TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#3ll<^l/? DATE: 1/23/lZ 

ADRESS:D^Wi fefJ.S-f^ S^>^ 

REMEDIATION CONTRACTGR: COASTAL ENVIRONMENTAL GROUP YEAR: 2J$IZ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

/ Executive Summary 

7 EPA-provided property sketch 

3 Signed Access Agreement for subject property 

Signed Access Agreement (s) for adjacent property 

y Restoration Agreement 

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

i V Confirmation data 

D Photographs SOD y Pre-Excavation 

Excavation 

i / As-Built sketch 

V Satisfactory restoration signed by Property Ow/ner 

B Property close-out check list signed by EPA 

^J!^ Description of areas of areas not meeting ROD cleanup criteria 

y j Utility clearances 

3 Property Information from Douglas County Assessor's Office 

D 

Date 

30261354 

Superfund 
y ^ 

( y 

& ' ^ 

vv 

<?-> 

Property Access Checklist 

Property ID: ^//<^ ^ n WORK STARTED ON: / /_ 

Property Address: J^^^l / fbf/j'Sjh/ ^t 3 D WORK COMPELTED ON: I I 

Owner: YMh Renter: y JbA<^ 

Address: Phone: 

IZ^2 . /V 1Z^ C7^ Fax: 

CeU/Pager: 

Phone: ^c^ ^ ^3 ^ 9^^ ^ Additional Information: 

Fax: 

CeU/Pager: 

0 Notification Letter Sent: / / By: 

• ^ Access Agreement Signed:/A / C^ / ft By: 

[ ^ Restoration Agreement Signed: /D/ 1^1 h By: 

tZ] TopsoU Sampling (if appUcable) 1 1 By: 

0 Disposal Sampling (if appUcable) 1 1 By: 

• Garden SampUng (if appUcable) 1 1 . By= 

^ UtiUty Clearance CaUed: (Ol f^ l f, By: k^c^J ^ 

D Video/Photos (Before) On: / / ^ 

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

• Video/Photos (After) On: / / By: 

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

• Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as appUcable) 

• Community Q Crew On: / / . By: 

Results: 

• Community Q Crew On: / / By: 

Results: 

• Community Q Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account InfiMgiation t^ma 

Douglas County, Nebraska Property Record -

Information is valid as of 2011 -9-13 

Owner 

BATES PHILLIP R 

12302 N 127 LN 

EL MIRAGE AZ 85335-0000 

Property Informatio n 

Page 1 of2 

 R1303220000 

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

New Feature -» -» -f Subdivision Sales Search 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

Land 

2011 

2010 

2009 

2008 

2007 

2006 

032.2 0000 13 

Residential 

1303220000 

2604 BRISTOL ST 

OMAHA NE 68111-0000 

HAWES ADD LOT 7 BLOCK 0 W 39.35 FT 39.35 X 132 

Improvement Total 

$500.00 $0.00 $500.00 

$500.00 $0.00 $500.00 

$500.00 $0.00 $500.00 

$500.00 $0.00 $500.00 

$500.00 $0.00 $500.00 

$500.00 $0.00 $500.00 

Show Ali Transactions 

Land Informatio n 

Acres SF 

0.13 5663.0 

Units Depth Width Vacant 

0.0 0.0 0.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R13... 9/22/2011 
Coasta l Environmenta l Grou p 

2411 Martha Street 

Onnaha, NE 68105 

Phone: 402.991.1199 

Toll Free: 877.662.4210 

Fax: 877.662.4211 

10/04/2011 

Phillip Bates 

12302 N 127 Ln 

El Mirage, AZ 85335 

Re: 2604 Bristol St 

Dear P Bates: 

We have received the paperwork for the property on 2602 Bristol St., but have yet to receive the 

paperwork for 2604 Bristol St. Enclosed you will find the paperwork that I reviewed with you over the 

phone. Please sign and retum the forms provided to the address listed above. If you have any questions or 

concerns, please feel free to call me at 402.991.1199 ext. 3612. Thank you. 

Very truly yours, 

COASTAL ENVIRONMENTAL GROUP, INC. 

^^nxT/^^pfta 

Site Coordination 

v(^ ^ COASTAL 

Solving problems. Building the future. 

Coastal Environmental Group, Inc. 

—8(a), HUB Zone, MBE, DEE 

2411 Martha Street 

Omaha, NE 68105 

(402) 991-1199 ext. 3612 office 

(877) 662-4211 fax 

(402)432-6947 cell 

w.lara(g)coastalqrp.net 

www.coastalgrp.net 

wvvw.coastaigrp.net 

Certified MBE • DBE • 8(a) • HUB Zone 
CONFIDENTIALITY NOTICE: This e-mail is intended only for the use of the 

person(s) or entity to whom it is addressed and may contain information that is 

privileged, confidential, and exempt from disclosure under applicable law. Unless 

stated to the contrary, any opinions or comments are personal to the writer and do 

not represent the official view of the company. If the reader of this e-mail is not the 

intended recipient, you are informed that any dissemination, copying or disclosure 

of the material contained herein, including attachments, in whole or part, is strictly 

prohibited. If you have received this e-mail in error, please notify the sender by 

return e-mail immediately and delete this message from your system. Thank you. 

Coastal Environmental Group 

vwtfw.coastalgrp.net 

Certified MBE • DBE • 8(a) • HUB Zone 
IRTH One Call Page 1 of 1 

Diggers Hotlin* 

Of 

Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2875570 . 

Original Call Date: 10/12/11 Time: 6:08 pm Op: WENDY18790 


Work to Begin Date: 10/17/11 Time: 7:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2604 Street: BRISTOL ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-NE,10-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: ENTIRE PROPERTY, INCLUDING EASEMENT, AND UP TO THE 


: PEDESTAL. 


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


: EMAIL ALL CLEARS TO: WLARA@COASTALGRP.NET 


: UNSURE IF CORNER LOT. 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name WENDY LARA Phone : (402)991-1199 


Alt. Contact JOSE CARDENAS Phone: (402)504-0981 


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


COXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Utility Service Area Name Contact Phone Numbers Code Type 

COXCATV co x COMMUNICATIONS ELMCOX ELMCOX Day: (406) 728 - 9343 

INC All. . fAr\/' \ -t-^- 7 -»r\-»/ ^ 

http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=860531 10/12/2011 
0\{f 

^ \ ' 

Wendy Lara V

From: agt_comm(girth.com 

Sent: Thursday, October 13, 2011 6:38 AM 

To: Wendy Lara 

Subject: Response to Dig Request 

To: COASTAL ENVIRONMENTAL SERVICE Attn: WENDY LARA 

Voice: 4029911199 Fax: 8776624211 

Re: Response to Dig Request 

This is an important message from Omaha Public Works replying to your request to locate our 


underground facilities in an area described on the one call center ticket. 


Ticket: 2875570 


County: DOUGLAS Place: Omaha 


Address: 2604 BRISTOL ST 


OMAHACOF (Sewer): 


City of Omaha Sewer- No Conflict per info on the one call ticket 


OMAHACOF (Traffic): 


The City of Omaha Traffic Engineering Division has determined our facility is 


not in conflict with the dig site provided by the one call center. 


If you have any additional questions please contact Omaha Public Works. 


This message was generated by an automated system. Please do not reply to this email, 

Wendy Lara M ^ ^ 

From: I RTH.Net(gq west.com 

Sent: Friday, October 14, 2011 5:12 PM 

To: Wendy Lara 

Subject: Message from Qwest 

To: COASTAL ENVIRONMENTAL SERVICE Attn: WENDY LARA 


Voice: 4029911199 Fax: 8776624211 


Re: Message from Qwest 


Message from Qwest 


Ticket: 2875570 


County: DOUGLAS Place: Omaha 


Address: 2604 BRISTOL ST 


QLNNEIC: 


The described dig area of your locate request has been checked and is clear for 


Qwest Communication's Local Network. If you have any questions please call 


Qwest at 1-800-283-4237. 


Message from Qwest 


This message was generated by an automated system. Please do not reply to this email. 


59 

0LS:31196 

As-Buil DATE EXCAVATED:10/24/11 t Drawing DATE USEPA SIGNED OFF: 11/01/11 

AREA SODDED: 2250 

COASTAL 

Envininmcntal (Jroup, Inc. Oinaha Lead Superfund Site

mil 3 1 I 96 

Omaha Lead Site Extenor Paml North Arrow

Site • Good Sketch 

I I Poor 

Sampling Address: 2604 BRISTOL ST 

1^1 Nol paint 

ation n LAB 

RYASCPXA-31196 F l p p m Firm EELXAiC Pe> KA 

Sample Number Lead Concentratio X R F Samples Collected 

y • RYBSCPXA-31196 F2 p p m Date a h 1 li O \ y RYCSCPXA-31196 B l • Time: °\-^Ci A>A /°2,q p p m nr^ n 

RYDSCPXA-31196 82 88M p p m ^ Samples Analyzed •

nD20CPXA-31196 D£ p p m n n 

p p m XRF Unit: tCiPirfLp Book: 26 8

• n

p p m n n Date n • n - ID 

Time P n Number of Samples = [ <-] \ \ Q Staff: na W 

Legend: F1 = Front Left. F2 = Front Right. Bl = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla 

All quadrants are as viewed frorr the street. Facing property 

^tSTTEREI^ 

NOV 1 2 2010 .,; .1 

; B1 =382ppm@ 13" o 

"^"~~~~-^^^:::>~^ B2 = 73ppm@13"

yy y

-===^^^ ; 

:1 ; f • /

mA. . . . r • '' "': 3 

> .1 u.I.C 

Fv bi Zz 

WAi_ K 

• 1 HO' 

'. .^Rir^-roL-. 'br..' Imilt rn am l .a.Nov 1" 

CONCRETE DRIP ZONE EXCAVATED QUADRANTS EXCAVATED 

AREA REPLACED WITH AREA LEFT BARE 

ROCK/MULCH AREA REPLACED WITH SOD 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
l\y (olir- (Prdl^ / , B OP-h^ I HI 31196 

Omaha Lead Site 

Site Sketch 

SamplliDs Address: -i'oo^ bKiarOL ST 

SafTiple Number Lead Concentration XRF LAB 

RYASCPXA-31196 F1 ppm D 

RYBSCPXA-31196

RYCSCPXA-31196

RYDSCPXA-31196

RDZeOPXA 31106

ROZSCPXA 31106

nPZCGPXA 31106

 F2 

 B1 

 B2 

 BZ 

 GZr 

 P2­

.ML L 

jyiBL 

_SfifL 

ppnn 

ppm 

ppm 

ppnn 

ppm 

ppm 

D 

n 

n 

D 

D 

D 

D 

a 

D 

Number of Samples = [ ^ 

Exterior Paint IMorth An-ow 

• Good 

• Poor 

[^^No t paint 

Samples Collected 

Firm ?^ X^^r. DE> KA 

Date: l|j|ili C 

Time: ^-M^^ AH 

Samples Analyzed 

XRF Unit: J£^.igU . Book: l& B 

Date M -n-io 

Time £tL 

Staff: haw 

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

All quadrants are as viesved from ttie street, facing property 

my NOV 12 2010 (yy'' yt33 

'.y^'z^izij 

2^3 

^1 

?Z z 

eg 

MO' 

WAvJK 

.bR.>SsXDL. r . '^T . Ucv ;(iW tVcitc^ la-Nri- !" 
in 31196 

Omah Exterior Paint North Arrow a Lea d Site • Good Site Sketc h • Poor 

Sampling Address: 2604 BRISTOL ST [Z4 ^-loi pain' 

Sample Number Lead Concentration XRF LAB Samples Collected 

RYASCPXA-31196 F1 ppm D Firm: Pg XMT . V ^ Kfl 

.2ai 

RYBSCPXA-3119 Date: llJllli O 6 F2 Md.. ppm \y D 

RYCSCPXA-3119 Time: '^-HA AH 6 Bl ^cZ°l ppm D 

RYDSCPXA-31196 B2 88M ppm D Samples Analyzed 

RDZSCPXA 31106 DZ ppm D D 

RCZSCPXA XRF Unit: IfyRiffLp Book: 26 8 31106 GZ- ppm D D 

RrZ6CPXA-31106 PZ- ppm D D Date: 1/ -11-1 0 

Time: p M 

Number of Samples =E Staff: M5 W 

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

All quadrants are as viewed from ttie street, facing property 

Rev :iil« Created; (M-NrvU im70l Ul :3 
4 

lliiiiilii 31196 

Omaha Lead Site 

Site Sketch 

Sampllna Address: 2604 BRISTOL ST 

Sample Number 

RYASCPXA-31196 Fl 

RYBSCPXA-31196 F2 

RYCSCPXA-31196 B1 

RYDSCPXA-31196 B2 

RDZ6CPXA-311Q6—^BZ 

ROZSCPXA 31106 62-

RrZCCPXA-31106 PZLegend: Fl = Front Left, F2 =

Lead Concentration

2ft3 ppm

•3<^/ ppm

/oZq ppm

68M ppm

" ppm

"~ ppm

•^ ppm

 XRF

 [ /

 [27

 U2Z

 [ 2

 D

 n

 D

Number of Samples = [ i^ \

 LAB 

D 

D 

D 

O 

D 

D 

D 

 \ Q | 

Exterior Paint North Arrow 

• Good 

• Poor 

0^Not paint 

Samples Collected 

Fimi: PETK\r. D & KA 

Date liinlic^ 

Time '^-MA AH 

XRF Unit: 

Date: 

Time: 

Staff: 

Samples Analyzed 

{r^P>(rJLt> Book: 26 8 

n -n-f P 

.£^L 

haw 

 Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla 

All quadrants are as viewed from ttie street, facing property 

-EW!rerH^x> 

\ NOV 1 . 2 2010: 

b 

' 88M 

a • > ^ : 

"—" y^ 

>'" ^ \ 

%9^ ^il.ai>\.... 

f l b! ri 

: r- • - •: 

• S : 

CSJ 

: MO- WAL K 

. .?>^) srDL:.*bx.­ • • . . . . :i>.lS Created: IM-No\'-li.i 

1U470I.. 
.%"* * j 

COASTA l 

E N V I R 0 K M £ N I A t 

C « O U r ' H C 

Consent fof Access To. Ffopterty 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to snd 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: ^\\\; ^ %v\e' b DaytimePhone: UC?^. ^ \ SL. "^MH ^ 

Address of Property 

covered by this \^r;^\o ^ ^ ^ 

'9-^0 ^ 

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 

agrees to: 

Page 1 of 2 
o r • " j 

V^-^ COASTA l IhVihOHt' , JKTt i 

'"l ..qol^'' 

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

piles, dog houses, etc; 

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

to save; 

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

necessary' subsequent to an initial watering penod 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 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 

—V)Q I grant access to my properties n I do not grant access to my properties 

Signature Signature Date 

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

Page 2 of 2 
COASTA L £MVIKONHIN7«kl . 

C N O U P . INC . 

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 fof 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: n^^^^^ 

Property Address: Zi\yyy<\ ^^\^c. \ <.\ 

Owner: 

^'AV^: ^ >^^e ^ 

Phone: V-^7)-. a\-5..^-V^ s 

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 of the property and the basement ifnecessary. 

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: 

(Xx^v^^ «sW-vDv\\ Vr> V <^^S<Z. 

Item: 

Item: 

Item: 

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

Item: 

fXvs.^ rA c r-\V •=;. Ve^V WU^^c l 

Item: 

Item: 

Item: 

Page 1 of '3> 
COASTA L 

Items to Be Removed By Contractor During Rernediation and Replaced 

Item: 

soW i -^A 

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 

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 Conditjpn/Type/Species 

e^jO ^ Quadrants [j Aj y L ^c^-5 5 

z. Each 

0 Each 

y Each 

y ^ \ • 

y Each 

Square Feet 

y $ 

y > Each {/tind y j ily/J^^ 

Page 2 of !> 
COASTA L KNVIMONHCNTA L 

GROUP . 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. 

I I Please check this box rf you understand the information outlined above. - ^ 

a OZ A \ I j ; ^ > ll-•= •> ^i^\ y ^^'' ^ -f.. \< 

• Check the box if Owner does not want CEG to document interior foundation walls and possible --t> 

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. 

Vok'a-l> 
XRF PROPERTY SAMPLE SHEET 


Date i.z)3zJ~3 Address 

Project Omaha Lead ARRA Sample time 

XRF 1D# sample length yzpyi 

Shot#__ Recdino J Sample'areF) Sho(# 

'yzLDlZy^. 

Q i t ( ^_ j Depth __ 7

... ^ ziylyiyL... Av/erage Average

Shot# Reading __ | Sample area Shot # 

_ 1O 5yyi^ inA 

'^ Z' f , u " I -. 

yzyyyjii..Li i..iznj 

Average / / - I J Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature 

Print /UICGICK S LZ/P C 

BVID# 7 / ( 9C 

73y.y7il£zyy3y337!L 

am/pm 

30 sec 

Reading Sample ares 

 \'jZZZy \ I Depth 

IJ 

 3yZ ^ 77-1.-

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Certificate of Verification 

5 

Soil 

2011-10-27 11:33 

90.52 

ppm 

2 

Final 

Avg of 2-4 

2604 bristol st 

EA 

1" 

KING 

EX-SITUS 

confirmation 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 62.288 

Supervised By: 

Certificate of Verification 

2 

Soil 

2011-10-27 11:32 

30.17 

ppm 

2 

Final 

31196 

2604 bristol st 

EA 

KING 

EX-SITUS 

confirmation 

± Error 

± 13.634 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 61.219 

Supervised By: 

Certificate of Verification 

3 

Soil 

2011-10-27 11: 33 

30.18 

ppm 

2 

Final 

31196 

2604 bristol st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 13.446 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 74.551 

Supervised By: 

Certificate of Verification 

4 

Soil 

2011-10-27 11:33 

30.17 

ppm 

2 

Final 

31196 

2604 bristol st 

EA 

1" 

KING 

EX-srrus 

confirmation 

± Error 

± 14.172 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

9 

Soil 

2011-10-27 11:36 

90.80 

ppm 

2 

Final 

Avg of 6-8 

2604 bristol st 

Bl 

13" 

KING 

confirmation 

confirmation 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 394.075 

Supervised By: 

Certificate of Verification 

6 

Soil 

2011-10-27 11:35 

30.27 

ppm 

2 

Final 

31196 

2604 bristol st 

Bl 

13" 

KING 

confirmation 

confirmation 

± Error 

± 29.256 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 372.146 

Supervised By: 

Certificate-of Verification 

7 

Soil 

2011-10-27 11:35 

30.24 

ppm 

2 

Final 

31196 

2604 bristol st 

Bl 

13" 

KING 

confirmation 

confirmation 

± Error 

± 29.820 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 379.971 

Supervised By: 

Certificate of Verification 

8 

Soil 

2011-10-27 11: 36 

30.29 

ppm 

2 

Final 

31196 

2604 bristol st 

Bl 

13" 

KING 

confirmation 

confirmation 

± Error 

± 30.468 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By 

Certificate of Verification 

13 

Soil 

2011-10-27 11:39 

90.41 

ppm 

2 

Final 

Avg of 10-12 

2604 bristol st 

B2 

13" 

KING 

confirmation 

confirmation 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 59.848 

Supervised By: 

Certificate of Verification 

10 

Soil 

2011-10-27 11:37 

30.08 

ppm 

2 

Final 

31196 

2604 bristol st 

B2 

13" 

KING 

confirmation 

confirmation 

± Error 

± 13.998 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 62.462 

Supervised By: 

Certificate of Verification 

11 

Soil 

2011-10-27 11:38 

30.20 

ppm 

2 

Final 

31196 

2604 bristol st 

B2 

13" 

KING 

confirmation 

confirmation 

± Error 

± 14.417 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 12 

Mode Soil 

Time 2011-10-27 11:39 

Duration 30.13 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

BVID 31196 

ADDRESS 2604 bristol st 

QUADRANT B2 

DEPHT 13" 

XRF TECH KING 

MISC confirmation 

NOTE confirmation 

ppm ± Error 

Pb 99.563 ± 18.615 

Supervised By: 
X 

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

Coastal Environmental Group Inc. . 

\ ^ • .^p* www.coastalhazmat.com " 

""•'«'"*' ' COASTAL 

EXECUTIVE SUMMARY: 

BVID #31196(2604 BRISTOL ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 

COASTAL IS UNABLE TO PROVIDE PRE-EXCAVATION AND EXCAVATION 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. 
COASTAL 

Property Completion Agreement 

This agreenieni documents lhe completion of remedial activiiies performed on my property. My signature will 

designate thai 1 am satistled with the resioration of my property, and thai no items are in question, now or ai any 

lime in the future, except ihosc iierrus listed below, if any 

Propeny ID: ".^W^lp 

Propeny Address: QCoOM ]l r \ <^\r, i -Sd- Owner: y V y^y^^ 

Phone: '^c^.. •:).\^. -z^-As 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

Additional Comments: 

Q I agree restoration in completed, except as noted 

I jLA-rtn not agree restoration is completed 

fo ^ y z Co •?/'</ 

r^^^lgnati xy^ Owner'sSlghature Date Contractor's Sig 
EPA Property Close Out Form 

Property ^,,r.^yCO±U^^lA ^ ^ Property #: , 7 J l 1 C>. 

Date/Time: Owner's Namt:. £.?^,\).L[ F. ..U^r^ ^

Quads Excavated: j3 L g ?~ Contractor Group Z Z c«.3 •T~C 

Excavation Ceneral 

1. If ncccssBiy, were the correct quadrant(s) excavated and restored? 

2. If necessary, were the correcl areas of drip zone excavaied and restored? 

GradInK Sod and VcRctation 

1 Does the grading around the perimeter ofthe house in cxcaviaieri areas generally slope away 

from the Iiouse? 

2. 

Has 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 tLmej)eriod) 

4. 

Are sodded areas generally firm and evenly graded? 

5. 

Are the joints between the sod sirips generally tight? (Only evaluate if inspected at z 30 day 

time period) 

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

7. 

Was damage to landscaping or plant materials avoided? 

r' Gates. Fences and RctaJnlpg Walb 

1. Do gates open and clo-se freely? (Ifapplicable) 

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

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

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

FoupdationTSidiiiRflnd Cntters 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

Was damage to downspouts or downspoui extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

^ 

Yes No 

/ 

/ 

Yes No 

y 

3 

3 

y 

y 

3 

y 

Ves No 

A 

7 

7 

7 

Yes, .No 7 

7 

J 

I 

I 

Ycfi No 1 
O^'tiers comisents: 

I Inspection notts: 

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

EPA Represenlatjve Qy_y\ Date: ^^^^ 
Propert}' Owner Assessment of Performance Form 

American Reco\ery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2011 

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

Property Identifier Number: 

Property Address: '^V^y^. %i 

Property Owrier's Name: ._r .h—LiI \li;i\c inlbmiaiion to be filJed oot by the retiiediation contractor prlur to utilization by the EPA ( t )f< i • •••••••oaBB««««««««BBDBBBiBa«vBaa*o««a>BaaBB*aBoaBiiH'•••••••••.••••••BoeBB***** ! 

Instructions to the Property Owner: 

Tliis fonn serves to record the Property Owner's assessment of performance (Incentive 1- Quality . • • • • • ( 

Assurance Surveillance Plan) irivolving 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 

problcrns and'or issues not specifically tied to an assigned address, for example, business relations that 

generally don't follow guidelines set forth in the Performance Work Statement. 

The Property Owner will indicate his'hcr 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, the sign & dale the fonn. 

9-10 "excellent" 

7-8 "ver>' good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property OH'ner's Assessment of Performance Regarding tbe Contractor's Work 

Additional Comments from EPA CORCoptional; continue on back page if needed) 

Property Owner Signature: ' ' 

/