r 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: I0IS3 Date: /JlMl^OO 7 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

i / Video of property (DVD) |)^^i, ifl> 

M Executive Summary 

Sr EPA-provided property sketch 

El Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

ST Restoration Agreement 

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

0 ^ Confirmation data 

0 Photographs SO-CMiti Dgi6<^<>^ 

Si As-built sketch 

•m Satisfactory restoration signed by Property Owne r 

H Property close-out check list signed by EPA /// 712J)0~J 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

^ Property information from Douglas County Assessor's Office 

n urtsyerjj flg^ds5 okoAdiA- ^ tQi^oJl' jirf(\ 

D 

Signature Date 

40312860 

IHiiilii 

Superfund 
''B^ 

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

Jlar d Copy Information 

l\ Property Check List 

2\^it e Working Drawing Map 

\ . EPA originals Map 

4\^ Douglas County Assessor's Map 

5x, Property Contact Sheet 

Agreement 

>vAcccss Agreement 

"2x8.estoration Agreement 

Miscellaneous Documents 

ivf inal Map from the Field 

'^Chang e Orders r^|ft 

">^R F Data 

^4^ny emails or PO correspondences v-v^ 

Property Completion 

K, Executive Summary 

^A S BUILT 

^-Property Completion Agreement 

X Any buyout info or reimbursement info ^/ ^ 

^ Check or money order copies f^ ('^ 

• ^ EPA Property Close Out Fonn 

TxAttached Begin Video 

Electronic Documentation 

xDrawings 

r \ EPA original 

"^. Working Drawing 

N^ AS Built.vso 

X AS Built.jpg 

Photos 

Begin Photos 

\2 ' During/Excavation Photos 

^ Sod Photos 

X ; 30-Day Sod Photos 

Scanned Documents 

Final Documents 

^ Executive Summary 

Videos 

X^ Begin Video 

'2^; My Movie 
9 

Property Access Checklist 

Property ID: j Q ) ^ ? ) n WORK STARTED ON: / / 

Property Address: n WORK COMPELTED ON: / / i^ ?> 2 p Ssd 

Owner: / /^J ^ ^ ^ j-± ] ^ f,^. Renter: 1 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

Fax: 

Cell/Pager: ^ ? \ Q ' 7 4 2 8 

1 1 Notification Letter Sent: / / By: 

1^ Access Agreement Signed: 9 / // / O J By: 

M Restoration Agreement Signed: ' ^ /JA/O J By: 

O Topsoil Sampling (if applicable) 1 1 By: 

1 1 Disposal Sampling (if applicable) 1 1 By: 

1 1 Garden Sampling (if applicable) 1 1 , By: 

J ^ Utility Clearance Called: ''1 //"^ /d:^ ^y-?iU^PiL^^% \WlM 

1 ^ Video/Photos (Before) On:£\_l_U_I C'V By: 

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

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

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

• Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable 

1 1 Community \Z\ Crew On: / / By: 1 

Results: 

1 1 Community CH Crew On: / / By: 

Results: J 

O Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 
10153 

Omah j Exterior Paint North Arrow Owne a Lead Site r Name: VINCENT MUNIZ SR * • Good Site Sketch Address: 4615 S 22 ST • Poor 

^11 Phone: H W. g^o t paint 

Sample Number Lead 

Concentration 

Sam.ple 

Collected LAB 

Firm;

Samples Collected 

Ti^ ^ AV^fM-Q 

RYASCPXA-10153 F1 L22­ ppm D Date: O ^ [ nfO^ . 

RYBSCPXA-10153

RYCSCPXA-10153

RYDSCPXA-10153

 F2 

B1 

B2 

\X?^ 

m± 

f^Ote 

ppm 

ppm 

ppm cr 

D 

D 

D 

Time; < ; 2-1 . 

Samples Analyzed 

•ROZSGPXA 10163 92 - ppm D D XRF Unit; (o'^H Book; I5D 

•RGZSCPXA-10t53

RPZ3CPXA-10153

 62 -

P2­

ppm 

ppm 

n 

n 

D 

D 

Date 

Time 

H- ift-Q^ 

.£M. 

Number of Samples = ; ^ Staff M^ W 

Legend; F1 = Front Left, F2 Front Right. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ • Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

Rev 046141.0123 
^ 
10153 

- r Omaha [ Exterior Paint North Arrow Owner Name:yiNCENT MUNIZ SR Lead Site • Good Site Sketch Address: 4615 S 22 ST 

Phone: H: W: 

Q^o t paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-10153 F1 122. ppm D Date O' ^ I it(oG . 

RYBSCPXA-10153 F2 12.?> ppm D Time 

RYCSCPXA-10153

RYDSCPXA-10153

 81 

B2 

J.&5_ 

-fiCLk. 

ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA 10163 BZ­ ppm D D XRF Unit; (o^'i Book; i50 

•RSZSCPXA-10103 -G ^ ppm D D Date; H • IP, • O U 

f^PZ3CPXA-1G153 -P2­ ppm D D Time; P M 

Number of Samples • Staff; MS W

Legend; F1 = Front Left, F2 Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTEEEB 

APR I 201)6 

fez 

80 (^ 

:^(o{5 <z> ^z^•fc • 

- ^ ' 

^ ^ 

^^ < 2 ­

ai. Q8 

AoaV(A. 

I Rev-4 S.. 2-^515 046141.0123 
Douglas County Page 1 of 1 

Douglas County, Nebraska Property Record - R0416080000 

Information is valid as of 2007-7-19 Print Report 

Values not finalized until after Board of Equalization View on IVIap 

Owner 

MARTINEZ ALDO 

2922 S 26 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1608 0000 04 

Account Type: Residential 

Parcel Number: 0416080000 

Parcel Address: 4615 S 22 ST 

OMAHA NE 68107-0000 

Legal Description: SOUTH OMAHA CITY LOTS LOT 12 BLOCK 122 N 1/2 25 X 130 

Value Informatio n 

j Land Improvement Total 

1­

2007 $2,500.00 $0.00 $2,500.00 

2006 $2,500.00 $0.00 $2,500.00 

2005 $2,500.00 $0.00 $2,500.00 

2004 $2,500.00 $0.00 $2,500.00 

2003 $2,500.00 $0.00 $2,500.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Date 

2007-01-23 

2006-11-29 

2000-09-08 

Type 

WDM 

WD 

Book 

2007 

2006 

2167 

Page 

011619 

135997 

445 

Price 

$10,000.00 

$1.00 

$800.00 

Land Informatio n 

Acres

0.07 

 i SF FF 

3250.0 25.0 

Units 

0.0 

Depth 

130.0 

Width 

25.0 

Vacant 

Yes 

Land Attributes 

Atbibute Attribute Description 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R041... 8/2/2007 
CONTACT FORM 

Property ID # 10 15 ^ 

Property 

Address: 4G/5 ^ -ZZ 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA • Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
Pi ^ i 

-1 

QV»^ ^ 
• t 

COASTAL f NVmOhH f NTAL 

C H C U f IN C 

Consent For Acces s To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following deschbed premises: 

Owner's Name: Daytime Phone: <^e M g"8" 0 - 7*V;^ ^ 

Address of Property 

covered by this %I5 S. z z

^ ^^ 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA. will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work before 

it begins. Once the work is finished, the Grantor will be asked to review the work and 

confirm that it is complete and meets with the Grantors 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 
/ 

iu't ^ m 

''-r^^ / COASTAL •" I PBOl* -

C « C L f IN 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 :o allow others to use the oroperty in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (877) 234-6270. 

iZf\I gran i t access to my properties L j I do not grant access to my properties 

Signatur gnaturee ^^ ^ Dat Datee Signature

 Date

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

Paae2 of 2 

I
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 'D: Idl55 1

Property Address: f\Uo Vi\(K(L\Y\LJ \ 

Owner: f6/5- J- ;2.2 ^-^ 

Phone: yd2- Uo-•lUt u

On the attached diagram(s) indicate area(s) to e.\cavated 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. hidicate digital photos 

by referencing the photo-log number w ith 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: 

Yymh 

Item: 

Item: 

Item: 

Item: 

/ 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

nm 

Item: 

^ \ 

Item: 

\ 

Item: 

Item: i 

1 

Item: 

/ 

Item: 

/ 

Item: / 

/ 

Item: 

/ 

Item: / 

Item: 

Item: 1 

Item: 

1 

Item: 

Item: 

Page 2 of. 
COASTA L ENVIKOrMMt N TA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
COASTA L 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with orass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves. 

Timers, Heads, etc. 

Anach a sketch of the 

sprinkler la\ out. 

Number of and size of 

each garden/ tlower bed 

area. 

.Atiacli a skeich of relaii\e 

^izes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of 
C O A S T A 

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 contractor. 

Agreed upon area of 

property' to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to he replitced with 

grass sod. 

.Area ofCit>' or County 

property to be landscaped 

per their requireinents. 

Include ci -kei.'li ol' iht 

area (s) 

Easement .Area, to be 

excavated 

Quantity 

/ 

/ 

Unit 

$ 

Each 

SF 

SF 

SF 

Condition/Type/Species 

Page 5 of 
COASTA L 

Additional Comments / Instructions: 

n 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^a agree HH I do not agree 

^J/j 9 ^^^.^^vL ^ ^/ / /O 7 ^//^ 7 

Owner's Signature Date ,/Contf^ctor's Sigq^rfre Date ^ 

Page 6 of. 
— * Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

vwvw.coastalhazmat.com 

COASTA L ENVIRONMENTA L 

G H O U r . INC . 

EXECUTIVE SUMMARY: 

10153—4615 S 22 ST 

No Issues or Concerns Issues/Concerns 

Detail Explanation 
As-Built Drawing 

COASTA L ^ maha Lead Superfund Site 

10153 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: VINCENT MUNIZ SR • Good Site Sketch Address: 4515 S 22 ST 4 l « • Poor Phone: H: W: Q^o t paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: fje ^ A^fn- O 

RYASCPXA-10153 F1 o , ppm D Date; 0<4 i lUCQ,. x RYBSCPXA-10153 F2 Llfu .ppm D Time; < : 2-1 • 

RYCSCPXA-10153 B1 1£L ^ ppm D Samples Analyzed RYDSCPXA-10153 B2 fio^ ppm D 

RD2SGPXA 10163 . ppm D D XRF Unit; {o1'^ Book; f5 0 

RG15CPXA-I0I53 S^ - . ppm D n Date H • /ft•OU 

ffP2SCPXA^1015a- . ppm D Time _£M. D Staff; Number of Samples = MSW 

Legend- F1 = Front Left, F2 = Front Right, B1 - Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, P2 = Play 

All quadrants are as viewedfrom the street, facing property 

OLS#: 10153 

Date Excavated: 10/1/07 

Date USEPA Signed Off: 11/6/07 

Legend 

Are Dripzone Excavated Quadrants Excavated 
 a no t Excavate d 

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

Sif>L EPA 

EPA Property Close Out Form 

Property ft: j D j . ^ ^ 

Property Addre«3:yP'<^> ' . , ^ " ^ 

Date/Time Owner's Name: Jth [ UQ . J ^ O^Iutify^j... ^ ^ (^) : 

Quads Excavated: " BJ^ 

Contractor Group ^,-, n s^ ^ /!> <^tA^Ujy.-rnS^ /^ ^ 

Excavation General Yes No 

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

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

y 

GradinK Sod and Vegetation 

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

from the house? 

Yes 

y 

No 

2. 

3. 

Has sod been laid in all areas that were excavated? 

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

day time period) 

t / 

t / 

4. 

5. 

Are sodded areas generally firm and evenly graded? 

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

time period) 

y 

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? y 

Gates, Fences 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? (If applicable) y 

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

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

Foundation, Sidiogand Gutters Yes No 

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspout extensions avoided? i / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? y 

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

Inspection notes: 

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

EPA Representative Po.^ A^ Date: ,,jclc7 
Property Completion Agreement 

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

signature will designate that I 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 ID: /O /S'3 

Propert, Aadres.s: ^ / ^ ^ ^ ^^S/ ^ 

Q""*^" Al/i ^ ilj/^LW/V. - ^ 

Phon 

- r4Dr^) ^^ o - ^ . 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I I I iiRrei' iTstoration is (-omplctcd, except iis noted 

I I I do not afjree lestoriition is completed 

7^-7-7 Z?/;^ ^ -• r ^^-^ ^ / / ' C -^"'7 

Owner's Signature "ST" Date Contractor's Signature Date 
PROPERTY CLEARANCE WORKSHEET 

Date »)//)/// Property ID ; 1 intbs 

Property Project Omaha Lead -- Fixed Price Address 4/^/S^cpp^^ 

Measurement XRF I D 0107-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot * Reading Sample Area 

sn: ^ 4 - V d~(a 

Sample Area ^A' U J 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

hi in A ( XRF Corrected Value ­ > 

?0 i 

5 (use calibration chart or add 

20% to value) Q(^ 

Sample Area 

Aliquot 

1 

2 

3 

4 

5 

I n Situ 

Reading 

- 5 * • 

^ y . Cor My ^Ci 

R'l q-U 

Composite Readings 

(Bag) 

Li V 

XRF Corrected Value —> 

(use calibration chart or add 

20% to value) 

Composite 

Average 

(Bag) 

^A 

S3 

Composite 

(Dried & 

Sieved) 

Pass/Fai l ? 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

Sample Area Pass/Fai l ? 

Aliquot 

1 

I n Situ 

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) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7 

2 

3 1 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

20% to value) 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) u. 

list ADOinoNAi sum s 11 

XRF NfFDfl ) Technician's SIgnituri Xzf^^t^ 
~f/id /ry/yy T 

^^>^i^h^(J A^> A2 = 

Owner Name: VINCENT MUNIZ SR 

Address:4615S22ST 

Phone: H:

Sample Number 

RYASCPXA-10153

RYBSCPXA-10153

RYCSCPXA-10153

RYDSCPXA-10153

•f)OZSGPXA-4Q16a

•RGZSCPXA-IQIG3

f^PZ3CPXA-10153

 W: 

Leaci 

Concentration 

 F1 L22­ F2 

 B1 

Aa_ 

 B2 fiOO' 

9ZS* -

P2-

Omaha Lead Site 

Site Sketch 

Sample 

Collected LAB 

ppm D 

ppm D 

ppm n 

ppm n 

ppm D n 

ppm D D 

ppm D D 

Number of Samples = ; i ^ 

Exterior Paint 

• Good " 

• Poor 

g^o l paint 

10153 

1 

North Arrow 

1 

Samples Collected 

Firm: 

Date: 

Time: 

Samples Analyzed 

XRF Unit: iol' ] Book: fSO 

Date: H- /ft-Q^ 

Time: _£M. Staff: NSW 

Legend: F1 = Front Left, F2 = Front Right B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ ^ Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

f^^TTti-/ 

04614 1.0123