TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

S/iID#: ^^26M_ Date: ^/^/^7 

Address: 32S7^(i7 }app/a^f\ fhM 

Remediation Contractor: _CoastaI Environmental Group_ Year: _2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

&f Executive Summary 

E EPA-provided property sketch 

t / Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

M Confirmation data 

M Photographs ' 

As-built sketch 

^ Satisfactory restoration signed by Property Owner 

Sr Property close-out check Hst signed by EPA 

D Descriptionof areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D , 

D • • • • • • 

'^''7i^^^''^J^^— —^4^ 

40317895 lliiiiilii 

Superfund 
Property Access Checklist 

1 Property ID: '(^ClP^ S 

1 Property Address: gQ(j2Lf foO f UiO n

o^n^r: ixm^trio V-C1 asquc-z 

Address: ^^ ^ f>onp(liVl ^

1 

1 

Phone: 34Q>-W7 I 

Fax: 

Cell/Pager: 

D Notification Letter 

[ ^ Access Agreement 

N L Restoration Agreement 

LJ Topsoil Sampling (if applicable) 

1 1 Disposal Sampling (if applicable) 

n Garden Sampling (if applicable) 

H^Utility Clearance 

" ^ Video/Photos (Before) 

El Video/Photos (During) 

[iKvideo/Photos (After) 

D Video/Photos (30-Day) 

• Property Completion Agreement 

CU Final Report 

Air Monitoring (as applicable) 

n Community [D Crew On:

Results: 

1 1 Community \Z\ Crew On:

Results: 

n Community • Crew On:

Results: 

A ^ 

Sent:

D WORK STARTED 

D WORK COMPELTED f ^ ' 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

/ / 

Signed: 5 / / 1 0 7 

Signed: 3 i ) i Ol 

1 1 

1 1 

1 1 

Called: (j> / ^ / 0 7 

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On: / / 

Signed: / / 

Issued: / / 

/ / By: 

/ / By: 

/ / By: 

Omaha Lead Site 

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PrnnertY Clasjjification EBL 

[7 ^ Excavated Area 

|~7 ] Existing Structure 

«—•— • Fence 

v^ Permanent Landscaping 

Quadrant Boundary 

Street Boundary 

/ \ Tree/Shrub hand quadrart; B1, backyard left-nand 

quadrant; B2. Backyard right-hand quadrant; 

F", front yard left-hand quadrant, hAl.onl yard rightS=Sr^|^-3,S::n;:S^TMndrSdat,qnq . the house,: 
Parcel Search Page 1 of 1 

Results 1 ­1 of 1 

B Q Parcels 

B ORTIZ FRANCIA M 

2566 POPPLETON AV 

Parcel ID 

Owner Name 

Property Address 

City 

Zip 

Owner Address 

Owner Address 2 

Owner City 

Owner State 

Owner Zip 

Sec-Twn-Rng 

Owner Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old Assessor Site 

New Assessor Site 

2218430000 ^ 

ORTIZ FRANCIA M 

2566 POPPLETON AV 

OMAHA 

68105 

2566 POPPLETON AVE 

OMAHA 

NE 

68105 

27-15-13 

SHULLS2NDADD 

8 

18 

E 20 FT LT 17 & 

W 48.2 FT 

68.2 X 168 

Valuation Information 

Valuation Information 

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Consento para el Acesso de la Propiedad 

DERECHO A ENTRA R LAPROPffiDAD 

Otorgante (dueno(a) de propiedad) se da consento y autoriza la Agenda para la 

Proteccion del Medio Ambiente de Los Estado Unidos (EPA) o su representantes 

autorizado, en conjunto el Cesionario, a entrar y llevar a cabo algunas actividades 

ambientales acerca de la propiedad describido que sigue: 

Dueno de la Propiedad: 

Direccion de 

Propiedades Cubieto 

por este Acuerdo: 

2^ 

Direccion:

Direccion: 

Direccion: 

Direccion: 

Direccion: 

Numero Diario: 

^ ^ (^ Mvi^^ 

Av-€^ 

PROPOSITO DE ACTIVIDADES AMBIENTALES 

El EPA solicita el acesso a collectar muestras de tierra y remover tierra que tiene alta 

concentraciones de arsenico y/o plomo que podria ser peligroso a su salud. La tierra 

estara removido y el(los) area(s) excavado(s) estara reemplazado con materials Hmpias y 

restaurado. Este trabaja estara realizado abajo del Omaha Lead Site Superfund Site 

programa de remediacion. 

Un representante de EPA se contactara el Otorgante pesonalmente a discutir el trabajo 

estar realizado, el Otorgante tendra la oportunidad a examinar y sancionar el plan de 

removimiento de tierra y el trabajo de restoracion antes de comenzar. Cuando el trabajo 

se termina, el Otorgante estara pedido a revisar el trabajo, confirmar su terminacion y 

cumplir con su aprobacion. Despues de terminacion, el Otorgante recibira un documento 

escrito por el EPA que indica la propiedad habia sido remediado. 

ACCIONES DE LA RESPONDENCIA AMBIENTAL. 

Por su firma de este Acuerdo de Acceso, el Otorgante concede el EPA, sus empleos, 

contractors y subcontractors el derecho a entrar la propiedad, en tiempos razonable y sin 

noticia anterior, para el unico proposito a realizar trabajo. Este acceso deberia persistir en 

efecto hasta que el trabajo habia sido terminado en un estado aceptado. El Ortogante 

tamiben esta de acuerdo con: 

Pagina 1 of 2 «Property_ID» 
s,

 3£M T­

"3 

• Remover obstruciones que incluye botes, ranolque, vehiculos, jugetes de ninos 

montones de madera, casas de perros, etc. 

• Remover de bulbos de flores, o otras plantas que el Otorgante o inquilino del 

Otorgante quisiera guardar, 

• Regar y mantener reemplazo de vegetacion, incluso la aplicadon de fertilizante 

como es necesano subsecuente de la riega inidal pea- d EPA; 

• Permanecer por la guia de Salud y Seguridad provddo por el EPA; 

• Si la propiedad esta rentado, asiste d EPA a obtener la aprobadon dd inquilino 

para acceso a la propiedad a llevar a cabo el trabajo, si d EPA esta inhabil a 

obtener acceso; y 

• Permitir a hacer un video y/o tomar fotos de la propiedad induyendo los areas 

exterior y interior de edifidos. 

ACTJERDOANO INTERFERIR 

El Otorgante esta de acuerdo a no interferir o meterse en cualquier actividades o trab^o 

hecho, o el equipo usado a llevar de cabo los actividades, o hacer cualquier acdones en 

respecto de la usa de dicho propiedad que podria arriesgar la salud o bienestar de los 

Cesionarios o el medio ambiente, o permitir otras personas a usar la propiedad en alguna 

manera. 

Si tiene preguntas sobre este programa, por favor contacta 

Eisi: yo pennito acceso a mi propiedad

 Q No permito acceso a mi propiedad. 

y 

7y^/^7 

Firma Fecha ^VCVML Fecha 

I I Me gustaria ser presento durante de cualquier colled6n de muestras. 

Pagina 2 of 2 

•Property ID» 
Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of propert> prior to 

remediation activities. This will also sene as decontamination for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States En\ ironmental 

Protection Agency (EPA). 

Property ID: 2 H ^ . 

Property Address: ^ U \\}H\3AdA M 

Ov»ner: 'mt\^\) \jm^Qm 

Phone: ^% G^1l 

On the attached diagram(s) indicate arca(s) to e\ca\ ated and depth of e\ca\ ation. location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used b\ 

contractor, and the direction of North. Indicate distances, depths, material tvpes. etc. Indicate digital photos 

by referencing the photo-log number \\ ith an arrow indicating direction of A icw 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

Item: 

ILF Sifp to 

Item: 

Pl^H 

Item: u Hpi'Sf [P 

Item: 

U l^i/^f {V 

Item: 

h'7ih Wi ' w 3) Item: ^- ^ 

Item: 

Item: 

Page 1 of ( / .. . 
^*= 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Page 2 of (^ 
m^ 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 
w^ 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-e.\isting property area 

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. 

Quantity 

I 

} 

K 0 

Unit 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

fhf w , 9^ 

1 ft((li , t iwi\ 

Page 4 of C^ 
Item Quantity Unit Condition/Type/Species 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

7 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

z 

Each 

Include a sketch of were 

each plant will be placed 

bv the contractor. 

Agreed upon area of 

propert> to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

arass sod. 

SF 

Area of City or Countv 

property to be landscaped 

per their requirements. SF 

Include

area (s) 

a sketch of the 

Page 5 of J ^ 
C«^1) 

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Legen d 1 NorthArrow Omaha Lead Site 1 Omaha, h4ebraska r^.j ^ Concrete 

l/"/ ] ExcavatedArea 

Property Numt>er 

OLS- 20688 Existing Structure L _J ' " • 

Scale 

Property Address 

1 Inch = 30 feet or 1 grid = 5 X 511

^:^ 2566 POPPLETON AVE 

» Fence 

1 R-V1 

— — _ 

Quadrant Boundary Post Excavation Concentrations (ppm)

• 1a:-vHC3 L - Street Boundary 

F1 B2 PlavArea Hy<i:r:iGf^,-r-lo^c. Jrv^ ^\^C l tr F 

b:as< T r a 5/Shnjlb »PP« " ^ ' 

— <> | N 

I cwarden Othler. E 

Desolptioi of post excavation areas: F1. front yard left-tiand quadrant F2. front yard right-hvxl quadrant; B1, t^acfcyardtafl-handquadrar^ B2, tKKkyard right-hand c^jadrant; 

DZ. dip zone (1-3 foot area of soil arouid the toundatian of Iha house). 
Additional Comments / Instructions: 

'^jCUilH^Vi f ^ M t 

-A ^ Z !^/r^s 1(^1^^ 4wf "f^ hiw^ 'W'? 

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^ f f<^^k 1^'' ^ ^^<^'^ ^ Wat phiJ^f f^^^iW^^^rT

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• 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. 

Q I do not agree 

'3Z-^r^ 

)wner's Signatur ignature Date Page 6 ootf v^ actor's Signature 
Q 

\ 

-1( fwo'^'^ 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # poi^ee 

Property Address 3^%^ t^^^Uc/o>7 

y . Owner Name ^^t^/^^/. ^ ^^/>}^^i7 ^ ^ 

Date 

Comments 

J ^ 

Owner Signature 

Contractor Signatur 
PROPERTY CLEARANCE WORKSHEE m 

Date arjiqjO Property ID l c^oGfy. Property Project Omaha Lead -- Fixed Price Address ^3:>6ipln Tbp0€-4on H J 

XRF ID 

Shot # 

^^3 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

0{0n-5l 

Sample Area 

Pass/Fail ? 

Analytical Lab Analytical Spilt Sent Number Results 

Pass/Fail ? 

Analytical Lab Analytical Spilt Sent Number Results 

Pass/Fail ? 

Analytical Lab Analytical 

Spilt Sent Number Results 

Reading 

. ^ ­

^ ) U 

Sample Area 

I n Situ 

Reading 

Sample Area

I n Situ 

Reading 

Sample Area 

I n Situ 

Reading 

M 

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223 

Sample Area 

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Composite Readings 

(Bag) 

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XRF Corrected Value -- > 

(use calibration chart or add 

20<H> to value) 

 X3 3 Z '

Composite Readings 

(Bag) 

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(us e calibration chart or add 

20'Mo t o value) 

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Composite Readings 

(Bag) 

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(use calibration chart or add 

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Average 

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(Dried & 

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( Dd(| ; Number Results 1 (Bag) Sieved) 7

Confidential 5/2/07 Page l of 2 
5 

2 1

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(use calibration chart or add 

20% to value) TZ3> 

Sample Area Pass/Fail ? 

Aliquot 

1 

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Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 

USE ADDITIONAL SHEETS I F 

XRF Technician's Signiture HEEDED 

V^f IJL^ O 

Confidential 5/2/07 Page 2 of 2 
X 

rlfi|^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 ^ J^^v f I Coastal Environmental Group Inc. 

%~^^ ^ www.c0astalha2mat.com 

^^tpRoT*^ COASTA L ENVIRONMENTA L 

CROUP . INC . 

EXECUTIVE SUMMARY: 

20688—2566 POPPLETON AVE 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated = 3116 

Property Classification EBL Total Drip Zone Linear Footage to be Excavated = 80 

Legend OLS#:20688 North Arrow Omaha Lead Site 

.•- • Date^xcavated: 6/19/07 Omaha. Nebraska 

nSiite USEPASJgned Off:7/2/07 Propert y Numbe r 

I i Exiting Structure Scal e OLS - 2068 8 

•

—

 • •

 — —

 Fence 

Pennanenl Landscaping 

 Quadrant Boundary 

1 Inch = 30 feet or 1 grid = 5 x S ft 

.y^'-". . 

Propert y Addres s 

256 6 POPPLETO N AV E 

Pos t Excavatio n Concentration s (ppm ) 

cQ)

Straal Boundary 

 Troe/Shrub ^ ^ ^ 

^•ty^imf^•^^l nrj»r. Irtr F1 . 

F2 

B1 

8 2

DZ

Garden

 Play Area 

 Easement 

 Other 

DaiLiUjaun o l fiottt axcavMnn «*a a n front yard l«fl -hand quadrant: r 2 from yard nght-hand quadrant B1 backyard lafl-hand quadrant B?. backyard nght-hand c 

OZ. dripxanm^t-3loa%mwm0t wot arawid llwfoiffidaIMn olttie house). 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
m^ 

Property Completion Agreement 

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

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

questions, now. or at any time in the future, except those items listed below, if any. 

Pn>perty ID: c^^i^m 

Property Addrcs.s: ^^^^ ^ PDl)t]M fVP PV t 

Owner: ni7}if3r/0'W/a<^a/Jl7^ 

Phone: <^3b-ioQ7/ 

Restoration Items in Question: 

Hem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I \ I iif;rce restnrjttlun Is coinplrtrd, except as noted 

I I I <lo not »Crcc restoi-Htion is completed 

3237 TiL: ^ 

Owner's Signature Date Contractor's Signature Date 
^ 

SEPA 

EPEPA Property Close Out Forf 

Property #: Property Address; 9'5lj>(T^ fhpplth p /?/€ . 

Datc/Tinc : Owner's Naaie:/}^/??^/// ^ \/-P7aSqijPr ^ 

Quads Excavated: Contractor Group ^ 

Excavatioa General Yes No 

1. If necessary, were the correct quadrant($) excavated and restored? 

(-^ 

2. If ncccssa'v, were the correct areas of drip zone excavated and restored? 

L ^ 

Gnidin t Sod and Vetetatton 

Yes No 

1. Does the grading around the perimeter of the house in excav ated areas generally slope away 

from the bouse? 

2. Has sod been laid in all areas that were excavated? ^Jce^ T 3h€/t , /? / ^^J A '7uJf*i7' 

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

day time period) 

4. .\re sodded areas generally fuin and evenly graded? i ^ 

5. Are the joints between the sod strips generally tight? {Only e\ aloate if inspected at a 30 day 

time period) 

6. Was the property graded such that water w ill not pool on the properr\' 

7. Was damage to landscaping or plant materials a\ oided? T^. 

Gales, Peaces aac Rciainint Wails Yes No 

\. Do gates open a.nd close freely'? (If applicable) y.. ^ 

1.. 

Were all gates or fences taken down during restoration activ ties re>.s'_a!ie-c? .if apr'-icabie) \ y 

3. 

Was damage to gates or fences avoided? (If applicable) ^ 

4. 

Was damage tc retaining walls avoided? (If applicable) p7^ . ^ 

Foundation, Sidiaf and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or dcwTispout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? ^ 

2. Was damage to walkwav surfaces avoided? ^ 
 T ^Owners comments: .

Inspection Dctes: 

Remc\'al and restoration acti\ ates complete including the 30-da>' sod warrantv': 

EPA Representative;^^^;^^^^^!;^^^^^^/!? ^ Date: y/py^- y