TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^3Hl^3 Date: 1 j'!>o j ^ q 

Address : "^711 K\ ^['^ ^ f 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs pr ^ -^.\^C^^j4|vt^ g^^l/cAflvt, 5g-r W Sdd.^ -\ia£A 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

ffi/ Utility clearances 

Property information from Douglas County Assessor's Office 

D 

^fi/y 
Property Access Checklist 

n WOUKSTARIED ON: / /_ ''':^*^'£Lj2aii33 

D WORK COMPELTED ON: / /_ i>mpc.-.; Addtcs;; ^^^-^ y q 13\ ^ 

Renter: 

.Address: J 

Phone: 

Fax: 

Cell/Pajfer: 

Additional Information: 

^ Ss^i-'^a^L 

2£i5n0i^ 

1 n Notification Letfci- Sent:

 / / y ^ . .. __J 

y^Acci'ss Ajjrcenicnf Si!;ned:i^/l9:/ ^ ^y-9AQim 

1 0'T^cs(()ralion A<>reenient Siuned: h / [T i Q \ 

''y%L(My_^.^ 

1 1 Top.soil .Sampling; (if applicahle) 1 1 By: 

• Disposal Samplinj; (if applicahle) 1 1 By: 

[U Carden ,Sani|)linj4 (if a|)plical)lc) 1 1 By: 

J^lJtilit v Clearance Called: ^/2_/6 ^ By: <^C 

n Video/Photos (Bcfoi-e) On: / / By: 

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

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

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

1 1 Property Conifiletion Afjreenient Siuned: / / By: 

1 n Final Report Issued: / / By:

Air IVIoin(orin<> (a.s applicahle) 

1 1 Comnuinity Q Crew On: / / By: 

Results: 

\ y Community C] CfCM' On: / / By: _ j 

Results: 

1 L J Community dJ CICM On: / ,/ By: 

Results: 

Omaha Lead Site 

 1 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

^.WJ3 

3^7 Id. ^yy . 

oo Date:^~/7'^^Time: / 3 Action: S/'GA^ . 

 Date: Time: Action: ^ 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

T-Q'Ci^ X>iea^c caxl th^ 6.004 tefore loeOre 
Douglas County Account Infimriatio ^jm £ n Page 1 of3 

Dougla s County , Nebrask a Propert y Recor d - R161417000 0 

Print Report 

Parcel Dimensions available @ scale 0-50 ft west of 144 St ^ Vie w OH Ma p Information is valid as of 2008-4-17 Treasurer's Tax Report 

New Feature ->-*- • Auto Sales Search 

Owne r 

CASKEY JASON M 

ETAL 

327 N 41 ST 

OMAHA NE 68131-0000 

Propert y Informatio n 

Key Number: 1417 0000 16 

Account Type: Residential 

Parcel Number: 1614170000 

Parcel Address: 327 N 41 ST 

OMAHA NE 68131-0000 

Legal Description: LA VETA PLACE LOT 7 BLOCK 1 1/2 VAC ALLEY & 40 X 116 

Valu e Informatio n 

Land Improvement Total 

2007 $5,500.00 $70,900.00 $76,400.00 

2006 $5,500.00 $70,900.00 $76,400.00 

2005 $5,500.00 $48,000.00 $53,500.00 

2004 $5,500.00 $48,000.00 $53,500.00 

2003 $5,500.00 $48,000.00 $53,500.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2006-10-23 

Deed Type: WD Book: 2006 Page: 123418 

Price: $116,000.00 

Grantor: Shurson Ellen L 

Grantee: Caskey Jason M etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1997-08-28 

Deed Type: D Book: 2073 Page: 

006 

Price: $45,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161... 5/7/2008 
Douglas County Account Inthnnatio .^jm s n Page 2 of 3

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1993-06-26 

Deed Type: Book: 1957 Page: 672 

Price: $57,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1991-05-28 

Deed Type: Book: 1899 Page: 082 

Price: $25,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Invalid 

Exclusion Reason: Invalid Sale 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.1 4640.0 1.0 116.0 40.0 No 

Improvemen t Informatio n 

Building 1 

327 N 41 ST 

[Pfl?:; 

fr a floor 

1 T«4 5n | ft S«oni! Floor 

520 g&q It 

2 1/2STORrUNFIN 

Bvnnl Block 8 D ., it-.v 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1284.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161... 5/7/2008 
Douglas County Account Infimriatio iaane n Page 3 of 3 

Unit Type: Conditior i : Very Good 

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

HVAC: Central Air to Air Rooms: 6,0 ' 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip Stories: 2.5 j 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 | 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1908 2006 0% 1957 51 

Detail Type Detail Description Units 1 

Add On Fence Wood 1.0 

Add On Unfinished Attic W/floor 520.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 545.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Porch Wood Deck 36.0 

Porch Wood Roof 130.0 II 

User MLS UPDATE • 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161... 5/7/2008 
Page 1 of2 

'"• > 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2072947. 

Original Call Date: 7/02/08 Time: 2:32 pm Op: ELIZABETH18790 

Work to Begin Date: 7/07/08 Time: 3:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address : 327 Street: N 41ST ST 

Twp: 15N Rng: 13E Sect-Qtr: 17-SE,20-NE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

Type of Work: Lead remidiation 


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


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


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Alt. Contact: Phone: (402)991-1199 


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 


BSHPCLKS CXCATV MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT EDWINA 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/2/2008 
Page 2 of2 

CITY OF OMAHA- OMAHACOF RON TRAFFICSEWER 

OMAHA PUBLIC POWER OPPDGPR5 NA DISTRICT 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/2/2008 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

^3H'd5 

Omaha Exterior Paint Nortti Arrow Lead Site 

[3 Good Sampling Address: 3E 7 N ^ t <Sf. Site Sicetch 

• Poor 

Phone: ^ SOeSdQS^^ 3^/~ 363 1 [ ] Not paint 

Sampl Lead Sample Samples Collected e Number 

Concentration Collected Firm: FPl^ V b CJ^ 

RYASCPXA-23 V53F1 ppm D Date; q-lM-CT 

RYBSCPXA-23V33 F2 ppm D Time: \V^ 5 

RYCSCPXA-23VJ5 B1 ppm Bl 

Samples Analyzed RYDSCPXA-23V33 82 F.ZO ppm D 

RDZSCPXA-£13>/33 DZ 

ppm I D XRF Unit: LS'^ Z Book: 79 3 

nozGonxA 03*^33 oz ppm D Date: lOIO I fo i 

Lab RYCSCPLA-23433 ppm D D Time: /f/V ' 

i Result 249 ppm D Staff: M^y f Number of Samples = } 

Legend: F1 = Front Left. F2 = Front Rigtit, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie street, facing property 

OLS#: 23433 : rp T ** \ ^ ^ t 

Date Excavated: 6/19/08 f.-'f t 

Date USEPA Signed Off: 8/14/08 

Area Sodded 1047 sq ft 

i4l-.!.ll.!)i:'| 


Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area left bar e 

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

^3V33 

Omah Exterior Paint North Anow a Lead Site 

g Good Satnpling Address: 3^ T A l ^ / <St. Site Sketch • Poor Phorw:»5oe-3dG6^^^ 36./- see / n Not paint 

Sampl Lead Sample Samples Collected e Number 

i

i 

LAB Concentration Collected Firm: ^Of\ 7 b C^ 

RYASCPXA 23^5 3 Fl ppm D Date q-iM-0? 

RYBSCPXA- 23*^33 F2 ppm D Time W-^fi 

RYCSCPXA 23^3 3 B1 ppm 01 Samples Analyzed 

RYDSCPXA Z3*^33 B2 ppm D 

RDZSCPXA- e3H33 DZ ppm D XRF Unit: (QS^Z . Book: i°l Z 

nCZCCPXA ppm u D Date: /g'/^//<? 7 

Xab RYCSCPLA-23433 ppm u D Time A/H. 2 Result 249 ppm Staff MS\M Number of Samples = 3 / 

Legend: F l = Front Lett. F2 = Front Rigtit, Bl - Back Lett, B2 - Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, lacing property 

r 

L NX r^[Ay\ 'Ty^'^r'F'" 

]}y^ j ^'^§. 1 

-Th-ktlylj^^'^ 

.> ^*t^s^ -^^ ^ 

. . . TT)^' ^ 

X4yj[yit f^/yif 

F^y c fj-L ly ^ //,/-.//.,> 
^3^3.^ 

Omaha Exterior Paint North Arrow Lead Site 

Q Good Sampling Address: 36 T Myfi l <Sf. ^ Site Sketch • Poor 

Phone: H SOe-ddGS^ ^ d^^ly dtS I 

Q Not paint 

Sampl Lead Samples Collected e Number LAB 
 Concentration Firm: fPf\ 7b CiS 

RYASCPXA- 23V33F1 fiso Date: ^-l^-Q ? 

RYBSCPXA-e3H-33 F2 L H l Time: \VMf) 

RYCSCPXA a3H33 Bl P H I 

Samples Analyzed RYDSCPXA 23V33 B2 Pza 

RDZSCPXA £3H33 DZ SHS- XRF Unit: ^VZ . Book: 7 9 3 

nCZCCPXA Q3*^33^^ Date: lOIO/fp- f 

— RYCSC PlA-23433 Time: JMJ . .Lab 

= Result 249 ppm M<^\A/ Number of Samples = : 3 : I 

Legend: F l = Front Lett, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Dnp Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

SEP 192(1 

'ic - '-fy>i,­

V \ y 

^ %kf/t f3 V'^\ \]iyj M', Z H l 

y 

ilifj^l^*' 

JZL W ^ ^^^^^ ^ ^ 

Fn. 

> 

'M 

j S 

'%y>Of. y(\^yy i ^ki^ 

.CliiX? 

X^ti^J^it- p[ y ^ 

foOc 
L 

^3V3J 5 

Omaha Exterior Paint North Arrow Lead Site 

Samplin 0 Good g Address: 32 7 N H-l <St Site Sketch • Poor 

Phone: ^50£-d3.Q6yi 5t[~3S.3 l Q Not paint 

Sample Numljer Lead Sample Samples Collected LAB Concentration Collected Firm: FPlft 72) Ci^ 

RYASCPXA-23 V33F1 

ppm D Date: q-lM-O; 

RYBSCPXA-23V33 F2 ppm D Time: \VA^ 

RYCSCPXA-23V^5 B1 

ppm EZI i Samples Analyzed RYDSCPXA-23^33 B2 7.ZO ppm D 

RDZSCPXA-213V33 DZ ppm D XRF Unit: (oS*fZ. Book: /9 3 

nozocPXA Q3H03 Qg ppm n D Date lOfO/fo-J 

Lab RYCSCPLA-23433 ppm D Time JU±. 

s Result 249 ppm Staff 

MSW Number of Samples = 3 i [_/ 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, 62 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 
,v-^« sr<. 

COASTA L ENVIRONMENTA L 

C R O U » 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: O'Xli'X' l 

Owner's Name: \L^f\i^^ ) Ccfokl ^ Daytime Phone: ^^ ^ ^ 5" ^ 9. " ^%ID ^ 

Address of Property 35^1 U- '<i^^­ 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 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 
>*':^^ .*» v w

 w ifm>^ 

I 

\^***" V COASTAL •*" -"^

 ENVIRONMENTA I ^^, PBO'T'- C R 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 T O 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 Q I do not grant access to my properties 

Signature Ly Date Signature Date 

O I would like to be present during any sampling that is required. 
COASTA L 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe propert\ prior to 

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

activities are completed to the satisfaction ofthe propert>' owner and the United States Environmental 

Protection Agency (EPA). 

I Property ID: '^^ 3> Ij ^ 3 

Property Address: ^^ ^ j<U 4 / "Sf 

Owner: 

/<r>5 ^ (jd^hy - Phone: Ht>A- so?. - ^i,ii,<^ 

On the attached diagram(s) indicate area(s) to excavated and depth of e.\ca\ation, location of all known 

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

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

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

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 Owners responsibility. 

Item: 

SWY^^li 0\t^^< > oU)rxi^r WiCK\A^<. ^ ^ hi^i) . 

Item: * 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 

1 
iJ 

COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

VlnW£ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

1 

Item: 

Item: 

Page 2 of 
m 

COASTA L 

r > "M c 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

bhL 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that wil l be excavated, that 

is covered whh grass. 

Square feet 

Number of trees

trunk diaineter 

 > 2 inch I Each y 

Number of trees • = 2 inch 

trunk diameter 1 

Each y^a •\(j2ji^yyc 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, etc. 

Anach a s^^elcil iif ihe 

;.pii;ikle.- k;\ out. 

" ^ 

Each 

1 

i 

Number of and size of 

each garden/ flower bed 

area. 

M:v^ an J. k")ca;ions. i 

Each 

Square Feel 

Page 4 of 
COASTA L 

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 propertv 

o\\ ner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant v\ill be placed 

b\ the coniracioi'. 

Agreed upon area of 

property to be replaced 

w ith grass sod. 

':ii.'li:(.1e a Nkeicli .>; liic 

.iieais) U'. he :epl.ict.-J '.^ 'i^i 

.Area of Cir> or Count) 

property to be landscaped 

per their requireinents. 

;!''>.l.!ilr 1 -,.v'UT' ^'l " :! c 

Easement .Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

$ 

Each 

SF 

SF 

SF 

Page 5 of. 
C O A S T A L (MVIHOMMtMTA L G m O U r . IN C 

Additional Comments / Instructions: 

• Check ttie l)Ox if Owner does not want CEG to document interior foundation wails 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 O I do not agree 

UMA^^yy Q^viy ^ f,-/^^r yF^^F^F7FF:^^f.c. io-nyjh 

Owner's Signature ( ^ Date Contractor's Signature Date 

Page 6 of. 
1

Date 

Project 

XRF 1D# 

Shot # 

\n 

Tl I 11 

Average 

Shot# 

' \ y 

y ^ 

1Mn 

y% 

Average 

Shot# 

Average 

 Shot # 

•••^vi 

'V\<< 

l y 

\ TKt> 

Average 

lab sample # 

XRF PROPERTY SAMPLE SHEET 


L,-\^ -0-^ Address 

Omaha lead FP 2nd year option Sample time 

-y^v y sample length 

Reading Sample area Shot# 

7 ON'iWvi -w' n

W± 

Dept uept h I i ny (in ^- fir m y y 

Average ll^^^k 

Reading Sample area Shot# 

\y . i'itn,o > H Is^D 

17.n. O^il IM.H^ Is'I 

y\yy i \^y^ Depth 'Kz 

y y i I'-^.M^ y ia 

^Hqu+ K,K Average 

Reading Sample area Shot# 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

y].i=\y]'i-i' \ 

V ^ 'Ho-lit 'i^^y 

'yy ^ 'i.oi Depth 

y.A'^t ivo^- y 

iC.-^i^ ^H.rr Average 

Lab result Sample area XRF Avg. 

Signature 

Print 

i 

BVID# 11^-i2> 

3a"\ u. 4!^^sA 

am/pm 

30 sec 

Reading Sample area 

\%y ^ i^.K 

'^-"nt v^y £1 

YU.d'y IL' ^ Depth 

:7.;,.".C.J: B.QMI 1 ^ 

 ^^ ' '\l J WF y 

Reading Sample area 

M1'^.UJ iii-Ms P i Ki^..ni; m.ii 

H'Zir-t.'r L',D.4N' Depth 

-y\i.y\y v^ y \ y 

i^^t.m i^^s 

Reading Sample area 

Depth 

Reading Sample area 

^,. ) 

„...-'-•" Depth 

y^'" 

yy^-

Mrrfv^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 120 

Mode SOIL 

Time 2008-06-19 14:25 

Duration 121.01 

Sequence Final 

Flags 

AVERAGE Avg of 116-119 , 

ADDRESS 327 n4 1 

QUAD/ZONE easement 

INSPECTOR DETRICH 

DEPTH SURFACE 

SAMPLE TYPE 

NOTE 

ppm ± y Error 

y 

Pb 168. in f yyy ' 16.203 

~ y y 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 116 

Mode SOIL 

Time 2008-06-19 14:23 

Duration 30.26 

Sequence Final 

Flags 

BVID # 23433 

ADDRESS 327 n 41 

QUAD/ZONE easement 

INSPECTOR DETRICH 

DEPTH SURFACE 

SAMPLE TYPE 

NOTE 

ppm ± Error 

Pb 174.287 ± 17.083 

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 169.305 

Supervised By: 

Certificate of Verification 

117 

SOIL 

2008-06-19 14:24 

30.23 

Final 

23433 

327 n 41 

easement 

DETRICH 

SURFACE 

± Error 

± 16.260 
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 161.675 

Supervised By: 

Certificate of Verification 

118 

SOIL 

2008-06-19 14:25 

30.23 

Final 

23433 

327 n 41 

easement 

DETRICH 

SURFACE 

± Error 

± 15.807 
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 167.201 

Supervised By: 

Certificate of Verification 

119 

SOIL 

2008-06-19 14:25 

30.29 

Final 

23433 

327 n 41 

easement 

DETRICH 

SURFACE 

± Error 

± 15.661 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 744 

Mode SOIL 

Time 2008-07-14 11:03 

Duration 120.97 

Sequence Final 

Flags 

AVERAGE ' Avg of 740-743 

ADDRESS 327 north 41st street 

QUAD/ZONE F l 

INSPECTOR MATEUS 

DEPTH 6 

SAMPLE TYPE 

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 191.303 

Supervised By: 

Certificate of Verification 

740 

SOIL 

2008-07-14 10:59 

30.19 

Final 

23433 

327 north 41st street 

Fl 

MATEUS 

6 

± Error 

± 17.352 
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 221.994 

Supervised By: 

Certificate of Verification 

741 

SOIL 

2008-07-14 11:00 

30.41 

Final 

23433 

327 north 41st street 

Fl 

MATEUS 

6 

± Error 

± 18.519 
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 182.096 

Supervised By: 

Certificate of Verification 

742 

SOIL 

2008-07-14 11:02 

30.08 

Final 

23433 

327 north 41st street 

Fl 

MATEUS 

6 

± Error 

± 16.837 
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 236.307 

Supervised By: 

Certificate of Verification 

743 

SOIL 

2008-07-14 11:03 

30.29 

Final 

23433 

327 north 41st street 

Fl 

MATEUS 

6 

± Error 

± 19.042 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 749 

Mode SOIL 

Time 2008-07-14 11:07 

Duration 121.11 

Sequence Final 

Flags 

AVERAGE Avg of 745-748 

ADDRESS 327 north 41st street 

QUAD/ZONE F2 

INSPECTOR MATEUS 

DEPTH «#. - SAMPLE TYPE 

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 183.191 

Supervised By: 

Certificate of Verification 

745 

SOIL 

2008-07-14 11:05 

30.16 

Final 

23433 

327 north 41st street 

F2 

MATEUS 

6 

± Error 

± 17.027 
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 127.080 

Supervised By: 

Certificate of Verification 

746 

SOIL 

2008-07-14 11:06 

30.36 

Final 

23433 

327 north 41st street 

F2 

MATEUS 

6 

± Error 

± 14.498 
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 151.927 

Supervised By: 

Certificate of Verification 

747 

SOIL 

2008-07-14 11:07 

30.30 

Final 

23433 

327 north 41st street 

F2 

MATEUS 

6 

± Error 

± 15.585 
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 115.676 

Supervised By: 

Certificate of Verification 

748 

SOIL 

2008-07-14 11:07 

30.29 

Final 

23433 

327 north 41st street 

F2 

MATEUS 

6 

± Error 

± 13.491 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 754 

Mode SOIL 

Time 2008-07-14 11: 12 

Duration 121.12 

Sequence Final 

Flags 

AVERAGE Avg of 750-753 

ADDRESS 327 north 41st street 

QUAD/ZONE DZ 

INSPECTOR MATEUS 

DEPTH .2. 

SAMPLE TYPE 

NOTE 

Pb 

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 4172.114 

Supervised By: 

Certificate of Verification 

750 

SOIL 

2008-07-14 11:10 

30.33 

Final 

23433 

327 north 41st street 

DZ 

MATEUS 

12 

± Error 

± 81.451 
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 1513.286 

Supervised By: 

Certificate of Verification 

751 

SOIL 

2008-07-14 11:11 

30.27 

Final 

23433 

327 north 41st street 

DZ 

MATEUS 

12 

± Error 

± 47.119 
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 1726.600 

Supervised By: 

Certificate of Verification 

752 

SOIL 

2008-07-14 11:11 

30.28 

Final 

23433 

327 north 41st street 

DZ 

MATEUS 

12 

± Error 

± 50.441 
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 398.979 

Supervised By: 

Certificate of Verification 

753 

SOIL 

2008-07-14 11:12 

30.24 

Final 

23433 

327 north 41st street 

DZ 

MATEUS 

12 

± Error 

± 24.660 
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 

ppm 

Pb 495.246 

Supervised By: 

Certificate of Verification 

781 

SOIL 

2008-07-14 18:38 

120.76 

Final 

— -

Avg of 777-780 

327 n 41 st 

DZ 

MATEUS 

13 

RETEST 

' Error 

24.889 
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 1311.694 

Supervised By: 

Certificate of Verification 

777 

SOIL 

2008-07-14 18:36 

30.30 

Final 

23433 

327 n 41 st 

DZ 

MATEUS 

13 

RETEST 

± Error 

± 44.278 
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 340.713 

Supervised By: 

Certificate of Verification 

778 

SOIL 

2008-07-14 18:37 

30.05 

Final 

23433 

327 n 41 st 

DZ 

MATEUS 

13 

RETEST 

± Error 

± 23.224 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 779 

Mode SOIL 

Time 2008-07-14 18:38 

Duration 30.04 

Sequence Final 

Flags 

BVID # 23433 

ADDRESS 327 n 41 st 

QUAD/ZONE DZ 

INSPECTOR MATEUS 

DEPTH 13 

SAMPLE TYPE RETEST 

NOTE 

ppm Error 

Pb 186.171 ± 17.028 

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 142.404 

Supervised By: 

Certificate of Verification 

780 

SOIL 

2008-07-14 18:38 

30.37 

Final 

23433 

327 n 41 st 

DZ 

MATEUS 

13 

RETEST 

± Error 

± 15.025 
/lfi|/ i Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ , 5 Coastal Environmental Group Inc. 

^y^^^ www.c0astaiha2mat.com ^^tPBoT*^ COASTA L ENVIDONHENTA L 

CROUP . INC . 

EXECUTIVE SUMMARY: 

BVID # 23433 - (327 N 41'* St.) 

I I No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

The Clean up activities went well; however, a $300.00 Gift Certificate fi-om Indian Creek Nursery was 

issued to the property owner to compensate for plants that were removed from the DZ while removing 

impacted soilfi-om this property. 
^#C«rjpA -^ 

EPA Propert\ Close Out Form 

y vi y y Property ^-.yyii. __Date/Tim „

 -— e 7 '^r-^rr;jEBs;^—

Quads ExcaValfd: V \ \- YV \ "^^ Contractor Group LoiK^TPnExcavation Yes Mo General 

1. if necessary, were the correct quadrant(s) excavated and restored? y' 

2. If necessary, were the correct areas of drip zone excavated and restored':' y 

Grading Sod and Vegetalion Yes No 

Does the grading around the perimeter ofthe house in excavaied areas generally slope away y from the house? 

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

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? y 

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

y time period) 

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

7 Was damage to landscaping or plant materials avoided"^ y 

Gales, Fences and Retaining Walls Ves No 

Do gates open and close freely? (Ifapplicable) l y 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) 

Was damage to gates or fences avoided? (Ifapplicable) p

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

Foundation, Sidipj; and Gutters 

Yes .No 

1 Was damage to the siding or trim avoided? y 

2 Was damage to the foundation avoided? y 

3 Was damage lo windows avoided? t . y 

4 Was damage to windows or door screens avoided? t^ " 

5. Was damage to downspouts or downspout extensions avoided? t y 

Sidewalks and Driveways (Concrete) Ves No 

1 Was damage to driveway surfaces avoided'/ 

2. Was damage to walkway surfaces avoided? y 

y 
• 

m 

Property Completion Agreement 

riiis agreement docuinenls the completion of remedial activilies performed on my property. My signature 

will designaie that I am satisfied with Ihe restoration of my properly, and that no ilems are in questions, 

now, or al any lime in Ihe future, except those items listed below, ifany. 

I Property ID: ^^^^' ^ 

Property Address: 3^ 7 // . Hj-J-i st" 

Owner: ^ cX S 1< ^ y ^yyKn,\ 

Phone: ^r^ 1 -o'o rC — ? 3 1 - 1 ^0^-9'^£.^ - /^ l -"^^71 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

yC/iS' ' agree restoration is completed, excepi as noted 

I I do not afjrec restoration is completed 

etii[o / 

Owner's Sigin.1 Date 

I
Property Damage Settlement 

Property ID 23433 

Property Address 327 N 41" Street 

Owner Kristen Caskey 

Phone 402-502-9865 

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

compensate for plants that were removed during the removal of lead-impacted soil from the property. 

Compensation Type Gift Card 

Value of Gift Card $300.00 

Redeemable at Indian Creek Nursery 

Description of Damage 

Coastal removed several small plants located in the drip zone "DZ" to be able to remove lead impacted soil 

within the DZ. Coastal agreed to compensate the homeowner by issuing a $300.00 gift certificate to the 

homeowner. 

My signature below acknowledges the receipt of the gift card listed above; further, I acknowledge 

that the compensation amount is fair for the replacement cost of the plants removed and release 

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

(?!(( ley 

Owner's Signaiwe Date Contractor's Signature Date 

Page 1 of 1 
• # 

i;m»l 

lan Creek Nursery 

^ ^ Vj^yv 

A..tlvcit t GiF t ('.di d 

INDIAN CREEK NURSERY 

303 N. SftUDLE CREEK RD 

OMAHfi. NE 68131 

(«2) 55ci-59« 

CARD AC ! IVAIEI ) 

TERHINAI. . TKGai 

iiEM It : mm m 

fifllCH It : M1815198 

Account Mber: mmmm^] ] 

tent: SJ8J 

liei Salarice; 

YOUR TRANSflfllON HAS BEEN SUCCESSfULLV 

PRKESSEti PLEASE REnEIIBER fC KEEP VOUR 

CARD IN A SAFE PEACE AS WE ARE NOT 

RESPONSIBLE EOR H S UNAUTHORIZED USE OR 

REPEACING A LOST/STOIEN CARD. 

THANK YOU' 

PLEASE COriE AGAIN' 

UWM.SECUREPAYHENTSYSTEMS.COM 

888-313-7812 

MERCHANT COPY 

T r W A Vn i ir Ca ' \ "VfrT A ^°^^ Satisfaction Always Guaranteed 

xAi>loL//\TM 303 North Saddle Creek Road 

American Nursery & OMAHA, NEBRASKA 68131 

Landscape AssociaU sAarociallon (402)558-5900 

/'SOLni nD B RYv ^ ' DATE >v 

NAME 

ADDRESS PHONE 

CITY 

.••' ) y c / , , yy i yT'yo^F 

n CASH Q CHARGE n MERCHANDISE RETURNED 

D C.O.D. n RAID OUT n RWD ON ACCOUNT 

QTY. DESCRIPTION PRICE AMOUNT 

1 •• •:.: <i y y y- ' • y y y y 

2 : ^ y.y F = y 

3 

4 

5 

'•'-•-V' f ' ' 'f . I­ y i \ \. ' 

- ­

y/:j / 

i 

f .;.-• G 

6 / / ia/y('­ y i ,J> / V.-. ' .•-. 

7 

8 

9 

10 

11 

12 

13 

14 

15 y'.-•• • 

16 V -y y _ RECEIVED BY , y'•'.-'• : ' ^ .. - ^ " 

TOTAL J 

y THAMK YOU 

289! 5S 1