TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 337^ 0 Date: /0-lZ~(^ ^ 

Address: Hl N R ) '^^^ ^ /1U £ • 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

^y ^ Executive Summary 

S"*^ EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property A^/''" 

Restoration Agreement 

Settlement documents (i.e., for damage or to replace'pranTs, etc.) ^^IH' 

-S ^ Confirmation data 

/ 

Photographs s^^'D)LCjud(m.Bi\^ Q.jJlIu^fAvbCX ^ 5^J ^ 3>0'A&M^ \,<>^\zbA . 

As-built sketch 

Satisfactory restoration signed by Property Owner 

^ ^ Property close-out check list signed by EPA 

D "7 Description ofareas not meeting ROD cleanup criteria 

.^3*^ Utility clearances 

^^ y Property information from Douglas County Assessor's Office 

M \fp^a.$.i4jr;^eCdS$ CJ^XXJfX^S^ 40316444 il 

Superfund 

II 1 

Signature Date 

yz^M 
Property Access Checklist 

Property ID: 3 3 t^t ^ 

n WORK STARTED ON: _/ / 

D WORKCOMPELTED ON: / /

Property Address: Ll j U k l 'T/T ' 

Owner:^\^^^e. Renter: S AfYl H 

Address: Phone: 

Fa.\: 

Cell/Pager: 

Phone: ^^( ^ - ?fi\Dl_ Additional Infonnation: 

Fax: 

Moreno VaUct) C^'^- ^^^^ ^ Cell/Pager: 

• Notification Letter Sent: / / Bv: 

wAccess Agreement Signed: ^/24/£i ^ By: 

Q^Restoration Agreement Signed: S I 2& I O t By: 

I I Topsoil Sampling (if applicable) / / By: 

O Disposal Sampling (if applicable) / / Bv: 

n Garden Sampling (if applicable) / / By: 

F^Utilitv Clearance 

Called: d^ I 3 I C ^ iy: a c i/.r t. i?pm ;7ni|dlng. 0'^Video/Photos (Before) 

On: (^ / 5/6 ^ «y-pr>^MM 

D Video/Photos (During) On: By: 

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

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

CD Property Completion Agreement Signed: / / _ By: 

n FinjiJ Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community Q Crew f On: / / 

Results: 

Q Community CH Crew On: / / Bv: 

Results: 

II 
CONTACT FORM 

Property ID # 137 ^ 

Property 

Address: Ljiw M. a<-"^ ht . 

Initial Contact: Date:S/<9Q/gccifTime: Action: maAed to Po 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action; 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

1 Coordinator 

1 Comment (s): 

1 
at 

•o 
Dougl^^ftunnti y Account InfjgMjation Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R143370000 0 

Print Report 

Parcel Dimensions available @ scale 0-50 ft west of 144 St - NfleWJ)!! Ma p Information Is valid as of 2008-4-17 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owne r 

JONES JOAN M 

POBOX 1508 

MORENO VALLEY CA 92556-0000 

Propert y Informatio n 

Key Number: 3370 0000 14 

Account Type: Residential 

Parcel Number: 1433700000 

Parcel Address: 4114N25AV 

OMAHA NE 68111-0000 

Legal Description: KENDALLS ADD LOT 3 BLOCK 6 S 10 FT LT 2 & N 35 FT 45 X 132 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$0.00 

Sales Informatio n 

Sales Date: 2006-01-30 

Deed Type: 

Price: 

WD 

$1,150.00 

Book: 2006 Page: 015543 

Grantor: Redwood Real Estate Development 

Grantee: Joan M Jones 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2005-09-16 

Deed Type: SHD BooAr: 2005 Page: 155770 

Price: $500.00 

Grantor: LAND REUTILIZATION COMMISSION 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R143... 5/8/2008 
Dou^^^Kit i nty Account In&gpatio &fin£ n Page 2 of 2 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Lan d Informatio n 

Acres SF 

0.13 

REDWOO REAL ESTATE DEVELOPMENT LLC 

Invalid 

Sale by Govt Agency 

2003-08-13 

SHD Book: 2005 Page: 155769 

$0.00 

DOUGLAS COUNTY SHERIFF 

LAND REUTILIZATION COMMISSION 

Invalid 

Sale by Govt Agency 

Units Depth Width Vacant 

5940.0 0.0 132.0 45.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R143... 5/8/2008 
J)_ _Rfflnote_ID!_ R_page of 

. . . ^ . 

Ticke t 

Origi n 

Work .•: 

State : 

Add r e .s 

Twp: 1 

Twp: 

Lega l 

Typ e •: 

Locat i 

: FLE?' 

Renar); 

Coir pa r 

Corta c 

Alt . c: 

Work Ii 

Depitt: 

Invol^, 

CXC:AI\ 

CD: 204690 3 

L Call Date: 

Begin Date: 

6/03/08 

6/05/08 

Time: 

Time: 

3: 57 fm. 4:15 pm 

Op: KST 

ME 

i 4114 

County: DOUGLAS 

Street: K 25TH AVE 

Place: OMAHA 

Rng: 13E 

Rng: 

Lven: C 

Sect-Qtr: 04-SE 

Sect-Qtr: 

Work: DIGGING FOR LEAD REMEADITION 


-. of Work: LOCATE ENTIRE PROPERTY 


3 NOTE THIS IS EMPTY LOT 


t 


: COASTAL ENVIRONMENTAL SERVICE 


Name: ELIZABETH Phone: (877)662-4211 


itact: MARCOS OR RON BROWK 


JLng Done For: EPA 


I: Excavation: 4FT Corner Lot: N Front: Y Rear: 


3 Tunneling or Horizontal Boring : N Explosives: N 

MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 
As-Built Drawing ^ 

COASTA L Omaha Lead Superfund Site 

33780 

Omaha Lead Site Exterior Paint 

Site Sketch • Good 

• Poor Sampling Address: 4114 N 25 AV ig^Not paint 

Sample Number Lead Sample Sampries Collected 

I 

LAB Concentration Collected Firm: FPPt F/g>-^W 

RYASCPXA-33780 Fl L2_a PP"i D Date: IO - \0-D 7 

RYBSCPXA-33780 F2 3<j l "7 ppm 

n Time: 3> H O prY^ 

RYCSCPXA-33780 B1 2 3 / ppm 

n Samples Analyzed RYDSCPXA-33780 B2 T 9 PPf" n 

RDZ3CPXA-33780 TW " ppm n 

n XRF Unit: ItjSH'Z . Book: iii RQZ3epxA-997eo—se- — ppm D D Date: JO-Z.^ - C>~?

RP2SePi<A-33TeO PZ ~ ppm n Time: AH n Staff: /*fSU / Number of Samples =\^ ^ OJ 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ • GarxJen, PZ = Play All quadrants are as viewed from the street, faang property 

OLS#:?37W 1 Date Excavated :6/6/08 i) 3IAO ' - ; pixTT'toTJiJ'.n 

:Date USEPA Signed OTt:7/2l5/08 JC/

i Area Sodded 1ZZ5 sq ft OCT 1 R 9n>ni

1 V I 0 cir 231 .I'i 

ai .; ^2; 

...c 

Q. 9 ^//^ l 1 :

M F2 =70 PPM@6" 

^ ^ ^^y"^ fl i ^ ^ 

> ^ ^ 

.12 ^ i ^ 

^ 1 

EA = 99PPM@1" 

^ 

^wm$imm^^Mm ^ 

Ji s h\je^ ; ^ 

Rev .^ «^reated 9Cft2iiii7<i9 :6:42 

Legend 

Concrete k^Z/d Drip Zone Excavate Excavated |$>00l Quadrants Excavated 


Area replaced with Area replaced with 


Area left bare
 Sod ' Rock/Mulch 


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

F ,t / / J <jt4^a- ^ 

33780 

Omaha Lead Site Extenor Paint North Amwir 

Site Sketch • Good 

• Poor 

Sampling Address: 4114 N 25 AV ( y Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: VPPt FS'( ^ 

RYASCPXA-33780 Fl / Z R ppm D Date IC) - 10-0 7 

RYBSCPXA-33780 F2 3^1 7 ppm D Time: 3> H O p/ n 

RYCSCPXA-33780 Bl 2 3 / ppm D Samples Analyzed RYDSCPXA-33780 B2 ia_ ppm i D

RDZ3CPXA'337O0 BE ppm D XRF Unit: {oSHZ . Book: |^ ^ D ReZSePXA-S9780 ©g- ppm D Date /i^-2?-0 7 D RPZ8ePi<A-S97eO P2 ppm D Time D Ad. Starr ^^U / Number of Samples' i„Q. 

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

All quad-sils are as viewed from Ihe streel. faang property 

:^ 5 k\j'e/~Z^ ^ 

Rc\ < I'reiioj «:i.:iii7i~ X,4: 
33780 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4114 N 25 AV (g''^Not paint 

Sample Number Lead Sample Samples Collected 

Concentration Collected Firm: FP>A F&'^ W 

RYASCPXA-33780 Fl /2f t ppm D Date: 10 ' ID ~D 7 

RYBSCPXA-33780 F2 361 7 ppm n Time: 3> • H O pn n 

RYCSCPXA-33780 Bl 2 3 / ppm I n

Samples Analyzed RYDSCPXA-33780 82 "»9 ppm n 

RDZ3OPXA-30700 B2 ppm n n XRF Unit: ([jS'-iZ. Book: 1^ 3 

RGZ3CPXA-3378 - 0 8*- ppm n Date: IQ-Z^ - 0 7 — D RPZSePXA-33700 P2 ppm n Time: A H n Staff: /^^W Number of Samples = [ i | 

Legend: Fl = Front Left, F2 Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ Garden, PZ - Play 

All quadrants are as viewed from the street, facing property 

cr 
33780 

Omah Exterior Paint North Antiw a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4114 N 25 AV l^NcA paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Firm:

Samples Collected 

 FP A F&'^ W 

RYASCPXA-33780 F1 (2f t ppm D Date: I D ­ I D ~D 7 

RYBSCPXA-33780

RYCSCPXA-33780

RYDSCPXA-33780

 F2 

 B1 

 B2 

36 1 7 

25 / 

i q 

ppm 

ppm 

ppm 

D 

D 

D 

Time: 3> - H O p/ n 

Samples Analyzed 

RDZ8ePXA-33780

R3Z3ePXA-33700

RPZSCPXA-33780

 Of. 

6* -

 Pe 

— 

— 

ppm 

ppm 

ppm 

Number of Samples =

D 

D 

D 

U 

D 

D 

D 

Qd 

XRF Unit: {QSHZ . Book:

Date 

Time 

Staff 

/O-Zf-0'7 

Ad. n\w 

 1°!" ^ 

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 the street, facing property 

jy ENTERED 

OCT 1 6 2IH)7 231 11 

u ...u 

I 

e 

'IIIH tt.29. flV. 

Fi.l-.F.l 

i 

J?5 k\J^ 

Re\ CrealHt 9/2&20lj7O9:»:42 046141.0123 

.' »»T .'DUf .Uf' Bfl" 1 
- * • 

vV^ <;<* 

COASTA L EN VtRO NMENTA L 

" i PRO-^^*^ CROUP . INC . 

Consent For Acces s 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: CSoouf \ C S Ot^ S Daytime PhoneZ/^.-5^^ ^ 59^ ^ 

HIIU Kl. %^ ^ ^v i 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: 

Pagei of2 
"lPROl^ " 

- * 

COASTA L ENVIRONMENTA L 

GROUP , 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 ofthe property. 

AGREEMENT NOT TO INTERFERE - -.. 

The Grantor agrees not to interfere or tamper with any ofthe 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 (877) 234-6270. 

H I grant access to my properties D I do not grant access to my properties 

Signatur^^ D^te Signature Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

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

remediation activities. This wiil also serve as documentation for the purpose of assuring that resloration 

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

Protection Agency (EPA). 

Property ID: Oy^^^ Q 

Property Address: 4 | (L{ 1\| "jl^" ^ Y\V ^ 

Owner: ^^^^ ^ ^on P (; 

Phone: mlMI^m^ 

On the attached diagram(s) indicate area(s) to e.vcavated 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 t>pes, etc. Indicate digital photos 

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

Items To Be Remove d By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Ow/ner s responsibility. 

Item: 

KknL 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: hioKje. 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
COASTA L (NVIMOMMtMTAl . 

CROUP . IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

h]onJL 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

PageSof. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunlv diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinl^ler 

Zones, Control Valves. 

Timers. Heads, etc. 

Anach ;i ikeicli of liie 

sprinkler !a.\out. 

Number of and size of 

each garden/ flower bed 

area. 

.-\lUicli ;•; skeicii ol' rc:aii\>: 

^ir'es and locations. 

Quantity 

fa 

^ 

- ^ 

^^v 

O^ 

- ^ 

Unit 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

0 \ ^ro^M-Kj . 

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 

\oucher 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 

b\ ihe contracior. 

Agreed upon area of 

property' to be replaced 

with grass sod. 

'lU'lude a skeich ^)\ ihc 

areais) lo be icplaccd '.villi 

Lirass >od. 

•Area of Cit> or Count}' 

property to be landscaped 

per their requirements. 

IncUide a -l-.ou-h v.;' ;|-:c 

aiea IS! 

Easement .\rea. to be 

excavated 

Quantity Unit Condition/Type/Species 

-a $o 

—®. Each 

ra 

SF 

^ SF 

SF 

Page 5 of. 
C O A S T A C 

Additional Comments / Instructions: 

-onply \oh 

y

G Check the box if Owner does rx>t want CEG to docuoient interior foundation walls and possible 

pre-existing damage. By checking this box CEG is rK)t responsible for any damage done to the 

interior of house, induding foundation cracks or fissures. 

IET. I agree Q I do not agree 

br %^g£g , <r-3^y^ 

Owner'^sS^A s t SieBatare Date Contractor's Signature Date 

PageSof. 
BVID# Vbl^O 

XRF PROPERTY SAMPLE SHEET 


Date [c^^-0 \ Address ^(iM AZ.. Q.^ i-v^. Project Omaha lead FP 2nd year option Sample time (\i ^ <l3i/pm 

XRF ID# Ki\-\r4t>i^ R-p.vvK sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

lo_ Iff^ynsiAnJc ieU> 1^.-? ^i:^, ^ rA (rr^ ,0*1 

JLL U7 13-^ i )^.7 

lU- P/-^ ir [^.<i Depth 1/^ L»/ -i l-^.i Depth \>'*"r 

JO- aC. q ii lb 3 I ^ ^ t ^ l ^T.i^^!^.f> to 

Average q^.^ ^ )^. ^ Average U^SS^-J - JH- ^ 

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 

Depth 

Shot# Reading Sample area 

f 

Depth 

Average 

lab sample # 

Date l^-f-o^ 

Lab result Sample area 

Average 

Signature 

Print 

XRF Avg. 

^. D^.'c^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XLt 14644 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

ppm 

Pb 97.755 

Supervised By: 

Certificate of Verification 

40 

SOIL 

2008-06-06 10:03 

30.78 

Final 

4114 N 25 AV 

easement 

detrich 

± Error 

± 15.220 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 41 

Mode SOIL 

Time 2008-06-06 10:04 

Duration 30.76 

Sequence Final 

Flags 

SAMPLE 4114 N 25 AV 

LOCATION easement 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 88.323 ± 14.680 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 42 

Mode SOIL 

Time 2008-06-06 10:05 

Duration 30.77 

Sequence Final 

Flags 

SAMPLE 4114 N 25 AV 

LOCATION easement 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

Error ppm ± 

Pb ± 15.806 101.925 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 43 

Mode SOIL 

Time 2008-06-06 10:05 

Duration 30.25 

Sequence Final 

Flags 

SAMPLE 4114 N 25 AV 

LOCATION easement 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 105.908 ± 16.316 

Supervised By: 

fW VQV %:^ i Y\. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 66 

Mode SOIL 

Time 2008-06-09 13:14 

Duration 35.15 

Sequence Final 

Flags 

SAMPLE 33780 4114 n 25 av 

LOCATION f2 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 79.652 ± 13.875 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 67 

Mode SOIL 

Time 2008-06-09 13:15 

Duration 30.21 

Sequence Final 

Flags 

SAMPLE 33780 4114 n 25 av 

LOCATION f2 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 73.903 ± 14.682 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 68 

Mode SOIL 

Time 2008-06-09 13:15 

Duration 30.15 

Sequence Final 

Flags 

SAMPLE 33780 4114 n 25 av 

LOCATION f2 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 60.970 ± 13.891 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XLt 14644 

Reading No 69 

Mode SOIL 

Time 2008-06-09 13:16 

Duration 30.22 

Sequence Final 

Flags 

SAMPLE 33780 4114 n 25 av 

LOCATION f2 

INSPECTOR detrich 

COR 1 

COR 2 

MISC 

NOTE 

ppm ± Error 

Pb 63.583 ± 13.780 

Supervised By: 

•W U-t1. JIJ^ . 
/r^JL\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I J^^^^ l Coastal Environmental Group Inc. 

V^^^j ? www.coastalhazmat.com 

^•'••no^ ^ COASTA L ENVIRONMENTAL 

c R o u r, INC . 

EXECUTIVE SUMMARY: 

BVID # 33780 - (4114 N 25 AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
S i ^ EPA • 

EPA Property Close Out Form 

UK M. , Property 

»:iilM P^perty Addre«:-^^^-^^ ^ 

Date/Time: Owner s Name: /^ y , _ , _, _j .« . ^tt. 

Quads Excavated: Contractor Croup L^/TVTyTb 

Excavation Yes No Ceneral 

I. If necessary, were the correct quadrant(s) excavated and restored? yy 

2. If necessary, were the correct areas ofdrip zone excavated and restored? 

Grading Sod and Vegetation 

Yes No 

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

y from the house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) ^___ 

4. Are sodded areas generally firm and evenly graded? 

5. 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 will not pool on the property? 

Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

Yes No 

1. Do gates open and close freely? (Ifapplicable) X 

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

Vk 

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

4^ 1 ^ 

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

Foundation, Siding and Gutlers Yes No 

/ . 1.

 Was damage to the siding or trim avoided? 

/ 

2. Was damage to the foundation avoided? .i^(^f^^^ n< 

3. Was damage to windows avoided? \ p v ^ 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

\ 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative^;^;^^^:^:^;^^,.^^—- Date: //yUy^y " 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My 

signature will designate that 1 am satisfied with the restoration of my property, and that no items are in 

questions, now, or al any time in the future, except those items listed below, ifany. 

Property ID: 3377^0 

Property Address: / ^ ) ( 6/ ^ ^^ ^ f^yC 

Q^"*"-' ^€xxf\ :5DK^ S 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Additional Comments: 

I I I iigree restoration is completed, except as noted 

I I I do not agree restoration is completed 

^ y , ^ ^y-^^-^ yy° ^ 

Contractor's Signature Date Owner's Sigmrfiirc Djrte *