TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: l^S^S^a Date: ::^llnjn^l 

Address: '^CT A ^ - ^ U ^S-J 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

a/ Video of property (DVD) 

5/ Executive Summary 

y EPA-provided property sketch Superfund 

\ y Signed Access Agreement for subject property 

)^Pr Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

Q/ Confirmation data 

5/ Photographs prd^jg^r^jQilM ^ Qy)LCyii)cJli\A^ -[cruUS'0<i 

?] As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

Jtjfl Description of areas not meeting ROD cleanup criteria 

\M Utility clearances 

3 / Property information from Douglas County Assessor's Office 

%CMtV9h 3/iry q 

Signature Date 
Property Access Checklist 

Property ID: j L\ g ^ 1 , 

D WORK STARTED ON: / / 

D WORKCOMPELTED ON: / / Property Address: '^O Q ] 'iD 3 4 ^^ ' 

Owner Renter : \W L C U OL Q J i r f 

Addrctis: ^ Phone: 

Fax: 

Ccll/Pager: 

Phone: ^ ^^ ) ^D30 2 Additional Infonnation: 

Fax: 

Ccll/Pager: 

D Notification Letter 

Sent: / / By: 

r ^ Access Agreement 

Signed: _U2/_i3/J2^ By:£(L 

Signed: iiI/i2L/. ^ By: ^.C . 

D Topsoil Sampling (if applicable) / / By: 

Q Disposal Sampling (if applicable) / / By: 

G Garden Sampling (if applicable) /

 / By: 

0 Utility Clearance Called: J0_/iD_/il2 By: 10 / 5/(D ^ 

0 Video/Photos (Before) On:l0 /Ql3>/n9. 

By^Uirk^Vi S 

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

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

n Video/Photos (30-Day) On: / / By: 

D Property Completion Agreement Siened: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community • Crew On: / / By: 

Results: 

• Conunnnity • Crew On: / / By: 

Results: 

r~1 Community • Crew On: / / By: 

Results: 

Omaha Lead Site 
CONTACT FORM 

Property ID)^ 

Propeity 

Address: 

Initial Contact: 

Second Contact: 

Final Conlact: 

Final Action: 

Comment: 

0^vne^ 

Comment (s): 

Site 

Coordinator 

Comment (sj: 

N ^S' Z 

3DDi ^ 3M ^"T" 

Dale: 

Date: 

Dale; 

Transmit 

Time: 

Time: 

Time: 

to EPA D 

Action: 

Action: 

Aclion; 

Other .Action: D 
JDouglas County Account Information Page I of2 

Douglas County, Nebraska Property Record - R1942610000 

Print Report 

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

New Feature -•->• • Auto Sales Search 

Owner 

MCGUIRE MIKE P 

ETAL 

3001 S 34 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4261 0000 19 

Account Type: Residential 

Parcel Number: 1942610000 

Parcel Address: 

Legal Description: 

3001 8 34 ST 

OMAHA NE 68105-0000 

PARKVALE LOT 14 BLOCK 4 40 X 130 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

Improvement 

$110,300.00 

$110,300.00 

$94,100.00 

$94,100.00 

$94,100.00 

$74,800.00 

Total 

$116,100.00 

$116,100.00 

$99,900.00 

$99,900.00 

$99,900.00 

$80,600.00 

Sales Informatio n 

Sales Date: 2001-11-02 

Deed Type: 

Price: 

WD 

$90,000.00 

Book: 2196 Page: 504 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5200.0 1.0 130.0 40.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
JPouglas County Account Information Page 2 of2 rmaiK 

Building 1 

Second Floor Fir^sFtooir 856 0 50 fl 

881 Osq tt 

^ ajARisrCalng -^y^" 

Two Story 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: i 1737.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: ; 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1921 0% 1921 87 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 863.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 198.0 

Porch Slab Roof Ceil 160.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Page 1 of2 

"> 

[ Create Another Ticket ~] [ Back to Irth Internet ] Send Email ] 

. YOUR TICKET NUMBER IS 2160976. 

Original Call Date: 10/23/08 Time: 8:52 pm Op: ELIZABETH18790 


Work to Begin Date: 10/28/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3001 Street: S 34TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 33-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING THE HOUSE ALL THE WAY TO 


: THE STREET. 


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: 4ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 

Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

1V1UD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 


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


Emerg: 4024445160 


Day: 4067289343 


OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: 4067289343 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/23/2008 
Page 2 of2 

QLNNE 1F QWEST LOCAL NETWORK MA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/23/2008 
0 As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Name: 

Aijdress: _ 30C I 5. ?a ^ r 

Phone: 

Team vli\{ii^jlh\U \f^ BVID#

Sample Number 

m 

Omaha Lead Site 

Stte Sketch 

 iMi ^ 

Lead Concentration 

>7<'± ^ ppm 

/2^=f-uli PPf" 

'^ggflppDate: iM ^ North Anow 

Time: 7'. J.^ ^ A 

XRF coAy^SS^OQ.-

Confirmation Sample 

f^lYes a No D -

No G3-

No oa^ 

No •3 ' 

No ^ ^ 

p/VYes S^ No Ifi ^ ^ Yes • No • 

5, ?v y

Omaha Lead Site 46130 

Legend 

Concret e Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare 
 Sod ' ' Rock/Mulch 


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

Name; Omaha Lead Site Date: iM a North Arrow 

Address: _ 3001 Site Sketch Time; ^I.» / ^ A ^.^^r Phone: 

Team A\iilyjih\U \f'(^ BviD#Ji^Mli XRF Code^SS^^n . 

Sample Number Lead Concentration Confirmation Sample 

'<--PXA-l¥StX •Si^ii ^ nnm flYes ^ No t3­ r lYes •—' 

y<iyy ^ ppm ("O/es, n No ta^ 

JLf.^'uh ppm No 03" 

L f g- J / ppm "P No tS' I ~f ^^SE^Z M No Q- ^ .scpxA- i^W: p/VYes S^ No IB*^ 

^ Yes • No • 

ft'^h-^ty ^ 

Omaha Lead Site 46130 ~y^^^±x 
"ou t tyvv 'K)^ - T y 

Name; Omaha Lead Site Date; i M ( ^ North Arrow 

Address; _ •3001 Site Sketch Time; "?! Zxj f^^ 5,^^ ^ f Phone; 

Omaha Lead Site 46130 
Name; Omaha Lead Site Date: nM^ J North Arrow 

Address; _ 30171 Site Sketch Time: 7'. Zlf fL^ 5, ^ ^-r Phone; 

Team \i^Mliy]th\it^ \f'^ BviD#_mil XRF Code^SS22n. 

5, 5v y. 

Omaha Lead Site 46130 
M COASTA

m

L INVIIONM f HTAl 

c a o u F, IN C '*^^i^y 

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: pT^W e YV\'"G^iV e Daytime Phone: i^a2,-^%l-o})(j ^ 

3oo| So. h^' ^ St- Address of Property 

covered by this 

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 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 t)egins. 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 
'wyi 

COASTA L 

(NVmOHtlFNTIIl 

C I O U > . IM 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 grant access to my properties D I do not grant access to my properties 

M y - n^yy-..> l^l'=i[o^ 

Signature Signature Date 

Q I would like to be present during any sampling that is required. 
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 purpose of assuring that restoration 

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

Protection Agency (EPA). 

t Property ID: I H ^ Y ^ 

j Property Address: ^ Q ^ ( S ^ ^ j ^ k S' T 

Owner: /M / A g / ^ c Q^ t 

Phone: TfToro^ •re 

On the attached diagrain(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: /U o yjCPage 1 of 
COASTA L 

FK.vtnoHi-'fM'rA L 

c « o w f . t « c 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

S (AA CLI ctyi'TS' / n:>c7^5>. ^n d f 

ci^lr.5 > I^P ^ Jyr-^lliino/ 

Item: 

Item: 

Item: 

I Item: 

Item: 

item: 

Item: 

Item: 

"7^ Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of J-) 
< ^ 

C Q A S T A L rMVtNOMncNTA L c M e u r IN C 

Item: 

Item: 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

y rs> \ \ y <>oX ^x ­ f l ­ D~ ^ ^ 

\ Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

ttem: 

Item: 

Item: 

Item: 

Item: 

Item: 

/ 

/ 

Page 3 of 1/7 
COASTA L 

f N *IKOI-"*l* < f* 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 layout. 

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/Specles 

Square feet 

1 •. 

Each 

Each 1 

y Each 

y^ Each 

Square Feet 

Page 4 o^_(2­
< ^ ^ 

C O /I S T A L 

Item Quantity Uriit Condition/Type/Specles 

Agreed upon value of 

plant materials not to be 

renlaced 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. 

Each 

Agreed upon 

property to be 

with grass sod. 

area of 

replaced 

Include a sketch of the 

area(s) to be replaced with 

arass sod. 

y 

<)y 

SF Qr^ ^ 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

SF 

Easement Area, to be 

excavated 1

UV SF Xt V ^

y 

 .^y^ 

Page 5 of. l 
C O A S T A 1-

Additional Comments / Instructions: 

W'ici^ f^\y ^A ^ y 

\J 5e Tc.*- c^cce5 ^~'=> B -^ 

D Check the box if Owner does not want CEG to document interiorfoundation walls and possible 

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

interior of house, including foundation cxad<s or fissures. 

yC\ I agree D I do not agree 

A ^ ^"4^- i^h/o^ ?fmy^. \y\j ^ 

Owner's Signature Date Contractor's Stature Date 

Page 6 of 
Date 

Project 

XRFID# 

Shot# 

^*~?8a 

^i&- ^ 

e^'"/«4 

^nss 

Average

Shot# 

cJl^ ^ 

.^SOfL^ 

-^pyAverage

Shot# 

Average 

Shot# 

Average 

lab sample # 

BVID# 1^8)6'^ 

XRF PROPERTY SAMPLE SHEET 


Address \\-n-o8 y£>o\ S sa^st - Omaha lead FP 2nd year opilon Sample time am/pm 

'^-^C^Pfi sample length 30 sec 

Reading Sample area Shot # Reading Sample area 

i7ft.\ \ t We.&\ -^701 ^^•lat ^ q-3, ^ 

i<^\.2foS ^MH S .c;^^ ^ cO"7rpr:) ^/>.'-if..t. ^n.pq y\ 

.^q.scb^ 14-o,-^ Depth oLeao-:::- ^ .0' ^ Depth 

lMA.^6 i 1^.13 I Ccb.^3.-t-tD/3lp t^n^h 'wy 

H^.^jl ^ ^ 6 Average ^C\ . ^T.t . ^.H/i ? 

Reading Sample area Shot# Reading Sample area 

iQg.^u.^S aQ cO^^I ^^^.Ql t \\.\ ^ 

iHo .mJ:^ iJA-asi b ^ ,s)nq« P.LAS^,y.\^.\ \ yy 

^.'^•(p^^Wlt ^ Depth .^1'^' ^ y^.tnCD t \'h<^^ Depth 

9b?-).ib-t\-i.iy, 15 cQ<^0 0 - ^^.^"^^^m u> 

 \hy , .^-^\ t - \ 4 .6 Q Average ^ . 1S t \<3.^t) 

Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot* Reading Sample area 

Depth Depth 

y/ 

Average 

Lab result Sample area XRF Avg. 

Signature 

l^m-^ M^K Print 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

2786 

SOIL 

2008-11-07 13:49 

122.81 

Final 

Avg of 2782-2785 

3001 s 34 st 

easement 

Ventry 

1 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 178.109 

Supervised By: 

Certificate of Verification 

2782 

SOIL 

2008-11-07 13:47 

30.64 

Final 

14882 

3001 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 16.205 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 141.345 

Supervised By: 

Certificate of Verification 

2783 

SOIL 

2008-11-07 13:48 

30.63 

Final 

14882 

3001 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.747 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 132.530 

Supervised By: 

Certificate of Verification 

2784 

SOIL 

2008-11-07 13:49 

30.59 

Final 

14882 

3001 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.034 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 142.351 

Supervised By: 

Certificate of Verification 

2785 

SOIL 

2008-11-07 13:49 

30.95 

Final 

14882 

3001 s 34 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 14.733 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

2791 

SOIL 

2008-11-07 13:53 

122.72 

Final 

Avg of 2787-2790 

3001 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 44.609 

Supervised By: 

Certificate of Verification 

2787 

SOIL 

2008-11-07 13:51 

30.88 

Final 

14882 

3001 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 

± Error 

± 9.358 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 55.784 

Supervised By: 

Certificate of Verification 

2788 

SOIL 

2008-11-07 13:51 

30.55 

Final 

14882 

3001 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 

± Error 

± 10.085 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2789 

Mode SOIL 

Time 2008-11-07 13:52 

Duration 30.41 

Sequence Final 

Flags 

BVID # 14882 

ADDRESS 3001 s 34 st 

QUAD/ZONE Fl 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 35.998 ± 9.031 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 60.927 

Supervised By: 

Certificate of Verification 

2790 

SOIL 

2008-11-07 13:53 

30.88 

Final 

14882 

3001 s 34 st 

Fl 

Ventry 

6 

CLEARANCE 

± Error 

± 10.559 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

2796 

SOIL 

2008-11-07 13:56 

121.71 

Final 

Avg of 2792-2795 

3001 s 34 st 

DZ 

Ventry 

13 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 108.455 

Supervised By: 

Certificate of Verification 

2792 

SOIL 

2008-11-07 13:54 

30.30 

Final 

14882 

3001 s 34 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 13.223 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 140.765 

Supervised By: 

Certificate of Verification 

2793 

SOIL 

2008-11-07 13:55 

30.62 

Final 

14882 

3001 s 34 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 14.920 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 89.673 

Supervised By: 

Certificate of Verification 

2794 

SOIL 

2008-11-07 13:56 

30.56 

Final 

14882 

3001 s 34 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 12.142 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 203.133 

Supervised By: 

Certificate of Verification 

2795 

SOIL 

2008-11-07 13:56 

30.23 

Final 

14882 

3001 s 34 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 17.783 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, 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 

2801 

SOIL 

2008-11-07 14:00 

122.53 

Final 

Avg of 2797-2800 

3001 s 34 st 

B2 

Ventry 

6 

CLEARANCE 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 71.265 

Supervised By: 

Certificate of Verification 

2797 

SOIL 

2008-11-07 13:57 

30.89 

Final 

14882 

3001 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 11.189 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2798 

Mode SOIL 

Time 2008-11-07 13:58 

Duration 30.50 

Sequence Final 

Flags 

BVID # 14882 

ADDRESS 3001 S 34 St 

QUAD/ZONE B2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 84.856 ± 12.114 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 105.596 

Supervised By: 

Certificate of Verification 

2799 

SOIL 

2008-11-07 13:59 

30.57 

Final 

14882 

3001 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 13.227 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 93.218 

Supervised By: 

Certificate of Verification 

2800 

SOIL 

2008-11-07 14:00 

30.57 

Final 

14882 

3001 s 34 st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 12.267 
X 

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

Coastal Environmental Group Inc. 

%. • ^ www.coastalhazmat.com ENVIIONnENTAL %PBo^ ^ COASTA CROUP . INCL . 

EXECUTIVE SUMMARY: 

BVID # 14882 - (3001 S 34 ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation 
sti. EPA 

EPA Property Close Out Form 

m<^A G P-~rt v Addr«.^- .300\ , " ^ ' ^ ^ Property ff: Property Address:^ 

Date/Time: -j=-A­ Owner's Name 

Quads Excavaied: -^ \ iRcQ ^ ^? r Contractor Grou 

Excavation Yes No General 

1. If necessary, were the correct quadrant(s) excavaied and restored? 

2. If necessary, were the correcl areas ofdrip zone excavated and restored? y ^ 

Grading Sod and Vctctation Yes No 

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

u ^ from the 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 time period) 

4. Are sodded areas generally firm and evenly graded? 

5 Arc die joints t)erween the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

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

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and RcUinine Wails 

Yes No 

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

2. Were all gates or fences taken c\owr\ during restoration acliviiies reinstalled? (If applicahle) y 

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

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

y 

Foundation, Sidioc and Gutters 

Yes No 

I. Was damage lo the siding or trim avoided? t ^ 

2. Was damage to the foundation avoided? y 

3. Was damage lo windows avoided? y 

4 Was damage to windows or door screens avoided? y 

5. Was damage to dowTispouts or downspoul extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? y 
OMoers comments: 

Inspection notes: 

Removal and resloration aclivales compleie including the 30-day sod warranry: 

HPA Represenlali><;7^I^4^^^^^<^^Xfe ^ Dale: ^y^S^ydy 
If» 

Property Completion Agreement 

This agreemeni documenls the completion of remedial activities performed on my properly My signalure 

will designale that 1 am satisfied wilh the restoration of my property, and that no ilems are in questions, 

now, or at any time in the future, excepi those items lisled below, ifany 

PropcrtyTD: \u\p ^ Q 

Property Address: 2,^^ ^ ^ . .--^gi ^ ^^ . 

Owner: |V^',S ^ ^ApCAlA:^r- e 

Phone: C^ ^ _ Q g ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: J 

J/\[ I agree restoration Is complcled, excepi as noled 

 I I do nol a(;rec resloralion is completed 

ynzn (/ \<\ o l 

Owner's Signature Datt ^ Contractor's Signature Date 

I
3o<i>i y j^ i ^^ y

1^ 

Punchlist Items 

ID# ii^y 

Date ; (yX i-oE 

Name /^ ( 1 ^ /^C Q O \ T<e. 

Descnption: