TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA1D#: 

MM Date: ^ . Address: n\n \i ^^"^ ¥ 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) • 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

• t / 

Restoration Agreement 

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

Confimiation data 

Photographs M^ [^fC\P<)Jf^\\s>^ -) CT^j^^h^^ V 4. ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Propertvififormation from Douglas County Assessor's Office 

u 

D 

V 

Date signature 

30218711 

Superfund 
# 

Property Access Checklist 

PropcTt>.ID: (pL).{:;^{3,g D WORK STARTED ON: J l_ 

Property Address: |-^^ ^ Kl ^ j .St . D WORK COMPELTED ON: I I 

Rcnten O^vncr: /V|p,[ , yQ f^^r i t^j-f-

Address: Phone: 

SAME Fax: 

Cell/Pager: 

Additional Information: 

Fax: K\4- KWk: c^c . I >^ I 

 sst^uiQ-ia 

Cell^ager: 

D Notification Letter Sent: / / By: 

^ Access Agreement Signed:)! I\^l ^ By: 

^ Restoration Agreement Signed: A//iC ^ By: 

LJ' Topsoil Sampling (if applicable) / / By: 

O Disposal Sampling (if applicable) / / By: 

Q Garden Sampling (if applicable) / / By: 

1 ^ Utility Clearance Called: I /iy./O a By: )| Qfbh\ 

/ ( ^h^ 

0 . Video/Photos (Before) On:^/S-'J O BySs, Mfi^-ddk. '•;ci o,j^<>iP£ ­ pi^'icui^j^^ly 

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

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

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

LD Property Completion Agreement Siened: / / By: 

D Final Report Issued: / / By: 

^ 

Air Monitoring (as applicable) 

n Community Q Crew On: By: 

Results: 

CU Community O Crew On: / / By: 

Results: 

C] Community Q Crew On: By: 

Results: 

Omaha Lead Site 
Douglas County Account Infc ^tt^H^r Page 1 of3 

Douglas County, Nebraska Property Record - R0843690000 

Print Report 

NEW Feature - Parcel Dimensions availabie (a) scaie 0-50 ft west of 52nd St - VJeW OH Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->-»• + Auto Sales Search 

Owner 

BRANDT ADELINE M 

1716 N 50 ST 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 4369 0000 08 

Account Type: Residential 

Parcel Number: 0843690000 

Parcel Address: 1716 N 50 ST 

OMAHA NE 68104-0000 

Legal Description: COUNTRY CLUB DIST LOT 3 BLOCK 28 55 X 120 

Value Informatio n 

Land Improvement Total 

2009 $16,500.00 $111,900.00 $128,400.00 

2008 $16,500.00 $111,900.00 $128,400.00 

2007 $16,500.00 $111,900.00 $128,400.00 

2006 $16,500.00 $111,900.00 $128,400.00 

2005 $16,500.00 $111,900.00 $128,400.00 

2004 $16,500.00 $107,200.00 $123,700.00 

Sales Informatio n 

Sales Date: 1998-04-06 

Deed Type: D Book: 2088 Page: 491 

Price: $116,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1993-09-22 

Deed Type: D Book: 1961 Page: 099 

Price: $84,950.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Dbuglas County Account Inf< :^ni|||or Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6600.0 1.0 120.0 55.0 No 

Improvemen t Informatio n 

Building 1 

1 1/2 Stor/ Fin 1716 N 50 St 

Mswn WDCODKK 

I CrBintOm w 

420 0 Sq Ft 

rtr 91(0 sq. n 79 

KMiql 

BsmnaooSt WeOSqFI ui«M»iiiMiiin«>Hiiim«wi«rnn 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1406.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Masonry Common Brick Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Slate Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1930 0% 1930 79 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 986.0 

Carport Attached 288.0 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Douglas County Account Infi [j^n^l^r Page 3 of3 

Fixture 

Fixture 

Garage 

Porch 

Porch 

User 

Base Fixtures 

Bath Full 

Basement Single 

End Solid Wall 

Wood Deck 

2002 BOE 212 

1.0 

1.0 

1.0 

108.0 

288.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Page 1 of 1 

"> 

Create Another Ticket | |, Back to Irth Internet Send Eniail | 

YOUR TICKET NUMBER IS 2560605. 

Original Call Date: 8/04/10 Time: 6:09 pm Op: ELIZABETH18790 


Work to Begin Date: 8/09/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1716 Street: N 50TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 18-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: (877)662-4211 


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility' Type 

Day: 4029340469 

CXCATV COX COM M UN I CATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

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

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/4/2010 
0 

f ' /:\i ^ 

( / ' 

64884 C\ear \.l Q^/feS 

OnMht Lead Site 

Site Sketch 

S*inj»tln8 AtWffBt.lTil^MgisV 

$anf)0l« LAE Concentfit'ori CollcctFd •nvn 

RVASCPXA-6<8B4 f l HS t ppm D Datt 

RVBSCPXA-64eS4 F2 

s C Timr 

RYCSCPXA-fi4M4 Bl 

Ely D 

&tT,p)e! Ana yzed RYOSCPXA44804 9 t 8 7 f*"^ D 

RDZSCPXA<«4»S4 02 Q I X« f Unil Book 23i ^ • " ppm D D I Dale „ IQf Q nt*eooif*M<'6«eo4 ng D D ; TiPTK' _ axL. 

Number of S«mp!es •= [ 5 I } Q ) rsw Lette<M f ' ' F'O'H tp n F7 • f font RiaW. B t * B««* Left. 8 2 » BKKRil ^ OZ •= Of* Z«>t. 6 2 « 6«rtfen. PZ • Pt»' 

gu-—-^^..^ > 

OCT D 9 MM 
As-Built Drawing 

C

ENVinONHCNTA

 OASTA L L Omaha Lead Superfund Site GROUP , IN C 

0L§#: ?4??4 

Date Excavated: 8/10/2010 

V Date USEPA Siqned Off: 9/10/2011; 

Area Sodden: 855 so ft lllllililllilillllliil l 64884 

Omah Extenor Paint HoiihAnxMt a Lead Site 

Sit • Good e Sketch n Poor 

Samplina Address: 1716 N 50 ST [J] Not paint 

Sample Lead Sample Samples Collected Number 

I

I 

LAB Concentration Collected Firm 

RYASCPXA-64884 Fl H S I ppm D Date <^-l^-Cfi 

RYBSCPXA-64884 F2 ^fl « DOTH D Time I'l o f>n\ 

RYCSCPXA-64884 B1 __^5_pp m Samples Analyzed RYDSCPXA-64884 82 8 7 ppm n 

RDZSCPXA-64884 DZ *^H ppm D XRF Unit: GSHt > Book: li b 

ROZ00PXA-CH084 S2 " ~ ppm D D Date /Q • /'Q • 08 

nPgOCPXA'64004 P2 — ppm D D Time 

D Staff: tanNumber of Samples = | 5 I | 0 | nsp 

Legend: F1 = From Left. F2 = Front Right. B1 = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla> 

AN quadrants are as viewed from the street, facing property 

N. 5c? 5t:: R*%iA« CICHCO ^»-.\m-'« 

Legend 

Concret e Drip Zone Excavated Quadrants Excavate d 

Area replace d wi1:h D Area replace d wit h 

Area lef t bar e Sod RocJc/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
64884 

Omaha Lead Site tt*rfOi P»ili" 

Site Sketch • Good 

n Poo. 

S«mp*ino AddrMS:'7iew>0ST Q] Hot p*n( 

Lead Sample 

Concentration Collected 

Sampte Number 

LAB Sanvie* Contded 

Fim, pttt tf-^JRYASCPXA-e4«84 Fl ppm D Date *f~/l-£>^ 

RYBSCPXA-64e84 F2 ppm D Time f/ e ^/H 

RYCSCPXA-e4««4 Bl ^ 

I D Samples Analyzed RYDSCPXA-«4884 B3 ppm D

RDZSCPXA-04884 D2 -az. -HiL . PPnTM D XRF Umt (»SHt> Book: 22 ^ 

rtoeoopw o«o94 oe ppm D D Daw 10 - /O OQ 

nr'gooPM»-«46»<—ft ppm D D 

T'me £BQ 

Staff PTSO Number of Samples « [ f f [ | Q [ 

Legend F l • Front Len, F2 • From RigM. 8 1 * Back Left. B2 • Back Righl OZ « Dnp Zone GZ -^ Garden, PZ « Pt » 

M 4u**ant* *r« w vi«wM t^in Wo »«r«*. iKxg p«ee«ny 
64884 

Omah Exterior Paint a Lead Site • Good Site Si(etch n Poor 

Sampling Address: 1716 N 50 ST [ 3 Not paint 

Lead Sample 

Samples Collected Sample Number 

Concentration Collected U B Fimi: Fm Pg-Ar 

RYASCPXA-64884 Fl H S I ppm a Date: f-lt-Qfy 

RYBSCPXA-e4884 F2 ^ 3 ) ppm D Time: 1'I P f>jv\ 

RYCSCPXA-64884 B1 ^ S ppm n Samples Analyzed RYDSCPXA-64884 82 8 7 ppm • 

RDZSCPXA-64884 DZ HH ppm 

XRF Unit: GSH O Book: lt d 

I

I n nozoor)(A-64oe4—ez " " ppm 

D Date /O'/Q-Q g D •nPZOCPXA-64004

 P2 — ppm D Time: 20Q_ 

Numbe

n Staff: 

<^LJ r of Samples = [ 3 I | Q | 

Legend: Fl = Front Left. F2 = Front Right. 81 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla> 

All quadrants ara as viewed from the street, facing property 

Re\' y* » Cre.ilrtl. ;f»-,\Mg-(»» 

^^jS\p ^ 

^ 
COASTA l 

'*< POO't' 

Consent fcf Access To PrapeFt)/ 

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 perfornn certain environmental response activities upon the 

follov^ing described premises; / A '\--fyiL 

(^674 

Daytime Phone: 

I Address of Property 

covered by this /7/.^ A 5 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) v»^ill 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 wor1< has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
w 

,*-^*°_*"v. 

' / COASTAL ''+ / r5 * IffVIBOHHIKTA l 

' l "ROl* - c « o u r IX C 

e 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; 

f 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 

[^^grant access to my properties G ' do not grant access to my properties 

i..,...^/- //-/3- ^ 

Signature Date Signature Date 

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

Page 2 of 2 
^\ 

COASTA L CNVIHONM C NTA L 

CROUP , 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 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: ^^WS ^ 

Property Address: (7/ 6 P 60 ^ 

Owner: /^OtLlO t g^^y^AJ CT 

Phone: ^^^-^1 ^ ^ QG ^ ^ GGl ^ 

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: 

/^-Y^v^ S-vnaU 9^0^ ^ 

Item: 

Item: 

Item: 

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

Item: 

Item: 

Item: 

Page 1 of /-, 
COASTA L eNVIKONME N T A L 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

Corj

Item: 

^fc |

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 propert>' 

owner. 

 Fl 

 F\ 

Landscape Inventory 

Quantity Unit 

F Quadrants l 

Each 

\ 

Each j r 

Each 

^ 

Each / 

Square Feet 

X $ 

Condition/Type/Species 

Bh'^n^pX 

Easement Area, to be Each 

excavated V ^^<^\y\ ^ Qc^l'^ ^ 

Page 2 of ^ 
COASTA L BNVmONMCNTAL CROUP , 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. 

{ ^ Please check this box if you understand the information outlined above. 

3 Oh^ AJof\6€ stftffT 

• 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. 

Kli agree O I do not agree 

Owner's Signature "^ Date Contractor's Signature Date 

Page 3 of. 
^^Jry 

ni ^ K'^ToL^. 

^.RFiD^ • ^. ^ --rif : 

ihO' i; if-/(C Cl'ca ! ihO! ^ j5;r.t,r rfei 

Deol!-i ue|j:n 

•-..veraqf: Hit IS c/ -•.'iraoe 

I Shol # I _Read^no__ I Sample area) Shot # Readir fSainpiir ireBi 

An 

__pepuh 

A' L^epl; 

/ M'.'era'je 

: />« t IT. Fl 

r^" 

.•eraqs i n W / 

JwKi ; A ^ • Rp;^:y F:f.3air.a i Saiiiple area | 

1/4 it' ^ iWffy^, 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

102 

SOIL 

2011-02-08 11:35 

90.93 

Final 

Avg of 99-101 

1716 N 50 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 161.377 

Supervised By: 

Certificate of Verification 

99 

SOIL 

2011-02-08 11:33 

30.19 

Final 

64884 

1716 N 50 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 19.569 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 127.992 

Supervised By: 

Certificate of Verification 

100 

SOIL 

2011-02-08 11:34 

30.54 

Final 

64884 

1716 N 50 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 16.039 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 138.540 

Supervised By: 

Certificate of Verification 

101 

SOIL 

2011-02-08 11:35 

30.20 

Final 

64884 

1716 N 50 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.822 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

98 

SOIL 

2011-02-08 11:31 

90.95 

Final 

Avg of 95-97 

1716 N 50 ST 

LS 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 95 

Mode SOIL 

Time 2011-02-08 11:30 

Duration 30.22 

Sequence .Final 

Flags 

BVID 64884 

ADDRESS 1716 N 50 ST 

QUADRANT LS 

DEPHT 1" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 113.466 ± 15.702 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 123.278 

Supervised By: 

Certificate of Verification 

96 

SOIL 

2011-02-08 11:30 

30.56 

Final 

64884 

1716 N 50 ST 

LS 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.489 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 128.248 

Supervised By: 

Certificate of Verification 

97 

SOIL 

2011-02-08 11:31 

30.17 

Final 

64884 

1716 N 50 ST 

LS 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 16.786 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

94 

SOIL 

2011-02-08 11:28 

90.74 

Final 

Avg of 91-93 

1716 N 50 ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm

Pb 68.656

Supervised By: 

Certificate of Verification 

91 

SOIL 

2011-02-08 11:26 

30.53 

Final 

64884 

1716 N 50 ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 12.851 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 71.635 

Supervised By: 

Certificate of Verification 

92 

SOIL 

2011-02-08 11:27 

30.12 

Final 

64884 

1716 N 50 ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.693 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 85.154 

Supervised By: 

Certificate of Verification 

93 

SOIL 

2011-02-08 11:28 

30.09 

Final 

64884 

1716 N 50 ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 16.214 
A^ <:* 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMENTA L 

CROUP , INC . 

EXECUTIVE SUMMARY: 

BVID #64884-(1716 N 50 ST) 

X No Issues or Concerns Issues/Concerns 

Detail Explanation: 

-DON BAPINKE WALKED THE PROPERTY ON 9/10/2010 
EPA Property Close Out Form 

Property Address: Property #:ij2ldBB ^ 

rropeny /iouress; -/V -.Ipi / A 

Date/Time: Owner's Name:. /c..^Cly.[ ' f ^ 

Qusds Excavated'. Contractor Group C/lCl^'Tt X ^ 

Excavation Ye* No General 

1. If necessary, were the correct quadrant(s) excavated and restored? u-" 

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

Grading Yes IVo Sod and Venetation 

I. Does the grading around the perimeier ofthe house in excavaieri areas generally slope away 

from the house? 

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 Z^"^ 

day time period) 

4. Are sodded areas generally firm and evenly graded? ' ^ 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day cY time period) 

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

^ ' 

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

^ ' 

Gates. Fences and Rctoinlng Walls 

Yes No 

I. Do gates open and close freely? (If applicable) iy{ 

Were all gates or fences taken down during restoration aclivilies reinstalled? (If applicable) l y 

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

<!. Was damage to retaining walls avoided? (If applicable) y 

Foundation, Siding and GnKers 

Ves .No 

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

2. Was damage to the foundation avoided? T:^^ 

Was damage lo windows avoided? ^ 

4 Was damage to windows or door screens avoided? 

V 

5. Was damage to downspouts or downspout extensions avoided? 

(y 

Sidewalks and Driveways (Concrete) 

Vcs No 

1. Was damage to driveway surfaces avoided? i/^: j L 

2, Was damage to walkway surfaces avoided? z^^ 
OMtiers comnienls: 

jinspectJon no<es: 

Removal and restoration activates complej^e iqcluding the 30-day sod warrapry: 

HPA Represenlaiive P^>--Ut/^/lL 
Property Completion Agreement 

I'his agieemenl documenis Ihe complclion ot remedial aclivilies perloimed on my properly. My signature 

will designate llial I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any lime in the future, except those items listed below, if any 

Property ID: [jp^p^ Q LJ[ 

Property Address: )- | |( ^ / ^ g ^ ^|~ ­

^:!!!!!i_^deJjjO£__Br-a^2 ^ 

Phone: ^voo yip'={' iddi ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

| X| 1 ayrcc ICitoralion w completed, except as noted 

y I I do not a(;rec restoration w coniplelcri 

Owiici' s Signature / Date ' Contiai tor's Signature Da 
Water Bill Settlement 

Propertj' ID 64884 

Property Address 1716 N 50'" Street 

Tenant Adeline Brandt 

58."^^ 

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

usage required to maintain the sod. 

Check Number 2152 

Value of Check $58.96 

Made Out To Adeline Brandt 

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. 

AJ. 7-^^y^ f/yM^^^(/-y- c^l^c^ 

Owner's Signature f^ Date Contractor's Signature Date 

-^• - ^y-...--.f—•v»^..-w>-..—^^—pj—^ '•-*7.----—'T.'^',-^ . >"•'?'.^'-y^r^t 

2152 COASTAL ENVIRONMENTAL GROUP INC. 27-5/1040 003 2411 MARTHA STREET 6247372904 OMAHA, NE 68105 ^IZ'ghQ DATE 

I'AY TO 

ORDER l\^ ftrlP.lmji ?)V-DJaC^t $5S ^ 

?ii^-^>u3^Qjy>^'^' ' iOD' DOLLARS a 

WHK Fargo Dank. N.A. 

Nebraska 

wedsfargccom 

FOR ?^V/D M<km \1\\^N6 0 i^^V\A^\Ph^ C^CPt--^ 

i: lOiiOODOSfli: E. EU73 7 E^OUH ' 0E15 E 
Account: 231039-1137952 Bryan Murray 

1723 Harney St •Oma SITECOORDIONATOR 

ADELINE M. BRANDT e-mail: customer_serviceiI'muc 

Sen/ice address: 1716N50THST 

2411 Martha St 

Billing date Omaha, NE 6810,S Call 554.7777 if you smell gas. Previous balance 

Paymen Office: [402)991.1199 << t received -Th No charge to check gas leaks. Have heating Curren Fax: C877) 662,4211 Toll Free t charges 

system checked every year by a qualified Mobile: (402) 504.2995 New balance i heating contractor. Keep chimneys and flues Certified MBE*DBE*8(a)*Hub Zone • Total due| free of debris. Your budget payment of $69.1 

Budget Variances: CurrenrDetails of current charges: 

GAS RESIDENTIAL RATE A: Aug 17 to Sep 17 250 " Meter Number 418542 P 

Current read (actual): 2481 - Previous read (actual): 2476 = 5 CCF 125 - Gas Use: 5 CCF x 1.005 (heat value) = 5.025 therms 

16 days 2.594 therms at 0.5003 • $1.30 n .J 1 | j . i>:t Mo^' nee Jan Feb Mai. Api May Jun Jul Aug Sep 15 days 2.431 therms at 0.5941 1.45 

Your Gas Use Service Charge 13.00 

Gas Cost • $15.75 • Past 12 Months Q Past 13-24 Montlis Gas Infrastructure Replacement 3.00 

This Month Last Year 

Billing units: 5 5 

Use per day: 0.2 0.2 

Average cost per day: $0.6.1 $0.55 

Number of days in billing cycle: 3T 32 

WATER RESIDENTIAL RATE W-1: Aug 17 to Sep 17 

Meter Number 2865106 Size: 5/8-inch 

Current read (actual): 337 - Previous read (actual): 299 = 38 CCF 

Water Use: 38.000 CCF or 28,424 gallons 

9.000 CCF at 0.9614 = $8.65 1_ LiMiL 21.000 CCF at 1.3451 = 28.25 Oct Nov Dec Jan Feb Mai Api May Jun Jul Aug Sep 8.000 CCF at 1.7298 = 13.84 Your Water Use Service Charge 5.22 

Past 12 Montlis Q Past 13-24 Monttis Water Cost • $55.96 

Water Infrastructure Replacement 3.00 

"This Month Last Year 

Billing units: 38 9 Budget Payment Plan Interest 0.01 CR Use per day: 1.2 0.3 

Average cost per day: $2.03 $0.51 City of Omaha Sew/er 13.49 

Number of days in billing cycle: 31 32 

Sales Tax 6.38 

• Current Charges $97.57 
Account: 321025-1134095 

JASON HARVEY 

Sen/ice address: 1519 BERRY AVE 

Save checks, postage and stamps. 

Pay your bill on-line. 

We accept all major credit cards. Go to 

www.mudomaha.com and click on "my 

account." 

# • 

1723 H^iiney SI = On-is.:­ c-rTiai:: cus:*.:-^.' ic'^:-:^ \ •,r\.'ij METROPOLIJAN UTILITIE S DISTRIC T 

Live Green. Ici m B\\,,i, Billing date Jul 6, 2010 

Previous balance $289.76 

Payment received -Thank you 130.00 C R 

Current charges 84.20 

New balance 243.96 

• Total due Jul 21, 2010 $243.96 

H payment is received after due date, a late fee will be assessed on gas and water charges. 

40 ' 

20 -

0 II Aug Sep Oct Nou Oec Jan Feb Mar Api May Jun Ju 

Your Gas Use 

• Past 12 Months O Past 13-24 Months 

This Month Last Year 

Billing units: 31 n/a 

Use per day: 0.9 n/a 

Average cost per day: $1.04 n/a 

Number of days in billing cycle: 33 n/a 

2 0 ­

10 ­

0 

Aug Sep Oct ^4ov Dec Jan Fob Mai Apr May Jun Jul 

Your Water Use 

• Past 12 Months Q Past 13-24 Months 

This Montti Last Year 

Billing units: 18 n/a 

Use per day: 0.5 n/a 

Average cost per day: $0.93 n/a 

Number of days in billing cycle: 33 n/a 

Details of current charges: 

GAS RESIDENTIAL RATE A: May 26 to Jun 28 

Meter Numt>er 457456 

Current read (actual): 256 - Previous read (actuao: 225 = 31 CCF 

Gas Use: 31 CCF x 1.002 (heat value) = 31.062 therms 

6 days 5.648 therms at 0.5495 = $3.10 

27 days 25.414 therms at 0.5460 = 13.88 

Service Charge 13.00 

Gas Cost • $29.98 

Gas Infrastructure Replacement 3.00 

WATER RESIDENTIAL RATE W-1 : May 26 to Jun 28 

Meter Numt>er 2908606 Size: 5/8 -inch 

Cun-ent read (actual): 33 - Previous read (actual): 15=18 CCF 

Water Use: 18.000 CCF or 13,464 gallons 

9.000 CCF at 0.9614 = $8.65 

9.000 CCF at 1.3451 = 12.11 

Service Charge 5.22 

Water Cost • $25.98 

Water Infrastructure Replacement 3.00 

City of Omaha Sewer 16.73 

Sales Tax 5.51 

• Cunent Charges $84.20 

Please return this portion lot the bill with payment.'• Please d o not staple paym ^ 

e-mail: customerjBervice@mudomaha.com 

website: www.mudomaha.com 

METROPOLITAN 

U TIL 1 lie s DISTRIC T 0003210251134 09 50000002 43965 
 6850 0010 MU RP 06 07072010 NYNNNY 01 003971 

l723HameySt • Omaha,NE 68102 

JASON HARVEY Due on or before Jul 21: $243.96 

1519 BERRY AVE If payment is received after due date, a late fee will 

OMAHA NE 68107-3554 be assessed on gas and water cliarges. 

Amount Paid: 

||l||,|„l||..l..l,„|,l|ll.,.||.ll||..|,lll,||l|l.,|,..ll,.,l||. 

METROPOLITAN UTILITIES DISTRICT 

PO BOX 3600 

OMAHA NE 68103-0600 

Q Check box and indicate change of mailing address ..l..tl|.,|ll|l.||,.l,t|,|„...||||,|ll,|||.l|,...l„.,.lll.l||.| or telephone numbers on the reverseside. 

Give to the Heat Aid Fund. See www.mudomaha.com 

Monthly donation - Add: n$ 2 D$ 3 D$ 5 Other$_ Account; 321025-1134095 
Account: 321025-1134095 # • 

Page 3 of 4 

JASON HARVEY 

Service address: 1519 BERRY AVE 

To help us better serve you... 

On the day your meter is scheduled to be read, 

please secure dogs away from your meter. 

Keep shrubs and bushes.trimmed and.away 

from meters. 

30 ' 

15 -^ 

0 

Ju! Aug Sep Ocrl r»iw De^ .'an Fe*; Mai Apr M?y Jun 

Your Gas Use 

• Past 12 Uoottis B Past 13-24 Months 

This Month Last Year 

Billing units: 28 n/a 

Use per day: 1.3 n/a 

Average cost per day: $1.29 n/a 

Numberof days in billing cycle: 22 n/a 

20 ~ 

1 10 ­

0 ^ 

Jul Aug Sep Oct Nov Oec Jan Feb Mai Apr May Ju n 

Your Water Use 

• Past 12 Uonttis B Past 13-24 Montlw 

This Month Last Year 

Billing units: 15 n/a 

Use per day: 0.7 n/a 

Average cost per day: $0.99 n/a 

Numtaer of days in billing cycle: 22 n/a 

± 

Please return ttiis portion of 

e-mail: customer_service@mudomaha.com 

website: www.mudomaha.com 

METROPOLITAN 

UrUtllES DISTRICT 

6850 0020 MU RP 03 06042010 YNNNNY 01 000215 

1723 Harney St • Omaha, NE 68102 

JASON HARVEY 

1519 BERRY AVE 

OMAHA NE 68107-3554 

„llll|...|||l.,..,.||.i,n,.l,(.,l|ll.l||ll..l,|llj|„|l,.,.|,j. 

Q] Check tx>x and Indicate change of mailirig address 

or telephone numbers on the reverseside. 

SHUT-OFF NOTICE ENCLOSED 

# # 

1723 Harney Si ^-Omaha. i>^E53ior^ - ^:02.554.6S6S 

e-rnail; cusiomer ££:r\':ccf.:-rT.U'J:;rr;yh3.curri -^ •,vcr.'£i:c-. '.".•..v..rr.'j'Jc'.'n?l:2.-:crr. METROPOLITAN 

UTILITIE S DISTRIC T 

Billing date Jun 3,2010 ImQiKn/fhiithBhic. 

Previous balance 

$0.00 
 Payment received 

0.00 
 Adjustments 

168.54 
 Current charges 

121.22 
 New isaiance 

289.76 


• Total due Jun 18, 2010 $289.76 

If payment is received after due date, a late fee will be ae&essed on gas and water charges. 

Details of current charges: 

GAS RESIDENTIAL RATE A: May 4 to May 26 

Meter Number 457456 

Current read (actual): 225 - Previous read (actual): 197 = 28 CCF 

Gas Use: 28 CCF x 1.012 (heat value) = 28.336 therms 

22 days 28.336 therms at 0.5495 = $15.57 

Service Charge 9.53 

Gas Cost • $25 10 

Gas Infrastructure Replacement 2.20 

WATER RESIDENTIAL RATE W-1: May 4 to May 26 

Meter Number 2908606 Size: 5/8 -inch 

Current read (actual): 15 - Previous read (actual): 0=1 5 CCF 

Water Use: 15.000 CCF or 11,220 gallons 

15.000 CCF at 0.9614= $14.42 

Service Charge 3.83 

Water Cost • $18.25 

Water infrastructure Replacement 2.20 

City of Omaha Sewer 12.27 

Turn On Charge 57.00 

Sales Tax 4.20 

• Current Charges $121.22 

Details of adjustments: 

Account Balance Transferred $168.54 

• Total Adjustments $168.54 

the bill With paymeht. • Please do~not~staple jSayirienrtoTnjr 

0003210251134095000000289765 

Due on or before Jun 18: $289.76 

If payment is received after due date, a late fee will 

be assessed on gas and water charges. 

Amount Paid: 

METROPOLITAN UTILITIES DISTRICT 

PO BOX 3600 

OMAHA NE 68103-0600 

.l.,.,||l|l,|ll.,||.l,ll.||lll|l|ll,|,ll||||.,.,l.|.,.„.l|.ll.l, 

Account: 321025-1134095 

1