TRANSMITTA L of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: l^^K Z Date: ZJ^bjrP } 

Address: 30E> b S ^' ^ SIT ' 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

y Executive Summary 

D EPA-provided property sketch 

y Signed Access Agreement for subject property 

QJiPC Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

y Confirmation data 

G / Photographs ^r^ ^ oxn£j^i-Lov\^ ^X./'/iJajh A^ -J\/LGA •S-dcL 

D As-built sketch 

y Satisfactory restoration signed by Property Owner 

Q/ Property close-out check list signed by EPA 

KJft' Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

y property information from Douglas County Assessor's Office 

^ ^ 

-^/a ^ 

^/^7 
Property Access Checklist 

Property ID: m>-.\Qg ^ D WORK STARTED ON: / /_ 

Property Address: go5^c^ , -Zl^^ ^- ^ D WORK COMPELTED ON: / /_ 

0>vncr:1\.c^V^^^ ^ ^ ^O^VAU.C . Renter 

Address: Phone: 

FiLv: 

Cell/Pager: 

Phone: 2JC^-^5 ^ Additional Inlormalion: 

Fax: 

Ccll/Pager. 

D Notification Letter Sent: / / By: 

B'^cces i Agreement Signed:/Z_//2/QB ^y-Krt^, ^ 

B^Restoration Agreement Signed: ^//^/O g B^Br.^w, 

O Topsoil Sampling (if applicable) / / By: 

1 1 DisposaJ Sampling (if ;)pplicable) / / By: 

• Cnrdcn Sampling (if applicable) / / By: 

n Utility Clearance Called: iL/H/£iSL B3:l\/3l M 

B ^ Video/Photos (Before) On: u_/r^a2 ^y- ?^ iG n 

D Video/Photos (During) On:\L/fi/£& B>nlj;il//^R 

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

D Video/Phoios (30-Day) On: / / By. 

D Property Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air MonitorinK {AS applicable 

D Community Q Crew 

Rc&uJls: 

) 

On: / / By: 

CD Communit}

Rcsu\ts: 

• Crew On: / / »,: 

• Community

Results; 

• Crew On: / / 1 

Omaha Lead Site 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

\^^Ba 

3osu S-S^^ . 

Date: Time: Action: 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 
Douglas County Account In^^ation Page 1 of3 

Douglas County, Nebraska Property Record - R1942880000 

Print Report 

NEW Feature - Parcel Dimensions available ©scale 0-50 ft west of 90th St - Vie w O n Ma p Information is valid as of 2008-11-5 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owner 

RISHLING JOSHUA L 

3056 S 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4288 0000 19 

Account Type: Residential 

Parcel Number: 1942880000 

Parcel Address: 3056 8 33 ST 

OMAHA NE 68105-0000 

Legal Description: PARKVALE LOT 2 BLOCK 8 41 X 130 

Value Informatio n 

Land Improvement Total 

2008 $5,900.00 $85,200.00 $91,100.00 

2007 $5,900.00 $85,200.00 $91,100.00 

2006 $5,900.00 $74,200.00 $80,100.00 

2005 $5,900.00 $74,200.00 $80,100.00 

2004 $5,900.00 $74,200.00 $80,100.00 

2003 $5,900.00 $55,800.00 $61,700.00 

Sales Informatio n 

Sales Date: 2001-11-30 

Deed Type: WD Sooilr; 2198 Page: 419 

Price: $85,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1995-12-14 

Deed Type: D Book: 2023 Page: 677 

Price: $55,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/17/2008 
douglas County Account In^^ation Page 2 of3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5330.0 1.0 130.0 41.0 No 

Improvemen t Informatio n 

Building 1 

• EwSttflWM • w 

it: SecondRoor 3S4.Q«|lt.„ First Flocr Detached 

5280sq ft 

scr I 

1 1/2 STORY FlNtSHCD 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1024.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: ! Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 92 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 624.0 

Fixture Base Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/17/2008 
Douglas County Account In^^ation Page 3 of3 

Fixture 

Garage 

Porch 

Porch 

User 

Bath Full 

Detached 

End Solid Wall 

End Solid Wall 

Attic Full Finish 

1.0 

528.0 

270.0 

208.0 

384.0 

http://douglasne.mapping-onIine.coin/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/17/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2178349. 

Original Call Date: 11/19/08 Time: 10:05 am Op: ELIZABETH18790 

Work to Begin Date: 11/21/08 Time: 10:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3 056 Street: S 33RD ST 

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

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 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 Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 


MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

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 

Day: 4067289343 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/19/2008 
Page 2 of2 

QLNNE 1F QWEST LOCAL NETWORK NA 

Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day:

 Alt:

 8002834237 

 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/19/2008 
14482 

As-Built Drawing 

C

ENVIRONHENTA

 OAST A L 

L Omaha Lead Superfund Site CROUP , IN C 

Omah Extefior Paint a Lead Site 

0(3ood Site Sketch • Poor 

Samplin g Address : 3056 S 33 ST I I Not paint 

Lead Sample Samples Collected 

Concentration Collected 

Sample Number LAB 

Firm FPA Fe-c s 

RYASCPXA-14482 F l ppm n 

Date 

RYBSCPXA-14482 F2 ppm D Time / / -^ c ^t ^ 

RYCSCPXA-14482 B l 3H- 1 ppm 

I n Samples Analyzed RYDSCPXA-14482 B2 ppm D 

RD2SCPXA-14482 DZ ppm D XRF Unit: GaSH O Book: 20~ \ 

nCZGCPXA-14462 QZ ppm n D Date: ( ^ -/Q-Qf l 

RPZOCPXA-14462 PZ 2 3 3 ppm

a Time n 

Staff: ^n. Number of Samples = j 5" nsv^ 

Legend: F l • Front Left, F2 = Front Rigfit, B1 = Back Left, B2 = Back Rigtit DZ = Drip Zone, G Z = Garden, PZ = Play 

All quadrants are as viewed from the street facing (property^) (^ y - • - • <,. . -ut—I . 

OLS#:144S2 

Date Excavated:11/24/08 

ENTERED

Date USEPA Signed Off: 1/14/09 

Area Sodded 1898 sq ft 

• « \ I'rcaitfd 'i7-j4n.4iK 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced wi1:h 

Area left bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 

Sod n Rock/Mulch 
Pe?i^^/?^p'y y^ ^ 

14482 

Omaha Lead Site 

Site Sketch 

Extefior Paint 

0 f Good 

• Poor 

North Arrow 

Sampling Address: 3056 S 33 ST [~| Not paint 

Sample Number 

RYASCPXA-14482

RYBSCPXA-14482

RYCSCPXA-14482

RYDSCPXA-14482

RDZSCPXA-14482

RGZCCPXA 14462

RPZOCnXA-14462

Lead Sample Samples Collected 

i 

LAB Concentration Collected lectec Firm 

 Fl 3H-I ppm D Date 

 F2 ppm D Time 

 Bl ppm D - B2 -15-5- ppm D 

 DZ 2.53 ppm D XRF Unit:

 6 £ ppm D Date u PZ ppm D 

Time 

Staff Number of Samples = 

ft>A Fe-pB 

 Samples Analyzed 

 G>5H D Book: 20 1 

Q -/Q-Qf l 

£n. n5u/ 

Legend: Fl = Front Left, F2 ^ Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie Etreet. facing |property^, l^ y 

ENTERED 

: MAY2 9i200B: 

\^i^'?<^':^sr'5-3:2 

3 X yj ^ - : Jg / 

-A:^ 

•et^ I ^c>t» ' 

i 
f 

Omaha Lead Site 

Site Sketch 

Sampling Address: 3056 S 33 ST 

Sample Number 

RYASCPXA-14482

RYBSCPXA-14482

RYCSCPXA-14482

 F1 

 F2 

 B1 

Lead 

Concentration 

3 H I ppm 

2 1 3 ppm 

CnlC ^ ppm 

Sample 

Collected i 

LAB 

D 

D 

D 

RYDSCPXA-14482 B2 15 ^ ppm D 

RDZSCPXA-14482 DZ 25", 3 ppm D 

RGZCCPXA 14462 eZ ~ ppm n D 

RPZOCPXA-14402 PZ ^ ppm n D 

Number of Samples • £L 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right 

All quadrants are as viewed from the street, facing 

t ^ 

- . ^ 

14482 

ExtMior Paint North An'ow 

[ 3 Good 

• Poor 

Q] Not paint 

Samples Collected 

Firm: FPA F0-p £ 

Date: V-;?5'-/3»^ 

Time; /f-S'tU ai ^ 

Samples Analyzed 

XRF Unit: G5H 0 Book: 20 1 

Date: G • tO'd B 

Time: PN 

Staff: f^iU / 

DZ = Drip Zone, GZ = Garden, PZ = Play 

property^jl^y 

ENTERED 

^c'>^'^' ' 
14482 

Omaha Lead Site Extefior Paint North Arrow 

Site Sketch [g^^Good 

• Poor 

Sampling Address: 3056 S 33 ST r~j Not paint 

Sample Number Lead Sample Samples Collected 

i 

LAB Concentration Collected Firm: fP A F^-p B 

RYASCPXA-14482 F l 3H- I ppm D Date: H-^S-OP> 

RYBSCPXA-14482 F2 ppm D Time: ll'-S c ai ^ 

RYCSCPXA-14482 Bl ppm 

Samples Analyzed RYDSCPXA-14482 B2 155 ppm n 

RDZSCPXA-14482 DZ 2.53 ppm I n

D 

XRF Unit: G5H 0 Book: 20 1 

nGZCOPXA-14462 9 £ ppm n D Date: G ;/Q-Q 6 

RPZOCPXA-14402 PZ ppm n n Time 2rL 

Number of Samples = j ^ Q Staff J^llWl 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie street, facing property cA\f- ^ 

ENTERED 

MAY 2 9 2088 

0>.i^o .(yaf^S^ 

J^<­

,..gj. 

G70 PEC u 

\SS 

255 £k 

F^l 3^6 S.l-3^, ft. 

l\<i. 

US.-

Fl F=2_ 

3H1 Zl3 

w/>-^/< 

5..5'3 5f-. Rf\- 2w8 N CrealCTl: i)7-.fm4l8 '14<;i41 illi5 
COASTA L 

(NVIISNHINTt l 

C R o u r . t M 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: ^QS^^ ^ 'R,s^^^(;^ ^ Daytime Phone: ^4^2-' 2 0 §'- 7 "^ ? 9 

402-7 (4-1 g'i-9 

Address of Property 

covered by this 5OUJ, S. yyjo 

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 tjegins. 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 unit! the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
^^^••• ^

 COASTAL ENVIItONHFMlA l 

C I 0 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 vwjuld 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 

-jclQlgran I granl t access to my properties Q i do not grant access to my properties 

„ _ y //-n-o K 

^ ^ Sighature ^ Date Signature Date 

Q I would like to be present during any sampling that is required. 
t 

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 vviil also serve as documentation for the purpose of assuring that restoration 

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

Protection Agency (EPA). 

Property ID: /tjt/^p , 

Property Address:^(^,q^ 5 . SV'" ^ S-f-. 

Owner: r£s^c(_Q /\/<;/i jyc^ 

I Phone: Jo ^ 1333 9 

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: 

S^^cneS 

Item: 

Item: 

Item: 

Item: 

Item: / 

Item: 

Item: 

Page1 of ( ^ 
% % 

( ^ ^ 

COASTA L 

C R O U r . IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

/i fern C ^ 

Item: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of JQ 
t 

COASTA L eMVlNOMnCMYA L 

c ff o u r t N e 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Soil-' N 

Item: 

" ~~~~--. $.nyj y / - 1^,9- pr< ..//- / \ 

Item: 1 

^ 

Item: 

/ 

Item: / 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

y Item: 

/ 

Item: / 

/ 

/ 

Pag e 3 of A 
t

- — <» 

C O A S T ft L 

e R o o r . t M c 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Iii 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 

each garden/ flower bed 

area. Each 

Square Feet 

Attach a sketch of relative 

sizes and locations. 

Page 4 o^IjL 
t w^ COASTA L 

I MvidONr^tMTA i 

c o o u r IN C 

Item Quantity Uriit Condition/Type/Species 

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. Each 

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. 

paK-f r / SF 

LA ^ Grass 

Area of City or County 

property to be landscaped 

per their requirements. SF 

Include

area (s) 

a sketch of the 

Easement Area, to be 

excavated SF " ^ y ^ ^^{tfr'/^'i^<^^ 

Pages of_l ^ 
% 

C O A S T A I. 

D Check the box if Owner does not want CEG to document interior foundation wails and possible 

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

interior of house, including foundation cracks or fissures. 

I agree O I do not agree 

,_„.^ —;-^ /1-/1-0^ yihHV.A Hfnir^ 

'0#ner1 ? Signature Q ^ Date Con&actor's Signatiire ' Date 

PageSof VO _ . 
BviD# )MdRS> 

XRF PROPERTY SAMPLE SHEET 


Date n-SM-oB Address .'^D^U :^- '-^.^ ^ir. Project Omaha lead FP 2nd year opilon Sample time \\\^^ j am/pm 

XRFID# sample length 30 sec tf^f^m 

Shot# Reading Sannple area Shot# Reading Sample are 

^'60^ \-^i.atM,\ ^ 4S\D 7-7.tMJ:)\.tH 

^•T^Vn •m'h.uo^-\^^\ n ^\? ^ 76^.()q tll.-^^(^o 

•A.-^ P,lt-)L^. ^ Depth <^.3^<5 yo.:^-7t \Q.\ D Depth ? 

A&S \\,Ao.,^^y\{..H u ^?>i-b h h X^ - )?3-90 

Average t ^ \ . .V^ ^ \A^.UL t Average J^L \ (o t J \ \ "7 ^ 

Shot# Reading Sample area Shot# Reading Sample area 

ii^ax 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature ^ ' 

Prinl /// ' < o/t^S if­
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 171.506 

Supervised By: 

Certificate of Verification 

4305 

SOIL 

2008-11-24 11:38 

32.34 

Final 

14482 

3056 s 33 St 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 16.147 
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 243.597 

Supervised By: 

Certificate of Verification 

4306 

SOIL 

2008-11-24 11:38 

31.00 

Final 

14482 

3056 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 19.310 
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 143.871 

Supervised By: 

Certificate of Verification 

4307 

SOIL 

2008-11-24 11:39 

30.59 

Final 

14482 

3056 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 14.976 
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 166.218 

Supervised By: 

Certificate of Verification 

4308 

SOIL 

2008-11-24 11:40 

30.62 

Final 

14482 

3056 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 16.188 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4309 

Mode SOIL 

Time 2008-11-24 11:40 

Duration 124.55 

Sequence Final 

Flags 

AVERAGE Avg of 4305-4308 

ADDRESS 3056 s 33 St 

QUAD/ZONE iB l 

INSPECTOR Ventry 

DEPTH 1-6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 181.298 ± 16.655 

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 77.035 

Supervised By: 

Certificate of Verification 

4310 

SOIL 

2008-11-24 11:41 

30.54 

Final 

14482 

3056 s 33 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 11.492 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4311 

Mode SOIL 

Time 2008-11-24 11:42 

Duration 30.53 

Sequence Final 

Flags 

BVID # 14482 

ADDRESS 3056 s 33 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 78.093 ± 11.331 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4312 

Mode SOIL 

Time 2008-11-24 11:42 

Duration 30.56 

Sequence Final 

Flags 

BVID # 14482 

ADDRESS 3056 s 33 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 90.366 ± 12.099 

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 90.537 

Supervised By: 

Certificate of Verification 

4313 

SOIL 

2008-11-24 11:43 

30.50 

Final 

14482 

3056 s 33 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 12.202 
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 

Certificate of Verification 

4314 

SOIL 

2008-11-24 11:43 

122.13 

Final 

tAvg of 4310-4313 

3056 s 33 st 

" easement 

Ventry 

;1 

CLEARANCE 

ppm ± Error 

Pb ^4.00 8 ± 11.781 

Supervised By: 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

%. • ^ www.coastalhazmat.com 

VpHO^"^ COASTAL ENVHtONHENTAL 

GROUP , INC . 

EXECUTIVE SUMMARY: 

BVID # 14482 - (3056 S 33 ST) 

'xl No Issues or Concerns []] Issues/Concerns 

Detail Explanation: 
>^^EPA 

EPA Propert) Close Out Form 

Prop«rt> P: \,L\L\fpyS ) Proptrt y AddrcM : 3D|S C 0 S - 3 3 o t 

Dtle/riroe : Owner's Namt: t5vr^P-^^^-^^^-^ ^ "RcUZr^^t ^^9 ^ 

Qu«d5 E»c»v«lfd: ^ 1 Conlrsrto r Croup Qtsy^ S.'Vt.'-J ^ "^^xA r Q<-N>AJ^'^'^H 

LxcivBtlo n Gencn l Yes No 

1 If necessi^, wert iht conrcl quadrani(s) cxcavaltd and reslored? 

y 

2 If necessary, were the correct areas of drip zone excavaied and restored' 

it\ 

CradlDK Sod and VctcUlioD Ves No 

1 Does the grading around ihe perimeler of the house in excavated areas generally slope away 

s y from Ihe house? 

2. 

Has sod been laid ir all areas Ihat were excavated? y 

3. 

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

day lime period) 

y 

A 

Are sodded areas generally firm and evenly graded'' ^ 

5 Are the joints berwcen Ihe sod stnps generally tight? (Only evaluate if mspecied ai a 30 day 

y time period) 

6 Was the properry graded such that water wil l not pool on the propeny'' 

y 

7 

Was damage to landscaping or plani materials avoided'' 1 y 

Galtt . FePCCT and ReUining W«ll i 

\t*, No 

I Do gales open and close fre«ly'' (Ifapplicable) 

2 Were all gates or fences taken down during resloralion activiiies reinstalled'' (If applicable) 

ii 

3 Was damtge to gates or fences avoided? (Ifapplicable) 

4 Was damage to retaining walls avoided? (Ifapplicable) 

f/A 

Fouodi ition , SidiBK and Cutler s Yes No 

1 Was damige to the siding or trim avoided? 

l y 

2 Was damage to the foundation avoided? 

y 

3 Was damage to windows avoided'' y 

4 VV'as damage to windows or door screens avoided'' y 

5 Was damage lo dowTispouis or downspoul exiensions avoided? 

y 

Sidewalka and Driveways (CoDcrelt) Ves No 

Was damage lo driveway surfaces avoided'' y 

2 Wa i damage lo walkway surfaces avoided'' y 
O »Ders comments: 

Inspection notes: 

Removal and resloralion aclivales complele incluciing ihe 30-(Jay sod warranty 

^//^/^ ; FPA Renrp^pnt;ilivp HQ W 
Property Completion Agreement 

'iliis agretiineni clocumenls the complclion of remedial activiiies perromied on my property. My signature 

will designate Ihat I am sati,sJied willi tlie restoration of my properly, and that no itcm.s are in question.s, 

now. or at any time in the fiiliire, except those ilem.s listed below, ifany. 

Ovvncr: J ^ OjS^yjo^ R\S^\\' WCV . _ 

PJjonc; -^ ~ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Additional Comments: 

L 

I agree re.stomtion i,\ completed, except as noted 

I I I ilo nol aercc resloration is completed 

/ iJzojo^ ^x^ ,,iH-yi 

r's Signnliirc z^ ) Dale Contractor' s .SijJiuatiice' Dale 
Q 

\ ^ ^ 

l•./l>^ ' 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # / VVS^ ^ 

Property Address 3 ^ -^ ^ S ^ \ S~^ 

Owner Name ~^O^r\{jc^ i\'s U linc^ 

Date / / /^^/o 9 

Comments 

7^k<- OU-h Conc\r<yr< u/^^lk^ on -j-J— 

Owner Signatun