TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID.: \<Oi i Date: ll|^^/ ^ 

Address: k>l ^ Oftf 4 < 

Remediation Contractor: Coastal Environmental Group_ Year: _200ft 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

/ Signed Access Agreement for subject property 

' ^ Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

-& Confirmation data 

E Photographs 

Y As-built sketch 

lY Satisfactory restoration signed by Property Owner 

lA Property close-out check list signed by EPA 

- ^ Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

'y Property information from Douglas County Assessor's Office 

[J 

D 

D 

jpcmmh ­ /i^/>y ^ Signature „„ / iDate 

30054517 

IIMIlii 

Superfund 
• • 

d 

Property Access Checklist 

Propc-tylD: ^^Q^g T 

Propcrtv Address: "^ ^ t T C'VX \ 

D

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 /_ 

 /_ 

Address Afl(lross^:

 < C^^^ ? ^ 0 

Renter: 

Phone: 

Fax: 

Phone:

Fax: 

 U?^0 ­ 2^^ ! 

Cell/Pager: 

Additional Inforn\ation: 

Cell/Pager: 

n

Iv/

1 5 7

CD

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoil Sampling (ifapplicable) 

Sent: / / 

Sinned: \i / ^ / ^ 

Sinned: 6? / gr / C) 

/ / 

By: 

By: .r t 

By: (, C 

By: 

[ 3

U

S ^

[ 0

n

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utilitv Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

/ / 

/ / 

Called: i/L/IL/_3-

On:Jj^/:^/ ^ 

On: / / 

By: 

By: 

B.v: e o 

B.v:A/iCk /Rriai ^ 

By: 

D

D

EH

D

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

On: / / 

On: / / 

Signed: 12-''^Z'/^Z 

Issued: / / 

By: 

By:

B.v=

B.v:

 /K^uk IAJ M 

J 

j 

Air Monitoring (as applicable 

[H Community \Y\ Crew 

) 

Results: 

D Conununit\ Q Crew 

Results: 

On: 

On: 

/

/

 /

 /

 Bv: 

 Bv: 

1 

D Community D Crew On: / / Bv: 1 

Results: 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 

\'bOl% 

^c>\x OQIC 

 Date: Time; Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
Douglas County Acco; >jM^nfa|^i tion Page 1 of2 

Douglas County, Nebraska Property Record - R2300490000 

Print Report 

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

New Feature ••-»• • Auto Sales Search 

Owner 

VOGEL CHARLES W 

ETAL 

3012 OAK ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 0049 OOOO 23 

Account Type: Residential 

Parcel Number: 2300490000 

Parcel Address: 3012 OAK ST 

OMAHA NE 68105-0000 

Legal Description: SUMMIT ADD LOT 16 BLOCK 4 48.4 X 128.25 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

Improvement 

$87,400.00 

$87,400.00 

$87,400.00 

$83,700.00 

$83,700.00 

$83,700.00 

Total 

$93,700.00 

$93,700.00 

$93,700.00 

$90,000.00 

$90,000.00 

$90,000.00 

L^nd Informatio n 

Acres 

0.14 

SF 

6144.0 

Units 

1.0 

Deptii 

128.0 

Width 

48.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R230... 6/6/2009 
• • 

Douglas County AccoMklnfqg^tio iU|klnfQ|^t n Page 2 of2 

1 WI- 160 

3 

1*0 

Hi)M n '9C­ TID 

UV 

FiaFUH t1»05llFl 'h V . 

.5^1 I « ' 1 

... 'iJ-Mi 

Hir 

r "•r^o 

i i Kir 1 sgcmFin 1 

A (MCSaFl IOO] 

p" & «» 

...r 1 

M " 

1 Mtr 'So a 

II%4C ^ Ft 

DMldMriCM:M« 

2J<5« 1 1/2 STORY FINISHED 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1808.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Forced Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1900 0 0% 1900 109 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1174.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 234.0 

Porch Open Slab 189.0 

Porch Slab Roof Ceil 84.0 

Porch Slab Roof Ceil 270.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R230... 6/6/2009 
http://www.dhoaor^ighiiitemet/DHONNoticeCreatioii/MessageText. oi^ighi .

Create Another Ticket | Back to Irth Intemet | Send Email 

YOUR TICKET NUMBER IS  2300160. 

Original Call Date: 6/22/09 Time: 12:44 pm Op: ELIZABETH18790 


Work to Begin Date: 6/24/09 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3012 Street: OAK ST 


Twp: 15N Rng: 13E Sect-Qtr: 33-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Leam Remediation 


Location of Work: INCLUDE ALL EASEMENT. 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 LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Ah: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMLINICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UnLITIES 

DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day: 4024447197 

 Ak: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 


lof 2 6/22/2009 12:45 PM 
ht^://www.dhoaor^jghlntemet/DHONNoticeCreation^essageTexL... # —~y 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

2 of 2 6/22/2009 12:45 PM 
W As-Built Drawing ^ 

COASTA L Omaha Lead Superfund Site 

9 r 

r 

Legen d 

*:•;«: Concrete Drip Zone Excavated Quadrants Excavated 'AV.V. 

Area replaced with Area replaced with 

Area lef t bar e Sod Rock/Mulch 

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

Name: 0;)J>aV^ \)Ot o Omaha Lead Site Date: North Arrow —i 

Address: Site Sketch Time: ^ \)-i<> ^ y^ n o^)Y. ^ ^ 

Phone: 1 

Team b^aA\)klDl36 ^^BVID # I50& 8 XRF Code ^^^2 . 

Sample Number Lead Concentratio 3 n Confirmation Sample 

/>5^ -^ '/^^ f^ Yes a No $ar ppm 

ppm f l Yes ° No ^ ±S^^<Y NoISK ' ppm ft) Yes D 

ppm No"^ ^ f 3 1 Yes O y^£>g^ ppm No ^r ­ 0 7 Yes [=1 dfzscpk A -f>5Pgrg^ ppm No *a : ^^Ye s • 

ppm r Yes • No • 

^ 

^ 
iNfaHttiAmwr 

^Hfff ^FKtffci(h Tmm: ^sj ^ Miiitess: '301'Z O^ K jfj^'ftO 

Wtone: 3$^- Si9^ 1 

fb^cu^okiiM^ ^^ # 85088 XRFCorfe ^5^2. 

iLead Cainoamtfattioro OonffmnaalliaB 

5 jR-f^sepJc/ ^ -f<^*5£>gg 

^ * Yes

^ 9 Yes

glYe s

#57 Yes

 a 

a 

a 

n 

No$a r 

iNto ISr 

^3^jk: ^r 
• • 

COASTA L ilOlteilMINIt l 

• • O U » . I ft 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: Daytime Phone: 

C.lnr.r|/^<^ \\c^ \ 

Address of Property 

covered by this 

Aoreement: 

,V,^Z r^t . SI 

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 v^th clean materials and the area will be restored to its original condition. 

This v^rk 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 v^ll 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 MAW 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 vwitten 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 VA)rk has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
•tL^ * 

COASTA l CNVIiOHfirflTAl 

C I « U * . Il l 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 

J^ i grant access to my properties 

D I do not grant access to my properties 

/A:>< ^ 

^ - e-- yy'f 

Signature Date Signature 

Date 

O I would like to be present during any sampling that is required. 
• • 

# • 

COASTA L 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. Tlus wili 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: \SO< ^ 

Property Address: ^?/'^jf2_ CDCK.^ *f^ 

\/o()p\ 

Phone: (fiTyP - 2-^' 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, sgrface 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 anow 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 retum of these items is the Owner's responsibiiity. 

Item: 

^l^ii ^ma [\ pkinK \n )ne <F^Kiod 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Page 1 of. 
# • 

COASTA L 

c M o u r . t »• c 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

f ^ p^cA c/rri M p/r.jYi ^ f/^-^f ^iTLiYid 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
C p A S T A L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item 

IItem: ^ 

Item: 

Kem: 

Item: 

Kem: 

Item: 

Kem: 

Kem: 

Item: 

Kem: 

item: 

Item: 

PageSof. 
• • 

COASTA L t N * IMONMft NTAI c n o w r IN C 

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 

Numbcr 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 

f\ 

\ 

t) 

v\<=> 

n^ 

Unit Condition/Type/Species 

Square feet 

•, 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of. 
• • 

COASTA L I N ViMOMH * N TA t 

C M O W r I N C 

I Item 

Agreed upon value of 

Diant materials not to be 

renlaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher 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 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

arca(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area(s) 

Easement Area, to be 

excavated 

Quantity Unit 1 Condition/Type/Species 

\ 

$ 

\ 

Each 

f^ SF 

y":^ SF 

SF 

1 

Page 5 of. 
• • 

C OAST A I. 

AddKional Comments / Instructions: 

% drop o^? o-^ ^^^^^ 

J ^ Check the box if Owner does not want CEG to document interior foundation wails and possible 

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

interior of house, induding foundation cracks or fissures. 

J^ I agree Q I do not agree 

Owner' wner'ss Signatur Signaturee // Dat Datee Contractor' Co&tractor*ss S^ata Svnatarr e Date

Page 6 of. 
Date 

Project 

XRFID# 

Shot# 

7D0 

J2D1 

3

m^ 

DJL 

Average

Shot# 

"UlO' 

1^-11 

1^35: 

UTIS 

Average

Shot* 

Average 

Shot# 

Average 

lab sample # 

XRF PROPERTY SAMPLE SHEET 

£,-?>o-nq 

Omaha lead FP Znd year opilon 

Reading Sample area 

>^^jt\1. ^ 

%•5.T^«^AH•'arq Dr 

151.? Depth . ± vi.ru 

H.2fi9±l!5.<K7 

 \1\.1 \ ± \1S.l ^ 

Reading

3^.q23;^.7T 

t l 11^.^2 

m.gi^^.to^i 

^T.?»utio.n 

 Hf i Q Q 1 .

Reading 

Reading 

Lab result 

 Sample area 

ii 

Depth 

m. q.(i> 

Sample area 

Depth 

Address 

Sample time 

sample length 

Shot# 

loE' 

JDL 

JMCOL 

J1Q3L 

Average

Shot# 

Average 

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Sample area XRF Avg. 

BVID#Jf)QM. 

?D\1- oakL 1S-V J 

IL.: \^ smm 

30 sec 

Reading 

Vl^lti l \T.l 

nViiH-Siy^.n^ 

lD.^ft ± 11/71 

THULl^t-^L. 

Sample area 

££:^ M/^' ' 

Depth 

 <K1.U ± iL j 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Signature. (^M? Sbu 

Print P\\oA\nP:M^ Cac.{'reb 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 704 

Mode SOIL 

Time 2009-06-30 16:20 

Duration 121.29 

Sequence Final 

Flags 

AVERAGE p ^ of 700-703] 

ADDRESS 3012 oak st 

QUAD/ZONE DZ 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb T21.707 J ± f 13.777 ,; 

Supervised By: (^CM^Jtyo 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 89.403 

Supervised By: 

Certificate of Verification 

700 

SOIL 

2009-06-30 16:18 

30.53 

Final 

15088 

3012 oak st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

± 12.109 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 701 

Mode SOIL 

Time 2009-06-30 16:19 

Duration 30.11 

Sequence Final 

Flags 

BVID# 15088 

ADDRESS 3012 oak st 

QUAD/ZONE DZ 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 83.037 ± 11.893 

Supervised By: 
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 151.798 

Supervised By: 

Certificate of Verification 

702 

SOIL 

2009-06-30 16:20 

30.17 

Final 

15088 

3012 oak st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

± 15.239 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 703 

Mode SOIL 

Time 2009-06-30 16:20 

Duration 30.48 

Sequence Final 

Flags 

BVID # 15088 

ADDRESS 3012 oak st 

QUAD/ZONE DZ 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 162.589 ± 15.868 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 709 

Mode SOIL 

Time 2009-06-30 16:25 

Duration 122.00 

Sequence Final 

Flags 

AVERAGE fAvg of 705-708 

ADDRESS ^0l2-o-a1csf 

QUAD/ZONE easement 

INSPECTOR nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb ± 

Supervised By: hpC^ijBt£eA\ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 705 

Mode SOIL 

Time 2009-06-30 16:22 

Duration 30.53 

Sequence Final 

Flags 

BVID # 15088 

ADDRESS 3012 oak st 

QUAD/ZONE easement 

INSPECTOR nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 88.780 ± 12.104 

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 116.426 

Supervised By: 

Certificate of Verification 

706 

SOIL 

2009-06-30 16:23 

30.48 

Final 

15088 

3012 oak st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 13.729 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 707 

Mode SOIL 

Time 2009-06-30 16:23 

Duration 30.41 

Sequence Final 

Flags 

BVID # 15088 

ADDRESS 3012 oak st 

QUAD/ZONE easement 

INSPECTOR nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 70.548 ± 11.219 

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 74.656 

Supervised By: 

Certificate of Verification 

708 

SOIL 

2009-06-30 16:25 

30.58 

Final 

15088 

3012 oak st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 11.358 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 674 

Mode SOIL 

Time 2009-06-30 12:57 

Duration 121.45 

Sequence Final 

Flags 

AVERAGE ^^?g"oF67D^73^ 

ADDRESS 3m2-oai<-st-—' 

QUAD/ZONE Fl 

INSPECTOR nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 145.997/ ± 

Supervised By: ^(l^tgfe) ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 670 

Mode SOIL 

Time 2009-06-30 12:55 

Duration 30.34 

Sequence Final 

Flags 

BVID # 15088 

ADDRESS 3012 oak st 

QUAD/ZONE Fl 

INSPECTOR nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 36.919 ± 8.771 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 671 

Mode SOIL 

Time 2009-06-30 12:56 

Duration 30.41 

Sequence Final 

Flags 

BVID # 15088 

ADDRESS 3012 oak st 

QUAD/ZONE Fl 

INSPECTOR nicolas 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 47.203 ± 9.821 

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 47.508 

Supervised By: 

Certificate of Verification 

672 

SOIL 

2009-06-30 12:57 

30.55 

Final 

15088 

3012 oak st 

Fl 

nicolas 

10 

CLEARANCE 

± Error 

± 9.635 
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 52.356 

Supervised By: 

Certificate of Verification 

673 

SOIL 

2009-06-30 12:57 

30.15 

Final 

15088 

3012 oak st 

Fl 

nicolas 

10 

CLEARANCE 

± Error 

± 10.170 
A^* % 

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

^^^ ^ I

^^^^ ^

 Coastal Environmental Group Inc.

 www.coastalhazmatcom 

v ^ ^ 

''^LP^oA^ COASTA L 

S 1 0 U P, IN O 

EXECUTIVE SUMMARY: 

BVID # 15088- (3012 OAK ST) 

py] No Issues or Concerns \A\ Issues/Concerns 

Detail Explanation: 
fi 

EwB» ^ 

EPA Property Close Out Form 

PropertyU: jf/^ ^ . , Property 

Datc/Tinc: Owner's 

Quads Excavattd: \) ^ , f I Contractor 

Excavation Yes No General 

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

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

GradlDg Sod and Vegetation 

Yes No 

I. Does the grading around the perimeier ofthe house in excavated areas generally slope away cr from the house? 

2. Has sod been laid in all areas that were excavated? 1/' 

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

S. Are the joints t>etween the sod strips generally tight? (Only evaluate if inspected at a 30 day A 

time period) 

6. Was the property graded such that water will nol pool on the property? 

7. Was damage to landscaping or plant materials avoided? yy 

Gates, Fences and Retaining Wails Ves No 

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

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

3. Was damage to gates or fences avoided? (Ifapplicable) 17^ 

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

Foundation, Sidiag and Gntlers 

I. Was damage to the siding or trim avoided? Yf 

2. Was damage to the foundation avoided? ^

^ 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? A-^ 

Ai. 

5. Was damage to downspouts or downspoul extensions avoided? 

lA^ 

Sidewalks and Driveways (Copcrcle) 

Ycs/No 

1. Was damage to driveway surfaces avoided? 

A 

2, Was damage to walkway surfaces avoided? lY'^ 
Ov^'ners comments: 

Inspection notes: 

Ayriml Alt-u^ur^ A)f^ (P^^^ ^ 

A^y XYl c£ert^/n ^ .AUAUAI/^'^^^ 

Removal and restorati(Drjactivales ccDqiplete^incjj^ding the 30-da so warranty: JO-dayy sodd warranry: 

EPA Represenlalive LACY>\ Date: 7A/07 
•t 

Property Completion Agreement 

/'Ills agreement documents (he complclion of remedial activilies performed on my prc>|x,Tty. My siijiKiture 

will desii^nale thai I am salislied wilh the restoration ofmy properly, and lhat no items nre in questions, 

now. or at any time in the future, excepl those ilems listed below, ifany. 

Pi­operty ID: 

Proporty A<Idrc.ss: ^0/ 2 Q^U i S^ ^ 

Owner (3Sw« jy-cL^ 

Phone: yo2-J^30A^£'iS:2. 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

p y I nyrcf restointion is contplctc<l, except as noted 

 I ' do not aurcc rcstorHtion is completed 

..^'A- Y A YMYj Owncr'.s-Signn ture Date I ffontrnrtor's Siijnatnre Date 

I
4 

Water Bill Settlement 

Property ID 15088 

Property Address 3012 Oak St 

Tenant Mr. Charles Vogel 

I have received fh)m the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 50.68 for 

water usage required to maintain the sod. 

Check Number 1716 

Value of Check $50.78 

Made Out To Charles Vogel 

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 full payment for the above, and release Coastal 

Environmental Group Inc. from further obligations or liability. 

,^AA ^^^-^/ ^ 7 ?e(^it^co^ lDl2.ICAh 

Owner's Signature Date Contractor's Signature Da Datl e 

f'V'.- T-^WH*».v:)i »yv--';a,riaj^'';//;"- i ^ 'jS^^«-<''^'?"--: .'vj^'JJI^g.-Ti^' . "^ ' ^•'AJ7.^'A . '^"^ •''•"^" S'^;' ' ' . 

1716 COASTAL ENVIRONMENTAL QROUP INC. 

2411 MARTHA STREET 

OMAHA, NE 68105 

PAY TO THE CHfAfl^ Vpt.ft 

ORDER OF _

iLm vr 

VIMIsFafgoBinli.NA 

NlbTHkl 

wHbfargacom 

FOR W/i^ l^m / ^o\i ^^ ^ 

1:101*0000Sai : £ziU7i7iROU« ' 0171E. 
D Remote XD: R page of rrain:m.Lxtu uxi- S 3uin-Y, im. Wk : d4 4 «WBU \m/<^^m m i<»:4s mie r. uuc/uue 

Afxount : 128811-1171771 JL 

1723 Harney St • Omaha, NE 68102 » 402.554.6666 

CHARLES W.VOQB. 9-inall: cuutanmrj68fv(Co<8nxKtonaha.oofn * wsbsRs: wwwjnuduinuhajtxxn METROPOLITAN 

Swvloe addrau: 3012 OAKOT UTILITIES DISTRIC T 

live Green. 7ftfn(fiJk Bmngdato Aug 7.2009 Call 811 before you dig in your yard, buBd a PrsMuus luuuioe $62.81 fence, eto. Coll at ieast two working days in Paymant reoalved -Thank you 70.00 CR advance. UUfilias wifl mark gas, water, eleatric, Cunent ohaigM 104.27 

cable and phone lines. No charge for this Newbaianae 97.18 

eervtee. • Total due Aug 25,2009 $97.18 

>p1>ifnti»inD«lwirtallif€>MidaKaMi*i»ttfa«i«niiin>rtam—andwIirohMg—. 

soo " ­

2S0-^ llll . 

0 . , aeipCMNfwD«i.MFibMirAprlta|Jun M-f m 

YoiirQasllBa 

• nntiaMMaHi • PMti»M«MaiM 

IMa Morth LaatYOar 

BflBng untts: SS 17 

Uao par dsy: 0.7 0.6 

Amrag* oast par day: $0.84 $128 

NumtMirof day* In Ulilng oyoki: 31 

BepaattatOeoJenPihtttrfifrmvJim M f m 

Your Walar Ua« 

in i • nmuMwi 

TWB Month LMtYaar BBHng un8a: 34 13 

Uaa per day: Averago oost par day: 1.0 

$1.84 

0.4 

$0.69 

Numbarof daya in MRno oyeto: 33 31 

QAS RESIDENTIAL RATE A: Jul 1 to Aug 3 

Meter Nundier 318^2 

Ounent read «MbMo: 6222 - Pmrtoua readtoatkiwiB}: 6200 - 22 COF 

Qee Use: 22 CCF x 1.023 (hoat value) » 22.606 therms 

2 days 1.384 therma at O.S>ffi3- $0.72 

31 daya 21.1421hemmat0.S286- 11.18 

, SarvloaOhartta 12.00 

QasCost ' • k $23.90 

Qum Infiraatruoluie Reptauement 3.00 

WATER RESIDENTIAL RATE W-1: Jol IIO Aug 3 

Meter Number 2848220 8lz8:a«-hah 

Cunent raadfteiwQ: 883 - Prevtoua read (Mtbnaia}: 629 « 34 CCF 

Wcder Use: 34.000 CCF or 26,432 galbna 

9.000 COF at 0.9814- $8.88 

21.000 CCF at 1.3481 - 28.2S 

4.000 CCF at 1.7298 - 8.02 

Sorvfaie Charts 4.86 

Water Cost • $48.68- ^ 

<o 

Water Infrastructure neplooemont 2.00/ 

Lata Payment Charge 1.48 

< ^ of Omaha Sewer 18.48 

SahMTax 6.72 

^ Current Chargee $104.27 

neoMi Mu m this portion of tha bm wflli poymont. • Ploaoodo itoC otoplo ppyiiiuHt lo Mil. 

JL WBDMRB* WMf.inudoRiflnBjOOin 

METBOPOUTAN 

UTILITIEI DliTIICt 0001288111171771000000097186 17S3HBinay8t • Omaha,NEM1Q2* 402.654.6688 

68500010 MunPOToeaaaoosyNNNNyoioosBss 

Dua on or before Aug 25: $97.18 CHARLES W.VOQEL 

3012 OAK 8T If paynMtit k NNiivBd alltr dua datiK a iBli (to wBI 

OMAHA r c 68108^704 ba MnHWMM on asK and watBf VVU9M. 

Amount Paid: 

.l|||l|||l|i,|,ill„||.,.l.l|..ti).|I..„||„|.i||||.,li||.l|l,., 

METOOPOUTAN U11UTIE8 DtSTRlCfT 

POBOXS600 

OMAHA NE S8103M00 

j.,I|.I„..II.,|„.l|,||I|.lll„„|,IIIII,.I.II.I.|I|.,I..,J.|II| 

GUvato tho Haat AM Fund. 8MiwMMr.inudDmaha.ao(n. 

MontMydonaUon-Add:n$eD93a$9 Ot»wr$_ Account: 128811-1171771