie, except Ihose ilems listed below, if any 

PropertylD: Z-l^^ZiSZ 

Property Address: ^ ^ / / A t ZT^^Zt ^ 

Owner: ^.fijuit 'S^ 

Phone: li ^ 3^ 

Restoration Items in Question: 

Item: 

Item: 

1 iiem: 

' Item: 

Item:

Item: 

PZ ' 1 »urcc restoralion i% completed, except as noled 

\Z i ) tio not flfjrec restoration is completed 

vnrr's SigMtnrr (|pf>tc Co^VfaTlor's Sicnaturc ? 'Date 

 1