TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \lF5(cS Date: f/^/^^/ " 

Address: 230\ 3 S Z. Avi-^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

5/ Video of property (DVD) 

\sZ Executive Summary 

M EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Si^ed Access AgTeement(s) for adjacent property 

5/ Restoration Agreement 

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

M Confirmation data 

[/ Photographs bdoc^ Oannd^ ^sod 36'aa.U 

E^ As-buih sketch ^ 

M Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA ~^/2-/ 2-£> 0~J 

D Description of areas not meeting ROD cleanup criteria 

Q^ Utility clearances 

M Property information from Douglas County Assessor's Office 

B^ PrryrJM (Ulceus cixeAcL^ 

D 

Signaturee Date 

40317108 

Superfund 
Property Access Checklist 

PropertylD I 1 S" 6 S D WORK STARTED ON OM / JT/ & ! 

D WORKCOMPELTED ON. / / Property Address ^ ^ Q ^ g^ 3^o d fVJ 

Renter Owner: ^_^Vi,-;&Vx)pV\«L ^ <C-a^^U. o 

Phone. 

Address. 230 , ^ 3^rN d (^ ^ 

Fax 

Ot^ak. 3 Me . (S,e.^ o « 

Cell/Pager 

Phone Z102 - 3f7- - MH M | 

Additional Information 

Fa\: 

Cell/Pager 

Q Notification Letter Sent: By. 

P T Access Agreement Signed. 0*f /<P^/e>~f B) ' ^ ^3^a.C-We_ ^a.g.tei{ i 

I I Restoration Agreement Signed- / Bv: 

n Topsoil Sampling (if applicable) / / By 

n Disposal Sampling (if applicable) By 

I I Garden Sampling (if applicable) By: 

B'''^LItility Clearance Called- V / 30 / 0 1 By -^rrfshkaX 1^19ftl^ ^> 

0 Video/Photos (Before) By- RJcJU^r ^ pneti ^ 

0^V i dco/Photos (During) On: l^ l9'llO'l By: /Z7( ^ 

Q/Video/Photos (After) Or^: iLlQillQ^ B>- /2J"6 K 

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

I I Property Completion Agreement Signed: / / By. 

• Final Report Issued By 

Air Monitoring (as applicable) 

n Community Q Crew On. / / By: 

Results: 

O Community • Crew On / / By: 

Results: 

n Community O Crew On- / / By: 

Results: 

Omaha Lead Site 
17565 

Omaha Exterior Paint North Arrow Lead Site Owner Name: C^imiB.C^^TBLL D • Good Site Sketch Mdress:£ail^.^>NnAm , D ^°°' 

Pt*oae:H,mbJmil ^ (~1 Not paint 

Sample Numt>er Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: 9f CO u ^ 

RYASCPXA- /f,5S 8 Fl Date: {| ff i Cr^ 

RYBSCPXA- IfSs S F2 Time; "S.'"? ^ 

RYCSCPXA- ^(^SaS ^1 

RYDSCPXA­ JfSiB^ ^ Samples Analyzed 

RDZSCPXA- f^,5QS DZ XRF Unit: t^^S , Book: f] S 

RGZSCPXvA GZ-. 

RPZSCPXA- JT^GS PZ Date: __2E2EzDd. Time: PM 

Staff: KEL 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden. PZ = Play 

All quadrants are as viewed from tlie street, facing property 
)(e ^ 

Nam ^Zf/irr^Z/O ' Z^»/r/-J'/Za J ^ Omatia Lead Site 

Address •ess; : ;<>,-f^/ ^ ,T.? ^ ^ ^rS^ ) Site Sketch 

Phone: ^os^lr^f x -//^ / vS<^ 

Tearr^y^^,/^^y^/^ ^ - BVIDtf/^?^ ^ 

Sample Number Lead Concentration 

/^yZI<SQP^A - /7.2^ 8 

/^YC^QPyA -/7i'}Qd ^'^^—7 ^ ppm 

RDZSCPXA ' /7^GA T^^T iJSa! ppm 

ppm 

ppm RYCSCPtj^-17568 

Lab 

166 ppm 

Lab RYDSCPLA-17568 '^^^—r TH­ Result 1220 ppm 

i 

# 

/ 3 6 i«r8i 

*)M­

>^' fj/c^^' j

i *i 

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Mi ^ V 

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tf 

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^'GZ C 

• to.^^l ^ i .JU £}L tri ^

V -

Date; T- ^ g'-OJ g North Arrow —i 

Time: 5 •' ;z ^ 

XRF Code ^^O ^ 

Confinmation Sample 

No CH 

^^Yes a No n 

J5/Yes n No Q 

^;eYes ° No •=! 

^^lYe s CD No n 

Yes n No O 

Yes • No • 

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:^he^ebYC•f*fy1Ut^U«••ccon•talY«Jrvtve(iCREI«+ ^ V4 ­

a> ;•: )t^&i3St"6nnp*oy a .corporafiw Qrqaruz«t anol an'd eiTistfoq'"''r^;-:"^' 

vj . TSe i(n<iltr3-<9/9et/,'nie Joht^A^reigWoo R««l Estate ' ••" j 

-JTUMS •|»T-A0OITI0N.«rtd««f oaksW« » atlVie Irfoopneri ^ r'jf^' 

y-v-'itfinjei ti^a taws <t Nebraat«.her«lD»^ etrtifWa iViafr i^t»the "<.,-• - jlhareoF aaiid addilton being deacrtbeol as follows , v ! l.-;^"j ';;;„'4^ . 

-'•'.jDwrwr of Ihc lota'mcloded wtthin-tneaccom^MnYing pUt of -.^f-', Caqinninqaiapotnt ontha Morthand Satitk Confer line of. '''-'i^yi^^ : 

•t'CreiqWoni First Addition in 1fe Oty of Otnaiia.DooqlaaOsorilY, ' , V:''" iaJio o 28TI5 N Ria t of 1V)e ClhP.M. 3«e f«e* NortJj of W , ^ ' f 

v'-,;,^ebra4lu,as aurwyed bv rhofws Shay/, Civil Enqinevn^^cl ,S.E comer (rf Ihe SW * of said Section Z8.saiol potnt bainq v'ft 

- . ; )Krf it caused Mi d Bur\«Y and pUt fe be made and hereby '"' " ' . bntVia^orlhlineaf [>»i(iqbt and Lyman a Add , tt)ance West' » i,io 

'' ; ttoe& approve and ratify said ptat in all particulars; and oed- ^;:vJilonq 1V>« North line of ^^gW t «nd LYmans Acid.ana Lyman­

,' * tcates rottw public use Ihe stfre«ifs,alleys and boulevard,as ,; ;pace tC40 %> feef 1b the Wli ^ line of Mi d Saction 20. is a ^, i.^fV'! 

'.j-:^bov*o upon said piat. I n witbeaa whereof. Ihe said. The iBoint 573 '•/» feet North of the SW. osmar of sai d 5action ' 0 "V ^ 

.''' 'dohn^Cr«igh1a> ^wal Estate.and -trust Cofnpsny.inpurauanos , ;,,48, thence North along 1t» Wji f line of said Section U . .'.((^ • ;;V>i;' 

^ ,,af a reaotuKon duty pasaad ata mcetinQ of its &<>ard of.Dinectora :,v.-^0"-/B farf lb Si_of WINDSOR PLACE. Ihence EAst iM9Jsi v.-il;'*:; 

, * -V.4vs caused this insFrumsnt lb be signed by its Prcsider^ and '.V liec t lb a point on the Mor^iBnd Soidh Canfer Ir a of aaid SciJisn •W, ^'_j',|iltestad fay its Secretary and has fixed it's oSTporate, seal -~ '-^ - ' a . IMOfu feet North of the & E car of Ihe 3.W)* of H^Sadip p 

, •fcer«fa.|>i»J O * day «f June. 1908 ^ - "{Athence So«j1h TWfiDfi^' ^ pUca ^'be^tnning . 

eightbn Rul Estate ATnjst Company ;. ' Omaha Hak. Juna 11 ^ H M Xhanaa Sh*<M Miryayor > • » 'SHM

.' ; ' ' ijbipruenceof 'B y John C^Kelly fVesident ;•••••.,;;;'•.;.';;••••,-• , . _ - ^,'Xi: ^ • X'P',-,-' ­

Atta«t Alfred ,Thamp.S<c(et*rY 

-•&sfy^^\». ^ \ ~' ' - ' '-'':•­ ;.-'i*---"'ei»l « of Nebraska » .. ' ^ Caunty oC Oouglas) C.. ~ I. Frank A.Fiinay.Traasurer ..'the On this Xlhday of Jone.noB.-bt^brcm r.^rO't^ of Omaha .aid Douglas Ca, doVio ^ a^^ Y^ ^ 1h»e mm i'i~::'-;'^ Motary Aiblic in and for said State and County, personallf a m ;-.-!",ii ;: i no unpaid taxes or unredeemed tsic aaMa,and no special 'l ' '•.#»aUw'Bawad John.CJCelly.fVesident,and AlfrJ-nwmas,Seer, • ;'4 * 

;^ ^ssessmenl^ due or delinquerit as shown by Ihe i^conds of .^•; ittsry, of TheJohn.ACretghtoo Real Eabte and Trust Company. . Ihisofiicc upsnlaxLotU.3acZa,TI5.N,Rl)C,ar1lt^f^M • • F'..- wr ^ Ihey several ly acttnowledged Ihe execution of this inatrumii^ in (Douglas CD.Nebraska.ae fully daseribad in Surveyor s . ''fV' ^ betbeirvslunlsryaci.aoddccdandthevQluntac^actanddaad carti'ficiilii. Except. Mine ,C9) inniltmerit t fo r the uum q ^ ^aaid corponition .:'-*''•' '"' .'^• of SZ-^Ave. Due butnotDelin<}uei.t r-*-^ : •' "If ' ..'£ ' ' Vfitnesa my hand and njfelnl ceal at Omaha.Kebraska fnank Arai« y Otf ACoui ^ TieiiMQi ^ i 

Thi s Ptat OF Creiqhtons I " A DWTION was acceptbd «i d 

^imrJUf i«pp^a««.fci«^3Ut « f Creightooa 1" : Addition «ppro\NKl bythe^f1£0accitrf4hc OtV of Onaha the ^i m 

:^'Oua..lSoJi: Dan B.Butler Oty Cleric. J, 

S?^S;;: Ift Jobnson ^as.Ci ^ Caunul, ft'-^-^^ferrX .••",•••• •••• ••-•'• £ ' • 

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Yahoo' Mail - trishkasl@yahoo com Page 1 ot 2 

f MAIL Print - Close Window 

From "Digger's Hotline" <info@ne-diggers com> 

To trishkasl@yahoo com 

Subject Re NE-Diggers com - LOCATE Contractors Request Form 

Date: Mon, 30 Apr 2007 13 14 26 -0500 

DIGGER'S HOTLINE PRESENTS THE "NO WAIT" N I T E S TICKET ENTRY' 

Avoid lenghty wait time Immediate ticket number response- User has access to all issued tickets 

Free training sessions Contact Connie or Lisa at 402-330-1866 for further information 

Ticket Number 1773958 fi6>l93^'Z) 

Work To Begin Date 5/2/07 115pm 

Utilites Notified City of Omaha, traffic, sewer cox, mud, oppd, qwest local network, level 3, qwest long distance 

If there are any other utilities other than those mentioned above, you will need to notify them yourself and 

pnvately owned lines will not be located 

Thank You For Using E-Mail 

Original Message — 

From: trishkasl@yahoo com 

To: info@ne-diggers com 

Sent Monday, April 30, 2007 12 14 PM 

Subject: NE-Diggers com - LOCATE Contractors Request Form 

NE-Diggers com - LOCATE Contractors Request Form 

Name Trishka Simmons 

Alt Name 

Phone 402-504-2194 

Alt Phone 706-7322 

Email trishkasl @yahoo com 

Caller ID 18790 

Company Coastal Environmental 

Type of work EXCAVATION 

For Whom COASTAL ENVIRONMENTAL 

How Deep 3ft Oin 

Explosives No 

Corner Lot Yes 

Front of Property Yes 

Rear of Property Yes 

Tunneling/Bonng Yes 

County DOUGLAS 

City OMAHA 

http //us 087 mail yahoo conVym/Shov\Letler'^ho.\=Inbox&Msgld=1013_2343144_27360 4/30/2007 
Yahoo' Mail - trishkasl@yahoo com Page 2 of 2 

Address 2301 S 32ND AVE 

Directions 

Where on Property 

OVERALL 

Township 

Range 

EorW 

Section 

1/4 Section 

Township 

Range 

EorW 

Section 

1/4 Section 

http //us 1387 mail yahoo conVym/ShowLetter'^bo\=lnbo\&MsgId=1013 2343144 27360 4/30/2007 
. » ' ••'I/ , 

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: 

Addresses of 

Properties covered by 

this Agreement: 

Daytime Phone: i^j-js^,^^^ ^ 

Address: 2.331 

Address: 

Address: 

Address: 

Address: 

S <y-*^'^4<^ Ov^J ^ AJL ^<^*c^-

PURPOSE or RESPONSE ACTIVITIES 

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

elevated concentrations of arsenic and/or lead and may pose a health hazard The soil 

will be removed and the excavated area(s) will be replaced with clean materials and 

restored This work is being performed under the Omaha Lead Site Superfund Site 

remediation program 

An EPA representative 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 

Grantor's approval Upon completion, the Grantor will receive wntten 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 

«Property_ID» Page 1 of 2 
•

 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 if EPA is unable to obtain such access, and 

• Allow videotaping and/or photography of the property including exterior and 

interior areas of buildings 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the activities or work done, or 

the equipment used to perform the activities, 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 questtons about this program, please contact 

I grant access to my properties 

n 1 do not grant access to my properties 

J M ^ ^ 

Sisnature r Dkte Signature 

Date 

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

Page 2 of 2 

«Property_ID» 
Restoration Agreement 

The purpose of this agreement is to pro\ide a mutual agreement as to conditions of propert> prior to 

remediation activities This VMII also serve as decontamination for the purpose o f assuring that 

restoration activities are completed to the satisfaction of the propertv owner and the United States 

Environmental Protection Agency (EP.A) 

Propertv ID: \ n «5 6 % 

Property Address ^•2^^ A Ai/ ^ 2,3><?l 

Owner. r JU.-.5>l-pp)lv< ^ r^7^.<:\-eJ J (-, 

Phone: 

-^a - ^Lol - ^ 6 Z,v 

On the attaclied diagraiT\(s) indicate area(s) to excavated and depth of e\cavaiion. location of ail known 

utilities, subsurface features, surface structures and landscaping features access location{s) to be used bv 

contractor, and the direction of North Indicate distances depths material types etc I;idicate d'g'tal photos 

by referencing the piioto-iog number witlt an arrow indicating direction of view 

items To Be Removed By Owner Before Start Of Remediat'on. 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the GAfner's responsibility 

Item 

Item 

Item 

Item: 

Item 

ItemItemItem 

Page 1 of (j 
!(P^ 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

ItemOVA^W-D a^d^ -K^^-s. F» ^tA ^ J 

Item 

ItemItem 

Item 1 

Item 

Page 2 of V 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item 

NhD-^^ 

Item 

Item. 

Item 

Item 

Item 

Item. 

Item 

Item 

Item 

Item 

Item 

Item 

Item 

Item 

Page 3 ofi^ 
VV. 

Item 

Pre-evisling property area 

that IS covered with iirass 

Number of trees ' 2 incH 

. ! ., • 

Number ot" Sprinkler 

Zones Control VaKes 

Timers Hsads etc 

Anach a sketch ot the 

sprinkler lav out 

Number of and size of 

each garden flouer bed 

area 

.Anach a sketch of relative 

sizes and locations 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

^ 

E..di |M a p ( C 

rjo-f h> r e rA 0 »>-je_e^ 

Each \Oo 

^ 

f r ^ Each 

Square Feet 

Page 4 of ^ 
Item 

Agreed upon value of plant 

materials not to be 

replaced bv contractor 

Note this value VMII be 

used to issue a plant 

voucher to the property 

owner 

Agreed upon list of plant 

materials that VMII be 

replaced by contractor Be 

very specific and detailed 

Include a sketch of \vere 

each plant will be placed 

bv the contractor 

Agreed upon area of 

property to be replaced 

vMth grass sod 

Include a sketch of the 

area(s) to be replaced with 

srass sod 

Area of Citv or County 

property to be landscaped 

per their requirements 

Include a sketch of the 

area (s) 

Quantity Unit Condition/Type/Species 

2_ 

s 

^-\AC-AiVYVCjC>« ^ 

S)S O \Jc)^c)^^x^''^ 

2 Bvk^ ^ 

Each 

'j^^Vv/^U.tf'O 

)c->r 

lap 

r\ F7_ SF 

NlD SF 

Page 5 of 
Additional.Comments / Instructions: 

\^ ^ ClAX CtV^ /fse^^ d d '5)rio< cr^ cU--^ 

6^ 550/Ooo^^cKi^-. Q ^ 

^ Check the box if Owner does not want CEG to document intenor foundation walls and possible 

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

intenor of house, including foundation cracks or fissures 

agree I I I do not agree Di agree 

//zs/^ 

Owner's Signature Date Page 6 of. actor ^ s Signature Date 
17565 

Extenor Paint North Arrow Omaha Lead Site Owr,er Name: CHRI S C/^^TEU D • Good Site Sketch Address: SSllA , S£NDAV& . • Poor 

Pf,on€:H,30/-?i37f^_ Q Not paint 

Sample Numt)er Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA- J?SiS Ft Q D Date: W 1?: .-,•? 

RYBSCPXA- f'f'SCS P2 D Time X-i o 

RYCSCPXA- 7?,S55 Bl 

RYDSCPXA ;?l5(i3B2 

Q 

0 

D 

D Samples Analyzed 

RDZSCPXA /7,558DZ D XRFUr lit: \93S,^Book: J ] 8 

D Date. 

RPZSCPXA- /?«5Q9 PZ 

Number of Samples = (- I 

D Time 

Staff 

PM 

mL 

Legend Fl = Front Left, F2 = Front Right. Bl = Back Left, B2 = Back Rigtit DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, facirtg property 

SNiTEEHD 

Z^x^l^.^'iA 

^ 

i^'K^z-jiZ^^^ C&i ^ 

S^S/d-lOO 

H^ro- HO ^3?* \ 

B. e 

'v 

(Tin 

W^K 1...... 

Hf- 4e-^< p-^t658... L.<^'*:^ ! 

(MfcMI oi:3| 
^ As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

OLS#:17568 

Date Excavated:6/22/07 

Date USEPA Signed Off:7/2/07 iTS(be> 

Omatia Exlerkx Paiiit t4o(th Arrow Lea d Site Owner Name: CHRJ S C^^TBLL O 

Sit • Good e Sketc h Address: ,330/^ . SSNDA)^ . r~| Poor 

Phone: »j301 - 7G1 1 ^^^^ _ 

f~l Not paint 

SamF>le Lead Sample Samples Collected Numtier LAB Concentration Collected Firm ocr O RYASCPXA- JT-SOS Fl • Q D Date II If/ C.ja' 

RYBSCPXA /?.5 ^ F2 D Time :;.•'? g 

RYCSCPXA- 7^?5 ^ Bl 13 n 

Samples Analyzed 

RYDSCPXA / TlSJiS B2 • 

RDZSCPXA /7»5SS° 2 

XRF Unit Book: IIR. nGZSCPXA S2- • Date 

RP2SCPXA /<^5<36 PZ Time 

v\ PM 

Staff Numt>er of Samples • r KEL 

Legend F l = Fronl Left, F2 = Front Right, B l = Back Left. B2 = Back Right DZ = Drip Zone. GZ = Garden. PZ ~ P(ay 

AM quadrants are as viewed from tt>e street, facing property 

ENiTEMJD 

V>>< ? '• ^ •> ^V^ ^ ^ 

Ct'i'X. 

B;I 

• a ^3?^ ii 

s t$3e>c © 

-.35./ 

DZ=65 PPM 

'^^^S- y//////// A 

.V i > M / ^ 

i:>^=»6l39 

EA=24 PPM ZZZZZZZZZZZA 

rt-^­

.^:.3aLfiy 

046141 0121 

Legen d 

Are Quadrants Excavated a not Excavated Dripzone Excavated 

Contract, #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
.•ff¥ 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # /^^^S 

Property Address ^3o ( .<,. ?/2'^^ AJt 

Owner Name CV\QJ:^ A,^<^ -^^ ^ Lo^-Ullo 

Date Crjin^^ 

Comments 

t^i •^iri ^ 

vC<D. ^-' /)nf >^ Uc ^ 

Owner Signature 

Contractor Signature 
ID #: l^SUfe 

Date: ^[v,\o^ 

Naine: r\\ C->\ 

Description: 

J 
."rs.ir^^^^'-^--^^^r-^'?iatff-a-°"/^i;^'^^'*^Ti-'^ Keep 

• 

^^sxr^Z^a/w/f ^ Z%<r/j>ZZa J f Omaha Lead Site Date: y-^l^-O S Noitti Arrow & 

Address: J?.-fig/tgl> .T^/t ^ ,.r^ ) Site Sketch Time: S/J2<9 -

Phone; </os^JF'V:i-^jfj// ^ 

Tearryy;^^,/^^,/^/;^ ^ ^ BVID # / ^ r;^^ g=^ XRF Code SSO ^ 

hf—h—hTe-r 

Sample Number Lead Concentration Confinmation Sample 

/^y/is(2PyjQ'Z7ffQf i f'fYes ^ST No 1^ 

f2Yes n No n 

/^YC^QPY A -/7yf<: a ^'^^—^- ^ ppm 

.£^3.—^. ^ ppm 

«/Yes

«?Yes

 n 

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Date 

Project 

XRF ID 

Sho t # 

: ^ 

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Adquc t 

Aliqjc t 

Aliquo t 

Property ID Oloj/7ld7 

Property Omaha Lead -- Fixed Price Address 

Measurement 0(01-51 Count/Time 

Field Shots 

Readin g Sampl e Are a Stiot # 

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, (use calibration chart o^ ic c 

20'"c tc value) ^ ^ 

Sampl e Area ! D 7 |?-IU^ 

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XRF Corrected Value --> 

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I n Situ Composit e Composit e Reading s Readin g Averag e (Bag ) (Bag ) a 3: 

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XRF Corrected Value — > 1^ ZL (use calibration chart or add 

! 20% to value) 

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(Drie d & 

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Analytica l 

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7 

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Result s 

Sample Area |^ ^ (Q- P Pass/Fail ' 

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1 

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Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

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(Dried & 

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Lab 

Number 

Analytical 

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Confidentia l ^cz& : : ' 2 
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Average 

(Bag) 

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(Dried & 

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Analytical 

Spilt Sent 

•> 

Lab 

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Analytical 

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2 

3 

4 

XRF Corrected Value ­ > 1 ! 

' 

(use calibration chart or add 

2 0% to value) ! 

an s ::5 a n u'r 

Confidential 
- * i^J^\ Omaha Lead Site—Fixed Price EP-R7-07-05 ° ^^^ ^ I Coastal Environmental Group Inc. 

V^^^^ ^ www.coastalhazmat.com 

^wo-i*^" ^ COASTA L ENVIRONMENTA L 

CROUP . IN C 

EXECUTIVE SUMMARY: 

17568—230 IS . Bl""* AVE 

n No issues or concerns X Issues or concerns 

Detail Explanation: 

PO was compensated for shrubs and bushes removed during excavation with a gift certificate from 

Indian Creek Nursery in the amount of $550.00. Coastal also repaired sidewalk on the west and the 

curb on the north which occurred during excavation. 
m^ 

Property Completion Agreement 

This agreement documents the coniplclion of remedial activities performed on my properly. My 

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

qucslions. now. or at any lime in ihc future, except those items listed below, if any. 

Propertv ID : r/^//^ 

Property Address: ^30/ %Zd^^A\/t- Owner: (Ihri^tomr CosUl/o 

Plione: 3^^ -'^HHI 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

II I iisrco restoration is completed, except as noted 

 I I <lo not iimce restoration is completed 

wner's Signature Date Contractor's Signature Date 

I
Omaha Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner ChnZcfhir CosZllo 

Property Address &30I S. 39'^'Ai^i. 

Property Identification Number n5bf) 

Material Removed Replacement Value 

Flower bed area 

Trees 

Itemized 

shrubs/bushes 

/55Z),^ Total 

The acceptance of the replaceinent certificate and the signature below is full 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of % "000^ has been received by the owner in the form of a gift 

certificate, # Z'lZ^ . to be utilized at "7^^v^^^ ZZ/ft^^ /Uuirst^y • 

d-^ZZ^ 1 '2--- ? -7- ^•^7 

Property Owner's Signature Date Contractor's Signature Date 
^ INDIAN CREEK NURSERY 2526 

Omaha's Best Kept Gardening Secret 

303 North Saddle Creek Road 

Omaha, Nebraska 68131-2229 

(402) 558-5900 Gift Certificate 

IN THE AMOUNT OF: 

ISSUED TO: (^)MfiHiUk> (J^^XJJLO COMPLIMENTS OF: A^g^pfe^ <?Wr >^>L^y * 

EXPIRATION DATE: a? '^^S-gg" 

Authorize nzedd Signatur Sii e 
^tP A 

% A Property Close Out FoTM 

Property *f'. I15l£?) Property Addre«= ^^{) / S,69^^AZ< ^ 

Datc/TInc: Owner's N.me: {Zl/iZiSfr)phfJ COSfpJio 

Quads Excavated: Contractor Group / 

EicavatloB Gencnl Yes No 

1 If necessary, were the correct quadrant(s) excavated and restored'' 1 ^ 

2 If neccssa^, were the correct areas of dnp zone excavated and restored'' y 

Gr«d>n£ Sod and Vetetatioa Yes No 

Does the grading around the peruneter of the house m excavated areas generally slope aN\ay 

from the bouse? 

oJf{^ e-)uu.fh-o^ c(^ COLAS. {SL) 2 Has sod been laid in all areas that were excavated'' / :^>£xt/?t4 b^ ?<g' J ^ kndscAJi'ir^ 

3 Does the » d appear to t)e generally healthy and growing' owinc''' (Onl (Onlvy Evaluat evaluatee iiff inspecte inspectedd aa^f aa ?6 j^ : 

day time period) 

4 Are sodded areas generally firm and evenly graded'' z 

5 Arc the joints btetween the sod stnps generally tight'' (Onl> ev aluate if inspected at z ?0 da\ 

titne period) 

6 Was the property graded such that water w lU not pool on the propc^' \ y 

7 Was damage to landscapmg or pla.nt matenals avoided'' z 

Guicv Fences and RcUinint ^alls \es No 

1 Do gates open and close freeh'' (!*• applicable) v 

2 Were all gates or fences taken down during Tsioration actn "'ts •-eipsiailed'' •,.lf applicable) / 

3 Was damage to gates or fences avoided'' (If applicable) A)A 

4 Was damage to retaining walls avoided'' (If applicable) ^1 

Foundation, Sidinsand Gutters \es No 

1 Was damage lo the sidu\g or tnm 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'' , / 

5 Was damage to downspouts or downspout extensions avoided'' */ 

Sidewalks and Drtvewiys (Concrete) Yes No 

1 Was damage to dnvev^ay surfaces avoided'' A^A 

2 Was damage to wallcwa) surfaces avoided'' Z^^ '-'Z^tZ^tJz* l^A^ 
•Owners comments: 

Inspection notes: , ^^ , 

I pressure LO^^U 4t^ f^ft^rx ^i ^ axx^fJ^r^iZs 

Remc\al and restoratio.n acii\ ates corr'p'ete inc'udirg the }0-u£> sod •^'arrar^.n 

EPA R^vTesemu:.^--y/^7^J^J^ ^ 7/^/^;^