TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA1D# : % ^^ 

Date: ^ | 1^ | U 

Add..: ^^^^ u y^*" y 

Remediation Contractor: Coastal Environmental Group_ Year: lOlOARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

1/ 

Video ofproperty (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

•rr 

Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

Confirmation data 

Photographs i H t>^6n/fVmA/\ y tr?°6Q(t/^ni^ < ^"^ 

As-built sketch 

/ 

Satisfactory restoration signed by Property Owner 

y 

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 

30217693 

Superfund 
1» 

^\ 

Property Access Checklist 

[PrPropert e y ID: ^30 , L/ ^ 

Property Address:'^^ ^ \ | 7, ^ ^T * 

D

•

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner; 

Address: 

IZipyi Dttr CruM

Phone 

Fax: 

1Q1­ b? m 

Cell/Pager: 

 f> 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

D Notification Letter 

^ Access Agreement 

SI Restoration Agreement 

D Topsoil Sampling (if appUcable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

j Q UtiUty Clearance 

Ca^ideo/Photos (Before) 

D Video/Photos (During) 

n Video/JPhotos (After) 

n Video/Photos (30-Day) 

Q Property Completion Agreement 

D Final Report 

Sent: / / 

Signed: _2^/_ll./K ) 

Signed: 2^/lL/l D 

/ / 

/ / 

/ / 

CaUed:3 I 131 10 

On: 1 I »0/ (O 

On: / / 

On: / / 

On: 7 / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

'hHT.h a 

CC^^Wt^ 

Air Monitoring (as appUcable) 

n Community D Crew 

Results: 

On: / / By: 1 

Q Community

Results: 

 QCrew On: / / By: 

• community

Results: 

 QCrew On: / / By: 1 

Omaha Lead Site 
Douglas Coimty Account In nm^o n Page 1 of3 

Douglas County, Nebraska Property Record - R2013610000 

Print Report 

NEW Feature - Parcel Dimensions available (9! scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-12-15 Treasurer's Tax Report 

New Feature •* "* ' ^ Auto Sales SearcKi 

Owner 

WRIGHTSELL INVESTMENTS LLC 

ETAL 

12657 DEER CREEK DR 

OMAHA NE 68142-0000 

Property Informatio n 

Key Number: 1361 0000 20 

Account Type: Residential 

Parcel Number: 2613610000 

Parcel Address: 3933 N 23 ST 

OMAHA NE 68110-0000 

Legal Description: PLAINVIEW LOT 18 BLOCK 3 50 X 124 

Value Informatio n 

Land Improvement Total 

2009 $7,000.00 $32,700.00 $39,700.00 

2008 $7,000.00 $32,700.00 $39,700.00 

2007 $7,000.00 $32,700.00 $39,700.00 

2006 $7,000.00 $32,700.00 $39,700.00 

2005 $7,000.00 $12,700.00 $19,700.00 

2004 $7,000.00 $11,500.00 $18,500.00 

Sales Informatio n 

Sales Date: 2006-01-23 

Deed Type: QCM Book: 2006 Page: 007796 

Price: $0.00 

Grantor: Latrell Wrightsell etal 

Grantee: Wrightsell Investments 

Valld/lnvalld: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 2006-01-09 

Deed Type: QCM Book: 2006 Page: 002694 

Price: $0.00 

Grantor: Wrightsell Investments 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 12/31/2009 
Douglas County Accoimt In&gjj^ion Page 2 of3 

Grantee: 

Valld/lnvalld: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valld/lnvalld: 

Exclusion Reason: 

. 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valld/lnvalld: 

Exclusion Reason: 

Land Informatio n 

Acres SF 

0.14 

Latrell Wrightsell etal 

Invalid 

Corrective Deed 

2006-01-06 

QCM Book: 

$0.00 

WRIGHTSELL INVESTMENTS LLC 

LATRELL WRIGHTELL ETAL 

Invalid 

Multiple Owner - Trade 

2004-11-16 

QCM Book: 

$0.00 

LATRELL WRIGHTSELL ETAL 

WRIGHTSELL INVESTMENTS LLC 

Invalid 

Multiple Parcel Sale 

2001-01-05 

2006 Page: 002004 

2004 Page: 160767 

D Book: 2171 Page: 653 

$23,000.00 

Valid 

Units Depth Width Vacant 

6200.0 1.0 124,0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 12/31/2009 
Douglas County Account In i^l^io n Page 3 of 3 

3933 N 23 a . 

•;sff 

•< 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 936.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Poor 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.0 

Fioorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1904 0% 1904 105 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 461.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 480.0 

Porch End Screen 60.0 

Porch End Screen 133.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 12/31/2009 
Page 1 of2 

"> 

Qrejte AnotherJTIcketjv^ J •j__ _ Backto^lrtMnternet_ ] Send Emajl^_;| 

YOUR TICKET NUMBER IS 2440697. 

Original Call Date: 3/18/10 Time: 12:47 pm Op: ELIZABETH18790 

Work to Begin Date: 3/22/10 Time: 1:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3933 Street: N 23RD ST 

Twp: 15N Rng: 13E Sect-Qtr: 03-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASTMENTS. LOCATE ENTIRE PROPERTY 


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 


ALT872 CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

ALT872 WINDSTREAM COMMUNICATION ELM 

LOCATING 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

x,MAGELLA f A /-CT T A XT MAGELLAN MIDSTREAM PARTNERS x^cor^o A U N . p DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 3/18/2010 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHATRAFFIC

Day:

 AW.

 4024447197 

 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

AU: 4062071494 

Emerg: 8887289343 

http://vmvv^.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 3/18/2010 
OLS#: 33643 ^ As-Built Drawing ^ Date Excavated: 3/29/2010 

Date USEPA Signed Off: 6/11/2010 

COASTA L OTiaha Lead Superfund St e EMViaONMtNTAL Area Sodden: 3375 sa ft « « O U P , INC . 

Omaha Lead Site Date: 6/yy/c>^ Noffth AiTow 

Address: ^O.T ^ AT. j:/ 3 -&- Stte Sketch T«ne: 

• ^ 

Team /^."r A J A/ilf,^ /fi^iJ^'a* .J3l^^ ^ XRF Code ^^^ ¥ 

Sample Number Lead Concentration Confirniation Sample 

pyy^i£fx^ ­ Kyi7$cyxft~ ss^^J ^ 

 3S6>^3 

ppm 

ppm 

^l\e s 

y^Ye s 

y/Ye s 

"B^Yes 

3>ZYes 

Yes 

Yes 

•

• 

•

•

•

• 

No 

^to 

iz5 

No CI 

No (2 

No H 

No a 

No • 

B2 = 341 PPM @ 6" 

F2=138PPM@6" 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavate d 

Are a replace d

Sod

 wit h ^H j

 ^ ^

 Area replace d wit h 

 Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc 
Hm^ 11 :^/|g| 

Omaha Lead Site Date W6>> North Arrow —i 

Address- ^ f ^.T,^ A^. JH/s - ^ Site Sketch Time 

Phone: •f'if.j'-'/ f 5-^-7/-y - V 

Team -/^.•T ^ J y%if ^ /^^VID # .T3z>V ? XRF Code -5"^^ ^ 

Sample Number Lead Concentration Confirmation Sample 

/^/Yes n No ^ 

j^ysf^'^xw /^Ye s a No tZJ 

y/Yes • No ca 

^i-Yes D No t2I 

:pzYes n No 0 

Yes • No • 

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Omaha Lead Site y.^^ny^^4(,nQ 
1 4^ 

Namer"%^/vt AJA^^A/^j^y^Ay Omaha Lead Site Date North Arrow —i 

Address: ^4»,-r.^ /y. J^.:5 -s ^ Site Sketch Time: 

Phone: ^^^2-^93-^-?/ ^ V 

Team -/ f . f ^ J /^/ ^ /f^^VfeviD # . T 3Z > V ? XRF Code ^S^ ^ 

Sample Number Lead Concentration Confirmation Sample 

-^/Yes ° No ^ "EJ^MH^KL /^Ye s n No I2J 

y/Ye s 2 No 12 

No 13 

No 0 

No CD 

No • 

• 1 11 / ' !• 

"^Mnim 

Omaha Lead Site 46130 
Omaha Lead Site Date: North Arrow 

Address: ^»,T. ^ M. ::fS ^ Site Sketch Time: 

Phone: ^/^g-.<^^,^-^-r/ ^ V 

Team /^. f o J y^/iif^ //wVfeviD # .73ZrV ? XRF Code ^^^ ^ 

Sample Number Confirmation Sample 

/7Yes n No ^ 

/^Ye s a No CJ 

y/Ye s n No C 

-Si-Yes CD No f2 

3)ZVes n No 0 

Yes n No n 

Yes • No • 

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Omaha Lead Site 46130 
^^^.eosr.,^^ 

COASTA I INVIRONKCkTAl 

C I 0 U r I h 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: 1/1,1 iL'Z 

Owner's Name: Daytime Phone: 

Address of Property 

covered by this ?755^i fh^ Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work Is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before It begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

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

ajgreesto: 

Page 1 of 2 
^ 

COASTA L 

INViaONKtKTtl 

t 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; 

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

necessary subsequent to an initial watering period by EPA; 

e 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 

H' I grant access to my properties D I do not grant access to my properties 

Signature Date signature Date 

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

Page 2 of 2 
COASTA 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: ^^(^4" j 

Property ^T ^  Addressr^^y^T^ ^ ^ " 

Owner: gVyv^. W^yrlr^ n m\te.4'i/ufc4 ^^ ^ 

Phone: 

A o l 7&7 <kZ^U 

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 dociunent the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or retum of these Items is the Owner's responsibiiity. 

item: 

<.^p»-3 

item: 

item: 

ttem: 

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

Item: 

/l^y .\ /^// PU J 

item: 

Item: 

Item: 

Page 1of ^ 
COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

item: 

item: 

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 

Niimber 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. 

Fasement Area, to be 

excavated 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

Quadrants 

Each 

Each 

u Each fr 

Each 

Square Feet 

$ 

Each 

Page 2 of. 
C O A S T A L 

o n o u r . INC . 

Additionai 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. 

j6^\ lease check this box if you understand the information outlined above. 

^ OLAC^fy fitr^cy^ St^i^Y. 

n 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. 

n I do not agree 

Z-l /-10 

OwTier's Si Signatur i e Date Contractor's iSignature Date 

Page 3 of. 
ft 

BVID # 33 ^ V 3 


XRF PROPERTY SAMPLE SHEET 


Date ^-•3 H O Address 39 33 y\/ Z 3 s r 

Project Omaha Lead ARRA Sample time am/pm 

XRFID# ;z^.^^» sample length 30 sec 

Reading Sample area 

;Sc/3 :^^ r cCW­

^cc-:^^^^ ^ Depth 

^^3J^ .$ir ly . 

^^ 6 ^^ ^ 

Reading 

<3<rir y^ 

Sample area 

r^ 

f^ ^ // ^ 

W^^/ ^ 

Depth 

M 

 /3^ J^ 13 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Shot# 

^£ r 

S ^ 

2^r? 

Average

Reading 

^<;i :t ^1 

^10 t ^ f 

rT^AT^^/ 

 <90 ^ t 5i { 

Shot# 

M± 

3SS 

"3 ^ 

Average

Reading 

5SS i^^-h 

32)6 >^9 ­

33^ ;f^^fp 

 3^ ( -><y ^ 

Shot# Reading 

Average 

Shot# Reading 

Average 

^^— y 

Signature 

Sample area 

i>a- Depth 

//) " 

Sample area 

^ 

Depth 

Sample area 

Depth 

Shot# 

.mi 

J23. 

SI 

Average

Shot# 

^22. 

. ^1 ^ 

Average

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Print ii[f^(o t^Wi^ 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certific 

XL3t-39022 

Reading No 391 

Mode SOIL 

Time 2010-03-31 13:56 

Duration 91.41 

Sequence Final 

Flags 

AVERAGE (rr^Avg-or388=390 

ADDRESS 3933 N 23 st 

QUADRANT DZ 

DEPHT 10" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Error 

Pb 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 388 

Mode SOIL 

Time 2010-03-31 13:55 

Duration 30.41 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT DZ 

DEPHT 10" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 201.949 ± 21.028 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 389 

Mode SOIL 

Time 2010-03-31 13:55 

Duration 30.51 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT DZ 

DEPHT 10" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 210.042 ± 21.192 

Supervised By: 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 390 

Mode SOIL 

Time , 2010-03-31 13:56 

Duration 30.49 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT DZ 

DEPHT 10" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 214.510 ± 20.872 

Supervised By: 
t 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 395 

Mode SOIL 

Time 2010-03-31 13:59 

Duration 90.74 

Sequence Final 

Flags 

AVERAGE rAvg ot 392-394^—-j 

ADDRESS "-igss N~23-st 

QUADRANT easement 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Supervised By 
t 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 392 

Mode SOIL 

Time 2010-03-31 13:57 

Duration 30.14 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT easement 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 243.283 ± 24.699 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 393 

Mode SOIL 

Time 2010-03-31 13:58 

Duration 30.52 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 St 

QUADRANT easement 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 252.815 ± 22.430 

Supervised By: 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 394 

Mode SOIL 

Time 2010-03-31 13:59 

Duration 30.08 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT easement 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 241.828 ± 24.548 

Supervised By: 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 387 

Mode SOIL 

Time 2010-03-31 13:53 

Duration 91.40 

Sequence Final 

Flags 

AVERAGE rAvg-Dr384^36___3 

ADDRESS S§337r23s t 

QUADRANT B2 

DEPHT 6" 

XRFTECH N. LOPEZ 

MISC confirmation 

NOTE none 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 384 

Mode SOIL 

Time 2010-03-31 13:51 

Duration 30.39 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 St 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 355.203 ± 27.147 

Supervised By: 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 385 

Mode SOIL 

Time 2010-03-31 13:52 

Duration 30.47 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 332.901 ± 26.532 

Supervised By: 
ft 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 386 

Mode SOIL 

Time 2010-03-31 13:53 

Duration 30.54 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT B2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 333.761 ± 26.300 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 238 

Mode SOIL 

Time 2010-04-15 07:30 

Duration 91.93 

Sequence Final 

Flags 

AVERAGE Ayg.X)«35=237 

ADDRESS 1.3933-1^23^1 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 235 

Mode SOIL 

Time 2010-04-15 07:29 

Duration 30.79 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 134.741 ± 17.529 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 236 

Mode SOIL 

Time 2010-04-15 07:29 

Duration 30.38 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 137.878 ± 17.777 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 237 

Mode SOIL 

Time 2010-04-15 07:30 

Duration 30.76 

Sequence Final 

Flags 

BVID 33643 

ADDRESS 3933 N 23 st 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 142.839 ± 17.929 

Supervised By: 
/lA. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I ' Coastal Environmental Group Inc. 

S^r^^r ^ www.coa8talhazmat.com 

^"i^y^ COASTAL ENVIIONHINTAL 

C t O U P, IH C 

EXECUTIVE SUMMARY: 

BVID #33643-(3933 N 23 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

DAN GARVEY WALKED THE PROPERTY ON 6/11/10 
4

EPA Property Close Out Form 

Property «»:_22iMi: ^ 

Date/Time: 

Quads Excavated: 

Excavation Gcnerml 

1. if necessuy, were the correct qtuulrant(s) excavated and restored? 

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

Grading Sod and VcgglatioB 

I. Docs the pvding around the perimeter ofthe house in excavated areas generelly slope away 

from the house? , 

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

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

day time period) _ ^ 

4. Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generelly tight? (Only evaluate if inspected at a 30 day 

time period) 

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

7. Was damage lo landscaping or plant materials avoided? 

Gates, Fences and Rcuinlns Walls 

1. Oo gates open and close freely? (If applicable) 

2. Were all gates or fences taken dowti during restoration activilies reinstalled? (If applicable) 

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

4. Was damage to reiainhig walls avoided? (If applicable) 

Foundation, SidiaKand Gntlers 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

5. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

y 

y 

Yes No 

y 

y 

y 

y 

y 

/ 

Ves Nu 

/ 

y 

V 

/ 

Yes No 

J 

/ 

/ 

J 

Yes No 

/ 

7 
Ort'oers comments: 

rinspection notes: 

Removal and resloration activales complete including the 30-day sod warranty: 

EPA Representative Qc^^^Juj Date: Bfu/io 

7 
ttSa 

Property Completion Agreement 

llns agreement documenls the complclion ot remedial acliviiies perioimed on my properly My signaiuie 

will designate ihal I am satisfied with ihe restoration of my property, and thai no items are in questions, 

now, or al any dine in the future, except liiose ilems ttslcd below, if any 

Properry ID: ^-^X^jJ ^ 

Property Address: 0 ^ ^ ^ K \ nl ^ , ^ ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

L 

Additional Comments: 

L 

n^A I Agree restoralion is completed, exccpl as noted 

[ J I rio not scree resforat/nn is complelect 

irk J. . _ * ^ . . « *>• Owner' s Signatiirr Date Contrarior' s Signature Dale 
109) 

Property Owner Assessment of Perfd 

American Recovery and Reinvestment Act (AlRJlA) .. 

Omaha Lead Superfund Site JUN 0 ^ ^"'" 

2009/2010 .^ rsn/icinM 

SUPERFUND OIVISION 

r: t..oasUl Remediation Contractor: Coastal Environmenta Envirqnmc l Group - EP-R7-09-06 

Propertv Identifier Nnmber: .^^?iilflVI'S 

Property Address: ?M?P » TKI 7.% " ^ 

Property Owner's Name: Uif\ri^<^A \ \(\N;p^EjyNP At-< 

Instructions to the Propertv Owner; 

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

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

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

relations, complaint resolution and the overall qudity of work. Ifneed be, the Propoty 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 

Perfonnance Work Statement. 

The Property Owner will indicate his/her assessment of perfomiance 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" 

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

10 5 

d)S 

Property Owner Additional Coanments from (optional; continue on back page if neededl 

Property Owner Signature: /y-S?./^ l \ ^ llyP H Date:K, / / '//j / /(. 
Water Bill Settlement 

Property ID 33643 

Property Address 3933 N 23 St 

Tenant Lenel R. Gills 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 42.94 for 

water usage required to maintain the sod. 

Check Number 2037 

Value of Check $42.94 

Made Out To Mary D. Anderson 

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. 

^^r ^ 

OnWtef's Signature "*' ' *-^^ Date Contractor's Signature 

Tyi^W^M^m^.jyi^yM^^^-y^yi^Syj^ ^ 

COASTAL ENVIRONMENTAL GROUP INC. 2037 

2411 MARTHA STREET 27-5/1040003 OMAHA. NE 681 OS 6247372904 

7(50|lil DATE 

PAY 

ORDE^^'^ R 

' Un d f?. 61115 $ 4 ^ 

foito-aw/uirf'*7M?~ . DOLLARS fi Si i 

WdhFugoIaiKNA 

IMiiuki 

FOR ?^q?>?> b^-zs s ^ "jyiMruu^ ^ eyo^— ^

i: 101,00005ai: tauT^TE^oi,"' osoa?