TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID »-.3m Date W \o ^ 1^^ : 

Address: Hl^c? 4 1> ^ ^ f 

Remediation Contractor: _Coastai Environmental Group_ Year: 2001 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

Executive Summary 

EPA-provided property slcetch 

i3 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.) Wftl]^ t^H' 

Confirmation data 

Photographs ^ bfCMik^f^ . '^CA/i^fU^ ^ ^'^ ^^ ^ 

D As-built sketch 

Satisfactory restoration signed by Property Owner 

/ Property close-out check list signed by EPA 

—B- Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

ll m. y ^ Signature 5at ")nfe p I 

30054511 

Superfund 
1^ 

Property Access Checklist 

Propert)' LD: ^3>L4" ^ 

D WORK STARTED ON: / / 

D WORK COMPELTED ON: / /

Propert, Addre«: Uf l H Q f ^ 1 r b S T 

Renter 

Addres Arl.lr..<c.

 C7 s 

Phone: 

P*.\: 

Cell/Pager: 

P>e)\^\in('. U9)ix3 

Phone: 2^ 1 -\^[^ ^ f Additionul tnlnrniHtion: 

Fa\: 

cci^»gtr.4^^Pf]Q, oe)HV 

D Nortfication L«ltcr Sent: / / By: 

• 0 " Access Agreement 

Signed:\Q_/jS/C::0 Bj=Mir.K^/^' l \i>lilW^.r 

B Restonition Agreement Signed: iiL/iB'<2 ^ ^y-iAirlAnp] \/] l\\fl^^fipli<-

O Topsoil Sampling (if applicuble) / / By:

 <^ 

O Disposal Sampling (rf applicable) / / By: 

O Gnrdcn Sampling (if applicable) /

 / By: 

D Uiilitv Clearance Called: / / By: 

[ ^ Video/Photos (Before) On:^/2i/^9 ' By- 0 c-f-o^vfO 

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

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

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

D Property Complelion Agreement Signed: / / By: 

D Pin"! Report Issued:

 / / By: 

Air MonitorinK (lU applicable) 

D Community CD Crew | On: / / By: 

Results: 

• ComraunitA' D Crew On: ' / By: 

Rcmlis: 

O Community D Crvw On: / / Bv: 1 

Result): 

Omaha Lead Site 
Douglas Coimty Account Intenatio mmaz n Page 1 of3 

Douglas County, Nebraska Property Record - R1719200000 

Print Report 

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

Now Feature -> -> ^ Auto Sales Search 

Owner 

WILBERGER MICHAEL D 

ETAL 

3362 TAMMY ST 

BELLEVUE NE 68123-0000 

Property Informatio n 

Key Numlter: 1920 0000 17 

Account Type: Residential 

Parcel Numtter: 1719200000 

Parcel Address: 4740 S 13 ST 

OMAHA NE 68107-0000 

Legal Description: MAXWELL & FREEMANS ADD LOT 8 BLOCK 3 40 X 120 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

Improvement 

$62,200.00 

$62,200.00 

$62,200.00 

$50,400.00 

$50,400.00 

$50,400.00 

Total 

$67,800.00 

$67,800.00 

$67,800.00 

$56,000.00 

$56,000.00 

$56,000.00 

Sales Informatio n 

Sales Date: 2004-03-15 

Deecf Type: 

Price: 

WD 

$38,000.00 

Book: 2004 Page: 033986 

Grantor: Monument Street Funding II LLC 

Grantee: Michael D Wilberger 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2004-01-29 

Deed Type: TRD Book: 2004 Page: 015083 

Price: $57,864.00 

Grantor: STEFFI SWANSON TR 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R171... 6/6/2009 
Douglas County Accovint In|»matio |M|1 £ n Page 2 of3 

Grantee: MONUMENT STREET FUNDING II LLC 

Valid/Invalid: Invalid 

Exclusion Reason: 

Foreclosure 

Sales Date: 1997-10-09 

Deed Type: Book: 2077 Page: 669 

Price: $45,000.00 

Grantor-

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 4800.0 1.0 120.0 40.0 No 

Improvemen t Informatio n 

Building 1 

4740S13ST 

SfconttRoor 

2720 So^ Ft 

rta • s 

U K DMKtIM F m Floor MpOSo n 

nr Tseosq R 

sur f V Mir 

Ha 

7iy 

u • n 0 1 1 1/2 Story i smTmacmr Bnnt Block SII 

TSeoSi) Fl 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1028.0 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: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: i Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl 71... 6/6/2009 
Dguglas County Accoimt In&gnatio fiMms n Page 3 of3 

Sprinkler Square Footage: | 0.0 

rearSufft Year 

Remodeled 

1912 1997 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

User 

Percent 

Remodeled 

0% 

Detail Description 

Fence Chain Link 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Slab Roof Ceil 

ASBESTOS 

Adjusted Year 

Built 

1912 

Physical Age 

95 

Units 

1.0 

1.0 

350.0 

1.0 

1.0 

188.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo,jsp?accountno=Rl 71... 6/6/2009 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact: 

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

l?>41 

MIMD s l-^ s4 

Date:Time: Action: 

Date:Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2311554. 

Original Call Date: 7/07/09 Time: 12:35 pm Op: ELIZABETH18790 


Worlc to Begin Date: 7/09/09 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4740 Street: S 13TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 03-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: 4ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


ATTNEBRl CXCATV DIGITEL LEVEL3 MCINEB MUD02 OMAHACOF 


0PPDGPR6 PAETEC QLNNEIF QWESTNE 


UtiUty Service Area Contact Phone Number Type 

Day: 80024136249 


ATTNEBRl ATT/T Alt: 


Emerg: 80024136249 


Day: 4029340469 


r-vf-ATM COX COMMUNICATIONS, TTCTT^T Alt: 4029340469 
 CXCATV _j_ , HEIDI 

Emerg: 4029329757 


Day: 8665624349 


DIGITEL LIGHTCORE NA Alt: 8008509048 

Emerg: 8665624349 


Day: 8773668344 


LEVEL3 COMMUNICATIONS, LEVELS NA Alt: LLC 

Emerg: 8773668344 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
Page 2 of2 

MCINEB MCI NO CALL PER MEMO 

MUD02 METROPOLITAN UTILITIES 

DISTRICT SANDY 

OMAHACOF CITY OF OMAHATRAFFICSEWER RON 

0PPDGPR6 OMAHA PUBLIC POWER 

DISTRICT NA 

PAETEC PAETEC COMMUNICATIONS NO NEED TO CALL OUT 

EMERGENCY 

QLNNEIF QWEST LOCAL NETWORK NA 

QWESTNE QWEST LONG DISTANCE 

Day: 8002893427 


Alt: 


Emerg: 8002893427 


Day: 4025047823 


Alt: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002834237 


Alt: 


Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
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•Built Drawing 

COASTA L Omaha Lead Superfund Site 

1347 

Exterior Paint North Arrow Owne Omah a Lea d S t e r Name: 

Sit • Good e Sketc h Address:4740S1 3 ST • Poor Phone: H W: ( D • n Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: Sverdrup 

RYASCPXA-1347 YA 329.6 ppm [ 3 Date: 

RYBSCPXA-1347 YB ppm • • Time: 

RYCSCPXA-1347 YC 272 ppm g na Samples Analyzed RYDSCPXA-1347 YD 522 ppm 0 0 

RDZSCPXA-1347 DZ 2369.6 ppm g 

0 XRF Unit: Book: 

RGZSCPXA-1347 GZ ppm • Date: 11/7/1999 

RPZSCPXA-1347 PZ 402.8 ppm 13 a0 Time: 04:03 

Staff: Number of Samples = 5 3 

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

OLS#: 1347 

Date Excavated: 7/15/OS 

Date USEPA Signed Off:7/2 r/09 

Area Sodden: 1530 sq fl 

YB= 154 PPM @ 1" YD = 29 PPM @ 10" 

n46Ml 0123 

Legend 

m Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare 
 Sod Rock/Mulch 

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

o 

1347 

Omaha Exterior Paint North Arrow Lead Site Owner Name: Site Sketch • Good Address: 4740 S 13 ST • Poor Phone: H: W: (S) • Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm:_ Sverdrup 

RYASCPXA-1347 YA 329.6 ppm 

a Date: . 

RYBSCPXA-1347 YB ppm a • Time: _ 

RYCSCPXA-1347 YC 272 ppm 

D Samples Analyzed RYDSCPXA-1347 YD 522 ppm 

RDZSCPXA-1347 DZ 2369.6 ppm XRF Uni I: Book: 

RGZSCPXA-1347 GZ ppm • a Date: _ 11/7/1999 

RPZSCPXA-1347 PZ 402.8 ppm 

Time: _ 04:03 

staff; Number ot Samples = 5 

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

nj<il41.0123| 
ll-< ^ 

1347 

Exterior Paint North An-ow vPiL&a'iijQePmaha Lead Site Owner Name: 

Sit • Good e Sketch Address: 4740 S 13 ST • Poor 

Phone: H: W: (D Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: _ 

Samples Collected 

SverdruD 

RYASCPXA-1347

RYBSCPXA-1347

 YA 

 YB 

329.6 ppm 

ppm • 

D 

D 

Date: _ 

Time: _ 

RYCSCPXA-1347

RYDSCPXA-1347

 YC 

 YD 

272

522

 ppm 

 ppm 

D Samples Analyzed 

RDZSCPXA-1347

RGZSCPXA-1347

 DZ 

 GZ 

2369.6 _ppm 

ppm 

121 

• 

0 

D 

XRF Uni 

Date:. 

t: Book: 

11/7/1999 

RPZSCPXA-1347 PZ 402.8 ppm 1^ 0 Time:. 04:03 

Staff: Number of Samples • 

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

^ 

Y/;»y:*^/."-—-^ 

Rev 4 046141 0123 
p 1347 

Exterior Paint North Anrow OwnerName: tl ^ .Mi^Ugl - VP^Lgg^t^QgPmaha Lead Site • Good Address: 4740 S 13 ST S'*® Sketch • Poor Phone: H: W: ® Q Not paint 

Sample Number 

RYASCPXA-1347 YA 

Lead 

Concentration 

329.6 ppm 

Sample 

Collected 

0 

LAB 

D 

Firm: _ 

Date: _ 

Samples Collected 

Sverdrup 

RYBSCPXA-1347 YB ppm a D Time: _ 

RYCSCPXA-1347

RYDSCPXA-1347

 YC 

 YD 

272

522

 ppm 

 ppm 

0 

0 

D 

0 Samples Analyzed 

RDZSCPXA-1347 DZ 2369.6 ppm 0 0 XRF Uni1 t: Book: 

RGZSCPXA-1347

RPZSCPXA-1347

 GZ 

 PZ 402.8

ppm 

 ppm 

a 

0 

D 

0 

Date: _ 

Time: _ 

11/7/1999 

04:03 

Staff: Number of Samples = : 5 

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

Rev 4 0461410123 
1347 

Omah Exterior Paint North Arrow a Lead Site Owner Name: 

Site • Good Sketch Address: 4740 S13 ST • Poor 

Phone W: : H: (S) • Notpaint 

Sample Numtier 

RYASCPXA-1347 YA 

RYBSCPXA-1347 YB 

RYCSCPXA-1347 YC 

RYDSCPXA-1347 YD 

RDZSCPXA-1347 DZ 

RGZSCPXA-1347 GZ 

RPZSCPXA-1347 PZ 

Legend: YA = Yard (NE). YB =

LKKI 

Concentration 

329.6 PPri 

ppm 

Sampte 

CoilectBd 

0 

a 

LAB 

a

• 

Firm: 

Date: 

Tirr»e: 

Sampte Coitected 

Sverdrup 

272 

2369.6

522 

ppm 

ppm 

 ppm 

0 

0 

0 

n 

0 

0 

Sampte ArBlyzed 

XRF Unit Book: 

402.8

ppm 

 ppm 

n 

0 

a 

0 

Date: __ 

Time: 

11/7/1999 

04:03 

Staff: Number of Sampte •=• 

 Yanj (SE), YC = Yard (SW). YD = Yard (NW), DZ = Drip Zone, GZ = GanJen. PZ = Play 

Brv4 046]41i)]Z3 
COASTA l 

(•l>i|OII«INT> l 

• I O U P . 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: 

Owner's Name: = flj^HA^ L / L t. r5Sff&i ^ay^me Phone: 

Address of Property //7^ ^ i-^ ^r. 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 renfx>ve 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 confimn 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 performirig the work. This access shall 

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

agrees to: 

Pa0e1of2 
m 

COASTAt 

C I « tl 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 pnaperty 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 properly in 

such a manner. 

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

Environmental Group, at (712) 352-0188 

^ 1 grant access to my properties Q I do not grant access to my properties 

Signature / Oate Signature 

Date 

O I would like to be present during any sampling that is required. 
c^'-y% S T ^ L iraVIMONIiMrAl , 

C K O bl r I N C 

The purpose of this agreement 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 lO'-^=^ i > W 7 

Property Address: ^ ^i/ 0 ^ J 3 S4' 

|<Hi«Hif: 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, matenal 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 removal, storaqe. disposal, and/or return of these items is the Owner s responsibility. 

item: 

/lA^^^A^ll PlJl- Kem: 

Item: 

Item: 

Page 1 of. 
C J M S T M L 

•**•"= ^^($i i - ^^^^ , 0^ ' 

Item: 4^. . ^'>/^2 / ^ ^ 

Kem: 

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. 

Atiach r. sketcli ot the 

.vrrviklci kvu-ui 

Number of and size of 

each garden/ flovrer bed 

area. 

Aiiacli -d sketch of relative 

sizes and location^. 

Agreed upon value of plant 

matenals not to be 

replaced bv contractor. 

Note llii'i w.liK' niii hi' 

•jsfc' ;c issue a j)!«n' 

\OiKi:ei 1(1 (lie prnpcr:\ 

o^^ ner. 

Easranent Area, to be 

excavated 

Landscape Inventory 

Quantity 

^K ^^,0 2 

^^\jt3f^\ 

^evtr ^ 

/

Tn r 

/ 

/ 

Ch 

HJ 1 

/ 

&i r 

u 

Unit 

Quadrants 

Each 

Each 

Rarh 

Each 

SquareFeet 

$ 

Each 

Condition/Type/Species 

feJl%w^ i(Z7e,o['t<, 

Page 2 of. 
C <- A i 1 /• L 

O h O U " . I M c 

IKional Comments / instructions: ^ ^ 1 

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

pre-existing damage. By checking this isox CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

I agree O I do not agree 

fl/ll/cA^ P ' W/^ ^ f^^Cnoo.ii!^ to\i^\no^ 

ner's Signature /Dat< / f Contractor's Signature ' llate 
BVID # iSH I 

XRF PROPERTY SAMPLE SHEET 


Date 1H5-O S Address H-Ne.S.I?.M 

Project Omaha lead FP 2ncl year option Sample time m m @>/pm . 1 XRF ID# ?i^0<^ ^ sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

no?. 25TMni:7n.- ^ iiliihL ^TQ2ill.7^ 

HS>3. IHHfS ^is.nfai^ ^\.7(^tl-Ll ^ £2. H ^ Depth f^.Z8^iO«DT IMMl ^ 1H.72f^l\.lo<^ Depth 

1HP5 ]l0\.7.nt\in.')% _LL lHH- 1 (^3.l<^tl0.;tq •i3~ 

Average n«X.- | t I U tp Average Ho . 1 ^ t M <S:n 

Shot# Reading Sample area Shot# Reading Sample area 

JHM. 2«a.7f.±

1 ?f.<=iM i5u>q Hib.^lit lUMT YD IHMP ?^l.a^q±l^.bq liTn. '^l.ft^lM-^^ 

IHHl 2Xo^'Li'9i.\ Depth j2ai m.'\^2Q.ttf Depth 

IM^2 ^P|l±'8f.ti>tg 22.5.M2i: 21.H^ \^iz 

Average 29 . 2 ± ^.' S Average YSH.U ±. i^.Sf g 

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 

1 lab sample # Lab result Sample area XRF Avg. 

Signature JU^QA 

printgliM ine>ih Creech 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1406 

Mode SOIL 

Time 2009-07-15 10:14 

Duration 121.65 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

± Error 

Pb ± 16.59S 

Supervised ^r&OMmA 
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 257.468 

Supervised By: 

Certificate of Verification 

1402 

SOIL 

2009-07-15 10:12 

30.60 

Final 

1347 

4740 s 13 st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 20.296 
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 245.167 

Supervised By: 

Certificate of Verification 

1403 

SOIL 

2009-07-15 10:13 

30.48 

Finai 

1347 

4740 s 13 st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 19.752 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1404 

Mode SOIL 

Time 2009-07-15 10:14 

Duration 30.01 

Sequence Final 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.881 ± 10.068 

Supervised By: 
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 161.266 

Supervised By: 

Certificate of Verification 

1405 

SOIL 

2009-07-15 10:14 

30.56 

Finai 

1347 

4740 s 13 st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 16.279 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1448 

Mode SOIL 

Time 2009-07-15 14:50 

Duration 121.36 

Sequence Finai 

Flags 

AVERAGE r3»K?^U,4^*«l;**4J 

ADDRESS ^r740nrr3rsl 

QUAD/ZONE PZ 

INSPECTOR Nicolas 

DEPTH 8 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb ± 

Supervised By : ^^fr& A 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1444 

Mode SOIL 

Time 2009-07-15 14:48 

Duration 30.29 

Sequence Final 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE PZ 

INSPECTOR Nicolas 

DEPTH 8 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb 87.018 ± 12.706 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1445 

Mode SOIL 

Time 2009-07-15 14:48 

Duration 30.50 

Sequence Finai 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE PZ 

INSPECTOR Nicolas 

DEPTH 8 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb 81.262 ± 12.181 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1446 

Mode SOIL 

Time 2009-07-15 14:49 

Duration 30.14 

Sequence Finai 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE PZ 

INSPECTOR Nicolas 

DEPTH 8 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb 74.278 ± 11.691 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1447 

Mode SOIL 

Time 2009-07-15 14:50 

Duration 30.43 

Sequence Final 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE PZ 

INSPECTOR Nicolas 

DEPTH 8 

SAMPLE TYPE RETEST 

NOTE 

ppm ± Error 

Pb 62.187 ± 10.892 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Pb 

Supervised By 

Certificate of Verification 

1443 

SOIL 

2009-07-15 14:45 

121.88 

Final 

^vq'oM439-1442 J 

s 13 st 

YD 

Nicolas 

10 

CLEARANCE 
P 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1439 

Mode SOIL 

Time 2009-07-15 14:43 

Duration 30.40 

Sequence Finai 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE YD 

INSPECTOR Nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 28.757 ± 8.541 

Supervised By: 
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 31.392 

Supervised By: 

Certificate of Verification 

1440 

SOIL 

2009-07-15 14:44 

30.45 

Final 

1347 

4740 s 13 st 

YD 

Nicolas 

10 

CLEARANCE 

± Error 

± 8.690 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1441 

Mode SOIL 

Time 2009-07-15 14:45 

Duration 30.66 

Sequence Finai 

Flags 

BVID # 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE YD 

INSPECTOR Nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 26.521 ± 8.097 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1442 

Mode SOIL 

Time 2009-07-15 14:45 

Duration 30.37 

Sequence Final 

Flags 

BVID# 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE YD 

INSPECTOR Nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 30.110 ± 8.658 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1373 

Mode SOIL 

Time 2009-07-14 14:38 

Duration 121.75 

Sequence Final 

Flags 

AVERAGE 

ADDRESS /^vg~of 1369312; 

r740 s 13 st 

QUAD/ZONE YB 

INSPECTOR Nicolas 

DEPTH SURFACE 

SAMPLE TYPE Insitus 

NOTE 

ppm Error 

Pb ^§±^ 3 ± /8.363 "7 

Supervised By: (^C^yUljB^ S 
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 106.964 

Supervised By: 

Certificate of Verification 

1369 

SOIL 

2009-07-14 14:33 

30.01 

Final 

1347 

4740 s 13 st 

YB 

Nicolas 

SURFACE 

Insitus 

± Error 

± 16.417 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1370 

Mode SOIL 

Time 2009-07-14 14:37 

Duration 30.70 

Sequence Final 

Flags 

BVID# 1347 

ADDRESS 4740 s 13 st 

QUAD/ZONE YB 

INSPECTOR Nicolas 

DEPTH SURFACE 

SAMPLE TYPE Insitus 

NOTE 

ppm ± Error 

Pb 91.152 ± 14.391 

Supervised By: 
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 192.902 

Supervised By: 

Certificate of Verification 

1371 

SOIL 

2009-07-14 14:38 

30.59 

Final 

1347 

4740 s 13 st 

YB 

Nicolas 

SURFACE 

Insitus 

± Error 

± 20.162 
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 225.415 

Supervised By: 

Certificate of Verification 

1372 

SOIL 

2009-07-14 14:38 

30.45 

Final 

1347 

4740 s 13 st 

YB 

Nicolas 

SURFACE 

Insitus 

± Error 

± 22.484 
Omaha Lead Site—Fixed Price EP-R7-07-05 - ^^_^ _ , Coastal Environmental Group Inc, 

\^^^^ ^ www.coastalhazmatcom 

'"tPRott^ COASTA L iNVIIONNIIITA l 

E HO U P, IH C 

EXECUTIVE SUMMARY: 

BVID # 1347 - (4740 S 13 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
• » • • 

Water Bill Settlement 

Property ID 1347 

Property Address 4740 S 13 ST 

Tenant Jeremy Evans 

I have received from the contractor, Coastal Enviroimiental Group Inc. (Coastal), the sum of $ 68.02for 

water usage required to maintain the sod. 

Check Number 1809 

Value of Check $68.02 

Made Out To Jeremy Evans 

Description of Settlement 

To reimburse tenant for estimated water charges on their MUD monthly invoices. 

My signature below is acknowledgement of the receipt of the sum listed above, which i further 

acknowledge to be fair compensation and fuii payment for the above, and release, Coastal 

Environmental Group inc. from further obligations or liability. 

/37L/jy^yiyH^[7/7^AAyin //P-^S-^9 ^ jm^l ^ lobhlo^ 

Owner's ligfiatun Sieiiature Contractor's Signature Date 

Page 1 of 1 
Account : 102902-1214473 

Page 2 of 3 

JEREMY D. EVANS 

Gennee addrew: 4740 8 1 STH 8T 

Call 811 before you dig in your yard, build a 

fenoe, etc. Call at least two working days in 

advance. Utilities will mark gas, water, electric, 

cable and phone lines. No charge for this 

service. 

200" IIJ 

100­

lll l 

0 . S ^ M < ^ 0 « JW F ^ MW Apr May Jun JOI Ai « 

YourOMUM 

• ra«1tMDatlM • MattMNMooM 

This Month Lut Year 

BillinQ unte: 18 14 

U M per day 0.6 0.4 

Average ooet per day: $0.77 $1.06 

Number of days in billing cycle: 33 33 

40 ~ 

20 ­ 1 

0 . 

S*pOo(NevOKJ«iF*UarAp(MayJun Jul Aug 

Your Water Use 

• MMItMMMka • M«1S««llaMd» 

This Month Last Year 

Billing units: 32 6 

Use per day: 1.0 0.2 

Average oeet per day: $153 $0.39 

Numbar ot days in bllng eyele. 33 33 

1723 Harney Si • Omaha NE 68102 • 402 554.6666 e-nnat' f jstomei setvw e-amudomdha ccir • WMI sue ^r.:-* ••i.icli mind ..MHI METROPOLITAN 

UIIL'TIE S DTSTRICT 

Billing date Aug 5.2009 Live Green. Think Bw-r 

Previoua balanoe $175.53 

Payment received -Thank you 50.00 OR 

Current oharge* 92.67 

New balanoe 218.20 

• Total due Aug 20,2009 $218.20 « paymant it ne«M*d alter du» date, • l*lB t M iwili ba aMMM d on gaa and <Ml>r ehauBM 

Datala tH ounent ohaigas: 

QAS RESIDENTIAL RATE A: Jun 26 to Jul 29 

Meter Numbar 429782 

Current reed (aotuai): 893 > Previou* read (aotuai): 875 - 18 CCF 

Gas Use: 18 CCF x 1.024 (heat value)» 18.432 therms 

6 daya 2.793 therma at 0.4966 - $1.39 

28 days 15.639 tfwrms at 0.5286 - 8.26 

Servioe Charge 12.00 

Gas Coat • $21.65 

Gas Infraatnicture Replaoament 3.00 

WATER RESIDENTIAL RATE W-1: Jun 26 to Jul 29 

Mater Numbar 2831849 Size: 5/8 -btoh 

Current read (aoiuao: 388 • Previoua read (aotuao: 356 •• 32 CCF 

Water Use: 3200 0 CCF or 23,936 gallons 

9.000 CCF at 0.9614 - $8.65 

21.000 CCF at 1.3451 ' 28.25 

2.000 CCF at 1.7298' 3.46 

Servioe Charge 486 

Water Cost > $45.22 

Water Infrastructure Replacement 

2.00 

Late Payment Charge 

1.48 ^'t City of dmaha Sewer 13 35 

Sales Tax 5.97 

P Current Charges $9267 

Pleas* retum this portion of tha Mil payment • Plsasedo not staple payment to bill. A. •-mail: cuatorner_yarvJae9mudonsUui oom 

iwabaKa www mudomaha«om 

METROPOLITAN UTiLim S OfSTRI C I 

000102902121447300000021820 2 1723Hamey8l • Omaha,N£ 68102- 402.5S4 6666 

eSSO 0020 MU RP 06 08062009 YNNNNV 01 00O«16 
aS>e. EPA 

EPA Property Close Out Form 

Property tf: {?^'^ l . . , Property Address­ M7 H O % fi ? " 

Daten-lme: -7/1^/0 ^ Owner's Name; . jTl iC H^^-* .1 Tlf^ W 

Quads Excavated: YQ^DX , P Z Contractor Group Ppifltbl fiiiulferwiAnif 

Excavation GenemI Yes >

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

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

u ^ 

Grading Sod and VegclatioB 

Yes No 

I. Does the crading around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

2. Has sod been laid in all areas that were excavated? "3^ 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 l y ^ day time period) 

4. Are sodded areas generally Hrm and evenly graded? y^ 

S: Are the joints t>etween the sod strips generally tight? (Only evaluate if inspected at a 30 day l y ^ 

time period) 

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

7. Was danuge to landscaping or plant materials avoided? 

Gates, Fences and Retatolng Walli 

Yes No 

1. Do gates open and close freely? (Ifapplicable) 

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

^ 

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

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

Foupdation, Sidinn and Gntters 

Yes No 

I. Was damage to the siding or trim avoided? u - ^ 

2. Was damage to the Foundation avoided? L / ' 

3. Was damage to windows avoided? 

4. Was damage 10 windows or door screens avoided? ly- ^ 

5. Was damage to downspouts or downspoul extensions avoided? z:^ 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage 10 driveway surfaces avoided? 3 

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

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: m activates complete inciuaing tne ju-aay soa warraniy 

EPA Represenlalive L.3cr> Q \ ^ {LLL Date:^^6^ . 
# 

Property Gompietion Agreement 

DIIS agreemem documenls the completion of remedial activities perlbimed on my property My signature 

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

now, or at any lime in the future, except those items listed below, ifany. 

Property ID: \ ^ H~ / 

Property Address: Lj J if Q J f^ j "f 

Owner: M'ck^tS^l W/\l h^^^-^"^_^ 

Phone: ^ 9/- ^ / P^^ ~ C^l/ yJ^^^i O 

Restoration Items in Question: 

Additional Comments: 

I Kyyaffrec restoration'ta completed, excepl as noled 

I I I Ho nol ajjrec resloration is completed . 

0»viic»''$ Signature D»tp/1 Contractor's Signature Dafe