TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA1D# : jMi 

Date: ^ f K / M 

Address: Ho ^ ^ ^^^ ^ ^ < 

Remediation Contractor: Coastal Environmental Group Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

/ 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

1 

y Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

7 

Restoration Agreement 

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

Confirmation data 

Photographs T K 0)0 <^/^TWV \ tS° (y^<^^\*x^ \ ^a ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

c/ 

Property information from Douglas County Assessor's Office 

-1 K h 
s 

Property Access Checklist 

Property ID: QjQ^' ^ D WORK STARTED 

Property Address: yiQ q c^ ^ ^ g::;-|. D WORK COMPELTED 

Owner Enn/fui Renter: L Fj^idyjo 

Address: Phone: 

F>^ ^ ^ ^0^" ^ Fax: 

umo Cell/Pager: i 

^ Additional Information: ''"""^M/Zr:) Qc^)n?) 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / By: 

IV Access Agreement Signed: £_/^/JC > By: 

^ Restoration Agreement Signed: & U / /j O By: 

Q Topsoil Sampling (if applicable) / / By: 

n Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

' ^ UtiUty Clearance CaUed:rOW"3Lb/\o ^y- Cfbl^fw^ 

^ Video/Photos (Before) On: S 1^ 1 I O By: 

n Video/Photos (During) On: / 7 By: 

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

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

Q Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

O Community • Crew On: / / By: 

Results: 

• Conmiunity C] Crew On: 7 / By: 

Results: 

[~] Community O Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account I: n||Mation Page 1 of4 

Douglas County, Nebraska Property Record - R1234900000 

Information is valid as of 2010-8-16 

New Feature "^ •^ r>

Owner 

ELIZONDO ENRIQUE 

5426 S 20 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 3490 0000 12 

Account Type: Residential 

Parcel Number: 1234900000 

Parcel Address: 1109 S 28 ST 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 22 BLOCK 1 N 40 FT 40 X 150 

Value Informatio n 

Land Improvement 

2010 $4,600.00 $54,100.00 

2009 $4,600.00 $56,400.00 

2008 $4,600.00 $56,400.00 

2007 $4,600.00 $56,400.00 

2006 $4,600.00 $54,600.00 

2005 $4,600.00 $54,600.00 

Sales Informatio n 

Sales Date: 1999-11-12 

Deed Type: D Book: 2138 

Price: $38,950.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1999-05-14 

Deed Type: D Book: 2122 

Price: $20,000.00 

Grantor: 

Print Reoort 

View Interactive GIS Mafi 

Treasurer's Tax Reoort 

 Subdivision Sales Search 

Total 

$58,700.00 

$61,000.00 

$61,000.00 

$61,000.00 

$59,200.00 

$59,200.00 

Page: 712 

Page: 557 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=Rl2... 8/20/2010 
Douglas County Account Inji^tetion Page 2 of4 ijjg^t 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 6000.0 1.0 150.0 40.0 No 

Land Attributes 

Attribute Attribute Description 

Negative Influence View 

Negative Influence Traffic 5 

Improvemen t Informatio n 

Building 1 

SMhRaNCX 

3:51 

First Floor 

7T0.0 Sa Fl. 

BtlTn WW H n Ranch 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 770.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 3.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinlder Square Footage: 0.0 

year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1875 1999 0% 1937 73 

Detail Type Detail Description Units 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 8/20/2010 
Douglas Coimty Accoimt I t^l^ation m Page 3 of4 

Appliance 

Basement 

Basement 

Fixture 

Fixture 

Porch 

Porch 

Allowance 

Bsmnt Block 8 ft 

Finished 

Base Fixtures 

Bath Full 

Slab Roof Ceiling 

Slab Roof Ceiling 

1.0 

770.0 

510.0 

1.0 

1.0 

208.0 

119.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp7accountno-R12... 8/20/2010 
Pagel of2 

Create Another Ticket Back to Irth: Intemet [•_ Send Email j 

YOUR TICKET NUMBER IS 2577778. 

Original Call Date: 8/26/10 Time: 2:38 pm Op: ELIZABETH18790 

Work to Begin Date: 8/30/10 Time: 3:15 pm 

State: NE Coimty: DOUGLAS Place: OMAHA 

Address: 1109 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 REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl MUD02 OMAHACOF 0PPDGPR5 0PPDGPR6 


QLNNEIC QLNNEIF 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2010 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH^-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2010 
OLS#: 21049 As-Built Drawing Date Excavated: 10/13/10 

Date USEPA Signed Off: 11/9/10 

COASTA L Omaha Lead Superfund Site Area Sodden: 2160 sa ft 

Name: /^i;, ^ .W - Omaha Lead Site Date: V-^i'^ i North Arrow 

Address: // ^ ^ 5 ?'" - Site Sketch Time: 

Phone: Y/ i - L^ r -//> 5 

Team f^n / yTJ y BV\D# _2/_£^_ ^ XRFCode ^^^Z . 

Sample Number Lead Concentration Confirmation Sample 

?XA-210^5 

ppm A/Ye s n 

ppm /TZYes n -21(5 ^ 'Y^^Q ppm '/)^Yes •

ppm /5iYes ° (2pg:gr,P>6A-2(W9 ppm Vves g" 

•Z--Z/ du g*? ppm ^ZYes •

ppm Yes • RGZSCPLA-21049 

Lab 

179 ppm 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced witih 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
# cUr u. OAI^O IVi," ' 1 I i ^nl 1 \j i 

- Name: /^^/^.Ae-t^C^ 

Address: //^' f 1 Z ^' ' 

Phone: f/l ~ ^ f - ^ ^>5 

Omaha Lead SHe 

Stte Sketch 

Date:

Time: 

 7^/"^ / North Arrow 

V 

Team A^ / y^Ty^/ BVID# 2 / <:? ^/ f XRF Code -^5^2-

Sample Number Lead Concentration Confimnation Sample 

gQ&^rcPyA-2(W9 

^^^ 

^^ / :i^

g

 ^ ^

 ppm 

 ppm 

ppm 

/^/Yes

rZYes

^/)/Yes

/52ves

V-Yes

^ZYes

Yes

 D 

n 

• 

n 

 g ' 

a 

• 

No g 

No g 

No pa 

No 12-

No 5 . No 

No 
ML 

Name: /^^/^,^t^tZ ^ Omaha Lead Site Date: 7 ^:$'-^ / North Arrow 

Address: //^ ^ ^. Z7 ^ Site Sketch Time: 

Phone: y/ ^ - /• / - ^/.^ ^ e 

Team /»^ / y^TJ y BVID # ^/^^/ f XRF Code ^^C?-2-. 

Sample Number Lead Concentration Confirmation Sample 

ppm ^/Ye s n No g . 

ppm No g rzYes n 

ppm No ^ Vj/Yes • 

ppm No 12­ j52Yes ° 

ppm ^Ye s g ^ No O 

-Tyzi ±. g y ppm ^ZYe s a No 

ppm Yes • No t RGZSCPLA-21049 

Lab 179ppm 
m • 

Name: F^Hr,£ ^ ^ ... Omaha Lead Stte Date: 7~Zi-^ S North Arrow 

Address Stte Sketch Time: : //^ ^ ^. 2/"-' 

1 Phone: W - ^ ^ - ^^> ^ C 

Team /»^ / y^J*- /

B£ BVID# Z/j^^ ^ XRFCode ^^(P-Z. 

Sample Number Lead Concentration Confinnation Sample 

-~2IQ^^ 

RGZSCPLA-21049 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

A / Yes 

riYes 

0) /Yes 

i^^e s 

^Ye s 

^ 2 Yes 

Yes 

•

•

•

• 

g 

• 

No 

No 

No 

No 

No 

No 

No 

Lab 179 ppm CP'G ^ 

2^fe:f^ 

t 

^/-2^2f 

fi^i^c^ 

y^i 5.Z i^v 

^ f~ ± 

^ 

Pa^ J5fr^ ' 

^ ( ^ ^if^ z 7Fi1±Z^ t1 f I J 

S^^ U/4/^ 

5. t ^'- ^1 
COASTA l INVISONKII^TAl 

c I 0 u r I»( c 

Cons&Pii tof kctc.a^^ To Piopeily 

RIGHT OF ENTRY TO PREMISES 

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

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

the Grantee, to enter and perform certain environmental response activities upor\ the 

following described premises: 

Owner's Name: £}vr^^i ^ C^^l^^ ^ Daytime Phone: Q j ^ _ S^Zog ^ 

Address of Property 

covered by this [XO^i S -^o S ^ 

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 wor1< is finished, the Grantor will be asked to review the work 

and confinn that rt is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing 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 
.„^«=<l«'4,, 

COAS1A i IKViaONHIKTAl 

C R O U f I ^ C 

Remove obstructions including boats, trailers, vehicles, playscape ilems, wood 

piles, dog houses, etc; 

Remove flower bulbs or plants that the Grantoi or the Grantor's tenant may wish 

to save; 

Water and maintain replacement vegetation, including ferlilizer application, as 

necessary' subsequent to an initial watering period by EPA; 

Abide by health and safety guidance piovided by EPA; 

If the property is rented, assist EPA in obtaining tenant approval foi 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, oi with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

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

^ nd^Q^-^l V .^ r>rrv Date Signature Date Signature 

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

Page 2 of 2 
C O A S T A L • MVinOMHItiTA L C • O U P . INC . 

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 documeritation for the purpose of assuring that restoration 

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

Protection Agency (EPA). 

Property ID: 2^10 M^ 

Property Address: /1 0 t X ^ Z O ^^ • 

Owner: j^f^^u c CUSAW Q 

^ ^ ^ ^ ^ ^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or return of these Items Is the Owner's responslbiltty. 

ttem: 

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

ttem: 

yUc '(Snr^^ 

ttem: 

ttem: 

Page 1 of. 
Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

ttem: 

^^ ^ ^l.-KL 

Landscape Inventory 

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. 

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 

Quantity 

P2jl*>Z 

H 

y 

\ 

y 

F 

Unit Condition/Type/Species 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

$ 

owner. 

Easement Area, to be 

Each 

excavated /// ^ 

Page 2 of. 
C O A 5 T A L • MViaOMHBNTAI . O • O U P . IMC . 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

tt you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

r~| Please check this box if you understand the information outlined above. 

^CjLr\fC^V/^ ^ Wr. h)c\ioe. 

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

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

interior of house, including foundation cracks or fissures. 

0 1 agree n 1 do not agree 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
BVID# Z(0< ^ 

XRF PROPERTY SAMPLE SHEET 


Date Address Ho8 ^ Z 0 S T /- n-zv a 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# 3^=10 2LI. sample length 30 sec 

Shot# 

•L5 

7J> 

Z,^ 

Reading 

/^3 t /fl 

^^-^ i CZ. 

nt i z^i 

Sample area 

SZ. 

Depth 

5" 

Shot# Reading Sample area 

Depth 

Average ZO^ t zn / Average 

Shot# Reading Sample area Shot# Reading Sample area 

U {IF{ i /8 F^ 

ZX- /33 t i2> Depth Depth 

t 3 I50t 18 6" 

y Average /Z'^? i IB Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

^^--yp Depth Depth 

y y 

Average Average 

Signature_ 

Print Tl4it^J^lm^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

28 

SOIL 

2011-01-19 10:52 

91.11 

Final 

Avg of 25-27 

1108 S 28 ST 

B2 

8" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 193.015 

Supervised By: 

Certificate of Verification 

25 

SOIL 

2011-01-19 10:51 

30.67 

Final 

21049 

1108 S 28 ST 

B2 

8" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.610 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 228.303 

Supervised By: 

Certificate of Verification 

26 

SOIL 

2011-01-19 10:52 

30.25 

Final 

21049 

1108 S 28 ST 

B2 

8" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.719 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 192.037 

Supervised By: 

Certificate of Verification 

27 

SOIL 

2011-01-19 10:52 

30.19 

Final 

21049 

1108 S 28 ST 

B2 

8" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.415 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

24 

SOIL 

2011-01-19 10:46 

90.65 

Final 

Avg of 21-23 

1108 S 28 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 124.886 

Supervised By: 

Certificate of Verification 

21 

SOIL 

2011-01-19 10:45 

30.16 

Final 

21049 

1108 S 28 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.247 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 133.912 

Supervised By: 

Certificate of Verification 

22 

SOIL 

2011-01-19 10:45 

30.29 

Final 

21049 

1108 S 28 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 18.578 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 130.916 

Supervised By: 

Certificate of Verification 

23 

SOIL 

2011-01-19 10:46 

30.20 

Final 

21049 

1108 S 28 ST 

F2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.578 
/^ O \ Omaha Lead Site—Fixed Price EP-R7-67-05 

I ^^^ ^ I Coastal Environmental Group Inc. 

S!y^y^ www.coastalhazmat.com 

^PHOt*" ^ COASTA L ENVmONHINTAl 

« • 0 U P, I N C 

EXECUTIVE SUMMARY: 

BVID #21049-(1109 S 28 ST) 

~x\ No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 9/16/2010 
^ 1 

EPA Property Close Out Form 

Property »: Property Addrcsr. 11DQ_1 

Date/Time: 9liilio Owner's Nametl^iQD ^ 

Quads Excavated: Contractor Group CV^i 

Excavation General 

I. If neccssuy, were the correct qtiadrantd) excavated and restored? 

2. If necessaiy, were the correct areas ofdrip zone excavaied and restored? 

Grading Sod and VegetatioB 

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

firom the house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a }0 

day tune period) 

4. Ate sodded areas generally firm and evenly graded? 

5. . Ajie 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 will not pool on the property'' 

I 7. Was danuge to landscBping or plant materials avoided? 

Gates, Fencca and RcUtnipg Walb 

{ 1. Oo gates open and close freely? (tf applicable) 

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

3. Was damage to gates or fences avoided? (I f applicable) 

<l. Was damage to retaining walls avoided? (Ifapplicable) 

FouDdatioD, Siding and Gnliers 

\. Was dannge to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage lo windows avoided? 

4 Was damage to windows or door screens avoided? 

5 Was damage lo downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage lo driveway surfaces avoided? 

2, Was damage to walkway surfaces avoided? 

Yes No 

/ 

y 

Yes ^o 

y 

y 

yl 

y 

y 

y

Vcs No 

y 

y 

y 

Ves No 

y 

y 

y 

" y 

y 

Yes No 

/ 
OM'ocrs comments: 

inspection notes: 

Removal and resloration activates cornplele including the 30-day sod warranry: 

F.PA Representative J^c^ ^0 ^ Date:^ lb^li°.._ 
ir 

Property Completion Agreement 

I his agreemeni docuinenls Ihe completion ot remedial acliviiies perroimed on my properly My signaluie 

will designate that I am satisfied with the re.<;toralion of my property, and lhal no items are in questions 

nov^, or at any lime in the future, except those items listed below, if any 

Property ID: ^]})U ^ 

Property Address: ^^Q Q Q^ i3D_St l 

Q"""' F^r<V|iiPv El'2on^n 

!!n: lf?lQ?-^^s^52l 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

= = Item: 

Additional Comments: 

I nyrrc icstoralion is complcled, rxccpl as nnleri > 

[ I I rio nol aurfc rrsioration is complclcri 

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