TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Date: 

Address: dAJ! M U W 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE 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 

Restoration Agreement 

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

Confirmation data 

Photographs ife {p^f^\( ^ \ \yC^P(^^\^ \^0' ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clea 

iationfrom Douglas County Assessor's Office 

30218466 

Superfund 
^v 

Property Access Checklist 

Property ID: 23&n D WORK STARTED 

ON: / /

Property Addriss: 25Jf l Mapfo^^ l D WORKCOMPELTED ON: I I 

Owner: Renter: Fnv/e?. €/ /^ajj(3t 

Address: Phone: 

Fax: 

Ceil/Pager: 

Phone: Zj(!jft^Q|^^ Additional Information: 

Fax: 

Ceil/Pager: iUdf. Sift«i{^J-7 

D Notification Letter Sent: / / By: 

ffi^ Access Agreement Signed: i/ti/l Q By: 

D Restoration Agreement Siened: I I By: 

D Topsoil Sampling (if applicable) 1 1 By: 

D Disposal Sampling (if applicable) 1 1 By: 

D Garden Sampling (if appUcable) 1 1 By: 

E . UtiUty Clearance CaUed: CM/V3k AO ®y=ou/i:S/io ix)cr\dyj 

H ' Video/Photos (Before) On: *l/J > Id 

^y- f^cXx^i^ 

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

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

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

n Property Completion Agreement Si&ned: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as appUcable) 

f~| Commuiuty Q Crew On: / / By: 1 

Results: 

n Commuiuty [U Crew On: / / By: 

Results: 

• Community O Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account In mi^^n Page 1 of2 

Douglas County, Nebraska Property Record - R2003450000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie @ scale 0-50 ft west of 52nd St - VJOW O n Ma p Infonnation is valid as of 2009-12-15 Treasurer's Tax Report 

New Feature -•••- » Auto Sales Search 

Owner 

EL-HAJJAR FAYEZ 

ETAL 

11718 MEREDITH AVE 

OMAHA NE 68164-0000 

Property Informatio n 

Key Number: 0345 0000 20 

Account Type: Residential 

Parcel Number: 2003450000 

Parcel Address: 2518 MAPLE ST 

OMAHA NE 68111-0000 

Legal Description: PATRICKS -A S- ADD LOT 5 BLOCK 8 W 30 FT 30 X 120 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$1,900.00 

$1,900.00 

$1,900.00 

$1,900.00 

$1,900.00 

$1,900.00 

Improvement 

$15,900.00 

$17,400.00 

$17,400.00 

$17,400.00 

$17,400.00 

$9,200.00 

Total 

$17,800.00 

$19,300.00 

$19,300.00 

$19,300.00 

$19,300.00 

$11,100.00 

Sales Informatio n 

Sales Date: 2003-09-25 

Deed Type: 

Price: 

Grantor: 

WD Book: 

$20,000.00 

JAMES HOLMON ETAL 

2003 Page: 196660 

Grantee: FAVEZ EL-HAJJAR ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.08 

SF 

3600.0 

Units 

1.0 

Depth 

120.0 

Width 

30.0 

Vacant 

No 

Improvemen t Informatio n 

http ://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo.j sp?accountno=R2... 12/31 /2009 
Douglas County Account In te|7|^)n Page 2 of2 

Building 1 

cjr m•© I JO 

2518 Maple 

MD li t 

iaTSil9q.R. 

RANCH ed*ffBM£»'fln fDID3«Pl 

i

HIT 140 

J&­ "in m 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1075.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Unfin 

HVAC: Central Air to Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Built Year 

Remodeled 

Percent 

Remodeled 

1885 0% 

Percent Complete: 100.0% 

Quality: Average 

Condition: Fair 

Condo Square Footage: 0.0 

Rooms: 5.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 2.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year 

Built Physical Age 

1885 125 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Slab Roof Ceiling 

Units 

1.0 

901.0 

1.0 

1.0 

172.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 12/31/2009 
Page 1 of 1 

# • 

•fiw^' '^'\^r^ 

Create Another Ticket Back to Irth Intemet I Send Email ] ][ 

YOUR TICKET NUMBER IS 2475434. 

Original Call Date: 4/26/10 Time: 3:27 pm Op: ELIZABETH18790 


Work to Begin Date: 4/28/10 Time: 4:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2518 Street: MAPLE ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-NE-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


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


Emerg: 4024445160 


Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/26/2010 
As-Built Drawing 

C OASTA L ENVIKONHENTAL Omaha Lead Superfund Site C K O U P , IN C 

OLS#: 29827 

Date Excavated: 4/28/2010 

Date USEPA Signed Off: 6/10/2010 

29827 Area Sodden: 2925 so ft 

Exterior Paint North Arrow 

Owne Qmaha Lead Site r Name:FAYEZ^UHAJjAR 

Site Sketch • Good Address: 2518MAPI£ ST • Poor Ptione: H 402-49M111 W: \ Q^ Not paint 

Sample Number Lead Sample j^ ^ Samples Collected 

Ckmcentration Collected ^ ^ Fimi:Pt.A \RS\CJ O 

RYASCPXA-29827 F1 

Date: OS - .aS-et . 

RYBSCPXA-29827 F2 '•J30 ppm 0 - n 

Time: \2.: I'^r ^ 

RYCSCPXA-29827 B1 3(y?, ppm E f • 

Samples Analyzed 

RYDSCPXA-29827 B2 S'?g ppm 0- n 

RDZSCPXA-29827 DZ S>IO ppm 0 ' • 

XRF Unit 90Z . Book; ItiLj 

RGZSCPXA 20827 6 2 ppm D D Date: Lc-S-OCr, 

RPZSCPXA 38827 P2- ppm D D 

Time: An 

Staff: Number of Samples = J Kr^w^ 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from ir\e street, facing property 

Legend 


D 

Concrete Drip Zone Excavated Quadrants Excavated 

tt/?;

Area replaced with Area replaced with 


Area left bare 
 Sod Rock/Mulch 


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

i e A^^ ^ /^«3K^ /c^ ^s"^ . /-iX. !4 ^ 29827 

Exterior Paint North Arrow Owne Omaha Load Site r Name: FAYEZ EL-HAJJAR 

Site • Good Address:.25i Sketch 8 MAPLE ST • Poor Phone: H: 402-498-8111 W: \

o f Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm 

RYASCPXA-29827 Fl ^3 Z ppm D Dale 

RYBSCPXA-29827 F2 ^3 6 ppm Time 

RYCSCPXA-29827 Bl a 3Qf i ppm D Samples Analyzed RYOSC^XA-29827 B2 -_53fi ppm 

RD2SCf5(A-29827 DZ D g/C> ppm izr XRF Unit; 90 Z Book: /QQ < RCZSCP.XA 20827 S * D ppm D Date: L - 5 - OCg RPZSCPXA 26827 F* D ppm D Time: Af ^ D 

f Staff: f^r^ W Number of Samples = 5" 

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

All quadrants are as viewed from tlie street, facing property 3 irpm the s 

^)k--y 
29827 

Exterio North Arrow Omaha r Paint Lead Site Owne r Name : FAYEZ EL-H-V_JAR. 

Site • Good Sl<etch Address : 2518 MAPLE ST 

• Poor 

Phone : H: 402-498-8111 W: \ (3^ Not paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm 

RYASCPXA-29827 F1 ^ 3 1 ppm D Date 

O S - nS~OL 

RYBSCPXA-29827 F2 ^3D ppm [T D Time 

RYCSCPXA-29827 B1 

3aP> ppm 

D 

Samples Analyzed RYDSCPXA-29827 82 

0' S?/? ppm D 

RDZSCPXA-29827 DZ ET 

^ J O ppm D XRF Unit: 902 , Book: lCiU_ < RGZSCPXA 20827 G i ppm D D Date: U - 5 _QL 

RPZSCPXA-2e827 PZ- ppm D D 

Time: A^ \ 

Staff: Krsu / Number of Samples = 5 

Legend: F1 = 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 

ENTERED 

\ 

^ 

CA 

Rev 

046141 Df23 
29827 

Exterior Paint NofthAiTow 1 Owner Name: FAYEZ EL-HAJJAR Omaha Lead Site 

Q Good Addre88:25i8iWAPLEST Site Sketch • Poor 

Phone: H: 402-498-8111 W: 

o f Not paint 1

Sannple Number Lead Sample Samples Collected LAB Concentration Collected Firm:yfrft\ftS\Ch? RYASCPXA-29827 Fl ppm Q­ D Date: OS-^S-o c 

RYBSCPXA-29827 F2 H 3 0 ppm [T 

a Time: i^lj.S<3L£a. RYCSCPXA-29827 B1 3Qa _ ppm ET 

RYDSCPXA-2982 Samples Analyzed 7 82 S i g ppm 

D

RDZSCPXA-29827 DZ B I O D

 ppm Ef XRF Unit ^O Z Book: IQU 

nCZCCPXA 20827 62 ppm D D Date: (fl-g-QCa 

RPZSrPYA i?9fl?7 PZ- ppm D D 

Time: A h D Staff: h\^\ y Number of Samples = \ 5" 

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

AU quadrants am as viewed from the street, fadng propeity 

ENTERED 

e 

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3oe 6<!6 

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ti 

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COASTA l fNVlROHKIRTAt 

c • D b r . t K 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: "^nzi 

Owner's Name: Coi^e.'L - ^ i fyiu 14/^ Daytime Phone: Y* ^ yff^ni 

P f 

Address of Property 

covered by this 26/a M^ ^ 5 T 

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 perfomied 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 perfomned, 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 perfomning the work. This access shall 

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

agrees to: 

Page 1 of 2 
c

V '^j f COASTAl •t'^

 ,rfC lUTIIIOHHtlcTAl 

^« PRO'^ C « 0 U r I K 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; 

c 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 perfonn the work. 

o 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 

BigI gran r 

t access to my properties D I do not grant access to my properties 

-r,2 / i /t? 

Date Signature Date 

D

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

Page 2 of 2 
^lO- ^ ZO[^lJ l 

COASTA L 

ENVIRONMENTAL 

GROUP . INC . 

ADJACENT PROPERTY ACCESS REQUEST 

WORKING PROPERTyADDRESS ol6\S KiWOiC. ^ 

ADJACENT PROPERTY ADDRESS Q.^99^ \<ACiS)\P ^ 

OWNER NAME f^y/^.n V>V\\rVS ^^ ^ 

ACCESS REQUESTED: 

OWNER SIGNATURE 

FOREMAN SIGNATURE 

SUPERVISOR INITIAL 
COASTA L 

Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: 7^^$ 2-7 

Property Address; *^2^/ € Li4i9^^'^^ ' 

Owner: fy^-^z^ S L M>y.^. ^y^^r^ ^mfu ^ 

Phone: If^^ <f9Si/U i=^-rs yer ^ 

On the attached diagram(s) indicate aFea(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 removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

ijMe. Item: 

Kem: 

Hem: 

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

Hem: 

M\yrn^ 

Kem: 

Kem: 

Item: 

Page 1 of. 3 
C O A S T A L • NVmONMBNTA L a R O U P . INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: 

^Oil t So!) 

Kem: 

f<W\<^^ 

Kem: 

Kem: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

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. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

y (lcJ^\3\/C 

Landscape Inventory 

Quantity Unit Conditlon/Type/Specles 

Quadrants 

iyi^\^ ^ 

3 Each 

s F,ach 

Each ^llv 

(51 Each 

Square Feet 

$ 

^ 

Easement Area, to be Each excavated ^&.s AUVI ^ Q-^ M 

Page 2 .rf" ^ 
C O A S T A L • MViaONMINTAI . o II o u r , INC . 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibK 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 underiying 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 wKhstanding 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 cKy of Omaha's Planning Department at (402) 444-5150. 

0PlPleas < e check this box if you understand the information outlined above. 

GAI I Z-'tC. Pf>iL ^^^-^^wWt 

Check 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. 

M I agree D I do not agree 

'^'^p^-t- JtC -^^gAU, 

Owner'sSignature Date Contractor's Signature Date 

Page 3 of 
BVID# r^S9-l-' 

XRF PROPERTY SAMPLE SHEET 


Date .^-[•2.-1 0 Address 

Project Omaha Lead ARRA Sample time 

XRF ID# sample length 

:^^£j: 

Shot# Reading Sample area Shot# 

loBS, 

^CS ^91 - £± iiSli. ^^ ^ 3h^ ^;9^<r Depth i

s ^ Mti- 3 % ^^S ^ "5^ isa. Average 0(0 ^ •^^^( p Average

Shot# Reading Sample area Shot#_ 

gg^^^V P2^ ^5 ~ 

b ^ 3 ? ^ ii^^K Depth fcfe(? 

hS- 3 ^ -hr^^ AIL ff?fe7­

Average tSW j J ^ ^' ^ Average

Shot # Reading Sample area Shot# 

M. ^0^ rf^H lia. >(P2 ^^• f 3) Depth 

LPG ^ ^^^ i ?>Y /3'^ 

Average /^/l J ^ .^ ^ Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

^ ^ 3? Depth 

/ " ^ 

Average Average 

Signature 

\m-u \ y\Pr%c^ 

Print 

f

30 sec 

Reading 

^ ^ ± ^^ 

/g^9- i : ^ 

^91 :^ yf 

_Q3i^H3 _ 

Reading 

e^^ i 2^/ 

n2sr^i ^? r:^3r 

 S^S^-^ 3 ZReading 

Reading 

 aam/p m m 

Sample area 

m 

Depth 

J EL 

Sample area 

^ 

^ 

Depth 

iii 

Sample area 

Depth 

Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 668 

Mode SOIL 

Time 2010-05-12 17:31 

Duration 90.32 

Sequence Final 

Flags 

AVERAGE «Avg of 665-667 

ADDRESS 2518 Maple st • 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.231 

Zr 405.422 ± 15.531 

Sr 197.004 ± 9.843 

U < LOD 15.885 

Rb 71.088 ± 6.931 

Th - 13.821 ± 9.186 

Pb 253.214 ± 21.794 

Se < LOD 6.237 

As 131.109 ± 22.267 

Hg < LOD 13.552 

Zn 257.990 ± 27.866 

W < LOD : _ 96.553 

Cu 56.611 ^< ^ / 23.729 

Ni 

Co 

Fe 

Mn 

< LOD 

< LOD

21802.338 

561.935 

X 

/ : 

;

/ 

/ 

/ 79.097 

204.818 

438.723 

103.552 y. Superv sed By: S^^ ^ v-
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

418.816 

194.036 

< LOD 

76.386 

18.882 

238.294 

< LOD 

137.996 

< LOD 

245.056 

< LOD 

62.568 

< LOD 

< LOD 

21388.639 

544.269 

Supervised By: 

Certificate of Verification 

665 

SOIL 

2010-05-12 17:29 

30.11 

Final 

29827 

2518 Maple st 

EA 

1" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.277 

± 15.610 

± 9.687 

: 15.576 

± 7.042 

± 9.411 

± 21.005 

* 5.876 

± 21.842 

I 13.396 

± 27.091 

I 98.425 

± 23.981 

: 80.647 

: 199.766 

± 430.873 

± 101.627 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

NI 

Co 

Fe 

Mn 

ppm 

< LOD 

386.060 

200.090 

< LOD 

70.479 

16.576 

252.938 

< LOD 

121.228 

< LOD 

243.637 

< LOD 

41.758 

< LOD 

< LOD 

21917.045 

601.779 

Supervised By: 

Certificate of Verification 

666 

SOIL 

2010-05-12 17:30 

30.10 

Final 

29827 

2518 Maple st 

EA 

1" 

CONFIRMATION 

N. LOPEZ 

Error 

J 8.307 

± 15.288 

± 9.948 

: 15.686 

± 6.902 

± 9.434 

± 21.839 

I 5.842 

± 22.057 

* 13.524 

± 27.192 

: 93.158 

± 22.667 

: 77.661 

: 206.422 

± 441.212 

± 106.366 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 667 

Mode SOIL 

Time 2010-05-12 17:31 

Duration 30.11 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.110 

Zr 411.391 ± 15.696 

Sr 196.885 ± 9.894 

U < LOD 16.394 

Rb 66.399 ± 6.848 

Th < LOD 13.068 

Pb 268.410 ± 22.537 

Se < LOD 6.993 

As 134.103 ± 22.901 

Hg < LOD 13.735 

Zn 285.276 ± 29.315 

w < LOD 98.077 

Cu 65.506 ± 24.539 

Ni < LOD 78.982 

Co < LOD 208.266 

Fe 22101.328 ± 444.086 

Mn 539.757 ± 102.663 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 664 

Mode SOIL 

Time 2010-05-12 17:28 

Duration 90.66 

Sequence Final 

Flags 

AVERAGE ^Avg of 661-663 

ADDRESS "251 8 Maple st 

QUADRANT DZ 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.281 

Zr 441.726 ± 16.000 

Sr 166.014 ± 9.074 

U < LOD 15.126 

Rb 69.153 ± 6.804 

Th 19.247 ± 12.054 

>kM ^ 1^^^11.18 8 ± _ ^ 33.045 

Se < LOD . 6.759 

As < LOD : 43.010 

Hq < LOD 13.540 

Zn 374.616 ± 32.709 

W < LOD : 94.292 

Cu 83.100 ± 25.414 

Ni < LOD 78.053 

Co < LOD 203.847 

Fe 22290.617 ± 442.451 

Mn 739.201 ± 114.293 

Cr < LOD 172^ 1 

V < LOD : ^ --- 404^03 

Ti < LOD 2102.368 

Sc < LOD yy^ . /134.642 

Ca < LOQ/ : y^ 4276.329 

K < LOO /T 6089.944 

S < LOD 174.254 

^ Superv ised By: / ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 661 

Mode SOIL 

Time 2010-05-12 17:26 

Duration 30.11 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT DZ 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.289 

Zr 431.685 ± 15.911 

Sr 163.819 ± 9.060 

U < LOD : 15.054 

Rb 69.728 ± 6.835 

Th 21.198 •' ± 12.351 

Pb 632.081 ± 33.763 

Se < LOD 7.123 

As < LOD 44.022 

Hg < LOD 14.040 

Zn 363.298 ± 32.405 

w < LOD 93.022 

Cu 89.272 ± 25.968 

NI < LOD ; 78.530 

Co < LOD ; 204.394 

Fe 22417.703 ± 445.463 

Mn 759.271 ± 116.365 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 662 

Mode SOIL 

Time 2010-05-12 17:27 

Duration 30.11 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT DZ 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.304 

Zr 440.609 ± 15.958 

Sr 167.005 ± 9.079 

U < LOD J 15.489 

Rb 67.955 ± 6.788 

Th 21.307 ± 11.800 

Pb 554.275 ± 31.470 

Se < LOD 6.454 

As < LOD 41.185 

Hg < LOD 13.561 

Zn 337.251 ± 31.211 

w < LOD : 96.086 

Cu 77.154 ± 25.001 

Ni < LOD : 78.773 

Co < LOD : 202.890 

Fe 22315.537 ± 441.869 

Mn 698.098 ± 111.690 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 663 

Mode SOIL 

Time 2010-05-12 17:28 

Duration 30.44 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT DZ 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD 8.252 

Zr 452.882 ± 16.132 

Sr 167.219 db 9.084 

U < LOD 14.835 

Rb 69.777 ± 6.790 

Th < LOD 18.016 

Pb 647.208 ± 33.900 

Se < LOD 6.700 

As < LOD 43.823 

Hg < LOD 13.018 

Zn 423.298 ± 34.511 

w 

Cu 

< LOD 

82.873 ± 

93.769 

25.272 

Ni < LOD 76.854 

Co < LOD 204.257 

Fe 22138.611 ± 440.021 

Mn 760.236 ± 114.824 

Cr < LOD 517.503 

V < LOD 1212.009 

Tl < LOD 6307.103 

Sc < LOD 403.925 

Ca < LOD 12828.986 

K < LOD 18269.832 

S < LOD 522.761 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 660 

Mode SOIL 

Time 2010-05- 12 17:23 

Duration 90.31 

Sequence Final 

Flags 

AVERAGE ^v g of 657-659. 

ADDRESS 2518 Maple st 

QUADRANT B2 

DEPTH 13" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

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 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

NI 

Co 

Fe 

Mn 

ppm 

< LOD 

408.180 

196.002 

< LOD 

67.215 

< LOD 

965.970 

< LOD 

170.674 

< LOD 

302.193 

< LOD 

62.681 

< LOD 

< LOD 

22270.096 

717.429 

Supervised By: 

Certificate of Verification 

657 

SOIL 

2010-05-12 17:21 

30.11 

Final 

29827 

2518 Maple st 

B2 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

8.477 

± 15.903 

± 10.003 

: 16.148 

± 6.963 

I 21.593 

± 42.072 

: 7.922 

J: 38.444 

: 13.931 

± 30.209 

: 92.966 

± 24.818 

: 83.416 

: 209.580 

± 450.055 

• ± ­ 115.571 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

423.948 

186.751 

< LOD 

66.950 

< LOD 

1026.515 

< LOD 

181.794 

< LOD 

370.858 

< LOD 

57.063 

< LOD 

< LOD 

22410.324 

651.014 

Supervised By: 

Certificate of Verification 

658 

SOIL 

2010-05-12 17:22 

30.10 

Final 

29827 

2518 Maple st 

B2 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.580 

± 16.403 

± 9.944 

I 15.022 

± 6.942 

: 22.141 

± 44.083 

: 8.305 

± 40.306 

I 14.767 

± 33.970 

107.743 

± 25.051 

: 80.199 

; 212.322 

± 459.366 

± 113.305 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

NI 

Co 

Fe 

Mn 

ppm 

< LOD 

408.236 

183.957 

< LOD 

70.286 

22.261 

950.675 

< LOD 

140.167 

< LOD 

355.270 

< LOD 

54.163 

< LOD 

< LOD 

22633.525 

600.450 

Supervised By: 

Certificate of Verification 

659 

SOIL 

2010-05-12 17:23 

30.10 

Final 

29827 

2518 Maple st 

B2 

13" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.262 

± 15.763 

± 9.643 

16.436 

± 7.073 

± 14.332 

± 41.478 

J 7.994 

± 37.447 

: 13.958 

± 32.316 

J 95.710 

± 23.890 

J 80.028 

209.666 

± 450.533 

± 108.250 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 652 

Mode SOIL 

Time 2010-05-12 17: 17 

Duration 90.33 

Sequence Final 

Flags 

AVERAGE ^Av g of 649-651. 

ADDRESS 2518 Maple st 

QUADRANT F2 

DEPTH 6" 

Pi'PE CONFIRMATION 

INSPECTOR N. LOPEZ 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

440.479 

174.351 

< LOD 

69.195 

19.229 

341.043 < LOD 

356.429 

< LOD 

637.343 

< LOD 

198.745 

< LOD 

< LOD

24953.26&/ 

682.646 

Supervised By:

± 

± 

: 

± 

± 

± 

± 

: 

± 

: 

^y-. / 

±

Error 

8.268 

16.050 

9.309 

15.244 

6.814 

10.281 

25.122 

6.725 

29.619 

13.970 

42.146 

^..-if»ft666 

32.352 

/80.693 

//216.819 

/0,469.701 r. 

//112.96 6 

z y> y 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

437.664 

177.775 

< LOD 

68.696 

17.291 

351.744 

< LOD 

358.945 

< LOD 

663.785 

< LOD 

214.867 

< LOD 

< LOD 

25120.207 

663.116 

Supervised By: 

Certificate of Verification 

649 

SOIL 

2010-05-12 17:15 

30.11 

Final 

29827 

2518 Maple st 

F2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.262 

± 16.022 

± 9.395 

: 14.639 

± 6.739 

± 10.221 

± 25.486 

I 6.698 

± 29.905 

: 13.869 

± 43.033 

: 103.409 

± 33.219 

I 79.778 

I 216.099 

± 471.497 

± 112.456 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 650 

Mode SOIL 

Time 2010-05-12 17:16 

Duration 30.11 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT F2 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD : 8.320 

Zr 449.285 ± 16.181 

Sr 172.060 ± 9.252 

U < LOD : 15.678 

Rb 69.536 ± 6.867 

Th 23.677 ± 10.551 

Pb 334.580 ± 24.919 

Se < LOD : 6.810 

As 362.450 ± 29.602 

Hg < LOD : 14.205 

Zn 621.493 ± 41.596 

w < LOD : 98.089 

Cu 179.825 ± 31.292 

NI < LOD 79.991 • : 

Co < LOD : 218.576 

Fe 24771.990 ± 467.854 

Mn 730.652 ± 115.420 

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 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

434.487 

173.216 

< LOD 

69.352 

16.718 

336.805 

< LOD 

347.892 

< LOD 

626.753 

< LOD 

201.541 

< LOD 

< LOD 

24967.607 

654.170 

Supervised By: 

Certificate of Verification 

651 

SOIL 

2010-05-12 17:17 

30.11 

Final 

29827 

2518 Maple st 

F2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

J 8.222 

± 15.948 

± 9.278 

; 15.416 

± 6.837 

± 10.070 

± 24.962 

: 6.667 

• ± 29.350 

: 13.837 

± 41.809 

: 100.500 

± 32.546 

: 82.310 

: 215.782 

± 469.751 

± 111.023 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 648 

Mode SOIL 

Time 2010-05-12 17:14 

Duration 90.35 

Sequence Final 

Flags 

AVERAGE Avg of 645-647 ^ 

ADDRESS ^"2518 Maple st 

QUADRANT Fl 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD 8.143 

Zr 425.731 ± 15.631 

Sr 170.453 ± 9.109 

U < LOD 15.157 

Rb 69.862 ± 6.770 

Th 17.698 ± 10.251 

Pb M^^•367.72 4 ± 25.739 

Se < LOD 6.761 

As 276.075 ± 28.231 

Hg < LOD 13.534 

Zn 264.381 ± 27.840 

W < LOD 92.454 

Cu 60.723 ± ^--23.563 

Ni < LOD - ^ 76k36 

Co < LOD 206.718 

Fe 23965.604 /y ± /455.222 

Mn 612.764/ ± y 106.846 

:y y c Supervised By: \- > 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 645 

Mode SOIL 

Time 2010-05-12 17:12 

Duration 30.11 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT Fl 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 


Mo < LOD 8.110 

Zr 405.456 ± 15.396 

Sr 163.109 ± 8.983 

U < LOD 15.322 

Rb 76.205 ± 7.045 

Th 19.043 ± 10.695 

Pb 404.565 ± 27.135 

Se < LOD 6.945 

As 257.897 ± 28.831 

Hg < LOD 13.287 

Zn 
 289.048 ± 29.010 

W < LOD 89.234 

Cu 62.230 ± 24.034 

Ni 85.280 ± 54.340 

Co < LOD 205.961 

Fe 23053.793 ± 449.369 

Mn 687.846 ± 111.953 

Supervised By: 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 646 

Mode SOIL 

Time 2010-05-12 17:13 

Duration 30.12 

Sequence Final 

Flags 

BVID 29827 

ADDRESS 2518 Maple st 

QUADRANT Fl 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD * 8.171 

Zr 433.602 ± 15.596 

Sr 178.006 i : 9.202 

U < LOD 14.831 

Rb 70.286 ± 6.695 

Th < LOD 14.520 

Pb 362.479 ± 25.301 

Se < LOD 6.780 

As 276.001 ± 27.819 

Hg < LOD 13.355 

Zn 245.027 ± 26.646 

W < LOD 90.497 

Cu 58.745 ± 23.009 

Ni < LOD 75.133 

Co < LOD 208.390 

Fe 23846.881 ± 449.364 

Mn 573.123 ± 102.922 

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 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

438.135 

170.246 

< LOD 

63.094 

22.416 

336.127 

< LOD 

294.326 

< LOD 

259.067 

< LOD 

61.194 

< LOD 

< LOD 

24996.139 

577.323 

Supervised By: 

Certificate of Verification 

647 

SOIL 

2010-05-12 17:14 

30.12 

Final 

29827 

2518 Maple st 

Fl 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.146 

± 15.901 

± 9.143 

: 15.319 

± 6.570 

± 10.378 

± 24.780 

\ 6.559 

± 28.044 

: 13.960 

± 27.863 

: 97.632 

± 23.646 

: 72.666 

: 211.802 

± 466.932 

± 105.663 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. SL~^^J ^ www.coastalhazmatcom 

^^iPHO^" ^ COASTA L 

mVIIOIIHiNTAL Clour , III c 

EXECUTIVE SUMMARY; 

BVID #29827-(2518 MAPLE ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

DAN GARVEY WALKED THE PROPERTY ON 6/10/10 
4 

C^dL 

EPA Property Close Out Form 

Property» Property Address: : "Z^^Z l ^.oer^.^\% ^P}Q;\, y 

Date/Time: Owner •« Nam.: /. FHV f.T . C^M^^ ' ^ 

Quads Excavated:. Contractor 

Excavatio Yes No n Ccnetat 

1. If neccssuy, were the correct quadranl(s) excavated and restored? / 

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

Gradin Yes No g Sod and VegctatloB 

1. Does the trading around the perimeter ofthe house in excavaled areas generally slope away /

from the house? _____^ _ _ _ 

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

r r Does the sod appear to be generally healthy and growing?~(Only evaluate if inspected at a 30 

day time period) 7

4. Are sodded areas generally firm and evenly graded? y 

5, Are the Joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day y time period) 

6. Was the property graded such that water will not pool on the property'' y 

I 7. Was damige to landscaping or plant materials avoided? 

Gates. Fences and Rctatoing Walb _^ _ Yes No 

I 1. Do gates open and clo.<se fiieely? (If applicable) y 

2. Were all gates or fences taken down during restoration activiiies reinsulled? (If applicable) y 

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

A. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and GnHers Yes No 

t. Was damage to the siding or trim avoided? • 

2. Was damage to the foundation avoided? y 

Was damage to windows avoided? y 

A Was damage to windows or door screens avoided? 

2. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? y 

2. W&s damage to walkway surfaces avoided? y 
Ort'Dcrs comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranry: 

EPA Representative jfL^ ^ Date: e://a/)a 
Property Completion Agreement 

Jhii agieemenl documenls ihe complclion of remedial acliviiies perloimed on my properly My signaluie 

will designate ihai I am satisfied wilh the restoration of my propeily. and ihal no ilems are in queslions. 

now, or al any nine in the fuluie, except those ilems listed below, if any 

Property ID: <2_ 0\ ??'7"7 

Property Address: 2.S\ V M^p k S J 

owoc.: p^,yp^ 61-HQ)jgt I r 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

y restoration K completed, except as noted 

I ^1 I ngrcc II 

\ J I rio not acrec resloration is completed 

attirr Dafc Condflcfor's Signnhirc Oftfc 
@ 

Property Owner Assessment of Perform! 

AmericanRecovery and Reinvestment Act (ARRA)j^)w Q-i ym 

Omaha Lead Superfund Site 

2009/2010 SUPERFUND DIVISION 

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

Property Identifier Number: "7 C\ ^ 2" 7 

Property Address: Z'^i g Mgip|- e ^ ^ 

Property Owner's Name: p aKj^l . G^. 1 - MCi jCl^- ' 

Instructions to the Property Owner: 

This fomi serves to record the Property Owner's assessment of performance (hicentive 1 

- Quality Assurance Surveillance Plan) involving the listed remediation contractor, as applicable 

to the Omaha Lead Site. This form documents the timeliness of punch list 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 the 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 definitions from 

the rating scale below, then 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 t syZ 5 

9 4 

8 3 

7 2 

6 1 

Property Owner Additional Comments from (optional; continue on back page if needed) 

Property Owner Signature: ~^T//^ ^ Date: _^_^_^_^ ^ ^