l l 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: (^^22M Date: lO/zfp/O^? 

Address: ao\( p H M?; fft 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video ofproperty (DVD) 

 Executive Summary 

 EPA-provided property sketch 

 Signed Access Agreement for subject property 

 Signed Access Agreement(s) for adjacent property 

 Restoration Agreement 

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

 Confirmation data 

 Photographs ftx t/^^V^V. \rrC ^ Y ^ ^\/y\ ^^•r 

 As-built sketch 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Description ofareas not meeting ROD cleanup criteria 

 Utility clearances 

Property information from Douglas Coimty Assessor's Office 

^ Signatur Mgnafuree ­ ­ ­ ­

30054503 

 DJ i2i. Date 

Superfund 
• • « • 

Property Access Checl<iist 

Property ID: {j^^Zl ^ 

Property Address: 201 ^ |\1 q ^

Owner: 

7!ux\}^ Honx'i^ 

Address: ^^^^ ^ 

Z^_S52Z3155 

Fax; 

Ccll/Pascr: 

j n Notification Letter 

1 Qj Access Agreement 

I 1 ^ Restoration Agreement 

n To;)Soil Siunpiin" (if a|)plicable) 

Q Disposal Sampling (if applicable) 

n Garden Sampling (if applicable) 

[ ^ Ltilitv Clearance 

^ Video/Photos (Before) g C'^'Ol 

n Video/Photos (During) 

n Video/Photos (After) 

D Video/Phofos (30-Day) 

CD Propert) Completion Agreement 

1 1 Final Report 

Air Monitoring (as applicable) 

n Coinmiinity D Crew On:

Results: 

LJ Community d l Crew On:

Results: 

1 n Community C] Crew On:

Results: 

n WORK STARTED 

D WORKCOMPELTED 5V 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Sent: / / 

Signed: Jg./ ^ /i _ 

Signed: i£_/ ^ 1 ^ 

/ / 

/ / 

/ / 

Called: J^/JX^ ^ 

0n:_^/j7/_ i 

On: / / 

On: / / 

On: / / 

Sinned: / / 

I.s.s'ueJ: / / 

/ / By: 

/ / B.v:

 / / By: 

By: 1 

B.- f y 1 

By^-tC. 

By: 1 

Bv: 

By: 

By: ^ 6 

B­- IVitk 

By: 

By: 

Bj: 1 

Bv: 

By: 1 

. 1 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 ^ ^ 2Z M 

goWo K] H%3V 

 Date: Time: Action 

 Dale: Time: Action 

 Date; Time: Action 

 Transmit to EPA D Other Action: D 
Douglas Coimty Accoi^feifoj^i l ition Page 1 of2 

Douglas County, Nebraska Property Record - R1205040000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w O n Ma p Information is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature - • •• ^ Auto Sales Search 

Owner 

MORRIS JERRY R 

ETAL 

2016 N 48 ST 

OMAHA NE 68104-0000 

Property Informatio n 

Key Numtier: 0504 0000 12 

Account Type: Residential 

Parcel Number: 1205040000 

Parcel Address: 2016 N 48 ST 

OMAHA NE 68104-0000 

Legal Description: GRAMMERCY PARK LOT 9 BLOCK 3 50 X 134.1 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,500.00 

$6,500.00 

$6,500.00 

$6,500.00 

$6,500.00 

$6,500.00 

Improvement 

$115,600.00 

$115,600.00 

$115,600.00 

$115,600.00 

$66,600.00 

$60,500.00 

Total 

$122,100.00 

$122,100.00 

$122,100.00 

$122,100.00 

$73,100.00 

$67,000.00 

Land Informatio n 

Acres 

0.15 

SF 

6700.0 

Units 

1.0 

Depth 

134.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R120... 6/7/2009 
Douglas County Accoi|^nfQ^^i tion Page 2 of2 

1 1/2 STORY FIN 

2016N4BST 

wmvOKX JMDiafl 

140 

11_ 

Second Floor ^^''^ k 8S3.0«q. It so 

• I j ;*v Bsiml Block B « I0«9C«) t 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1922.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1909 0% 1909 100 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1069.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceil 24.0 

Porch Wood Deck 354.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R120... 6/7/2009 
Page 1 of 1 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2293376. 

Original Call Date:

Work to Begin Date:

 6/12/09

 6/16/09

 Time:

 Time:

 3:08 pm

 3:45 pm 

 Op: ELIZABETH18790 

State: NE 

Address: 2016 

County: DOUGLAS 

Street: N 48TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 07-SE,08-SW,17-NW,18-NE 

 Sect-Qtr: 

Type of Work: lead remediation 

Location of Work: LOCATE 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: 4ft Corner Lot: N 

Involves Tunneling or Horizontal Boring : N 

Front: Y

Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

 Rear: 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/12/2009 
n Page 1 of 1 

[ Create Another Ticket ] [ Back to Irth Intemet | [ Send Email j 

YOUR TICKET NUMBER IS 2326025. 

Original Call Date: 7/24/09 Time: 5:46 pm Op: ELIZABETH18790 


Work to Begin Date: 7/28/09 Time: 6:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2016 Street: N 4STH ST 


Twp: 15N Rng: 13E Sect-Qtr: 07-SE,08-SW,17-NW,18-NE 


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: 4ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring ; N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet^HONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/24/2009 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

69224 

Omah Exterior Paint Nortti Anxw a Lead Site • Good Site Sketch 

Q'Poor 

Sampling Addrass: 20i6 N 48 ST ["~| Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: f g Xwr . D 6 T \ 

RYASCPXA-69224 F l H 7 3 ppm D Date: lM7a>lr>ft 

RYBSCPXA-69224 

F2 jJLZtL ppm D Time: <0:3g Ar^ 

RYCSCPXA-69224 Bl 

ppm n Samples Analyzed 

RYDSCPXA-69224 82 IG2. ppm 

RDZSCPXA-69224 DZ t Ef 

-2.010 ppm XRF Untt: CoSH O Book: ZZO. 'ROZOCrXA-69224 SZ ppm D Date: 11 • Q ^ .03. 

nrZGCr'XA-69224 -PS- ppm D D Time: ffm

^ Lab RYDSCPLA-69224 D D Staff: Numljer ot Samples = | ^ m<,i ^ 

i Result 167 ppm 

Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla< 

All quadrants are as viewacf fram ttie slreet, facing property 

:OLS#: 69224 

Date Excavated: 7/30/09 

Date USEPA Signed Off: 8/11/09 

Area Sodden: 1£37 sqft 

Legend 

Concret Drip Zone Excava1:ed e Quadrants Excavated 

Area replaced witih Area replaced with 

Area lef t bare Sod ' ' Rock/Mulch 

Contiract #: EP-R7-07-05 Coastal Environmental Group Inc . 
rrr ?/^^ 

20U ^f^ ^^ 69224 

Omah Exterior Paint North An-cw a Lead Site • Good Site Sketch 

Q'Poor 

Sannpling Address: 2016 N 48 ST Q] Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: f g iMf. P6 TX 

RYASCPXA-69224 Fl ppm a' D Date I^l7^lf>» 

RYBSCPXA-69224 F2 \\V\ ppm D Time iP-3S AtA 

RYCSCPXA-69224 B1 ppm D 

Samples Analyzed RYDSCPXA-69224 82 /6,Z ppm Ef 

RDZSCPXA-69224 DZ Z070 ppm I D XRF Unit: (oSH O Book: 22. 0 

'RGZeCPXA-69224 SZ ppm Date i l O^ - oe , D n RPZOCPXA-69224 P£­ ppm D Time frn 

Lab RYDSCPLA-69224 Staff Numt}e j23ijL2­ r of Samples = | ^ \ [ ) | •Result 167 ppm 

Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla^ 

All quadrants are as vievi«d Irom ttie street, facing property 

OCT 2 7 

* - m­ m . I . ' < 

Re\:rtlf Creatd lU-Sep-c.i,' 

CoS ^ 
69224 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch 

[3^ Poor 

Sainpling Address: 2016N 48 s i Q Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Fimi: FglNf. V^T^ 

RYASCPXA-69224 Ft iLLL ppm nf D

Date ir>l^?>loa 

RYBSCPXA-69224 F2 1 2± ppm Time n I0-35 AK. RYCSCPXA-69224 81 IB. ppm 

D Samples Analyzed RYDSCPXA-69224 82 ppm mi

Ef . RDZSCPXA-69224 DZ 207Q ppm XRF Unit: (tSH O Boole 22 Q 

'RGZOCPXA-69224 SZ ppm n D Date i/ojo e 

RPZOCPXA-69224 P?- ppm 

D n Time n ja m

Lab RYDSCPLA-69224 Staff: Number of Samples = | ^ \ \ ) | n^L j 

: Result 167 ppm 

Front Right, Bl = Back Lett, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla^ 

All quadrants are as viewed from the street, facing propetty 

RtvIrtIS Created; li;-S«pJiS 
69224 

Exfeafior Paint 

Q Good 

Onalui Lead Sta 

Sta Sketch 

GTPoof 

SainDftKlA<MrB^:2n6N48ST 

Q Notpaint 

Batnpte Lead Sampte Colleated Number LAB ConcantTBUon CoUBUtod 

RYASCPXA<6a224 F1 _JlIJL_PPm n Date: lM9i>.lrJL 

RYBSCPXA<68224 F2 n Tma: J&-.3g Al*v 

RYCSCPXA«e224 81 2JL S pp") n 

Sampte AnalyzBd RYDSaPXA«B24 B2 /& Z ppm GZf 

RDZBCPXA-6B224 DZ Z07 Q Pont n XRF Unit: taS*f D Book: 2?, g 

uf^eaBap^MSBam—az a n Data: ilOHO ^ 

Rr'jnaoFw>«)2a4 nz 

n n TinBe: flrD 

^Lsb RYDSCPLA.6ffi24 SWf:_JZ23LUJ Numtttr of Sampte=1 ^ | | | | «ReBUll 167 ppm 

' Front RQM , B I « teok Left, K = Bmk RigM DZ » Drip Zone, GZ = GaidBn. PZ " Pta« 

AflnuadBBntBafBSB vtaMfld huiithBSliMt, fiBtlnB pmpBCty 

niv2a S Cimttd IO.Se|).<S 
^ 

COASTA L ^ fNVIIOMntNTil '^i. ^ • • 0 U f . ( N 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:

9 ^ ' ^-*, ^ ^ 

4 

Daytime Phone: 

^ ¥-t>Jh'jrjr^^^?^Jr-' 

Address of Property 

covered by this 

;>.o/7'A7'' ^-^^- h 

Aoreement: 

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, vi/ill 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 v^rk 

before it begins. Once the work is finished, the Grantor vi/ill 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 
\ 

COASTA L CNVItOMiriiT*! 

E • 0 U r I •) C 

• Remove obstructions Including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

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

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT 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 

^

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

.^^^y^^y^ ^ f-^'O 9' 

signature Date Signature Date 

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

COASTA L 

Restoration Agreement 

The purpose ofthls agreemem 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 propert}' owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: 

Property Address: ^ ^ / / / J ^ ^ ^ T " 

Owner: 

Phone: 

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: 

f/oifi^S -hy i<^ S^^/uo^j<^'7 

Pagel of. 
• # 

C O A S T^A L 

c n o u » . * f c 

items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

A^^yi^ - 7 

Item: ' / 

Item: / 

Item: / 

Item: / 

Item: 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 1 

Page 2 of. 
• • # • 

C p A S T A L 

C M O U r IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

1 Item: 

Item: 

1 Item: 

^ TD 

f^T^ 

J 

X 

fl<^cK 

D^ ­

-v^ ­ Jo^o.'h^Ji 

fi-rt 

fl'F2 .., Fl-fZ.

 V 

/ 

Item:

/ 

/ 

Item: / 

Item: / 

Item: / 

Item: 

Item: 

/ 

Kem: 

/ 

Item:

/ 

/ 

Item: / 

Item: 

Item: 

/

/ 

Page 3 of. 
C O A 5 T fk L 

e #( o u p IN C 

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 

noink 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. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

a •_ 

Each 

z Each 

3 Each 

y " Each 

Square Feet 

Page 4 of. 

rag e o or. 
# # • • 

C OAST A I. 

«»«wr . (Ma . 

Additional Comments / Instructions: 

j^^^y t ^^^ ^ Jjct^ct P I ^1 

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

pre-existing damage. By checkir^ this box CEG is not responsible fbr any damage done to the 

interior of house, induding foundation cracks or fissures. 

*E31 agree Q I do not agree 

A/wt^.'^^^'^ i f-f-'^P' P3^7:md ^9/69 

Owner's Signature Date GontrBctor*s Sigaatare Date 

Page 6 of 
y 

BVID#.^[2M 

XRF PROPERTY SAMPLE SHEET 


Date 7'2.b-T^ Address ^o\{o ^ M% &i 

Project Omaha lead FP Znd year option Sample time /o:*-/2r a®pm 

XRFID# sample length 30 sec ^zoi^ 

Shot# Reading Sample area Shot# Reading Sample area 

.2311. m.zi Z32n 3&2fftl2q.t ^ t n.oi ZS2^ mMt\\o.\'i> £L .252 714.-71120.^5 XI. Depth Depth .252R Vli^H.\ai\°\^Z _252 ^ H-^.y/ir?.?^ 

7^2^ 2?iO.Dl^»CXp J:S2iD_ 2^5 y/lr^) -12 la 

Average ZOl .IQ ± /"] ^ M Average Vl ^ .\ T J X\ . 2\g 

Shot# Reading Sample area Shot# Reading Sample area 

2^^' 2 W».«1ut n.5\ 2^3 1 l^72ttS.\ q 

2^«%a> lU^. I t lltf 0 1 D2. jiaaL IMT n t lSfb^^ «A ..e;^ ' 

2'^':^H /MM.»2*15.4'». Depth Depth .13S± }%.m t5 3^ 

2a»^S 2n.0f)±l?.7l 15 '2-'^ ^ K>2.2*^i^i?;.:^ 

Average p^q?* ^ 1 /U.^J l Average 13«> .5 ^ J N.j' b 

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. ^MIU(7 ^ 

Print tix/^ihdMn Cmrf^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2326 

Mode SOIL 

Time 2009-07-30 10:48 

Duration 121.97 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE F l 

INSPECTOR Nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± 

Pb / 201.190 i ± 

Supervised By: QTCAPQJgfi A 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 179.268 

Supervised By: 

Certificate of Verification 

2322 

SOIL 

2009-07-30 10:46 

30.57 

Final 

69224 

2016 N 48 st 

Fl 

Nicolas 

10 

CLEARANCE 

± Error 

± 17.016 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 159.023 

Supervised By: 

Certificate of Verification 

2323 

SOIL 

2009-07-30 10:46 

30.54 

Final 

69224 

2016 N 48 st 

F l 

Nicolas 

10 

CLEARANCE 

± Error 

± 16.145 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 236.459 

Supervised By: 

Certificate of Verification 

2324 

SOIL 

2009-07-30 10:47 

30.33 

Final 

69224 

2016 N 48 st 

Fl 

Nicolas 

10 

CLEARANCE 

± Error 

± 19.529 
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 230.009 

Supervised By: 

Certificate of Verification 

2325 

SOIL 

2009-07-30 10:48 

30.53 

Final 

69224 

2016 N 48 st 

Fl 

Nicolas 

10 

CLEARANCE 

± Error 

± 19.058 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2331 

Mode SOIL 

Time 2009-07-30 10:52 

Duration 121.74 

Sequence Final 

Flags 

AVERAGE ^:/g^g.or2327-2330./ 

ADDRESS 2016N?8st" ""^ 

QUAD/ZONE F2 

INSPECTOR Nicolas 

DEPTH 4 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ' 779.11£LJ ± i _ 21.^58 / 

Supeivised By: ?(fAjnj(lQ A 
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 352.545 

Supervised By: 

Certificate of Verification 

2327 

SOIL 

2009-07-30 10:49 

30.45 

Final 

69224 

2016 N 48 st 

F2 

Nicolas 

4 

CLEARANCE 

± Error 

± 24.642 
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 274.717 

Supervised By: 

Certificate of Verification 

2328 

SOIL 

2009-07-30 10:50 

30.56 

Final 

69224 

2016 N 48 St 

F2 

Nicolas 

4 

CLEARANCE 

± Error 

± 20.848 
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 193.344 

Supervised By: 

Certificate of Verification 

2329 

SOIL 

2009-07-30 10:51 

30.15 

Final 

69224 

2016 N 48 st 

F2 

Nicolas 

4 

CLEARANCE 

± Error 

± 17.825 
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 295.870 

Supervised By: 

Certificate of Verification 

2330 

SOIL 

2009-07-30 10:52 

30.58 

Final 

69224 

2016 N 48 st 

F2 

Nicolas 

4 

CLEARANCE 

± Error 

± 21.717 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2336 

Mode SOIL 

Time 2009-07-30 10:56 

Duration 121.50 

Sequence Final 

Flags 

AVERAGE ^Sg3E2332E23^ 

ADDRESS 2016 N 48 st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 15 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb ± 

Supervised By: Q)C^fI^J?py ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 191.955 

Supervised By: 

Certificate of Verification 

2332 

SOIL 

2009-07-30 10:53 

30.51 

Final 

69224 

2016 N 48 st 

DZ 

Nicolas 

15 

CLEARANCE 

± Error 

± 17.514 
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 162.100 

Supervised By: 

Certificate of Verification 

2333 

SOIL 

2009-07-30 10:54 

30.39 

Final 

69224 

2016 N 48 st 

DZ 

Nicolas 

15 

CLEARANCE 

± Error 

± 16.015 
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 144.816 

Supervised By: 

Certificate of Verification 

2334 

SOIL 

2009-07-30 10:55 

30.53 

Final 

69224 

2016 N 48 st 

DZ 

Nicolas 

15 

CLEARANCE 

± Error 

± 15.427 
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 217.054 

Supervised By: 

Certificate of Verification 

2335 

SOIL 

2009-07-30 10:56 

30.07 

Final 

69224 

2016 N 48 st 

DZ 

Nicolas 

15 

CLEARANCE 

± Error 

± 18.711 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2341 

Mode SOIL 

Time 2009-07-30 11:00 

Duration 121.81 

Sequence Final 

Flags 

AVERAGE 3j^i&M233323AQ] 

ADDRESS 2016 N 48 st 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb /Il33L5a0—/ [. 14.851 • 7 

Supervised By: ^(^^^LCJU^ ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 138.724 

Supervised By: 

Certificate of Verification 

2337 

SOIL 

2009-07-30 10:57 

30.55 

Final 

69224 

2016 N 48 st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.185 
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 147.171 

Supervised By: 

Certificate of Verification 

2338 

SOIL 

2009-07-30 10:58 

30.56 

Final 

69224 

2016 N 48 st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.534 
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 146.172 

Supervised By: 

Certificate of Verification 

2339 

SOIL 

2009-07-30 10:59 

30.57 

Final 

69224 

2016 N 48 st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.386 
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 102.294 

Supervised By: 

Certificate of Verification 

2340 

SOIL 

2009-07-30 11:00 

30.13 

Final 

69224 

2016 N 48 st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 13.301 
/1A. \

8 ^^^ ^ I

V/^^lj f

^tinatf^

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

 Coastal Environmental Group Inc. 

 www.coastalhazmatcom 

 COASTA L ENVI>ONHINTAl 

6 I O U P. IH C 

EXECUTIVE SUMMARY: 

BVID # 69224 - (2016 N 48 ST) 

"yj No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
EPA Property Close Out Form 

Property ff: 1.^1-lH Property Addr«r.- JgHMn T^H ) >^4-.^ 

Datemme: Owaer^s Name;. .{.A^VQ^ .i.VWf C^ ^ t ^ 1 

Quads Excavated; p\ ^ p 2 |t>T- Contractor Group f*^^^^ FrvV/l f\TmiLy\-T^ I 

ExcavatloD Yes No Gcaenil 

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

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

GradJDK Ves IN» Sod and Vegetation 

1. Does the grading around the perimeier ofthe 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 -v^ 

day time period) 

4. Are sodded areas generally firm and evenly graded? T7-" 

5. Are the joints l)etween the sod strips generally tight? (Only evaluate if inspected at a 30 day 1}', time period) 

6. Was the property graded such that water will not pool on the property? y 

1. Was danuge to landscaping or plant materials avoided? V 

Gates. Fences and Retaining Walls 

Ve s IM N K 

I. Do gates open and close freely? (If applicable) y 

2. Were all gates or fences taken down during restoralion activities reinstalled? (If applicable) y^ 

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

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

Foundation, Sidinx and Gutters 

Yes , > 

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

2. Was damage to the foundation avoided? L / / 

3. Was damage to windows avoided? \y ' / 

4. Was damage to windows or door screens avoided? v/ / 

5. Was damage to downspouts or downspoul extensions avoided? t / 

Sidewalks and Driveways (Concrete) 

Ycs/No 

1. Was damage to driveway surfaces avoided? 

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

Inspection notes: 

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

EPA Representative ^(T H UOMJL ^ Date: ^jll(0 ^ 
Property Completion Agreement 

I his agreement documents the completion ol remedial activities peribnned on my properly My signalure 

will designate that I am satisfied with the restoration of my propeity, and thai no items are in questions, 

now, or al any lime in the fulure, excepl ihose Hems listed below, ifany 

Property ID: (^°\'2'2' ^ 

Property Address: 2,6Z^ - / / Q ^ ^ f 

Owner: SefCy j/i/l<syn<. Phone: ^ B L ] ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

flfjrec restoralion it complclrd, cxccpl as nOlttl ^ 

I rio not aijrcc rescoratian is completed 

</ h Q^ 

Ownci''.<: Sicnatiirr Date ' / ^ J ntrarlor's Signature Date