TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: IZL8 Date: /^i/^^ ? 

Address 

Remediation Contractor: Coastal Environmenta l Group _ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0^ Video of property (DVD) beio<"^ 

0^ Executive Summary 

0^ EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Q^ Restoration Agreement 

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

m Confirmation data 

iZf Photographs ^jC-acuj {kJ^jOi^ CCtiJ Own M e^ryij)nk<fr\^ S6<=1 

0' As-built sketch 

^ Satisfactory restoration signed by Property Owner 

(0^ Property close-out check list signed by EPA /' / i / 2Z^O ^ 

D Descriptionof areas not meeting ROD cleanup criteria 

D Utility clearances 

B^ Property information from Douglas County Assessor's Office 

y Vrp^(!4-H^ (lC.c.t<.s C^MipkLs^ ^ rjmJTlJr'rfbnin 

D 

/m^^ 

40312887 

Superfund 
l. 

2 

3. 

4. 

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2 . 

j . 

2 . 

n 

Final Report Property Check List (piease place with each file) 

Hard Copy Information 

1. Property Check List 

2. Site Working Drawing Map 

3. EPA originals Map 

4. Douglas County Assessor's Map 

5. Property Contact Sheet 

Agreement 

1. Access Agreement 

2. Restoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

3. XRF Data 

4. Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3. Property Completion Agreement 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

6. EPA Property Close Out Form 

7. Attached Begin Video 

Electronic Documentation 

Drawings 

1. EPA original 

2. Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

Begin Video 

My Movie 
Property Access Checklist 

Property ID: 

D WORK STARTED ON: -1^ ^ 

Propert WORKCOMPELTED ON: y Addre.s.s: ^Q^ . S 1 ^ S t 

n

Owner: Renter: "• fhszy.^ y^oyM i^ Address 

Phone: 

Fax: 

Cell/Pager: 

Additional (nt'ormation: 

Pho"^-- (Y^g^KTo^-.T/A? 

Fax: 

Cell/Pa«er: 

-S " Notification Letter 

Sent: ^7^/03 : Bv: JULOL-CA.! ^ 

-S ^ Access Agreement Signed: 9 / r?Ol 6 ^ ^y ?i<^:^V,-f/- T 3 Restoration Agreement Signed: _^/^/i ^ By- i^e^ciLcjjdttn Topsoil Sam|)ling (if applicable) / / By: 

[U Disposal Sampling (if applicable) / / By: 

O Garden Sampling (if applicable) /

 / Bv: 

K Utility Clearance Called: ^ MT/O ? 

^ Video/Photos (Before) On:_5/^/6^ By: Zic^kruPtf— 

CH Video/Photos (During) On: / / Bv: 

* 

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

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

1 1 Property Completion Agreement Signed: / / By: 

D Final Report Is.sued: / / By: 

Air Monitoring (as applicable 

r~l Community CH Crew On: / / By: 

Results: 1 

Q Community O Crew On: / / Bv: 

Results: 1 

[U Community O Crew On: / / By: 

Results: 

Omaha Lead Site 
^ 

a^Hs 3^< 

Total Qua^^HSquare Footage to be Excavated = 354 

Property Classification: 800 Total Drip^n ip^ne Linear Footage to be Excavated = 113 

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South 12 Street 

Legend North Arrow Omaha Lead Site 

|v,:':;j Concrete Omaha, Nebraska 

K/ 1 Excavated Area Property Number 

1 I Existing Structure Scale OLS-1268 

•—•— •

yy X

 Fence 

Permanent Landscaping 

1 Inch = 20 feet or 1 grid = 5 x 5 ft Property Address 

4302 S 12 ST 

— — — Quadrant Boundary 

Street Boundary s A i V HG L Fl

Post Excavation Concentrations (ppm) 

B2 Play Area 

F2 DZ Easement 

cQ) Tree/Shrub 81 Garden Other 

Descriptionof post excavation areas: Fl, front yard left-hand quadrant; F2, front yardright-handquadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
Total QilHIh t Square Footage to be Excavated == 354 

Property Classification: 800 ^ F Total Dri^on e Linear Footaqe to tie Excavated == 113 

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 Concrete | 

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Omaha Lead Site 

Omaha, Nebraska 

Property Number , 

OLS-126 8 

Property Addres s 

4302 S 12 ST 

Post Excavation Concentrations (ppm) 1 D 7 Pla w Aro 3 1 DUU[I Jdi y 1 .V, , 

<.q»,l ^ reel 

1 F2 Ease men Tree/S irub '^-^ — o 

1 Garc e n _ Othe Bl 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2. front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
v^ ' 1268 

Omah Exterior Paint North Arrow a Lead Site Owner Name: ^MJ:. ZoividU Q] Good 

Address:4302S12ST Site Sketch • Poor 

Phone: H: yfir-^Mr/^z 7/ W: Q Not paint (S) 

Sample Number Lead

Concentration

 Sample

 Collected 

 . ._ 

Firm:

Samples Collected 

 Sverdrup 

RYASCPXA-1268 YA 661.6 ppm Ivl 0 Date: 

RYBSCPXA-1268 YB 267.6 ppm RT) Fl Time: 

RYCSCPXA-1268 

RYDSCPXA-1268 

YC 

YD 

232.8

172.5

 ppm

 ppm

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n Samples Analyzed 

RDZSCPXA-1268 DZ 854.4 ppm [71 n XRF Unit: Book: 

RGZSCPXA-1268 GZ ppm n n Date: 11/7/1999 

RPZSCPXA-1268 PZ ppm n n Time: 01:29 

Number of Samples = 5 ;

1 

i 1 Staff: 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 

046141 0123 
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COASTA L *- E N V I fl 0 N n [ N t It L 

C • C t f •« 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 prcpety. 

AGREEMENT NOT TO iNi'ERFERE 

The Grantor agrees net to irter^ere or ts-^^per with ar.y of the /v'ck activities, or with any 

of the work done, or with the eq^iprrient wSed on "^is property, or to undertake any 

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

..•olfprc i '^.f •'h o :'^'-p>~+oec '^ ' ^^.S. c —•, .'r o "-r-a" * —- - - cM'^'i/v..' •^•h,ttr c *'> c p *''*P '"i'''-,f-,pr+,,' ' n 

Should you have any questions about t""^* pTograr.. olease co-,:act Coastal 

Envi-onTiental Group, at ;877) 234-52:^0. 

^ [ grant access to .ry properties 1 do T\O\. grant access to rry properies 

^-/^' o7 

Signatyj*^^^-;;;?^''t--^/ Date Signatcire Date 

: I would like to be p.-esent during sny sampling that is required. 

Paae 2 of 2 
COASTA L 

Restoration Agreement 

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

remediation activities. This will also serve as 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: / 2 6g 

Property Address: ^}(?2 J 1 2 I T J-r 

Owner: /Inqjc Zun^ejCj 

Phone: iZol' ^dZ'Jh S 

On the attached diagram(s) indicate area(s) to excavated and depth of e.xcavation. 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 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 Owner's responsibility. 

Item: 

OiAJ/ie^ ^AVM rcvo^v*; ell Sr^. l l Er . y /Saizx»^ / 

Item: 

• ( ( (P^Ipt^iXiSt^Q ^ Oucx!^^ U l rt,*- a-^ ? la. Jsc^f i \^CJ^ '•> 

Item: 

dj^S^r/ l (jO(\' flc/i^^Jn X|o- > c c P-+ \ \ X t a n 

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: 

a I Ua^( ^ S-^'^<- SorM-^ e^bj ^ OZ 4)/^ 

Item: 

S ^ J p/^f- (eU ^t/. V 

Item: 

^i U 1. f Z <^b ^ ^ por^'^L b^f ety/i^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
COASTA L 

& H O U »• . IN C 

items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

1 Item: 

> / / 

Item: 

y o 

Item: 

^h^—^^^^^--'^^^L^..^.^^i^.J^-~^ ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: ! 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
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 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

1 

Nuinber of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Anach a sketch of the 

sprinkler laNOut. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity Unit Condition/Type/Species 

Square feet 

Each 

\ 

t Each 

Each 

/ 

Each 

Square Feet 

/ 

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\' the coniraciur. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be I'eplaced \>.ith 

grass sod. 

1 .Area of City or County 

property to be landscaped 

per their requirements. 

Include a skeicli of tiic 

area (s) 

Easement .Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

X $ 

Each 

/ 

M SF 

1 

SF 

SF 

Page 5 of 
# 

COASTA L 

Additional Comments / Instructions: 

'Vla^-i (l^p-7 0-V \c»r.i^' 5 

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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. 

ia I agree EH I do not agree 

OwK&^fSigirafure^-''^ Date ..ontractor's Signature 

Page 6 of. 
X 

p V N 

/Vfi^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^^ ^ ° Coastal Environmental Group Inc. 

S^y^^ ^ www.coastalhazmat.com 

%PRoi«^ COASTA L ENVIKONMENTAL 

C H O U <• . IN C 

EXECUTIVE SUMMARY: 

01268-^302 S 12 ST 

No Issues or Concerns Q] Issues/Concerns 

Detail Explanation: 
SI As-Built Drawing 

COASTA L maha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated - 354 

Property Classification: 800 Total Drip Zone Linear Footaqe to be Excavated = 113 

0LS#: 1268 1 1 i M 

Date Excavated: 10/8/07 

1 

Date USEPA Signed Off: 11/5/C 7 i 

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Legend Nortti Arrow Omaha Lead Site 

I^J . Concrete 

Omaha. Nebraska 

l/'y l Excavated Area 

Property Number 

OLS-126 8 Existing Structure Scale 

> Fence ., 

^ 

Property Address Inch = 20 feet or 1 grid = 5x 5 ft 

IxV^ 4302 S 12 ST 

[Y< ^ , =i,i.=,i=,i. i.=,,u=.,<,f..,,a p 

^ ^ TM 

Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary 

_ F1 B2 PlavArea ,." ,7^ . ^ J ­ y T ee/S irub 

V^w* 81 G arc e n _ _ Othe r 

Description ol post excavation areas Fl, front yard left.hand quadrant F2. front yard rigtu-hand quadrant, Bl, aackyard left-rtand quadrant. B2, backyard ngtittiand quadrant. 

DZ. drip zone {1 -3 foot area of soil around the foundation of the house] 

Legend 

Area not Excavated Dripzone Excavated Quadrants Excavated 

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

EPA Property Close Out Form 

Property #: 1?^-^.. Propert rro|n:riy /%uurc33;y Address:- i ' '* ^ — '^' ' ^—1»-^ 

Date/Time: Owner's Name:. /jr^yC^.. '^Zt'^Z^ ^ 

Quads Excavated: Contractorr Grou Crouop

 ^ 

Excavation General 

Yes No 

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

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

Grading Sod and Vegetation 

Yes No 

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

from the house? y

2. Has sod been laid in al! areas that were excavated? xZ. 

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

day time period) y 

4. Are sodded areas generally firm and evenly graded? J 

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

time f)eriod) ___^ _ y 

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

y 

7. Was damage to landscaping or plant materials avoided? 

u y 

Gates, Feoces and Retaining Walls Yes No 

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

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

3. Wasdamage to gates or fences avoided? (If applicable) i / 

4. Wasdamagetoretaining walls avoided? (If applicable) 

y 

Foundation, SidioK and Gutters 

Yes 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? t / 

5. Was damage to downspouts or downspout extensions avoided? l y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? y 

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

Inspection notes: 

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

EPA Representative 9c ^ yff^ Date: //Z^Z<^^ 
(p> 

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

Property [D: /^:t>- Property Address: .,0^ ^ < ^ /V ^ Jj^y* ^ 

Owner: 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

J^ I a^icc restoration is completed, except as noted 

 I I do not agree restoration is completed 

Date Contractor's Signature Date 

I
r^^^ 

5 . ^ it .

P'oper.y Ci,^ssif:calion: 800 ^WCTUl^b'^Z p 

C . •= I Z. "

South 12 Street 

Legend North Arro w 

liiii*] Concrete 

Y/ \ Excavated Area 

\ I Existing Structure Scale 

•—•— • Fence 1 Inch = 20 feet or 1 grid = 5 x 5 ft 

yy ^ Permanent Landscaping 

— — — Quadrant Boundary 

Street Boundary F1_ 

<Q) Tree/Shrub 

F2 

Bl 

 Total QL^^ V Square Footage to be Excavated = 354 

)n[^8n6 

 Total DriiWlne Linear Footage to be Excavated =113 

I 

^ 

Omaha Lead Site 

Omaha, Nebraska 

Property Nunnber 

OLS-126 8 

Property Address 

4302 S 12 ST 

Post Excavation Concentrations (ppm) 

82 Play Area 

DZ Easement 

Garden Other 

> 

Description of post excavation areas: F1. front yard left-hand quadrant; F2, front yard right-hand quadrant; B1, backyard left-hand quadrant; B2. backyard right-hand quadrant; "i ^ 

DZ, drip zone (1-3 foot area of soi! around the foundation of the house). V I 
PROPERTY CLEARANCE WORKSHEET t

Date vMff/ Property ID /MQ Property Project Omaha Lead — Fixed Price Address ^^a^G lO:^ 

Measurement XRFID 0107-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

s ^U m z2./iz 'Zd- CfL. 25g^ 

^./ y _3S- /S?V ^ 

Sample Area PZ^ /^-/iZ" 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) ? 

2 

3 .^^I 

4 4L ^^7 XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 

S8 

Sample Area ^7^-^=- Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 7 

2 A ^ 

4 

3 ^ & XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 

T ? 

Sample Area Pass/Fai l ? Z^zz^'/.- I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 ^ ^ (Baq) Sieved) 7 

2 - 7/ /?f 3 -_/ .-^^ 3 ? 4 L3 • ^ XRF Corrected Value —> 

5 -n (use calibration chart or add 

2 0 % to value) 

4y 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 

2 

3 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value). 

U \ t ADOiriOH M SHIFI S I t 

XRF Technician's Signlture HCFIIfl )