TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID*: B^^d-' ^ Date: ///^ ^ 

Address- ^-S^^ O / V / ^ '^^ ^ 

Remediation Contractor* Coastal Environmental Group Year: '^^^f 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

"^T ^ Video of property (DVD) 

T Executive SummBiy 

y ^ EPA-provided property sketch 

l y Signed Access Agreement for subject property 

Signed Access AgFeenient(5) for adjacent property 

Restoration Agreement 

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

ConfiimalioD data 

Photographs / ^ ^C^-raMh ^ O^a^^rxu^WY^ / S^K ? 

:y ^ As-buih sketch 

y Satisfactory restoration signed by Property Owner 

U Property close-out check list signed by EPA 

y .Description of areas not meeting ROD cleanup criteria 

I y Utility clearances 

y ^ Property information from Douglas County Assessor's Office 

30261686 

n* 

Superfund <y^ A V 

'^-/- % 
^v 

Property Access Checklist 

Property ID: -mw^ D WORK STARTED ON: / / 

PropertyAddressIS::

 Qt QS^ Q /j y /^'S y n WORK COMPELTED ON: / / 

Owner: li^^^/^; ^ fXiL C Renter: 

Phone: 

Fax: 

Cell/Pager: 

Phone: HQZ ^ ^^jp ^ ^9^ 0 ^ Additional Information: 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

y j Access Agreement Sisned: l O 1 ^^ll / By:iCl,^a^i^­

1 ^ Restoration Agreement svijieA./jQ_i^£:i a _ By: t/jy/h^ . 

D Topsoil Sampling (if applicable) 1 1 By: 

D Disposal Sampling (if applicable) 1 1 By: 

D Garden Sampling (if applicable) 1 • 1 By: 

P Utility Clearance CaUed: Jjl_f,l ^ By= [jhLM^ . 

^ Video/Photos (Before) On:i^lZS.'U- By: 

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

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

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

D Property Completion Agreement Siened: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community QCrew On: / / By: 1 

Results: 

n Community Q Crew On: / / By: 

Results: 

n Community D Crew On: / / By: 1 

Results: 

Omaha Lead Site 
1 Douglas County Account Inforr-^+ion Page 1 of2 

Douglas County, Nebraska Property Record - R1600800000 

Print Report. 

1 View Interactive GIS Ma£ Information is valid as of 2011-10-13 Treasurer's Tax Reoort 

1 New Feature ->->- • Subdivision Sales Search 

Owner 

BALL JANICE L 

2532 FLORENCE BLVD 

OMAHA NE 68110-0000 

Property Informatio n 

Key Numtier: 0080 000016 

Account Type: Residential 

Parcel Number: 1600800000 

Parcel Address: 2530 N 19 ST 

OMAHA NE 68110-0000 

Legal Description: LAKE ADD LOT 3 BLOCK 2 N 1/2 30.5 X 140 

Value Informatio n 

\Land improvement Total 

2011 $300.00 $0.00 $300.00 

2010 $300.00 $0.00 $300.00 

2009 $300.00 $0.00 $300.00 

2008 $300.00 $0.00 $300.00 

2007 $300.00 $0.00 $300.00 

2006 $300.00 $0.00 $300.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4340.0 0.0 140.0 31.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/26/2011 
1 Douglas County Account Inforp^'^tion Page 2 of 2 

Locust Si Locust St Locust St 

ID 

2 

1 - Maple SI a 

Maple St i 

CortvySt CortJii Sl 

lyAlami St W i 

Miami Sl z 

ro 

M Ohio SI OMOSI 3 ^foS t 

5 a. 

t^ 2? Ohio St N HtfiSt 

3 St 

Cady Ave Lake St Lake St z z 

o 

52 Z CO w ShretvTOod Ave Willis Ave Willis Ave V«/pWs Ave " 

Witts Aue 

Victor Ave Grant St 

BL»r<tette Grant Si 

PBTk 

C' RttrHAll A Map data ©2011 Google < ^ DI..V4.^4 A 0 « Burdelle St 

The above map is powered by GooqIe, and is intended to provide a general idea of a property's location. If 

you require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

http://douglasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accountno=Rl... 10/26/2011 
IRTH One Call Page 1 of 1 

Diggers Hotlin* 

Of irth Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2889590. 

Original Call Date: 10/28/11 Time: 5:21 pm Op: WENDY18790 


Work to Begin Date: 11/01/11 Time: 5:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2530 Street: N 19TH ST E 


Twp: 15N Rng: 13E Sect-Qtr: 12-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: ENTIRE PROEPRTY, INCLUDING THE EASEMENT, AND UP TO THE 


: PEDESTAL. 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: EMAIL ALL CLEARS TO: WLARA@COASTALGRP.NET 


: UNSURE IF CORNER LOT. 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name WENDY LARA Phone: (402)991-1199 


Alt. Contact JOSE CARDENAS Phone: (402)504-0981 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


COXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area 

Code 

Service Area Name Contact Phone Numbers 

Utility 

Type 

COXCATV COX COMMUNICATIONS 

INC 

ELMCOX ELMCOX Day: (406) 728 ­ 9343 

http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=878608 10/28/2011 
Wendy Lara 

From: IRTH.Net@qwest.com 

Sent: Monday, October 31, 2011 3:09 PM 

To: Wendy Lara 

Subject: Message from Qwest 

To: COASTAL ENVIRONMENTAL SERVICE

Voice: 4029911199

Re: Message from Qwest 

 Attn:

 Fax:

 WENDY LARA 

 8776624211 

Message from Qwest 

Ticket: 2889590 


County: DOUGLAS Place: Omaha 


Address: 2530 N 19TH ST E 


QLNNEIC: 


The described dig area of your locate r^equest has been checked and is clear for 


Qwest Communication's Local Network. If you have any questions please call 


Qwest at 1-800-283-4237. 


Message from Qwest 


This message was generated by an automated system. Please do not reply to this email. 

Wendy Lara 

From: agt_comm@irth.com 

Sent: Sunday, October 30, 2011 7:53 PM 

To: Wendy Lara 

Subject: Response to Dig Request 

To: COASTAL ENVIRONMENTAL SERVICE Attn: WENDY LARA 

Voice: 4029911199 Fax: 8776624211 

Re: Response to Dig Request 

This is an important message from Omaha Public Works replying to your request to locate our 


underground facilities in an area described on the one call center ticket. 


Ticket: 2889590 


County: DOUGLAS Place: Omaha 


Address: 2530 N 19TH ST E 


OMAHACOF (Sewer): 


City of Omaha Sewer- No Conflict per info on the one call ticket 


OMAHACOF (Traffic): 


The City of Omaha Traffic Engineering Division has determined our facility is 


not in conflict with the dig site provided by the one call center. 


If you have any additional questions please contact Omaha Public Works. 


This message was generated by an automated system. Please do not reply to this email. 

• • 

As-Built Drawing 

COASTAL 0LS#: 28923 

DATE EXCAVATED:11/09/11 invironmental Group, DATE USEPA SIGNED OFF -.11/15/11 

Inc. Omaha

AREA SODDED: 1238 

 Lead 

Superfund Site 

28923 

Omah a Lea d Sit e 

Exterior Paint Nortti Arrow Owner Nam*: JANICE L BALL Sit e I I Good Sketc h Address : 2530 N 1S ST I I Poor 

Phone: H 

[^"No t paint 1

Sample Number Lead Sample L AB Samples Collected Concentration Collected Firm: (\Sr<r'\ fcg| hr ^ RYASCPXA-28923 F1 P.H°I ppm 

^ Date: i o \^-<= > C~ RYBSCPXA-28923 F2 r •

ppm B ^ Time : c t •. <-i «^ RYCSCPXA-28923 B1 \ ^ 2- ppm B ^ 

•

RYDSCPXA-2892 • Samples Analyzed 3 B2 I -I 3 ppm B " 

RDZSCPXA asoas B 2 — ppm C• D XRF Unit: IC3C-7 Book i7 3 

RGZSCPXA aeoaa ez ~ ppm 

•

Date ^ Ol ' RPZOCPXA aooao pa 

• • — Time Prrx ppm 

Number of Samples ' 

Staff n^v^ 

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

An qu«dr«nts ara as viewed from trie streel. facing property 

t AWe ^ r I i 

1 ; ENTTI 2REt) . i'\'? • n;3 ... -OCTl r o ZOO D 

: e-i f ^2 ­

1 

1 

."Z-^.^.Q . . . ; N . *fH. 9^.»-. 

-e ' 

: 1 • • - ; 

• i. . 

F2 = 126@6" ...vL.-i 

ZMf» j -^ '- ' ^ ,z^ 

I i • ^ ' 

\ \ 

; : ic • 

[•;•: / • •;:i;;:::fea:^;N::v<_ • :::;;| 

Rev4'_ 

• I . . . ts): . . V«t. ; *%. tr • : 046141 I 

DRIP ZONE EXCAVATED 

QUADRANTS EXCAVATED CONCRETE 

AREA REPLACED WITH AREA LEFT BARE AREA REPLACED WITH SOD ROCK/MULCH 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
Cy^yyQl/iM^r 

i-^ ,lllll l !^^ ofh \ ^ ^il 28923 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: JANICE L BALL • Good Site Sketch Address: 2530 N 19 SJ • Poor 

Phone W: : H P^^ot paint 1

Sample Number 

RYASCPXA-28923 Fl 

Lead 

Concentration 

ppm 

Sample 

Collected UkB 

D 

Samples Coiiected 

Firm: h^^ \ ftg| ^ 

Date: i 0-ta.- o c 

RYBSCPXA-28923 F2 ppm D Time: <q ­. <_n; 

RYCSCPXA-28923 Bl 

RYDSCPXA-28923 B2 

RDZSCPXA 28023 B2 

RGZCCPXA 28023 6Z 

RPZOCPXA aooaa—P Z 

113 

ppm 

ppm 

ppm 

ppm 

ppm 

[T 

(Z' 

D 

D 

D 

D 

D 

D 

D 

D 

Samples Analyzed 

XRF Unit: IQO l Book: jl^ 

Date: // ­ I H • O U 

Time: P m 

. 

Number of Samples = j ^ n Staff: M5U / 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

All quadrants are as vie>wed from th« street, facing property 

Rev 4 046141 UI23 
( ) li. •Il l 28923 

Exterior Paint North Arrow 

Owne Omaha Lead Site r Name: JANICE L BALL • Good Site Sitetch Address: 2530 N_19 ST • Poor 

Phone W: : H: 0^o t paint 1

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: A^iHifi-SLfi^ I 

RYASCPXA-28923 Fl ppm 0" D Date: iQ_ '^'<='<2> 

RYBSCPXA-28923 F2 ppm [T D Time: CK. Cjt^ 

RYCSCPXA-28923 Bl ppm n Samples Analyzed RYDSCPXA-28923 B2 I 1 3 ppm D RDZSCPXA 28023 BZ ppm D XRF Unit: /00 7 Book: J7 3 

RGZSCPXA 28023 SZ D

ppm D Date: // - JH O b 

RPZOCPXA 20020 P2 D

ppm n Time: Pnr, D 

Staff: M5U / Number of Samples = ] ^ 

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 4 046141 U123 
28923 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: JANICE L BALL 

Sit • Good e Sketch Address: 2530 N 19 ST • Poor Phone: H: W: 

Q^o t paint 1

Sample Number 

RyASCPXA-28923

RYBSCPXA-28923

RYCSCPXA-28923

RYDSCPXA-28923

RDZSCPXA 28023

nOZSCPXA 26023

 Fl 

 F2 

 B1 

 82 

 BZ 

 GZ 

RPZOCPXA aooao—p z 

Lead Sample LAB Concentration Collected 

ppm D 

52. ^ ppm [T D 

\ ^Z. ppm \zr D 

1 I' h ppm cr D 

ppm D D — ppm D D — ppm D D 

Number of Samples = {_^ 

Samples Collected 

Firm: As.wi| Qs\ t ^ 

Date: IO-IA-O C 

Time: g^-. C4 g 

Samples Analyzed 

XRF Unit: lOO l Book: J7 3 

Date: // • I H O b 

Time: pf n 

Staff: M.^tv^ 

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

All quadrants aia as viewed from the street, being property 

— I : — AWc 

I 

ENTERED 

./7;3. oe-T t 62006 

si 

.X^.^.Q N..y^..?.»-. 

-.-4-- ' 

-.1 

-vl ' FL 

2 4 ^ ; 52; ^ 

I 

I 

VOd\< 

Rcv 4 M -. ..VOt.-. ..*P».t 046141.0123 
COASTA l 

[HVtKONIIIHTAI 

c > 0 u r. IN 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: .W>;c«, "^ovVN Daytime Phone: Hogi. ^Ht.^l'J.CO 

Address of Property 

covered by this g^S^bO V3 \«^ -av 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 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 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 
^*^!^''** ^^. l 

COASTA L 

tiiriiiO)iH(Kr«L c no u r in c 

« Remove obstructions including boats, trailers, vehicles, playscape Items, wood 

piles, dog houses, etc; 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

ft Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

c 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 (402) 991-1199 

• ^ Q^^ant access to my properties D I do not grant access to my properties 

Sianature Date Signature Date 

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

Page 2 of 2 
v* 

COA S T A L • MVinONHEHTAL C • O U P , INC . 

Restoration Agreement 

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

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: r?$W7^3 

Property Address: as-sjc^ >o' t«H sv 

Owner: ^fl.^^. o ^^V \ 

Phone: HD^ . -S^vo. oy-toOL 

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

access location(s) to be used by the contractors. Indicate distances, depths, material 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, storage, disposal, and/or retum of these items is the Owner's responsibility. 

Item: 

f^iriM ^vr»nk\\ -rAa r^V<; \r> W <a/xv.*rl 

Item: 

item: 

Item: 

Item: 

P\«f>vA '\J\OVVNV*. \.cv VoW^Ji 

Item: ^ ^ 

Item: 

Item: 

Pagel of !> 
VS 

COASTA L • MVIROHHa N T A I. G • O U P . INC . 

Items to Be Removed By Contractor During Remediation and Reolaced 

Item: 

•SoiV i ^A 

Item: 

Item: 

Item: 

Landscape Inventory 

Item Quantity Unit ConditionH'ype/Species 

Pre-existing property area, V^L Quadrants that will be excavated, that 

is covered with grass. 

Number oftrees > 2 inch Each ?• trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter / 

Number of Sprinkler 

Zones, Control Valves, 

f Each Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Nimiber of and size of 

each garden/ flower bed Each 

area. Square Feet 

Attac / h a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 0 $ Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be N*. Each •^rt^ir^a '^e.V^Hs excavated 

Page 2 of T> 
VS 

COA S T A L • NVmONHB N TA L O • O U P . INC . 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

Q-Please check this box if you understand the information outlined above. H? 

__^ [S<^heck 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. 

©TUgree Q I do not agree 

-1? 

Owner''ss Signatur Signaturee Date Contractor ignature 

IQ.A-fe/t 

Date 

Page 3 of % 
BVID # Z^H2 ^ 

XRF PROPERTY SAMPLE SHEET 

2 5 3r:, /u ; <? s r 

am/pm 

30 sec 

Reading Sample area 

!^5 ± \^ ?t 

I27J: 1^ Depth 

Ii7 i t ^ (, " 

12^ — ^ ^ 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Date y/-^-l ( 

Project Omaha Lead ARRA 

XRF ID# -^ctoT.-/. 

Shot# 

^Z 

^3 

B ^ 

Average

Reading 

7^± l^ 

7 7 J: W 

^^i : 15 

^ 5 - ^ ^ ^/ 

Sample area 

BA 

Depth 

1 ^ 

Shot# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Address 

Sample time 

sample length 

Shot# 

^C 

S7 

U 

Average

Shot# 

Average 

Shot# 

Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Signature_ a y 

Average 

Print BDWkR O KiA^6 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 85.357 

Supervised By : Agr

Certificate of Verification 

55 

Soil 

2011-11-09 12:25 

90.44 

ppm 

2 

Final 

Avg of 52-54 

2530 n 19 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± 

 y . 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpil<e 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 79.930 

Supervised By: 

Certificate of Verification 

52 

Soil 

2011-11-09 12:23 

30.11 

ppm 

2 

Final 

28923 

2530 n 19 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 14.660 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 53 

Mode Soil 

Time 2011-11-09 12:24 

Duration 30.16 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

BVID 28923 

ADDRESS 2530 n 19 st 

QUADRANT EA 

DEPHT 1" 

XRF TECH KING 

MISC EX-SITUS 

NOTE confirmation 

ppm ± Error 

Pb 77.906 ± 14.486 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 98.234 

Supervised By: 

Certificate of Verification 

54 

Soil 

2011-11-09 12:25 

30.17 

ppm 

2 

Final 

28923 

2530 n 19 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 15.762 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 59 

Mode Soil 

Time 2011-11-09 12:27 

Duration 90.54 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

AVERAGE Avg of 56-58 

ADDRESS 2530 n 19 st 

QUADRANT F2 

DEPHT 6" 

XRF TECH KING 

MISC confirmation 

NOTE confirmation 

ppm ± Error 

Pb 126.701 ± 18.326 

Supervised By: ty—y^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 135.286 

Supervised By: 

Certificate of Verification 

56 

Soil 

2011-11-09 12:26 

30.22 

ppm 

2 

Final 

28923 

2530 n 19 st 

F2 

6-

KING 

confirmation 

confirmation 

± Error 

± 18.578 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 127.262 

Supervised By: 

Certificate of Verification 

57 

Soil 

2011-11-09 12:27 

30.16 

ppm 

2 

Final 

28923 

2530 n 19 st 

F2 

6" 

KING 

confirmation 

confirmation 

± Error 

± 18.316 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 117.555 

Supervised By: 

Certificate of Verification 

58 

Soil 

2011-11-09 12:27 

30.16 

ppm 

2 

Final 

28923 

2530 n 19 st 

F2 

6" 

KING 

confirmation 

confirmation 

± Error 

18.085 
iyjQL\ Omaha Lead Site—Fixed Price EP-R7-09-06 

I ^^^ ^ I Coastal Environmental Group Inc. 

T^^*~r p www.coastalhazmat.com 

COASTA L ENVIIONMENTAL 

S t o U P. IN C 

EXECUTIVE SUMMARY: 

BVID #28923- (2530 N 19 ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
COASTAL 

Property Completion Agreement 

This agreement documents the completion ofremedial activities performed on my property. My signature will 

designate that I am satisfied with therestoration of my property, and that no items are in question, now or at any 

time in the future, except those items listed below, ifany 

PropertylD: Z^l ^ , 

PropertyAddress: Z5J 0 JU I f <>i~ 

Owner: c)o^AVc e 6o>\\ 

Phone: r'-io2.) -yHr. ^7^07 ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I agree restoration in completed, except as noted 

LJ I do not agree restoration is completed 

OdJi il''"'' n-iH-i\ 

}wner's Signature Date 
^ 1 

EPA Property' Close Out Form 

Propert Z3Jo /J n sT y tl: 

Diitc/Tirae: Property Address:' -=V^ ; ^ - " " 

Qusdi Excavaled: mt Con(r8c«o Owner's Name:./,-. r Croup . JjoVrS . C. « Ck $ yo ^ 

 vjft^^ 

LxccvBtloD Vf* No General 

1. If necessary, ^'cre the correct qtiadr?nt(s) excavated and restored? 

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

Grading Sod and Ve^cUtk>ii YM NO 

Docs the grading around the perimeter oflhe bouse in e xcavaierl areas generally slope away 

from tbe house? 

2. Has sod been laid in all areas that were cjicavated? y 

i Does the sod appear lo be eenerally healthy and growing? (Only evaluate if insprrird at n 30 / day time period) 

4. Are sodded areas generally firm and evenly graded? yy..._ 5 Are the joints between the sod strips generally tight? (Only evaluate if inspected at i 3f) day 

time period) 

y-\ 6. Was th* propeny graded such thai waier will not pool on the property'' 

A.y.. 7.

 Was damige to landscaping or plant materials avoided? 

\ / 

r 

Gates. Fences Bad RcUtnlng Walls V « N(i 

n— • Do gates open and close freely? (Ifapplicable) 

2. Were all gates or fences taken down during restoration aciiviiies reinsulled? (II applicable) 

/ ZA 

.1. Was damage to gates or fences avoided? (Ifapplicable) y 1. Was damage to retaining walls avoided? (Ifapplicable) 

/ 

Foundaiion, SidiBKind GnUtrs 

Ves, No 

1. Was damage to the siding or trim avoided? 

r 

2. Was damage to the foundation avoided? 

Was damage lo windows avoided? 

VI 

4 WB.S damage to windows or door screens avoided? 

L 

/ 

Was damage lo down.spouis oi down.spoui extensions avoided? 

Sidewalks and Driveways (Concrete) 

Vci No 

1. Was damage to driveway surfaces avoided? 7­

- / 2. Was damage lo v^alkway surfaces avoided? 
OM-ners commenls: 

Fn.iipection no<fs: 

Removal and re.sloration aclivale.s complele including the 30-daY sod warranry: 

HPA Rcpresentaiive Q ^ J ^ Dale: i\\**^*^ 
@ 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2011 

Remediation Contractor: COASTAL Environmental Group - EP-R7-09-06 

Property Identifier Number: 2..^? Z- 3 

PropertyAddress: . 2.5 'JO M I H i T 

Property Owner's Name: Oo-AJcg Q>CK\\ 

(Above information to hie tilled out by the remediation contractor prior to utilization by the EPA COR) 

Instructions to the Propertv Owner; 

This form serves to record the Property Owner's assessment of perfonnance (Incentive 1- Quality 

Assurance Surveillance Plan) involving the listed remediation contractor, as applicable to the Omaha 

Lead Site. This form documents the timeliness of punch Ust resolution, business relations, complaint 

resolution and the overall quality of work. If need be, the Property Owner may utilize this form to record 

problems and/or issues not specifically tied to an assigned address, for example, business relations that 

generally don't follow guidelines set forth in the Performance Work Statement. 

The Property Owner will indicate his/her assessment of performance with the contractor's work 

by checking a numerical rating on the table below using the numerical definitionsfix)m the rating scale 

below, the sign & date the form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property Owner's Assessment of Performance Regarding the Contractor's Work 

10 -C l 5 

9 4 

8 3 

7 2 

6 • 1 

Additional Comments from EPA COR(optional; continue on back page if needed) 

Property Owner Signat U))AAUZ n,.„. Z-/^'%Oll