- -

TRANSMITTAL of OMAHA LEAD SITE 


SOIL REMEDIATION FILE FOLDER 


sAID #: ~t- ' z, ' Date: _1___,(___,_~-+-f-'-'--''__ 

(JIJ A- L /}_ ( ~ r:~· Address: -~Dw.J£-_J....z_-=-- 7J___].L-.:.....-I_____ 

Remediation Contractor: _Coastal Environmental Group_ Year: 201 OARRA 

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 (k ~1\11~ ~ ~~~ 1" ?9'Vz 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

0 

0 

0 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

l4 


30287387 

11111111111111111111111111111111111111111111111111 

Superfund 
---

• 


Property Access Checklist 

Property ID: ON: I I 

ON:_/_/_ 

Owner: Renter: 

Address: Phone: 

Fax: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Cell/Pager: 

D Notification Letter Sent: _/_/_ By: 

() Access Agreement Signed: 2,_ t!.JJ J{1 By: 

~ Restoration Agreement Signed: ~I /i_ I/!._ By: )/1 ( /! 

D Topsoil Sampling (if applicable) --­

I I By: 

D Disposal Sampling (if applicable) --­

I I By: 

D Garden Sampling (if applicable) --­

I I By: 

D Utility Clearance CaUed: _/_!_ By: 

[] Video/Photos (Before) On:Ob I _j_g!~ By: o~rrnlio 

ill Video/Photos (During) On:L/li._til By: )/I Cf<//tlf fr 

D Video/Photos (After) On: --­

I I By: 

D Video/Photos (30-Day) On: --­I I By: 

D Property Completion Agreement Signed:_/_/_ By: 

D Final Report Issued: --­

I I By: 

Air Monitorin2 (as applicable) 

0 Community 

Results: 

0 Crew I On: --­I I IBy: 

Ocommunity 

Results: 

Ocrew I On: --­

I I IBy: 

Ocommunity Ocrew I On: I I IBy: 

Results: 

Omaha Lead Site 
Douglas County Account .ation Page 1 of2

Douglas County, Nebraska Property Record ­ R1015620000 

Information is valid as of 2009-12-31 

Print ReROrt 

NEW Feature - Parcel Dimensions available@ scale 0-50 ft west of 52nd St- View on MaR 

Treasurer's Tax ReRort 

New Feature ~~~ Auto Sales Search 

Owner 

MORA GENOVEVA 

ETAL 

820 S 35 ST 

OMAHA NE 68105-0000 

Property Information 

. Key Number: 1562 0000 10 

Account Type: Residential 

Parcel Number: 1015620000 

Parcel Address: 820 S 35 ST 

OMAHA NE 68105-0000 

Legal Description: ELLIS PLACE LOT 19 BLOCK 0 40 X 125 

Value Info.rmation 

Land Improvement Total 

2009 $5,700.00 $104,200.00 $109,900.00 

2008 $5,700.00 $104,200.00 $109,900.00 

2007 $5,700.00 $104,200.00 $109,900.00 

2006 $5,700.00 $44,200.00 $49,900.00 

2005 $5,700.00 $44,200.00 $49,900.00 

2004 $5,700.00 $44,200.00 $49,900.00 

ISales Information 

Sales Date: 2003-10-31 

Deed Type: WD I Book: 12003 I Page: 1217393 

Price: $76,000.00 

Grantor: LYNN DANAHER ETAL 

Grantee: GENOVEVA MORA ETAL 

ValldRnvalid: Valid 

Exclusion Reason: 

Land Information 

Acres SF Units Depth Width Vacant 

0.11 5000.0 1.0 125.0 40.0 No 

IImprovement Information 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R10... 1/28/2010 
Douglas County Account . ation Page 2 of2

IBuilding 1 

Square Footage: 1628.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Fin 

HVAC: Forced Air 

Exterior: Frame Aluminum 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Built Year Percent 

Remodeled Remodeled 

1916 0 0% 

Detail Type Detail Description 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch Slab Roof Ceiling 

Porch Slab w/Steps 

.... 

1 1/2 Story Fin 

Bsmnt Block 8 ft 

994.osq n 

,, 

:t; 

I 

.. " ~~o~:'~. 

... 

Second Floor 

634 0 s.q 1t 

h 11t! 

~- · -....

,':".:.:. n 

LICI E~LARGE IMAGE 

Percent Complete: 100.0% 

Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 7.0 

Units: 1.0 

Baths: 2.0 

Bedrooms : 2.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adj usted Year 

Built Physical Age 

1916 92 

Units 

1.0 

994.0 

1.0 

1.0 

216.0 

176.0 

25.0 

http:/ /douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 0 ... 1/28/20 l 0 
·- ­

Page 1 of2 

"> 


~--c_re_a_t_e_A_n_m_h_er_T_ic_k_e_t__~)~(___B_ac_k_ro__lrth__ln_re_r_ne_t__~ _( Send Email 


• YOUR TICKET NUMBER IS 2521485. 

Original Call Date: 

Work to Begin Date: 

6/16/10 

6/18/10 

Time: 4:52 

Time: 5:15 

pm 

pm 

Op: ELIZABETH18790 

State: NE 

Address: 820 

County: 

Street: 

D

S 

OUGLAS 

35TH ST 

Place: OMAHA 

Twp: 1SN Rng: 13E Sect-Qtr: 21-SW 

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 LEVEL3 MUD01 OMAHACOF OPPDGPRS QLNNE1C 

Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOI METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 402504 7970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH!fRAFFIC Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS ... 6/16/2010 
Page 2 of2 

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/irthinternet/DHONN oticeCreation!MessageText.asp?ret=<RESUL TS. .. 6/16/2010 
e As-Built Drawing el 


COASTAL Omaha Lead Superfund Site aMVtAONM8NTAL 

c a ouP. t N C.. 

Owner :§ENOVEVAMORA 

Addteu: 820 S 35 ST 

Sample Number 

RYASCPXA­22121 F1 

RYBSCPXA-22121 F2 

RYCSCPXA-22121 81 

RYDSCPXA-22121 82 

RDZSCPXA-22121 DZ 

RGi!SGPX.tl i!i!~rt GiZ 

RPZSeP*A 22121 PZ 

Lead 

Concentration 

Omaha Lead Site 

Site Sketch 

Sample LAB Collected 

~~ 8'""' 0 

I!:Y' 0 

s­ 0 

g.--­ 0 

g/ 0 

ppm 0 0 

ppm 0 0 

~ 

0 Good 

Finn: 

Date: 

rvne: Jo:oc 4r"­

Samples Analyzed 

XRFUnit 

Date: 

Time: 

Staff: 

22121 

o~O 

·'"""n 

81 = 324 PPM @ 8" 

Omaha lead Site 

....... 

0 

~o· ..SEP- 2° 0 • ' • • 

0. 0 : 0 0 03 :.1. 0<:\ 0~. 00-0 :0 0 0 0. 0 

F2 =82 PPM @ 8" 

4{)130 

Leqend 

Concrete ~ Drip Zone Excavated ~ Quadrants Excavated 

Area replaced with ~ Area replaced with 

Area left bare Sod Rock/Mulch 

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

- - --

0 

Omaha Lead Site 

Site Sketch 

W: 

Lead Sample LAB Concentration Collected 

Lpm ~ 0 'p_pm g--" 0 -ppm g­ 0 


ppm g--'" 0 


ppm 


ppm 


ppm 


g/ 0 XRF Unit: 

0 0 Date: 

0 0 Time: 

Number of Samples =.._5 ~ 

D Staff: 

• • • ~ • • • • • • • .. • .. • • .. • o- • • • • • • • • 0 • • .. 

0 • • • 

. . . ' . . . . . uA'iA'G~ . . . . ... ~ .. ... ~ .. ...:.. ... ~ .....~ ... .. ~ . . . . : . -. ·S EP. 2· . ~~il! !- .: 

. . . . . . I) . . a . . .. .. · .. ... . : .... ' ... .. . ; ..... ~ ..... ~ .. ... ,e,,·. ~ .. .3 ; \ .. :\ . ; ..... ~ .. .. . 

' . . • • • 0 '

• 0.: .. . ... :. 0•. . : • .. •.•• 0 • 

. . . . ' • • • • • 0 . . ...... . ....... ... .. .. 0 • • 

. . . - • . • • • . • • .. • • . • . ! 0 • • 0 • : • • • • 0 • • • 0 • .. • !. • • • - • ~ • • • • • '.. - • • - • ••• ' ••• • 0 .... . ... ' 0- • • • 

Omaha Lead Site 

22121 


Exterior Paint North Arrow 


O Good 
 " ....... 
 O Poor 

~paint 

~amples Collected 

Firm: .E· M':\-..S.A.e.. 

Date: q. d--t· ~ 

Time: to: cc ~ 

Samples Analyzed 

-.. .. _ 

.. . 
 C\. 

Owner Name: GENO~EVA.M_Q~ 

Address: ~~ ~ 3~ --·

Phone: _l-!; _____ 

Sample Number 

RYASCPXA-22121 F1 

RYBSCPXA-22121 F2 

RYCSCPXA-22121 B1 

RYDSCPXA-22121 B2 

RDZSCPXA-22121 DZ 

RGZSCPXA 22121 cz 

RPZ3CPXA•2z121 PZ 

46130 
• 22121 

Omaha Lead Site Exterior Paint North Arrow Owner Name: GENOVEVA MORA 

Site Sketch O Good

Address: 820 S 35 ST ' O Poor ' 

Phone: H: _:..;.;__ w: ____ ~alnt 

Sample Number 

RY ASCPXA-22121 F1 

RYBSCPXA-22121 F2 

RYCSCPXA-22121 81 

RYDSCPXA-22121 82 

Lead Sample 

i{: 

LAB Concentration Collected 

~ 0 

~ 0 

-ppm g- 0 

ppm w 0 

Firm: 

Date: 

nme: 

~a es Collected 

-E· t'\:'\--.S.A .e.. 

q. d.-'§>. {.\ 

to: t:>Q ~ 

Samples Analyzed 

RDZSCPXA-22121 DZ ppm g/ 0 XRF Unit: 

RGZSCPAA 22121 GZ ppm 0 0 Date: 

RPZSCPX:A•22121 PZ ppm 0 0 Time: 

Number of Samples = ._5 .-­

L_ 

D Staff: 

• ~ • .. • .. .. .. .. • .. .. .. .. .. .. • • .. .. • .. • .. .. • 0­ .. • • 0­ - • 

r 0 • I o n . ' . . . . . · · · · : · · · · · :· · · · · :· · · · < · · · · -:-· -· ·: · · · · ·:· · · ·S E P- 2· • • ' • 0 • 

0 0 I o o 

.. . . J.-:. · a . . . . . . ; ... .. ; ..... : .. ... :. . : .. ·.... ~ \.. ~\ . ·.... .. : ..... . . . . . . . 

... :.. ... :.. ..... :.. . ... ; ...... :. .... .............. . .. . ~ ....... ~ ...... . 

•, • 0 • .. • • • • • • • ~ • • • • • .. • .. • - • ~ • • • • • •• • • • .. • ~ • .. • 

. . . .. . . .. .. . . . . . . . . . . .. . . . .. . 

Omaha Lead Site 46130 
• • 

22121 

Owner Name: GENOVEVA MORA ---­ Address: 820 S 35 ST 

Phone: H:_ W: 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

0 Good 

0 Poor 

~paint 

Sample Number Lead 

Concentration 

RYASCPXA-22121 F1 

RYBSCPXA-22121 F2 

RYCSCPXA-22121 81 

RYDSCPXA-22121 82 

Sample LAB Collected 

EY" 0 

ppm (g-" 0 

ppm e­ 0 

ppm 9-"" 0 

RDZSCPXA-22121 DZ 

RGi!SSPXf, 5!5!15!1 sz 

ppm g./ 0 

ppm 0 0

FtPZSePJEA 22121 PZ ppm 0 0 

Number of Samples= [5 j lz>i L::..___; 

Firm: 

~amples Collected 

-E· iV\-:{....S.A.e.. 

Date: '\·d-!i· 4 

Time: to: t>O 41-­

Samples Analyzed 

XRF Unit: ~\\ BooAJ_ 

Date: \(\·. .., -f\l...l

Time: l,X).,A I 

Staff: \ ~ 

I 

--

. 

( 

... ~ ... - . ._ . . . . . . ~ . . . . . . . .. . . . . . . . . . . . . . . ~ . . . 

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"}:c· : :'"'"'~: ..s:.2c.­ S' : : ---,--·

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}. . --: .•... : .1_,_. .:....:..·-~---:--r4'cJ~.'Z...~.:_~..._~::±:::r-;~-: l·?:. 

I L 6. :I . I ~!>· r-~~--~--~--~~~~~ 

-.... , . ­-.. ·­ . r·..:..·'"-i'·:..:.·-=-·:...:.··...:...·....,,.'-'­. ..:...;··'-'-·-i-':...:.··-=-·..:...;·-~'-=-·:...:.··...:...· ;:..:.~..:...;~=-=-~¥-<-=-_·;....:·­.....:....f. 

. . . . . . ••••• : ••••• : 0 0 • 0 • : •• 0 •• : • 0 • 0 • : ••••• : 0 •••• : ••••• ~ •• • • • • • • • •• 0 ••• '. ••••• 

: : : : p. l : : : ... .. :...... ; ..... ; ..... ~ ..... ; ..... ,Pt~; ..... ;.. . ·r') ·;­ .

. 

.; ... )S\\..9_:·· 

•• • • • • • ~ • • • • • ~ • • • • • ~ • • • • • '. • • • • • • • • • • • • • • • • 0 ... • • • • • ':. • • • • • ~ • • • • • . . . . . '.. ................. . 


Omaha Lead Site 46130 
L --- -~ 

-· •• 


Consent for Access lo Property 

RIGHT OF ENTRY TO PREMISES 

COASTAl 

UtYIItONMI MTAl 

G I 0 Ll I I ltf ( 

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: 

;}-~/2-{ 

Daytime Phone: f33 -'t.:, 0I 

Address of Property 

covered by this 

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 AcnoNS 

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 of2 
• • .. 

COASTAL 

UIYIIIOiriiKfkTiol 

,.GU' INC 

E 	 Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

€ 	 Abide by health and safety guidance provided by EPA; 

• 	 If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

~ Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

The Grantor agrees not to interfere or tamper with any of the wort< 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 

ti9-l grant access to my properties 	 0 I do not grant access to my properties 

Signature Date Signature 	 Date 

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

Page2 of2 
a_ • - .., e 

COASTAL 

.NVIaONM.NTAL 

o•ouP, INC. 

•

Restoration Agreement 

The pl.rrpose 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: 

Phone: 

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


Item: 

5' {/VL {A 1J (} /C\11 ts -f6 fo... V+2~--- Item: u 

Item: 

Item: 

ltems to beRemove db ,Y th e C on tr ac t or D . R unng erned"1at"1on andN0 tRep1aced 

Item: 

) Mo. t( /l(Clf1t-) (~ {-!-­ he. A~, ~~J Item: (/ 

Item: 

Item: 

Page1 otl 
COASTAL 

a•ouP. 

.NVIRONM.NTAL 

INC. 

• • 

ltems to Be Remove dB iY C on t t rae or D . R ur1ng emed"1at"1on andRep1aced 

Item: 

\ e> 

50\ FZ-Jr.> \ 

Item: 

)o o\ ~z_, () I 

Item: 

Item: 

Landscape nvento•ry 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

f z_J~ I Quadrants 

Number oftrees > 2 inch 

trunk diameter er Each 

Number of trees <= 2 inch 

trunk diameter g Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

g Each 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

ff Each 

Square Feet 

Agreed upon value ofplant 

materials not to be 

replaced by contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

p $ 

Easement Area, to be 

excavated I Each ~Ve" J',VI) Re ~(} 1-b 

Page2ofl 
• • ... . . 

COASTAL 

.MVI.ONM.NTAL

aaou•. 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 soli 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 soli 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. 

~Please check this box If you understand the Information outlined above. 

D 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. 

Biagree 0 I do not agree 

Ownlf'SSigll8t1IIO Date Date 

Page3of_J_ 
• • 

BVID# 22\2-\ 

XRF PROPERTY SAMPLE SHEET 

Date Dll l3 /1-o \ 0 

Project Omaha Lead ARRA 

XRF ID# 0,C1 DL-f_..­

Address <(:) 1-0 S. r;.,.S s-tSample time am/pm 

sample length 30 sec 

Shot# Reading Sample area 

"ll\ uro t w BA 

\l'"1 1{)5 ~ w Depth 

'111 w~~w \ l• 

Sample area 

Depth 

Shot# Reading

Average Average 

Read in 

Average 

Average 

Sample area 

Depth 

Shot# Reading 

Average 

Reading Sample area 

Depth 

Shot# 

Average 

Shot# Reading_ Sample area 

De th Depth 

Average Average 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

714 

SOIL 

2010-07-13 08:37 

91.83 

Final 

Avg of 711-713 

820 s 35 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

711 

SOIL 

2010-07-13 08:36 

30.62 

Final 

22121 

820 S 35 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 208.028 ± 20.254 

Supervised By: 
• • 

Ther111o 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

712 

SOIL 

2010-07-13 08:37 

30.61 

Final 

22121 

820 S 35 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 205.304 ± 20.049 

Supervised By: _________________ 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

713 

SOIL 

2010-07-13 08:37 

30.60 

Final 

22121 

820 s 35 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 208.063 ± 20.093 

Supervised By: _________________ 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

Pb 

Supervised By: 

722 

SOIL 

2010-07-13 08:43 

91.61 

Final 

Avg of 719-721 

820 s 35 st 

F2 

8" 

N. LOPEZ 

confirmation 

none 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

719 

SOIL 

2010-07-13 08:41 

30.50 

Final 

22121 

820 S 35 st 

F2 

8" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 82.023 ± 14.866 

Supervised By: 
• • 

Thertno 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

720 

SOIL 

2010-07-13 08:42 

30.59 

Final 

22121 

820 S 35 st 

F2 

8" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 80.859 ± 14.507 

Supervised By: 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

721 

SOIL 

2010-07-13 08:43 

30.52 

Final 

22121 

820 S 35 st 

F2 

8" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 85.286 ± 15.045 

Supervised By: 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

Pb 

Supervised By: 

726 

SOIL 

2010-07-13 08:45 

91.63 

Final 

Avg of 723-725 

820 S 35 st 

B1 

8" 

N. LOPEZ 

confirmation 

none 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

723 

SOIL 

2010-07-13 08:44 

30.64 

Final 

22121 

820 S 35 st 

B1 

8" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 297.957 ± 24.347 

Supervised By: 
• • 

Ther111o 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

724 

SOIL 

2010-07-13 08:45 

30.66 

Final 

22121 

820 S 35 st 

B1 

8" 

N. LOPEZ 

confirmation 

none 

ppm :I: Error 

Pb 353.525 :I: 26.260 

Supervised By: _________________ 
• • 

Thermo 

SCIENTIFIC 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

725 

SOIL 

2010-07-13 08:45 

30.33 

Final 

22121 

820 s 35 st 

B1 

8" 

N. LOPEZ 

confirmation 

none 

ppm Error 

Pb 320.713 28.652 

Supervised By: 
• 


Omaha Lead Site-Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTAL 

IIIYIIOIIMIIITAL 


GIOUP, HIC. 


EXECUTIVE SUMMARY: · 

BVID #22121-(820 S 35 ST) 

·[!) No Issues or Concerns D Issues/Concerns 

Detail Exolanation: 

-DAN GARVEY WALKED THE PROPERTY ON 8/26/10. 

--

---

-- ----- --

----------------------------------------------

-------

---

- ..:r--· SEPA • 	 • 

EPA Property Close Out Form 	 ~, 

~:~:7rr:!; 2..21 L I . ~~:.!~:!';0~£f~q\['fr;f N\()~ Quads Exca-v-at.,-.t-d·-.-------- Contractor Group_·_·_______ 

Excantioa Geaeral Yes No 

1. If neccssll)',.were the correct quadrant(s) excavated and restored? ./ 

2. Ifnecessary, were the comet areas of drip zone excavated and restored? / 

Gradlat Sod aad Veptattoa Yes No

I. 	 Does the arading III'OUJid lhe perimeter of the house in excavated areas generally slope away 


from the house? 
 ./ 

2. 	 Has sod boen laid in all areas that were excavated? ,/ 1-·- ·­ 3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

,/ day time period) f-

,. r· An: sodded areas generally fum and evenly graded'? 

5. 	 Are the joints between the sod strips generally tight7 (Only evaluate if inspected at a 30 day ,/ 	' 

time period) I 

r 6. Was the property graded such that water will not pool on the prnperty? I 

·- ~- --1 

7. 	 Was damage to landscaping or plant materials avoided? ,/ ! r ___.,___ -	 -· 

Gates, feoc:a aad Retalalaa Walls 	 \'es No I I. Do gates open and close ~ly? (lf applicable) 1--­

~--2_.__w_e_re_al_l_ga_re_s_o_r_ren_._c_es_tak_e_n_d_o_wn_d_ur_i_n_a_re_s_ro_ra_t_io_n_ac_t_iv_i_1iP_s_r_e_in_sta_lle_d_?_<_l_fa_P_P_Ii_ca_b_lf_) 

j 3, Was damage to gates or fen~s avoided? (lrapplic:able)

I~ 4. Was ~ge to retaining walls avoided? (Jhpplicable) 

_. ___ Yes No -·­

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

2. 	 Was damage to the foundation avoided? ,/ ·-·· ___, 3. · Was damage to windows avoided~ ,/

1 

i 

4 	 Was damage to windows or door screens avoided'? """--,;""

y/ 5. 	 Was damage to downspouts or downspout extensions avoided? ---·----.. 

Yes No 

t----'-·_w_as_d_•_ma&e __,_o_dri_·_v_ewa_y_s_urfi __ a_ces_a_vo_i_de_d_? __________ ~----_-_-_-_-__ -__ ~---.. ­.. _--._-·.·. I~.1.1, 2. 	 Wao; damage to walkway surfaces avoided? 

. --------------------­
• • 

-------------

,Ownen; comments: 

I 

I --- ---·-­

r--Jnl!ipection notes: 

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


EPA Representative ____B_C>I"_~....,.r------ Date:__8--'-/ z.#JI' o___ 

• • 

Property Completion Agreement 

rtm agreement documents the complcllon ot remechal activtttes performed on my property My stgnature 

wtll destgnate that I am sat•sfied wtth the restoration of my properly. and that no ttems are 111 quesltons. 

now. or at any tune mrhe future. exceptlhose.ilems listed below, if any 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I agree ,.cuoralion i~ completed, t'llccpr as nored · 

0 I do not AJlrec rc$toratlon i~ completed 

Datf 
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2009/2010 

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


Property Identifier Number: Z.'Z../2../


Property Address: £-tLO _ __;....;;.s~.-~:::-:::5:---;r-t-.-

Property Owner's Name: {1\.e.llt)Vt.no.. fYk)ret... . 


Instructions to the Property Owner: 

This form serves to record the Property Owner's assessment ofperformance (Incentive 1 

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

to the Omaha Lead Site. This form documents the timeliness ofpunch list resolution, business 

relations, complaint resolution and the overall quality ofwork. Ifneed 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 ofperformance 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 

~ 

7-8 

5-6 


3-4 


1-2 

"excellent" 

''very good" 

"acceptable" 

''poor" 

''very poor" 

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

cP . 

7 

/ 5 

4 

8 3 

7 2 

6 1 

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

Property Owner Signature: --->..::Cfil/J~/6!~.- -+.·._;:, _________.Date: e;?jr/Ju
• 

Water Bill Settlement 

Property ID 22121 

Property Address 820 S 35 ST 

Tenant MANUEL M ANDREADE-MORA 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of$ 48.58 for 

water usage required to maintain the sod. 

Cheek Number 2074 

Value of Check $48.58 

Made Out To MANUEL M ANDREADE-MORA 

Description of Settlement 

To reimburse tenant for estimated water charges on their MUD monthly invoices. 

My signature below Is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be fair compensation and full payment for the above, and release Coastal 

Environmental Group Inc. from further obligations or liability. 

Date Date 

P:·.'c-.=~-~--.:,< ·--=--=-- ;......· ~~---... ·-·...!·;_;__,~_/;~;.~"'-'--.d.=....~-----. 2074 

\ COASTAL ENVIRONMENTAL GROUP INC. 

' 2411 MARTHASTREET 

OMAHA, NE 68105 

PAYlO THE MClY\W..\ . M BrOYe~- MCYCA. 

ORDER OF - · stl _lE::EEAAj~~-~~~ ~()J'l~O~~nJO'b~------oouARs 

27-511040 003 

6247372904