TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID it^ 7 7) ^ I DATE: 5/o2 I / I A 

ADRESS: 1^/ / l l Z 5 SAREMEDIATION CONTRACTOR: COASTAL ENVIRONMENTAL GROUP Contract: EP-R7-09-06 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

H Executive Summary 

^ EPA-provided property sketch 

W Signed Access Agreement for subject property 

Signed Access Agreement (s) for adjacent property 

M Restoration Agreement 

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

^ Confirmation data 

O ^ Photographs SOD 

Pre-Excavation 

Excavation 

>SP As-Built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas of areas not meeting ROD cleanup criteria 

J j Utility clearances 

Tl Property Information from Douglas County Assessor's Office 

D 

9f 

SignatureSignature- COASTA i L Signature- EPA .«<> i?'" * 

Date Date 

30262919 

Superfund 
Property Access Checklist 

Property ID: ^T^p^ / 

Property Address: /^y ^ /I / ^^ T "^^T— ^ 

D

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Address 

'6, />7h2^ 'y y 

• y-e(criii 

Phone: 

Fax: Shr^y/sri 

Cell/Pager: 

Fax: 

Cell/Pager: 

Additional Information: 

r~]

n

l~l

|~|

" ^

n

n

Q

 Notification Letter 

Access Agreement 

Restoration Agreement 

 Topsoil Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

ideo/Photos (Before) 

Video/Photos (During) 

Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / By: 

SigaedzlO l/Xf' f O By: 

Signed://^ 2^1 1 f) By. 

/ / By: 

/ / By: 

/ / By: 

CaUed: VV / 9:> / Vu »y= V/i^A c

On:lS2/^UP By: 

On: / / By: 

On: / / By: 

On: By: 

Signed: / / By: 

Issued: / / By: 

 t.,.wJL t 

Air Monitoring (as applicable) 

• Community • Crew 

Results: 

On: / / By: 1 

• Community

Results: 

• Crew On: / / By: 

• Community

Results: 

• Crew On: / / By: 

Omaha Lead Site 
Douglas County Account I t^|^u) n Page 1 of2 

Douglas County, Nebraska Property Record

Information is valid as of 2010-8-30 

­ R1945280000 

New Feature -^ ­ f -^

Print Reoort 

View Interactive GIS Mao 

Treasurer's Tax Reoort 

 Subdivision Sales Search 

Owner 

ORDUNA ALONZO 

ETAL 

2436 PARKER ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Numtier: 4528 0000 19 

Account Type: Residential 

Parcel Numtier: 1945280000 

Parcel Address: 

Legal Description: 

1911 N 25 ST 

OMAHA NE 68111-0000 

PARKERS ADD LOT 7 BLOCK 6 N 50 FT 50 X 126 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

Show All Transactions 

Land Informatio n 

Acres SF Units Deptfi Width Vacant 

0.06 3000.0 0.0 60.0 50.0 Yes 

http://douglasne.mappmg-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 94... 9/2/2010 
3/31/2011 www.dhon.org/irthinternet/DHONNotic... 

Create Another Ticket Back tOTTt t^S h Intemet "c* I Send Email 

• YOUR TICKET NUMBER IS 2700327. 

Original Call Date: 3/31/11 Time: 3:37 pm Op: ALFONSO18790 


Work to Begin Date: 4/04/11 Time: 4:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1911 Street: N 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,16-NE 


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: (4 02)934-2811 


: PLEASE INCLUDE ALL EASEMENTS 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name; ALFONSO Phone: (402)934-2837 


Work Being Done For: Coastal 


Depth of Excavation: 4ft Corner Lot: N Front: Y Rear; 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Ak: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS COMMUNICATIONS, LEVELS NA Ak: LLC 

Emerg: 8773668344 


Day: 4025047823 


METROPOLITAN UTILITIES MUDOl S/^DYMUD Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 


CITY OF OMAHA- OMAHACOF RICHTRAFFIC Ak: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

dhon.org/irthinternet/.../MessageText.as... 1/2 
3/31/2011 j ^ www.dhon.org/irthinternet/DHONNotic... 

W ^Day : 4067289343 

r^ni^T^r^no^ OMAHA PUBLIC POWER ELM y ,^__ , ,^, 

0PPDGPR5 j^jg^^ ^ LOCATING ^ = 4062071494 

Emei^: 8887289343 


Day: 4067289343 

FTM 

QLNNEIC QWEST LOCAL NETWORK TM\^T ^ Alt: 4062071494 

LOCAHNCJ 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

OLS#: 27091 

Date Excavated: 4/9/2011 .. r Date USEPA Signed Off: 4/19/2011 

Area Sodden: 1012 sa 

%llii 27091 

Omaha Exterior Painl Lead Site Owner Nain«: RICHARD D Mt'lER3 IK 

Site Sketch • Good 

Address: 1911Ji25 ST • Poor Phone: H: ^ . «/f|:-«!20 0 

[ig'Not paint 

Sampt Lead Sample Samples Collected e Number LAB Concentration Collected Firm: 

RYASCPXA-27091 F1 2.S 0 ppm D Date: f7n7o r 

RYBSCPXA-27091 F2 / 2>0 ppm C3' D Tinrw: i:i Q 

RYCSCPXA-27091 B1 2./0O ppm D 

Samples Analyzed RYDSCPXA-27091 B2 ISQ ppm Ef D 

RDgGCP)(A-g709< 82 - Pom D D XRF Uni t: lO'b l Book: 133 

nOgCCPXA 27001 62 - ~ OPm D D Date: /D-Zl-OS -

RPZ6CPXA 27001 PZ- ~ ppm D D Time: Prn 

Staff: ^ A Number of Samples = * / 

Omaha Lead Site 46130 

Legend 

Concre'te Dzip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area lef t bare Sod Rock/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
LL 27091 

Owner Name: RICHARD Dw^ww-TR Omaha Lead Site 

» j j <nHH inc OT Site Sketch Address: 1.?11.N.2.5 §[ 

Phone: H: W: H<lZ~°tZ.0O 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-27091 F1 2.S0 ppm D 

RYBSCPXA-27091 F2 / 3( 9 ppm 13' D 

RYCSCPXA-27091 B1 2./ciO ppm D 

RYDSCPXA-27091 B2 7^ ^ Dom D 

nDZQCPXA 27001

nOgOCPX/'i 27001. 

RPZSCPXA D7001 

 B2­

-P2­

'^

~

 ppm 

 ppm 

D 

D 

D 

n 

D 

D 

Numt)er of Samples = */ \ 

Exterior Paint North Arrow 

• Good 

• Poor 

(3^ Not paint 

Samples Collected 

Firm: At ^ ca/t- M 

Date: H/M/OS -

Time: / : /o 

Samples Analyzed 

XRF Unit: /02> 1 Book: 133 

Date: /0'Z7'0S r 

Time: PJT) 

Staff: I. A 

^P- 2 7; 2805 

Omaha Lead Site 46130 

^y) 
iini 27091 

Address: 1911 N 25 ST

Phone: H:

Sample Number 

RYASCPXA-27091 F1 

RYBSCPXA-27091 F2 

RYCSCPXA-27091 B1 

RYDSCPXA-27091 B2 

nDgOCPXA-2700i BZnOZSCPXu^ 27001 -GZrRPZSCPXA 27001 -PZr 

 ^'*® Sketch 

 W: H^Z-' ^ ZOO 

Lead Sample LAB Concentration Collected 

2.5 0 ppm n 

/ S>0 ppm D 

Zla^ppm D 

7S6o ppm D 

ppm D D " " ppm D D ~ ppm D D 

Number of Samples = V 

Exterior Paint Nortti Arrow 

• Good 

• Poor 

Q^ Not paint 

Samples Collected 

f^imi: A^u/ csAi' ^ 

Date: <»//•>/or 

Time: ^ :/ o 

Samples Analyzed 

XRF Unit: /<g3 7 Book: t 3 3 

Date: /0'Z7-^S ' 

Time: B!2l 

Staff: l ^ 

Omaha Lead Site 46130 
27091 

trier s 

Owne Omaha Lead Site r Name: RjCHARD p wefBPRTTR 

Site Sketch Address: 1911 N25ST 

Phone: H: w HiZ-'^ZOO 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-27091 Fl 2.S 0 ppm D 

RYBSCPXA-27091 F2 / 3 0 ppm D 

RYCSCPXA-27091 Bl 2/^2j2_PPm D 

RYDSCPXA-27091 B2 ISC o ppm D 

nDgGOPXA-27091 B2­ ppm D D 

nOZCCPXA 27001

RPZSCPXA 27001

 6£-

 PZ­

"^

~

 ppm 

 ppm 

n a 

Numt)er of Samples = Y 

Exterior Paint (»tortti Arrow 

• Good 

D ^°°'^ 

[3^ Not paint 

Samples Collected 

Pin": itf..c u/ ca A »\ 

Dale: '^/n/^f 

Time: ^ :/ o 

Samples Analyzed 

XRF Unit: /O^ l Book: 15 3 

Date: /0'Z7-^S ' 

Time: P^yj 

Staff: rLAji 

Omaha Lead Site 46130 
j^^eosr,. ^ 

COASTA l 

IIIVIIOHHIItlAl 

C t 0 tl 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: ^ 

OiPUMT^ ALOtJl* Owner's Name: Daytime Phone:2 ® S* ^lS { 

Address of Property /^/ / h7 2S g ^ 

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, v\nll contact 

the Grantor in-person to discuss the work to be perfonned, 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 wilF 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 perfomiing the work. This access shall 

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

agrees to: 

Page 1 of 2 
V^^j f

 COASTAL * .

 .r' y mtHOHHUlTi l - i ORO^t^ C ft O U r I K c 

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

piles, dog houses, etc; 

e 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; 

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. 

c 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 

1^ I grant access to my properties D I do not grant access to my properties 

Signatun^ Date Signature Date 

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

Page 2 of 2 
COA S T A L 

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: 'ly^TT// 

Property Address: 1^^// //zy^^' ^ 

Owner: Orclurxct7^l(i^^<i 

Thone:J^^(yl^ ^ 

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

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

Item: 

Kem: 

Page 1 of. 
COA S T A L 

Items to Be Removed By Contractor During Remediation and Reolaced 

Item: 

^ 7 L 

Hem: 

S^P 

Kem: 

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 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. 

Easement Area, to be 

excavated 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

Quadrants 

• ^ ^ 

1 Each 

<P Each 

Each 

^ 

f Each 

Square Feet 

S $ 

yyy Each 

Page 2 of. 
COA S T A 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. 

IKI Please check this box if you understand the informzrtion outlined above. 

G 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. 

f)Cl I agree Q I do not agree 

Ai£^. y67.y..^ •/.-,.-... y^d^eu^ 7oL/c() 

Owner's Sji^ature Date Contractor's Signature Date 

Page 3 of. 
XRF PROPERTY SAMPLE SHEET 

BVID# *Z^Cf\ I 

Date 

Project 

XRF ID# 

Shot # 

3 ^ 

3-\ 

Z-B 

Average

.oMt 

Omani 

^ g U a Lead ARRA 

'Hia^ 

Reading 

341 ^X5 

:^o31 2^3 

zen t 2.3 

Sample area 

B^ 

Depth 

^ " 

 ^i/ O t Z 4 

Address 

Sample time 

sample length 

Average 

Shot# 

i^n M. -7.^ g?" 

am/pm 

30 sec 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

" Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Average / 

Signature y "ft 

Print ' 

^ 

y A Depth 

y / 

yy ^ 

/tf ^ (Hff1^> 

Average 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

J<L3t-32089 

Reading No 

Mode 

"Yime 

Duration 93.38 

Sequence Final 

Flags 

AVERAGE. Avg of 36-38 

ADDRESS 

1911n 25 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH 

N. LOPEZ 

MISC 

confirmation 

NOTE 

none 

ppm Error 

Mo < LOD 8.170 

Zr 489.883 ± 16.551 

Sr 182.176 ± 9.375 

U < LOD 15.027 

Rb 72.816 ± 6.844 

Th 19.037 ± 10.051 

_^_310.80 8 ± '«"-TM-«4TG8?" 

'I ' Se < LOD 6.099 

± As 33.633 21.506 Hg < LOD 12.521 

Zn 216.990 ± 25.152 

W < LOD ^^" ^ 88.^42 

Cu < LOD ^ / 32C984 

Ni < LOD y y78.744 

y^ Co < LOD / /l98.30 3 

Fe 20412.555/ ± y 414.207 

Mn 596.42S y ^ 112.423 

y 

Supervised By: V/'^ y y 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpil<e 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 36 

Mode SOIL 

Time 2011-04-22 13:43 

Duration 30.82 

Sequence Final 

Flags 

BVID 27091 

ADDRESS 1911 n 25 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Mo < LOD 8.335 

Zr 523.333 ± 17.097 

Sr 175.019 ± 9.251 

U < LOD 15.465 

Rb 70.367 i 6.830 

Th IR nfin ± 10.252 

Pb ^1041.07 4 ^— ^ ^ 25.312 

Se < LOD ^ ^ 6.648 

As < LOD 33.661 

Hg < LOD 12.225 

Zn 226.358 ± 25.610 

W < LOD 84.330 

Cu < LOD 32.663 

Ni < LOD 81.393 

Co < LOD 194.730 

Fe 19650.223 ± 408.546 

Mn 578.309 ± 111.239 

Supe rvised By; 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 37 

Mode SOIL 

Time 2011-04-22 13:44 

Duration 31.35 

Sequence Final 

Flags 

BVID 27091 

ADDRESS 1911 n 25 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Mo < LOD • 7.970 

Zr 473.843 ± 16.202 

Sr 187.660 ± 9.431 

U < LOD 14.886 

Rb 72.728 ± 6.784 

Th 17.407 ± 9.798 

^^^03.46 9 ± JH ^_?3.60 0 

Se ^ ^ ^ < LOD 5.600 

± As 38.566 21.248 

Hq < LOD 12.864 

Zn 208.142 ± 24.656 

W < LOD 92.031 

Cu 45.131 ± 22.736 

Ni < LOD ; 74.784 

Co < LOD : 199.665 

Fe 21196.857 ± 418.738 

Mn 555.671 ± 109.248 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 38 

Mode SOIL 

Time 2011-04-22 13:44 

Duration 31.21 

Sequence Final 

Flags 

BVID 27091 

ADDRESS 1911 n 25 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Mo < LOD 8.204 

Zr 472.474 ± 16.355 

Sr 183.848 ± 9.442 

U < LOD • 14.731 

Rb 75.353 ± 6.918 

Th 21.646 ± 10.102 

o^ m ^^P87.880 ­ . 23.34Z 

?P " As 

" ^ < LOD

< LOD 

~ 6.05(T 

31.244 

^ 

Hg < LOD 12.472 

Zn 216.469 ± 25.189 

W < LOD 89.267 

Cu < LOD 32.185 

Ni < LOD 80.054 

Co 212.698 ± 133.675 

Fe 20390.584 ± 415.338 

Mn 655.295 ± 116.783 

Supervised By: 
• • 

1^^^^ ^ Omaha Lead Site—Fixed Price EP-R7-09-06 

S ^^^7 I Coastal Environmental Group Inc. .| l 

^*^^J ^ www.coastalhazmat.com TM 

""•"^ COASTAL 

EXECUTIVE SUMMARY: 

BVID #27091- (1911 N 25 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

COASTAL IS UNABLE TO PROVIDE PRE-EXCAVATION, EXCAVATION, AND SOD 

PHOTOS AS PART OF THIS FINAL PROPERTY FOLDER. THESE PHOTOS WERE IN 

THE POSSESSION OF A SUBCONTRACTOR THAT WAS CONTRACTED TO PERFORM 

ALL OF THE SITE COORDINATION REQUIRED BY THE SCOPE OF WORK AND THE 

SUBCONTRACTOR HAS SINCE LEFT THE PROJECT. THEREFORE, THE PHOTOS 

ARE NO LONGER AVAILABLE 

DAN GARVEY WALKED AND SIGNED OFF ON THE PROPERTY AS COMPLETE ON 

4/19/2011. 
m 

Property Completion Agreement 

This agreement document ihe complclion ot remedial acliviiies perloimed on my properly My signalure 

will designate thai I am satisfied wilh ihe restoration of my propeily. and that no items are in questions, 

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

Property [D: ^pZjp^ f 

Property Address: /^/ / 7172- ^ 

Owner: (Mlk2^^^T^ 

Phone: r-(Qi^ l 

Restoration Items in Question: 

ttem: 

item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

''^V 7"' ^ xr^,^9 

I Rgrcc restoralion is completed, except as noted 

[_J I rio /lol «(>rec restoration i.\ completed 

Owner' s SiHt^tiire' ' " Date Conti arlor's Signature 
% 

EPA Property Close Out Form 

Proptrty #i JlhT^f. . Property Address: s T^ 

Date/TlRic: Owner's Name:, /4_ 

Quads Excavated: Contraclor Group 

Excavatio Yes No n General 

1. If necessaiy, were tlie correct qiiadrant(s) excavated and restored? / 

2. If necessary, were the correct areas ofdrip zone excavaled aod restored? y 

Grading Yes No Sod and Vegelattoa 

I. Does the trading around the perimeter ofthe house in excavated areas generally slope away "TT from the house? 

2. Has sod been laid in al! areas that were excavated? / 

3. Does the sod appear to be generally healthy and growing? (Only evaluale if inspected at a 30 

/ day time period) . 

4. Are sodded areas genetally (irm and evenly graded? / 

5. Are the Joints t>etween the sod strips generally tight? (Only evaluate if Inspected at a 30 day / time period) 

6. Was the propeity graded such that water will not pool on the property? / 

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

Gates, Ftaccs and Retaining Walls Yes N^ 

I 1. Do gates open and close fieely? (Ifapplicable) 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 7

4. Was damage to retaining walls avoided? (Ifapplicable) 7

Foundation, SidiSK and Gntlers Yes .No 

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

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4 Was damage to windows or door screens avoided? y 

S. Was damage to downspouts or downspoui extensions avoided? y \ 

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage lo driveway surfaces avoided? y \ ' 

2. Was damage to walkway surfaces avoided? y 
% 

OM'tiers comnaents: 

(n.spetrtion no*es: 

Removal and resloration aclivales complete including ihe 30-day sod warranty: 

EPA Representative ^9Ws5L Dale: iUtl'-t­
V 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: >9^0 9 ! Date: My 

Address: l9/ l M 2 ^ S T 

Remediation Contractor: _Coastal Environmental Group_ Year: _2011ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

n Executive Summary 

n EPA-provided property sketch 

D Signed Access Agreement for subject property 

n Signed Access Agreement(s) for adjacent property 

D Restoration Agreement 

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

D Confirmation data 

D Photographs 

D As-built sketch 

D Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D 

D . 

Signature Date