TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

ly ^ 

[0 SAID #: 

M l Date: 

Address : Wiq 9 •^^'^ m 

Remediation Contractor: Coastal Environmental Group Year; 200| 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

Video of property (DVD) 

A 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

TT 

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

Confinnation data 

Photograplis ^^^ ^ ^ f k ^^l^-n ^ 

3/ As-built sketch 

Satisfactory restoration signed by Property Owner 

7 Property close-out dieck list signed by EPA 

•"-fr 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

A Property information from Douglas County Assessor's Office 

30054845 

Superfund 
• • • • 

i.\^y^' ^ 

Pioperty Access Checklist 

Property ID: )f^L\^ Q 

n WORKSTARTED ON: / / 

D WORKCOMPELTKD ON: / /

Property Acldresi:;<9;9 <>. ^ fi^O 

0>vncr; Renten 'rxtf\<s\^ V/»t;qV\A 

Atldrcss: 

Phone: 

Fax: 

Cell/Pager 

Phone Additional Information: : ^Q^^ .ujs.<^qaft 

Fax: 

Ccll/Pager: 

D Notiflcation Letter Sent: / / By: 

^ Access Agreement Slg«cd:^/^/( ^ By: 

^ Restoration Agreement Signed: 5-/20/(3 By: 

O Topsoil Sampling (if applicable) / / By: 

O Disposal Samplmg (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

" ^ Utility Clearance Called: <^ lU^l( ^ By:q/2ftM HC'.lllolM 

Cg^ VWeo/Photos (Before) On:l€> / 5 / ? By: (^(j(^-^^ ; 

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

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

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

Q Property Completion Agreement Signed: / / By: 

D Pinal Report Issued: / / By: 

Air Monitorine (as applicable 

DCommuiuty Q Cnsw On: / / By: 

Results: 

D Community • Crew On: / / By: 

ResnHs: 

• Communtty Q Crew On: / / By: 1 

Results: 

1 

Omaha Lead Site 
• • 

^Douglas County Account bi^rai^on Page 1 of2 

Douglas County, Nebraska Property Record - R2542190000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJeW O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ->••- • Auto Sales Search 

Owner 

VAUGHN TIMOTHY J 

1919 S 35 AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4219 0000 25 

Account Type: Residential 

Parcel Number: 2542190000 

Parcel Address: 1919 S 35 AV 

OMAHA NE 68105-0000 

Legal Description: WINDSOR PLACE EXT LOT 36 BLOCK 0 50 X 135 

Value Informatio n 

Land Improvement Total 

2009 $6,500.00 $94,000.00 $100,500.00 

2008 $6,500.00 $94,000.00 $100,500.00 

2007 $6,500.00 $94,000.00 $100,500.00 

2006 $6,500.00 $85,600.00 $92,100.00 

2005 $6,500.00 $85,600.00 $92,100.00 

2004 $6,500.00 $85,600.00 $92,100.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6750.0 1.0 135.0 50.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 9/17/2009 
• • 

Douglas County Account L|£arn|^ion Page 2 of2 

I i 

5Jt 0 S<J f l 

rwtrvxr 14 IT U P 

StOCSo Fl ; 

.50­

%^*s* 1 1/2 story Bwimt Block 8 < 

7G0.0 S<|. R 

CLICK TO ENLARGE IMAGE 

O ENI^RGE IMAGE 

Square Footage: 1334.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: i Average 

Unit Type: Condition: I Average 

Built As: 1 1/2 Story Rn Condo Square Footage: j 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: •. Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: I 1.5 

Floorcover: i Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1926 0% 1926 83 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 790.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 720.0 

Porch End Solid Wall 70.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 9/17/2009 
• • 

CONTACT FORM 

Property ID # jsH^a 

Property 

Address: \(\\0\ ^rAbfKw 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date; Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

li^-u^xxa-y^A^ 

Comment: 

Owner 

Comment (s): - ' • 

Site 

Coordinator • 

Comment (s): 
• • • • 

Page 1 of2 

Create Another Ticket ] Back to Irth Internet | , [ Send Email 

• YOUR TICKET NUMBER IS 2387335. 

Original Call Date: 10/15/09 Time: 1:43 pm Op: ELIZABETH18790 


Work to Begin Date: 10/19/09 Time: 2:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1919 Street: S 35TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 28-NW-SW,29-NE-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF 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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utmty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/15/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/15/2009 
As-Built Drawing w 

COASTA L Omaha Lead Superfund Site 

18459 

Omah a Lead Site Exterior Paint North Arrow Owner Name: TIMOTHY J VAUGHN 

Site • Good Sketc h Address : 1919 S 35 AV • Poor <d- Phone: H:3«#a- Iip7 w: 3HS-&t3 » ig^Not paint 

Sample Number 

RYASCPXA-18459 F1 

Lead 

Concentration 

6^9 

Firm: 

Date: 

Samples Collected 

ff\psy.u^A^.p 

RYBSCPXA-18459 F2 Time: 3 :jt3 

RYCSCPXA-18459 Bl 

RYDSCPXA-18459 B2 Samples Analyzed 

RDZSCPXA-18459 DZ XRF Unit: 'o3 7 Book; I2J ^ 

nCgCCPXA-10450 Date: <=T't -os r 

RPZSCPXA-104G9- Time: At^i 

Staff: A=A. 

OLS#: 18459 

Date Excavated: 10/19/09 

Date USEPA Signed Off: 11/5/09 

Area Sodden: 666 sa ft 

83 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced

Rock/Mulch 

 with 

Area lef t bar e 

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

46130 
1 

Pm Pm 

j 18459 

Omaha Exterior Paint North Arrow Lead Site Owner Name: JJMQTHY AYj^yGH^^^^^ 

Site • Good Sketch Address: 1919 S 35 AV • Poor <d- Phone: H:3H2ZliOJ w: ?«/S-;B?3g [g^Not paint 

Samples Collected 

Firm: /7?gS-^.M/9.F 

Date: ^iKe/o ^ 

'^AiKrn^r 

Omaha Lead Site 46130 
'ill Y^ t 

18459 

% Omaha Lead Site Owner Name: TIMOTHY j VAUGHN 

Site Sketch Address: 1?19 S 35 AV 

Phone: »3H2- ^OJ _ W; ?</g-;g<f7fl 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-18459 Fl ^ (ols9 ppm [ ^ D 

RYBSCPXA-18459 F2 1 0 ppm a 

RYCSCPXA-18459 Bl 2.2.*^ ppm B^ n 

RYDSCPXA-18459 62 13 7 ppm B " a 

RDZSCPXA-18459 DZ 274 ppm n 

nCZGCnXA 104S0 G ^ ~ ppm D n 

RPZSCPXA-10459 P2 - " ppm D D 

Number of Samples = ^ 

Exterior Painl North Arrow 

• Good 

• Poor ^ 

g^Not paint 

Samples Collected 

Firm: ^^^.5-/?./-/./^. F 

Date: SJ/(,/oS 

Time: 3 -tj ^ 

Samples Analyzed 

XRF Unit: 1^3 7 Book: /Z*? 

Date: 7- / "^S ^ 

Time: A A ^ 

Staff: AzA. 

Omaha Lead Site 46130 
18459 

Omaha Lead Site Owner Name: TIMOTHY J VAUGHN 

Site Sketch Address: 1919 S 35 AV 

Phone: H:3^a>»g7 v flS-MSf i 

Sample Numtier Lead Sample LAB Concentration Collected 

RYASCPXA-18459 Fl (ti> ^ ppm \sA D 

RYBSCPXA-18459 F2 1 0 ppm D 

RyCSCPXA-18459 Bl 2.2A ppm \EA D 

RYDSCPXA-18459 B2 /3 7 ppm E A n 

RDZSCPXA-18459 DZ 274 ppm n 

nOg6CP)(A-i(>400 Og " ppm D n 

nrzaCVXA.iMiM pa - " ppm D D 

Numt>er of Samples = i ^ i i O 

fy ^ =ae: 

1 3 1 

^3« 

B 

Ce^. 

Exterior Paint NoctiAirow 

• Good 

• Poor 

B^Not paint 

Samples Collected 

Firm: j(^^^jL^£ _ 

Date: SjfWnS 

Time: 

Samples Analyzed 

XRF Unit: lo3 7 Book: /Z 9 

Date: 'f't'OS' 

Time: ^/ H 

Staff: i- A 

AUG t 8 

€ Co'^tDZ.:r274 

M|^S.35**:/W n. . 

¥ 

^ 6 9 io i - ^^yr^< ­

•y-3.^t?./fc»-

Omaha Lead Site 46130 
# 

COASTA l tttVlttONHIRTAl 

C It 0 ll r . IH 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: jr> ^ ^ q 

\lr^^^akv^y.^xnn^l\ 

Address cf 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 perfonned, 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 perfomiing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
^<,«) tv^ . 

".^>-~ / COASTAL V^ r5 ^ IHVIM0HH(KTAL 

C R O U » I h C 

« Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

c 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; 

c 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 (402) 991-1199 

• ^ 1 rant access to my properties D I do not grant access to my properties 

AA^-d^ 

Date Signature Date 

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

Page 2 of2 
* 

Restoration Agreement 

The purpose of this agreemeni is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation 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: is^e? . ZZI 

Property Address: \Cj jC^ '^ . '^ ^ AV ^ 

(Phone: TJ^-Og-Q aS ^ Q 

On the attached diagram(s) indicate ana^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 ranoval. storaqe, disposal, and/or return of tfiese items is the Owner's responeibility. 

Item: 

MtiVlE' 

Item: 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Wot Replaced 

Item: 

Item: 

Item: 

Kem: 

Page l 

^y 

i 
AC - % 

COASTA L 

% 

Items to Be Removed m. 

Contractor Durinfi 1 Remediation and Repiaced 

Kem: 

Ksm: 

-^cd V} Kem: 

i 

Item: 

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. 

Aiiath .-I skeicli ol tlif 

^rripklci t;iv'.iiii 

Number of and size of 

each garden/ flower bed 

area. 

Alliith ;i vkL'lch 1)1 ri.-!:ili\i' 

MZi'S mid local iiMii 

Agreed upon value of plant 

replaced bv contractor. 

Voir l!"ii' VHliic «ill nt 

i;si't' 10 i:;u( .1 OIHII: 

vniifhi'.- 1(1 llie i;ro))Cii> 

0" ner. 

Easement Area, to be 

excavated 

Quantity 

A 

\ 

^ 

\ 

V 

r 

Landscape Inventory 

Unit Condition/Type/Species 

Quadrants 

Each 

Each 

Each 

Eacfa 

Square Feet 

S 

Each feh(!UUlCA \iiAu^ ^ 

Page 2 y 
COASTA L 

, e i% i u I. . IN C 

! Additional Comments / Instructions: 

4,yo^ynos ,|wMc ^^^^ ^^^ 

L. 

""SCheck the IKJX If Owner does not want CEG to document interior foundation walls and possible 

preHSxisting damage. By checking this box CEG is not responsible for any damage done to the 

Interior of house, including foundation cracks or fissures. 

O I do not agree 

(^y^^o^ 

Date Contractor's Signature 

Page 3 < of 4
BVID# I^^S ^ 

XRF PROPERTY SAIWPLE SHEET 

Date Address n \H b^ :^<r (h ^ 

Project Omatia lead I FP 2nd year option Sample time am/pm 

XRF1D# sample length 30 sec :^^n^^ 

Shot# Reading Sample area Shot# Reading Sample area 

^ 3 ^ Mt2. 

¥9s - t^ g^^fi WIT £L 

Depth Depth v-f i='l3' ZML J?4 ^ 

2A12. 73 :t.z3» 4 ^ 

Average I'^J ^ { A^ Average /^ ^ -'^ t JS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature.^£aiM ^ 

Print 9 \ju^p}DQ\^ Oace^^ts 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 248 

Mode SOIL 

Time 2009-10-20 14:55 

Duration 120.00 

Sequence Final 

Flags 

AVERAGE 

LOCATION J5"ave 

INSPECTOR VENTRY 

COR 1 easement 

COR 2 1 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

^Pb _ 73.147 . ± -• 13.468—7 

Cd < LOD : • 19.07r- ^ 

Ag < LOD \ 13.954 

Sr 108.681 ± 7.875 

U < LOD : , 19.984 

Rb 49.776 ± 6.153 

Th < LOD I 11.819 

Se < LOD : 5.422 

As < LOD : 16.805 

Hg < LOD : 12.518 

Zn 105.997 ± 19.605 

W < LOD : 74.688 

Cu 42.928 ± 21.074 

Nl < LOD : 69.633 

Co < LOD : 145.348 

Fe 12892.867 ± 354.414 

Mn 384.603 ± • 93.469 

Cr < LOD 147.997 

V < LOD 217.259 

Ti < LOD 786.360 

Sc < LOD ^ 65.366 

Ca < LOD / 1149.964 

K < LOD y 1596.750 

S 1251.241 

-y 

Supervised By: / A y 1 7 ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR l 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

w 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

ppm 

75.255 

< LOD 

< LOD 

110.241 

< LOD 

48.910 

< LOD 

< LOD 

< LOD 

< LOD 

116.925 

< LOD 

42.339 

< LOD 

< LOD 

12828.251 

466.545 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

Certificate of Verification 

244 

SOIL 

2009-10-20 14:53 

30.00 

Final 

18459 

1919 s 35 ave 

VENTRY 

easement 

1 

clearence 

epa gun 

EPA 

± 

± 

± 

± 

± 

± 

± 

Error 

13.631 

18.964 

13.724 

7.931 

20.492 

6.170 

12.343 

5.239 

17.409 

12.499 

20.379 

73.970 

21.036 

69.828 

146.121 

354.033 

99.955 

37.985 

128.086 

662.452 

96.970 

982.042 

49.195 

809.573 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

User Login 

Certificate of Verification 

245 

SOIL 

2009-10-20 14:53 

30.00 

Final 

18459 

1919 s 35 ave 

VENTRY 

easement 

1 

clearence 

epa gun 

EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

78.861 

< LOD 

< LOD 

105.610 

< LOD 

47.546 

< LOD 

< LOD 

< LOD 

< LOD 

97.162 

< LOD 

43.458 

< LOD 

< LOD 

12953.876 

372.890 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

± 

± 

± 

± 

± 

± 

i : 

Error 

14.066 

19.548 

14.353 

7.881 

19.801 

6.096 

11.301 

5.928 

17.177 

13.011 

19.239 

76.541 

21.485 

71.534 

149.589 

359.652 

93.827 

119.109 

211.000 

827.172 

23.414 

906.609 

2849.798 

1570.865 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

ppm 

62.361 

< LOD 

< LOD 

111.046 

< LOD 

55.333 

< LOD 

< LOD 

< LOD 

< LOD 

103.392 

< LOD 

39.990 

< LOD 

< LOD 

13364,001 

398.094 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

Certificate of Verification 

246 

SOIL 

2009-10-20 14:54 

30.00 

Final 

18459 

1919 s 35 ave 

VENTRY 

easement 

1 

clearence 

epa gun 

EPA 

± 

± 

± 

± 

± 

± 

± 

± 

Error 

12.567 

18.619 

13.680 

7.834 

20.164 

6.331 

11.893 

5.551 

16.029 

12.149 

19.047 

70.589 

20.394 

69.149 

146.440 

355.723 

93.164 

169.228 

76.567 

767.725 

110.654 

1536.298 

1803.565 

1438.456 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR l 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Nl 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

76.113 

< LOD 

< LOD 

107.827 

< LOD 

47.314 

< LOD 

< LOD 

< LOD 

< LOD 

106.510 

< LOD 

45.925 

< LOD 

< LOD 

12425.344 

300.884 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

Certificate of Verification 

247 

SOIL 

2009-10-20 14:55 

30.00 

Final 

18459 

1919 s 35 ave 

VENTRY 

easement 

1 

clearence 

epa gun 

EPA 

± Error 

± 13.608 

19.178 

14.060 

± 7.852 

19.479 

± 6.014 

11.738 

4.971 

16.607 

12.411 

± 19.757 

77.653 

± 21.380 

68.022 

139.241 

± 348.250 

± 86.928 

265.667 

453.383 

888.090 

30.427 

1174.906 

1684.443 

1186.071 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 243 

Mode SOIL 

Time 2009-10-20 14:51 

Duration 120.00 

Sequence Final 

Flags 

AVERAGE 1 Avq of 239-242/ 

LOCATION 1919 s 35 ave 

INSPECTOR VENTRY 

COR l f l 

COR 2 13 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

^§y . - r?SiSi9 , • ±-—i—l12L574_7 

Cd < LOD 20.926 

Ag < LOD 15.030 

Sr 114.517 db 8.565 

U < LOD 22.006 

Rb 52.144 ± 6.716 

Th < LOD 13.254 

Se < LOD 5.936 

As < LOD 22.235 

Hg < LOD 13.550 

Zn 146.296 ± 23.615 

W < LOD 77.976 

Cu < LOD 32.896 

Ni < LOD 78.692 

Co < LOD 179.416 

Fe 16996.504 ± 431.129 

Mn 502.587 ± 111.462 

Cr < LOD 89.721 

 < LOD rtsp.ivi 

Ti < LOD y^^^.S^ R 

Sc < LOD X 81.065 y Ca < LOD A / 848.174 

K < LOD / J / 1495.551 

S < LOD/ 7 1045.270 4Vyn 

Supervised By: /V > A/yy-^' 

V
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 239 

Mode SOIL 

Time 2009-10-20 14:49 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18459 

LOCATION 1919 s 35 ave 

INSPECTOR VENTRY 

COR l fl 

COR 2 13 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm ± Error 

Pb 89.778 ± 15.608 

Cd < LOD 20.465 

Ag < LOD 15.347 

Sr 108.582 ± 8.409 

U < LOD 21.758 

Rb 49.580 ± 6.601 

Th < LOD 11.951 

Se < LOD 6.191 

As < LOD 19.506 

Hg < LOD 13.176 

Zn 154.891 24.324 

W < LOD 79.196 

Cu < LOD 31.166 

Nl < LOD 77.903 

Co < LOD 168.829 

Fe 15103.525 ± 409.198 

Mn 511.070 112.319 

Cr < LOD 107.095 

< LOD 275.751 

Ti < LOD 627.066 

Sc < LOD 20.838 

Ca < LOD 803.770 

K < LOD 1155.262 

S < LOD 839.165 

Supervised By: 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 240 

Mode SOIL 

Time 2009-10-20 14:49 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18459 

LOCATION 1919 s 35 ave 

INSPECTOR VENTRY 

COR l fl 

COR 2 13 

MISC clearence 

NOTE epa gun 

User Login EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

75.863 

< LOD 

< LOD 

118.457 

< LOD 

54.612 

< LOD 

< LOD 

< LOD 

< LOD 

108.503 

< LOD 

40.718 

< LOD 

< LOD 

16452.441 

440.293 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

± 

± 

± 

± 

± 

Error 

14.521 

21.087 

15.052 

8.596 

21.558 

6.728 

11.989 

6.667 

18.547 

12.765 

20.667 

73.666 

22.298 

75.946 

174.064 

420.565 

104.900 

43.794 

50.977 

508.521 

100.256 

1022.340 

1686.868 

1147.841 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 241 

Mode SOIL 

Time 2009-10-20 14:50 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18459 

LOCATION 1919 s 35 ave 

INSPECTOR VENTRY 

COR 1 fl 

COR 2 13 

MISC clearence 

NOTE epa gun 

User Login EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Tl 

Sc 

Ca 

K 

S 

ppm 

113.435 

< LOD 

< LOD 

109.378 

< LOD 

51.847 

< LOD 

< LOD 

< LOD 

< LOD 

141.788 

< LOD 

< LOD 

< LOD 

206.726 

20542.377 

553.024 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

± 

± 

± 

± 

± 

± 

Error 

16.986 

20.794 

14.694 

8.400 

21.954 

6.692 

12.599 

5.133 

21.669 

14.145 

23.381 

78.596 

32.364 

80.113 

133.316 

474.095 

116.105 

52.116 

396.580 

927.830 

187.182 

928.069 

1864.738 

1323.123 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 242 

Mode SOIL 

Time 2009-10-20 14:51 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18459 

LOCATION 1919 s 35 ave 

INSPECTOR VENTRY 

COR 1 f l 

COR 2 13 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm ± Error 

Pb 223.000 23.183 

Cd < LOD 21.359 

Ag < LOD 15.028 

Sr 121.653 •± 8.854 

U < LOD 22.754 

Rb 52.536 ± 6.845 

Th < LOD 16.477 

Se < LOD 5.753 

As < LOD 29.219 

Hg < LOD 14.115 

Zn 180.003 ± 26.087 

W < LOD 80.445 

Cu 40.786 ± 23.071 

Nl < LOD 80.809 

Co < LOD 174.796 

Fe 15887.669 ± 420.659 

Mn 505.960 ± 112.523 

Cr < LOD 155.881 

< LOD 227.569 

Ti < LOD 394.933 

Sc < LOD 15.983 

Ca < LOD 638.518 

K < LOD 1275.336 

S < LOD 870.952 

Supervised By: 

V 
\ Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

V v^ vinww.coa8talhazmat.com 

^<iPH0T«^ COASTA L • NVOONHINTAl 

C 1 0 U P. IN C 

EXECUTIVE SUMMARY: 

BVID #18459-(1919 S 35 AVE) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-COASTAL TO REIMBURSE FOR PLANTS REMOVED FROM DZ. 3-ROSE BUSHES -$40.00,4­

LILYS-$15.00,2-LAVANDER-$15.00,1-STILBE-$15.00,1-COROBELF-$15.00 AND 3-5 GALLONS 

POTS. (COMPLETED 2/23/10) 

-COASTAL TO REPLACE BROKEN CONCRETE. (COMPLETED 10/29/09) 

-COASTAL TO SCRAPE THE EASEMENT, LEVELOUT AND RE-SOD (10/29/09) 
f^-

EPA 

EPA Property Close Out Form 

Property #:_LViSa ^ Property Addr^j g ^ ^ V^^ . gy^^^-^^ 

Detc^ne : 

Quads Excavated: F \ Contractor Group (VQSctQ V F.V^VJ irtsm f ntt > I 

Excavation Yes No General 

1. If necessaiy, were the correct quadrant(s) excavated and restored? y 

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

Gradin Yes No g Sod and Vcgctatioa 

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

fix)m the house? ______^___ y

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

3. Does the sod appear to be generally healdiy and growing? (Only evaluate if inspected at a 30 Z'^ day time period) ^_ _ 

4. Are sodded areas generally nrm and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day v^ time period) 

6. Was the property graded such that water will not pool on the propeny"! \ y ^ 

7. Was danuge to landscaping or plant materials avoided? y ^ 

Gates, Fences and Retaining Walls Ves No 

1. Do gates open and close finely? (Ifappiicable) y ^ 

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

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

4. Was damage to retaining walls avoided? (Ifappiicable) y 

Foundation, Siding and Gutters Ves No 

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

2. Was damage to the foundation avoided? y ^ 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouls or downspoul extensions avoided? c y 

Sidewalks and Driveways (Concrete) Ves No 

1. Was damage lo driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 7y^ 
0 

Property Completion Agreement 

Dili agreement documenis lhe compielion of remedial aclivmes.perroimed on my properly My signaiure 

will designale Ihal I am satisfied with lhe re.<itoralion of my properly, and ihal no items are in quesfion.*;. 

now. or at any lime in the future, excepl ihose items listed below, ifany ^ 

Property ID; / ft 'V C ^ 

Property AiAAresr. / ^ f^ 3 . 35'A</'f c 

Owner: 

->*i c- _ o « 5»o y Phone -^H5'- 8<\Z^ 

Restoration Items in Question: 

Item: ft, ^ » . \ ^ i 

^ ^.TK^^VVN^^W V S^CACK^ P \/:^€i \ O\\ \ OiWi^ rz-Ao A 

Item: 

Item: 

Item: 

Additional Comments: . 

^^H-'lTyrcc restoration K complcttd, except as noted 

l_J I rto nol ^K^ec rtsioration is comptelcri 

gnaturr Date I Otnliitrioi's Signaiure Dale 
Property Damage Settlement 

Property ID 18459 

Property Address 1919 S 35 Ave 

Owner Timothy Vaughn 

Phone (402) 345.8938 

I havereceivedfiomthe contractor, Coastal Enviromnental Group Inc. (Coastal), the sum of $200.00 to 

compensate for plants that were removed during theremovalof lead impacted soilfix)mthe property. 

Compensation type Check 1885 

Value of Check $200.00 

Check to the order of Timothy Vaughn 

Description of Damage 

While excavating 1919 S 35 Ave (BVID 18459) Coastal damaged some plants beyond salvage. Property 

owner received a check for the amoimt of $200.00 dollars for the replacement ofthe plants. 

My signature below acknowledges the replacement of my plants; further, I acknowledge that this 

work was completed satisfactory and within my and release Coastal Environmental Group, Inc. from 

further obligations or liability related to this property. 

COASTAL ENVIRONMENTAL QROUP ING. 1885

2411 MARTHA STREET 27-5/1040 003 

OMAHA, NE 6810S 

6247372904 

• ^llll Q DATE 

S<2_ PAY TO THE' 

ORDER OF. 

'TimMii' V/iugwn $aoo' 

Tloo ^m)f\6JJU MJm Qjnd^ '/BU ' . DOLLARS OataUton 

«MbFwB0B«*,HA. 

fevtp \^^9^ Bi^ s S6^^^^ ^4Wstw c B^i-v^ FOR 

i: 101*00005Bi: E.Et,7 37 2'10l.ii' 0 1BB5 

Owner's Signa uri A ^Date CJhtractor's Signature Date 

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