TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: S^^icfb Date: :X^^\cP \ 

Address: 11 ^ . ^ 5lR 5 V 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) a/ 

Executive Summary ^y 

EPA-provided property slcetch 

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.) 

5 ^ Confirmation data 

Photographs pre-i2^<^<eA<yn Sa(au)ah6^ S ^ ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

m Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

IrO^rki'drXJTS^ CMMISJ ' 40318151 

Superfund D 

Sienature Date 

y/a/of 
^ 

Property Access Checklist 

Prop<..rt,ID:2j06^5 

Property Address: l\-^0| ^ 1. ^ ^ 

n

D

 WORK STARTED 

 WORK COMPELTED 

ON:

ON:

 /

 /

 / 

/ 

Owncn ^(y^v^t Kx'vnaw\o 

Address: 

Phone: 

Fax: 

^\q-.40^.1 

Cell/Pagen 

Renter 

Phone: 

Fa.\: 

Cell/Pager 

Additional Information: 

D

0

0 '

D

D

IZl

0

Q '

n

D

n

n

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoil Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Signed: l£)./:2^/ ^ 

Signed: 10./2^/i: ^ 

/ / 

/ / 

/ / 

Called: JCL/^/D S 

On:/ a J 7 /o f 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: tv^\rlrtn\f\5 

^y- [\\Q^[\£^^% 

By: 

By: 

By: 

^r- l^lt//^ 

^y- \/-e /if^^r-y 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

• Community Q Crew | 

Results: 

On: / / 1 

n Community

Results: 

Q Crew On: / / By: . 1 

n Community

Results: 

• Crew On: / / By: 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): 

lOl^l^' b 

n^c, S ^S . ST -

Dale: Time; 

Date: Time: 

Date: Time: 

Transmit to EPA D 

Action: 

Action: 

Action: 

Other Action: D 
••tawa><l-';«'i- -Tk,'' 

t Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

I.,.. 

• YOUR TICKET NUMBER IS 2146757. 

Original Call Date: 10/02/08 Time: 9:18 pm Op: ELIZABETH18790 


Work to Begin Date: 10/07/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1139 Street: S 28TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-SE,28-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY STARTING AT 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 LEVEL3 MCLEODNE MUDOl MUD02 OMAHACOF 0PPDGPR5 


0PPDGPR6 QLNNEIC QLNNEIF QWEST2 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, j^ ^ 

Day:

Alt: 

 8773668344 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl 

METROPOLITAN UTILITIES 

DISTRICT SAIvTOY 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/2/2008 
•r- ' ' 

METROPOLITAN UTILITIES MUD02 DISTRICT 

OMAHACOF CITY OF OMAHATRAFFICSEWER 

OPPDGPR5 OMAHA PUBLIC POWER 

DISTRICT 

r>DDr.r-DD A OMAHA PUBLIC POWER

OPPDGPR6 DISTRICT

QLNNEIC QWEST LOCAL NETWORK

QLNNEIF QWEST LOCAL NETWORK

QWEST2 QWEST LONG DISTANCE

^V7-^'- "•-'" '"rl' 

SANDY 

RON 

NA 

 ., . 

 ^ ^ 

 NA 

 NA 

 SARA 

Page 2 of2 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

Day: 8002834237 

Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/2/2008 
Douglas County Account Infrnmation Page 1 of3 :^mat 

Douglas County, Nebraska Property Record - R1234830002 

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 

VASQUEZ ARMANDO 

1139 S 28 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3483 0002 12 

Account Type: Residential 

Parcel Number: 1234830002 

Parcel Address: 1139 S 28 ST 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 15 BLOCK 1 W 100 N 40 FT LOT 14 & S 40 W 100 FT 

LOT 15 80X100 

Value Informatio n 

Land Improvement Total 

2008 $5,400.00 $38,500.00 $43,900.00 

2007 $5,400.00 $38,500.00 $43,900.00 

2006 $5,400.00 $37,500.00 $42,900.00 

2005 $5,400.00 $37,500.00 $42,900.00 

2004 $5,400.00 $37,500.00 $42,900.00 

2003 $5,400.00 $37,500.00 $42,900.00 

Sales Informatio n 

Sales Date: 2001-03-18 

Deed Type: WD Book: 2184 Page: 723 

Price: $60,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Invalid 

Exclusion Reason: Multiple Parcel Sale . -

Sales Date: 2001-03-18 

Deed Type: WD Book: 2184 Page: 725 

Price: $900.00 

Grantor: i 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 9/27/2008 
',!"'' • .W'^ ' '^r :'^W'TTT^' 

Douglas County Account Infoimatio ^jma n i Page 2 of 3 

Grantee: 

Valid/Invalid: Invalid 

Exclusion Reason: Multiple Parcel Sale 

Sales Date: 1990-05-17 

Deed Type: D Book: 1874 Page: 339 

Price: $27,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.18 8000.0 1.0 100.0 80.0 No 

Land Attributes 

Attribute Attribute Description 

Negative Influence Traffic 5 

Negative Influence View 

Improvemen t Informatio n 

Building 1 

SiaC liKOl CM .to., ._i3lia « 

tmnta t 

4«Dsl 

, Two Story 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1132.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 9/27/2008 
Douglas County Account Information Page 3 of3 ormal 

1 '** 

i Exterior: Frame Alumi num Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gambrel Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1895 0 0% 1895 113 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 636.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 192.0 

Porch End Screen 96.0 

Porch Slab Roof Ceil 20.0 

User Constant Traffic Noise 1.0 

User Faces 1480 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R12... 9/27/2008 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

20665 

Omaha Exterior Paint Lead Site North Arrow Owner Name: ARMANDO VASQUEZ 

Site • Good Sketch Address: 1139 3 28 ST _ • Pogp Phone: H: Not paint 

OLS#:2(!665 

Date Excavated: 10/9/08 

Date USEPA Signc d Off: 1/12/09 

Area Sodded 4Q& sq ft 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc, 
Omaha Lead Site Owner Name: ARMANDO VASS QQ ^

Site Sketch Address: 1!39 S^28 ST 

Phone: H; W: 

Sample Lead Sample Number LAB Concentration Collected^--

RYASCPXA-20665 Fl ppm D 

RYBSCPXA-20665 F2 ppm D 

RYCSCPXA-20665 Bl 

RYDSCPXA-20665 B2 ppm D /f<^ 

ppm n 

RDZSCPXA-20665 DZ ppm D ILJ- RGZSCPXA-g0665 ppm B­ -BIi 

2066^ 

xterio North Arrow r Paint 

• Good 

• Pogp^ \ 

pTNot paint 

Samples Collected 

Firm: 

Date: ^ - \ % - ^ 

Time: ^'SSN ^ 

Sannples Analyzed 

XRFUnit: ^^" ^ Book: ^ ^ 

Date: ^ - "^--^ ^ 

/:^r^ 7 Time: 

Staff: r7-:r7<n 

Omaha Lead Site 46130 
20665 

Owner Name: ARMANDO VASQUEZ 

Address: 1139 8 28 ST 

Phone: H: W: 

Lead 

Concentration 

RYASCPXA-20665 F1 

RYBSCPXA-20665 F2 

RYCSCPXA-20665 Bl 

RYDSCPXA-20665 B2 

RDZSCPXA-20665 DZ I' l 

nOZGCPXA-20GGG 

Sample Number 

Omaha Lead Site 

Site Sketch 

Sample LAB Collected,^ 

ppm D 

ppm D 

ppm D 

ppm D 

ppm D 

ppm B­ -B­ ppm 

Exterior Paint North Arrow 

• Good 

• Pogt­ \ 

[3^0 1 paint 

Samples Collected 

Firm: 

Date: V- i^- ^ 

Time: ^:J3-A ^ 

Samples Analyzed 

XRFUnit: ^^" ^ Book: ^"Z- , 

Date: ^ ' T '^" ^ 

Time: /^rr? 

Staff: j:7<rm 

Omaha Lead Site 46130 
20665 

Owne Omaha Lead Site r Name: ARMANDO VASQUEZ 

Site Sketch Address: 1139^28 ST 

Phone: H: W: 

Sample Number Lead 

Concentration 

Sample 

Collected,-- LAB 

RYASCPXA-20665 Fl ppm D 

RYBSCPXA-20665 F2 ppm B 

RYCSCPXA-20665 Bl ppm B 

RYDSCPXA-20665 B2 ppm B 

RDZSCPXA-20665

R020CPXA-20665

RPZSCPXA-20665

 DZ 

 G2­

 PZ 

UJ . 

^63 

ppm 

ppm 

ppm 

B

5 ^ 

B 

-BB 

Number of Samples = j U? 0\ y. > — 

/ : 

Exterior Paint North Arrow 

• Good 

• Pogp­ \ 

r^No t paint 

Samples Collected 

Firm: 

Date: ^ - l%- ^ 

Time: <^'SSI ^ 

Samples Analyzed 

XRFUnit: ^^ ^ Boole: '^2 -

Date: ^ ' T '^ ^ 

/^r^r ^ 

Time: 

Staff: i7<77<n 

-

b \ 

\V z.a.<^. 

¥^^3 (fili^ h- ^ / 9 ^ 

9." 

54 U^^ *^ ^ ^r <o 

Q ur» - ^ 

OZ - I/T 

-V= T 

«Nr k - >

^O'S-^ 

M L^AllC 

S H CcD 

v Si 

^c 

Bl f4 

7^6^ c? 

\yjt<\\ ^ 

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Omaha Lead Site 46130 
0 

I , 

COASTA L ENVIRONMENTA L 

C f O U P , IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

Owner's Name: Daytime Phone: 9^^ . -—3 ' ?^ ^ ^ ^ l 

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 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 
••^ ••*'.' 1 "'-^'' f iia''; 

fC^^'^f^ 

V*^**^ * COASTAL ENVIRONHENTAi 

C fl 0 u f . INC . 

• 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 . ' . 

[ZJ i grant access to my properties D i do not grant access to my properties 

5 '/ ^ / Cl. {/Ci.S 9 (^ e z 

Signature Date Signature Date 

Q I would like to be present during any sampling that is required. 
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 documentation for the purpose of assuring that re.storation 

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

Protection Agency (EPA). 

Property ID: ^ 

Property Address:

^ ^

 ])1, ^

 f ^ 

S • .Z ^ ^ T~ 

1 

Owner:

Phone:

 ^ , ( ^ i CK [/^i.au^Z . 

 'J ( f I/O J f 1 

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

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

item: 

Page l o f (^ 
C O A i T A L 

G R O U •• . IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

item: 

< ^Vl 

on 

J f 

p j 

l/c nTs c^nl lUe-~^Aj> 

/ 

/ 

-y 

Item:

/ 

/ 

Item: / 

item: 

Item:

/ 

/ 

Item: 

Item:

/ 

/ 

Item: / 

Item: / 

Item: / 

Item: . / 

Item: 

/ 

Page 2 ^S­

'•^••*' JVi'fa ^^-T^''. _^i-.j: 
C O A £ T A L fMVlRONMIMTAl . c II o u r IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

5 c i -f- f ofii ow r ? <" i::}. Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

, 

/ 

Item: / 

Item: / 

Item: / 

Pages of ^ 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that P Square feet 

is covered with grass. ^ 

0 •^ 

Number of trees > 2 inch Each trunk diameter 

Number of trees <= 2 inch Each trunk diameter J 

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. 0 

Page 4of / 
C O A S -T A L 

Item 

Agreed upon value of 

Diant 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. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

I. 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

^ 

$ 

f> : 

'A 

Each 

SF 

, ­ '% 

^y^'' 

y" SF 

0 SF 

• ' ^ ' • ' ' • ' 

Page 5 of 0 
C OAST A L 

«««wr . IN C 

D Check the tx>x 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. 

Q I agree Q I do not agree 

^'^U^^ \)<ysqo^Z ?^MW^j ^ \ikj^l;)tisi 

Owner's Signature Date Contractor's S^atnre Date 
BVID#c3(rXolo ^ 

XRF PROPERTY SAMPLE SHEET 

Date t^pnlQg' Address \\?.q s . afe-^J^^H 

Project Omaha lead FP 2nd year option Sample time am/pm i^a. XRF 1D# sample length 30 sec 

Shot# 

n^-^

Uf.^ 

n^ ^ 

)l<. ^ 0 

Average

 . 

Reading 

o\-i.-\Bii8.^3 

^? ^ "^11 ^t: \C\.\o 

jc^^q.^at n.i- ^ 

9o i i^fit: n. ^ 

Sample area 

Pl^ 

Depth 

v ^ 

 c9M -ioA t ] ^ , \3, 

Shot # 

Average 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Average 

lab sample # Lab result Sample area XRF Avg. 

Average 

Signature 

Print \\] UlAU Iff^t^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1157 

Mode SOIL 

Time 2008-10-10 08:39 

Duration 121.96 

Sequence Final 

Flags 

AVERAGE -Avg of 1153-1156 

ADDRESS ^S28t h 

QUAD/ZONE 

INSPECTOR ventry 

DEPTH 1^3 

SAMPLE TVPE '^CLEARANCE 

NOTE 
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 217.479 

Supervised By: 

Certificate of Verification 

1153 

SOIL 

2008-10-10 08:37 

30.86 

Final 

20665 

1139 s 28th 

PZ 

ventry 

13 

CLEARANCE 

± Error 

± 18.429 
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 239.960 

Supervised By: 

Certificate of Verification 

1154 

SOIL 

2008-10-10 08:37 

30.63 

Final 

20665 

1139 s 28th 

PZ 

ventry 

13 

CLEARANCE 

± Error 

± 19.103 
i r w 

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 199.420 

Supervised By: 

Certificate of Verification 

1155 

SOIL 

2008-10-10 08:38 

30.24 

Final 

20665 

1139 s 28th 

PZ 

ventry 

13 

CLEARANCE 

± Error 

± 17.392 
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 201.682 

Supervised By: 

Certificate of Verification 

1156 

SOIL 

2008-10-10 08:39 

30.23 

Final 

20665 

1139 s 28th 

PZ 

ventry 

13 

CLEARANCE 

± Error 

± 17.540 
# 

^tt D 9T4f. 

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

Coastal Environmental Group Inc. 

%. ' J? www.coastalhazmat.com 

%p„o^>^ COASTAL tNVIRONNENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY; 

BVID # 20665 - (1139 S 28 ST) 

^ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
SEPA 

% 

EPA Propert) Close Out Form 

Property #: 6?bLg-U- ^ Property Addrew: \\ ^ '^•QB'^^ % • 

Dalc/TliDc: Owrner' i s Nime: AY-mC5r\A Vn^p/r x iL/p v j, , 

Quad ntractor Croup ^OCUS^SuJ l ^NTsV^f^iV^*"^^ ^ s Excavated: 'Y' ^ 

Contr 

Excavation Ctnerel 

Yes No 

1 If necessary, were the correct quadrant(s) excavated and restored? ^ 

2 Ifnecessary, were the correcl areas of drip zone excavated and restored'' y 

GradloK Sod and Vetctation Yes No 

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

^ 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 nrm and evenly graded? ^ 

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

- ^ time period) 

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

y 

7 Was damage to landscaping or plant materials avoided'' 1 ^ 1 

Galei , FcDc n and ReUininc Walls Ves No 

1 Do gates open and close freely? (If applicable) 

c ^ 

2. 

Were all gates or fences taken down during rtstoraliori activities reinstalled? (If appi icable) ^ 

3. 

Was dam«ge to gates or fences avoided? (Ifapplicable) 1 ^ 

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

Foundation, SidioK and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 1 ^ 

2 Was damage to the foundation avoided? • ^ 

3 Was damage to windows avoided'' y ^ 

4 Was damage to windows or door screens avoided'' y ^ 

5 Was damage to dowTispouis or downspout extensions avoided? ^ 

Sidewaiki and Driveways (Concrete) Yes Nc 

Was damage to driveway surfaces avoided'' 

2. Was damage to walkvay surfaces avoided? 
• Jk 

O • ners coinmenls: 

Inspection notes: 

Removal and resloralion aclivales complete including the 30-day sod warrant) 

EPA ReDresentalivex/^^^^^^^--^::^^^^^^^:^^^^^^^ Hale- V ' 
\ 

Property Completion Agreement 

Ihis, agieemeni documenis Ihe LOmplclion of remedial aclivilies perlbi med nn my properly My signalure 

wili designale thai 1 am saiisfied with Ihe restoration of my properly, and thai no items are m quesMons. 

now, or al any time in ihe t'uiuie. except (hose iiems hsled below^ if any 

Piopcrry "^ xo^/^s 

Property Addrcv-i l l J ^ ^ • 3^" ^ ^ 1 - Ownci /h)rr>^c^n. c^c V c K T tf t/«'- ^ 

Phone 

i n "io:^! I 

Restoration Items in Question: 

Item: 

Item: 

Item 

. . _ mi l I .ST. 

Item: 

Item: 

Item: 

Additional Comments: 

j y i I a(;rcc r cstoralion is completed, cxctp l m noleri 

[ I I fki nol a(;icc fcsloralrnn i< coniplelcrl 

j^rrT^^T^ac^ 00^^'9 ^ ^ g i /Z >^ -o^ 

Owiu r s SigriPdiiif Date Ccmt i »( (01 's Signature