% 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 9;^\\5 Date: ?>j\\\7l^\ 0 

Address: '^K'^Q ?>. 'Bf^ 9 A 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ ' Video of property (DVD) 

J?f Executive Summary 

0^ EPA-provided property sketch 

yd^ Signed Access Agreement for subject property 

Y^ Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

J^ Confirmation data 

^ Photographs pf<^.-ev.. fbryj pVrkrfN, e-Vr 

pt' As-built sketch 

JZ Satisfactory restoration signed by Property Owner 

j ^ Property close-out check list signed by EPA 

^ Description of areas not meeting ROD cleanup criteria 

^ Utility clearances 

 Property information from Douglas County Assessor's Office 

CJ 

D 

• 

4^4m^ ZOI O 

signature 4)at ^ e 

30055256 iiymii 

Superfund 

0
« « 

Property Access Checklist 

Property ID; lti\ 5 " n WORK STARTED ON: __/__/_ 

Property Addm»; 9(ip ^ 2.Q~5T D WORK COMPELTED ON: __/__/_ 

Owner Renten 

Addrcu: Phone: 

5S\3 S J86r 5^- Fax: 

Cell/Pagen kAiSSL 

Phone: Of^^l{[m ^ Additioaal Information: 

Fax: 

Cell/PageR C^^^i^' ^•|'^\e>t3 

D Notification Letter Sent: / / By: 

^ Access Agreement Signed: iii/\^0 ^ By: 

^ Restoration Agreement Signed: AQ/iS ^ By: 

D Topsoil Sampling (If applicable) / / By: 

D Disposal Samplhig (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

1 ^ Utility Clearance CaIlcd:)IL/lU/(2a By:lS)2n/0 q 

{B^Ideo/Photos (Before) On:i£./iZ/_ol By: OC^i4i,ra//hya>u 

a Video/Photos (Daring) On: / / By: 

l a Video/Photos (After) On: / / By: 

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

D Property Completion Agreemoit Signed: / / By: 

D Final Report Issued: / / By: 

Air Monitorlne (as apDlicable] 

I n Community O Crew On: / / By: 

Results: 

D Community QCrew On: / / By: 

RCSDHS: 

G Community Q Crew On: / / By: 

Results: 

Omaha Lead Site 

1 
Douglas County Account Inf< Page 1 of3 

' ^ ^ % • 

Douglas County, Nebraska Property Record - R2320790000 

Print Report 

NEW FAatura - Parml Dimonsions avnilablfi ffl) scale 0-50 ft west of 52nd St - Vle W OH Ma p Information is valid as of 2009-9-29 Treasurer's Tax Report 

New Feature ->-•- » Auto Sales Search 

Owne r 

PEPEK WALLY 

ETAL 

5515 S 185 ST 

OMAHA NE 68135-0000 

Property Informatio n 

Key Number: 2079 OOOO 23 

Account Type: Residential 

Parcel Number: 2320790000 

Parcel Address: 832 S 29 ST 

OMAHA NE 68105-0000 

Legal Description: TERRACE ADD LOT 29 BLOCK 0 N 40 FT 40 X 140 

Value Informatio n 

Land Improvement Total 

2009 $6,000.00 $81,600.00 $87,600.00 

2008 $6,000.00 $81,600.00 $87,600.00 

2007 $6,000.00 $81,600.00 $87,600.00 

2006 $6,000.00 $78,300.00 $84,300.00 

2005 $6,000.00 $78,300.00 $84,300.00 

2004 $6,000.00 $78,300.00 $84,300.00 

Sales Informatio n 

Sales Date: 2004-03-26 

Deed Type: WD Book: 2004 Page: 040327 

Price: $37,000.00 

Grantor: CITIFINANCIAL MORTGAGE 

Grantee: WALLY PEPEK ETAL 

Valid/Invalid: Invalid 

Exclusion Reason: 

Sales Date: 2003-08-07 

Deed Type: WD Book: 2003 Page: 188136 

Price: $0.00 

Grantor: Philip M Kleinsmith 

1 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/13/2009 
• • 

Douglas County Account Infoi^non Page 2 of3 

Grantee: CItifinanclal Mortgage Comp. 

Valid/Invalid: Invalid 

Exclusion Reason: ' Foreclosure 

Sales Date: 1998-02-24 

Deed Type: Book: 2083 Page: ] 403 

Price: $48,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5600.0 1.0 140.0 40.0 No 

Improvemen t Informatio n 

Building 1 

, TDO t 

\nu 

i 

nsaiM P: 

•tz T T 

|><r UW 9ttiMftatt 

UOMK •" ; 

1 1/2 STORY FINISHED 

CLICK TO ENLARGE IMAGE CLjCKXCLEilLARGE IMAGE 

Square Footage: 1921.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: 1 Average 

Unit Type: Condition: Fair 

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

HVAC: Forced Air Rooms: 9.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: I 2.0 

Roof Cover: Composition Shingle Bedrooms: ! 4.0 

Roof Type: Gable Stories: i 1.5 

Floorcover: Allowance Foundation: i Block 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfor;sp?accountno=R2... 10/13/2009 
Douglas County Account Infi Page 3 of3 

^ ^ ^ % # 

Sprinkler Square Footage: 0.0 

Year Built 

1885 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

Year 

Remodeled 

0 

Percenf 

Remodeled 

0% 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Additional Fixtures 

Base Fixtures 

Bath Full 

Detached 

End Screen 

Slab Roof Ceil 

Slab Roof Ceil 

Adjusted Year Physical Age Built 

1885 122 

Units 

1.0 

1083.0 

1.0 

1.0 

2.0 

216.0 

80.0 

132.0 

80.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/13/2009 
u • • 

Property ID #

Property 

Address; 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 l-^W ^ 

^?{l %.^'^^ \ 

 Date: Time: Action: 

 Date: Time: Action:_ 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
Page I of2 

# # 

"> 

[; Create Another Ticket I , Back to Irth Internet . ] j[: SendEmajl ] 

• YOUR TICKET NUMBER IS 2387923. 

Original Call Date: 10/16/09 Time: 10:55 am Op: ELIZABETH18790 


Work to Begin Date: 10/20/09 Time: 11:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 832 Street: S 29TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-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: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 PAETEC QLNNEIC 


UtiUty Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, ^^j^j 

Alt: 4029340469 INC 

Emerg: 4029329757 

Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 

CITY OF OMAHA- OMAHACOF RICH/TRAFFIC Alt: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/16/2009 
Page 2 of2 

OPPDGPR5 °TM^"^^^^^°^ ^ NA 

NO NEED TO CALL OUT PAETEC PAETEC COMMUNICATIONS EMERGENCY 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/16/2009 
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Page 1 of2 

# 

Create Another Ticket Back to Irth Internet^^l Send Email 

• YOUR TICKET NUMBER IS 2397992. 

Original Call Date: 11/02/09 Time: 11:05 am Op: ELIZABETH18790 


Work to Begin Date: 11/04/09 Time: 11:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 832 Street: S 2 9TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-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: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 TEC QLNNEIC 

Service Area Contact Phone Number UtiUty 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, ^ ^ 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2009 
Page 2 of2 

# 

OPPDGPR5 g^TM'''^'''^ ^ NA 

NO NEED TO CALL OUT PAETEC PAETEC COMMUNICATIONS EMERGENCY 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /2/2009 
remote ID: R page of 

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> 0 —44 X —0223 . 
OLS#: 22115 As-Built Drawing A Date Excavated: 11/3/09 

Date USEPA Signed Off: 3/4/10 

COASTA L Omaha Lead Superfund Site Area Sodden: 2601 sq ft 

22115 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch • Good 

ErPoor 

Sampling Address: 832 S 29 ST Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm TVlMr. PBT ^ 

RYASCPXA-22115

RYBSCPXA-22115

RYG6CPXA22116

RYDSCPXA-22115

RDZSCPXA-22115

 Fl 

 F2 

 B4 

 B2 

 DZ 

.^ (.2.. 

ppm 

ppm 

ppm 

ppm 

ppm I 

D 

D 

D 

D 

D 

Date L>||/c,1 

Samples Analyzed 

XRF Unit: IO&IMI . Book 2 M 1 

RGZSCPXA-22115

RPZOCPXA-ag-IIS

 GZ 

 PE­

_I9iilS_ ppm 

ppm 

D 

D 

Date 

Time 

-7-0 /

tt ^ 

 09 

Number of Samples = | 5 | [ O | Staff: jnsi ^ 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play Al quadrants are as viewed from tlw sii«el. facing property & • , — u 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area left bare 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc, 
i)--/4 IV-W-^ # 

22115 

Omaha Exterior Paint North Arrow Lead Site 

Site • Good Sketch 

G / Poor 

Sampling Address: 832 S 29 ST [~| Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm 

RYASCPXA-22115 Fl U2. S* ppm D Date 

RY@SCPXA-22115 P2 W^l - ppm D Time 

I PHbPh 

RYG8CPXA-22115 B4- ~ ppm D 

Samples Analyzed RYDSCPXA-22115^_ B2 D 

RDZSCPXA^22116__ OZ D XRF Unit: (06(^1 , Book: ZW 

RGZSCPXA-22115 GZ _iaiUS_ppm D Date 7-0 / •'yR 

RnZGCnXA-22115 PZ- — ppm D D Time tcsa- Staff: m.^U) Number of Samples = | 5 j | O 

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

All quadrants are as viewed from the street, facing property A i , e-v/ 

ENTEIRED 

^ 

« - i 

CO 7^-^-^300 :[\\o'\ 

RevZOOR Cr«t«l: l»Frb-00 ' 04J701.01.r) 

t:pf,\yK(>^tvH|tv\uUw 
"

• • 

T -^V^,-r 

ll \ph 

22115 

Omaha Exterior Paint North Arrow Lead Site • Good Site Sketch 

C/Poor 

Sampling Address: 832 S 29 ST n Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm 

RYASCPXA-22115''I loZ 5~ ppm D 

Date 

RYBSCPXA-22115 F2 _LliLl_PPm D Time 

nYGSCPXA 22116 B4- •" ppm D 

Samples Analyzed 

RYDSCPXA-22115 B2 3_£fl2_PPm D 

RDZSCPXA-22115 DZ 

21 1 CP ppm D XRF Unit: |Q6(g7, Book: Z H 1 

RGZSCPXA-22115 GZ lOlH e ppm D Date -7-Q/ 09 

RPZOCnXA-22115 PZ- - " ppm a D Time at>x. 

Numbe Staff: pg^tJ r of Samples = | S | 

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

All quadrants are as viewed from the street, facing property A. . «rv/ 

^ •—• " ^'^^5/;Dfe: 

Cf()VAOiV\il](v\uvly\ 
22115 

Omaha Lead Site 

Site Sl(etch 

Exterior Paint 

• Good 

[JPoor 

North Airaw 

Sampling Address: 632829 ST Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Fim:VfX»r. DBTA 

RYASCPXA-22115

RYBSCPXA-22115

 F1 

F2 _ppm 

D 

D 

Pate: taf|/oi 

Time: ililli^cL 

nYOCGPXA flails—etRYDSCPXA-22115 B2 

.ppm 

.ppm 

D 

D Samples Analyzed 

RDZSCPXA-22115 DZ 2Zlif .ppm D XRF Unit: loeia t Book: ZH \ 

RGZSCPXA.22115 GZ .ppm D Date: l-O / -OR 

RrgOOPXA-gflllB PZ­ .ppm D "nme:__fleb 

Number of Samples = \ S I | o | Staff m^t:) 

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

Al quadrants arree aass viewed from the sireel, facing property Ai i v> /

ItcYjOW aaM : It-Fcb-W 

szscc 
P ^ ^ 

ms' .•^^"""*, 

COASTA l INVIItONnlhTA I 

CROU P IN C 

Consent for Access To PFopeftj/ 

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: ^W^^\\^\) Tepe\ L v:y).vvid^ 

Address of Property 

covered by this 

Agreement: 

t) S. lo\SH 

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 perfomied, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration viorV. 

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 vmtten 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 worii. This access shall 

remain in effect until the worit has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
• • en» 

^-rr^r^^' J COfeSTAl IHVINONH^KTA l 

"-.PBO^* ^ C « O U r ID C 

t 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; 

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

necessary subsequent to an initial watering period by EPA; 

t 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 

grant access to my properties

 Q i do not grant access to my properties ^4^' 

(MJd/A- ^-^^Z /(^'i^~o9 

Signature / Date Signature Date 

Q

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

Page 2 of2 
•• o 

^^'-^ . 

COASTAl . 

RestoratSon Agreemsnt 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe properly 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: 2/I.V \ ^ 

Property Address: <^2^2. ^ . 2 Q f=A 

[^°e: q2^^. ^y ^(^ -J>^'^ye; S^^'S^C^l 

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, 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 lemoval. storage, disposal, and/or return of these items is the Owner's responsibility. 

item: 

P\>o>vv Sm a W (^Nan-V^ VfN Vie, Scw^A 

item: 

Item: 

item: 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Item: 

P^m ^mc^Al pbnu K-f behind 

Item: 

M. item: 

Item: 

Page 1 of y 
• • # • 

'H-.. '^^(L 

COASTA L 

C h (> IJ r lo t 

Items to Be Removed By Contractor During RemediationjrKf Regjaced_ 

Item: 

SO\L r.^As>{Vl t F> • F-L • P^ -V P.> 

ttsm: 

Item: 

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 '^rinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aliat h ;i skiMcli ul lilt' 

••pr'i'klcr li>\;nii 

Number of and size of 

each garden/ flower bed 

area. 

AlliR-h ;i ski-'lclt 1)1 r<.-!;\Iivf 

M^'i'S mid locjiii'M". 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\ol f l!ii' \HIIIC V\(II hi 

i;5f'i.' 10 liiu i .1 <-,U\n'i 

voiu-'iH'; Ki tilt i:-rci|Kri\ 

UM lUT. 

Easement Area, to be 

excavated 

Quantity 

X 

^ 

r 

^ 

^ 

r 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

S 

?-

Each 

Condition/Type/Species 

Page 2 of. 
1 

• • # • 

"'..-/.Ii 

C O A S 1 A L 

I Additional Comments / Instructions: 

fefr "P ^vY h \ ^f^'''- >^ ^ 

i. 

• Check the box rf 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. 

t I agree [D I do not agree 

a 

Owner's Signnure Date Contractor's Signature Date 

Page 3 of. 
# 

I 

o 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # 17^ H T 

Property Address /J Z ^ £.f // ~ 

Owner Name / A rr y 

Date //y^/ 

Comments , 

Owner Signature U)fy^/^ ^^^ ^ 

Contractor Signature C^ CO-ccfiji.q^^ 
% 

BVID #jz:2j_L5 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRFID# 

Shot# 

r ^ l 

Average

Shol# 

.^^O . 

li sa. S2. S ^ 

Average

Shot# 

:sz 

a 

SH 

Average

Shot# 

Average 

lab sample # 

\\-'>y-D^ Address JP^A <5 a*? sj - Omaha lead FP 2ncl year option Sample time am/pm 

^ ^ ^ sample length 30 sec 

Reading Sample area Shol# Reading Sample area 

r»V^ PI T73 p.2­ no ± /u ^HH Depth MUS Depth ­ m ^ /^ -^U^A- ri2. rbi(^ 7 ^ 

 l^S^'t. / ^ Average 5?S J^ (S " 

Reading Sample area Shot# Reading Sample area 

<^5g> 5/f ^^^ - m D2­ ^.lA /»'=;•?- AAL 

it-.A :i:<^ Depth ^3 ^ :fe ^3 , Depth 

^( r h7J> JIM. ^ ^ fc^^ JJL . 

^ 0 (j? ^ / ^ Average 3(^ 7 " ^ JSi'^ 

Reading Sampl ^amp e area Shot# Reading Sample area l 

^(24. ^Y ^ IP Dn ii^uxx\ /.s.? ^r?^ - ^^f I c /3s 

W -h-iifl Depth ^ ^ -h.fCl Depth 

c<n? ^Hf» ISL 5 ^ Uuo^^il-' 1 3 " 

1 5 0 ^/S " Average ^ S d: 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

Signature ^C0iemLh 

Print FX^gyM ^ C(MO^Q^ 
/^fiLr \ Omaha Lead Site—Fixed Price EP-R7-07-05 

8 ^^^ ^ o Coastal Environmental Group Inc. 

V^*^ ^ www.coa8taihazmat.com 

^pnott' ^ COASTA L HtVIIOMHINTAl 

G lO U r, IN C 

EXECUTIVE SUMMARY: 

BVID #22115-(832 S 29 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-DAN BAHNKE WALKED THE PROPERTY AND SIGN OFF ON IT 3/4/10 
# 

EPA Property Close Out Form 

Property #: Xt'WS. . Property Addmr. 

DataTlme: Owner's Name: /J 

^^^ -^i^ 

Q«iid« Excavattd; ^ | ^ p?. ^ iX/^ f Z. Contractor Croup^OQ ^ 

ExcBvatloD Genenil Yw N 

If necessary, were the correct quadiantfs) excavated and restored? IT! 

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

Gradlpg Sod and Veitetalton Yes Mo 

I Does (he gndtng around (he perimeter ofthe house in excavated areas generally slope away 

from the house? 

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

i. Does the sod appear to be generally healthy and growing^ (Only evalifete if inspected at a 30 

day time period) ^AlOkr ^ CjiTl^ey^M^ yiy9d /Pl/Si ^ 

4. Are sodded areas generally firm and evenly graded? 

5 Are the joints l>e(ween the sod strips generally tight? (Only evaluate if inspected at a 30 day 

^ time period) 

r 6. Was the property graded such (hat water will not pool on the propeny 

r- 7. Was damage to landscaping or plant materials avoided? J 

Gates. Fencea and Rcutnlng Walls Vcs Nil 

' Do gates open and close freely? (If applicable) 

2 Were all gates or fences taken down during restoration activities reinsulled? (Ifapplicablcl 

.1 Was damage to gates or fences avoided? f If applicable) 

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

Foundation, SidiBRand GnUers Yes Nc 

( Was damage to the siding or trim avoided? 

2. Was damage tn the foundation avoided? 

?. Was damage lo windows avoided? 

h 4 Was damage to windows or door screens avoided? I/' 

Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrele) Vcs No 

I 1 Was damage to driveway surfaces avoided? 

2, Was damage lo walkway surfaces avoided? 
OM'ncrs commenits: 

Firtstr>ection notes: 

/]/)\jt;l^C^ /?ne^ ^ /2< ^ /^ ^ 

Removal and rcsioration activates complele including the 30-day sod warranry: 

EPA Representative l^_ ) QV^ [ j f^fl/r[/(/-^ Date:3/^/<30/[) 
Property Completion Agreement 

riiis agreement documents the completion of remedial acliviiies perroiiTied on my properly My signature 

will designate Ihal I am saltsfied with the rctloralion of my propeiiy, and Ihal no Hems are in queslions. 

now, or at any lime in the future, except those ilems listed below, if any 

Property ID: O '9 i I CT" 

Property Address: (^2, ^ S ) 2 ^ ^ ^ 

o-"^'=\AlaUn PftOftK 

Phone: QC^L^^MlUtf), 

Restoration Items in Question: 

ritem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

rn J agree icxtoralion is completed, except as noted 

[_J I rio not agree restoration is completed 

P'O W^//Q (^COM^ 3^k\i ILQ. Contrartor's Signature Dale