TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAlD#:JtO_tl_ _ .. Date: _Jltii[l ; 

Address: %<^ \ ^\^ ^ ^ T 

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 adjacc'nt property 

y Restoration Agreement ' ''• 

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

-C- Confinnation data 

0 Photographs \\ t Cy?(^t ^ rv ^ ^ Cy=-<^tAVH V^>^ X; f a ^ 

U As-built sketch 

B Satisfactory restoration signed by Property Owner ' ': 

u Property close-out check list signed by EPA 

-B ^ Description of areas not meeting ROD cleanup criteria 

0 Utility clearances 

u Property iafomiatioi/froni Douglas County Assessor's Office 

-2 f< /, 

Date 

30218729 

Superfund 
^ * 

^ 

Property Access Checklist 

PropertyW:-l20l„ J 

Property Address:3(^, ^ ^^1^ ^ f^ . 

D

D

 WORK STARTED

 WORK COMPELTED

 .ON:

 ON:

 /

 /

 / 

/ 

Owner: jS/lQV^y ^ WrAoe S 

Address: 

Phone: Ho3L-y>\-cr>g>9^ 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n Notification Letter 

Vf Access Agreement 

1 1 Restoration Agreement 

Q Topsoii Sampling (if applicable) 

O Disposal Sampling (if applicable) 

• Garden Sampling (if applicable) 

S Utility Clearance 

n Video/Photos (Before) 

n Video/Photos (During) 

n Video/Photos (After) 

D Video/Photos (30-Day) 

O Property Completion Agreement 

D Final Report 

Sent: / / 

Signed: I il l ij^ ) 

Signed: / / 

/ / 

/ / 

/ / 

CaUedO~V /Ob / \ o 

On: / / 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By= o'>/b?)Ao 

By: 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

• Community • Crew 

Results: 

On: / / By: 1 

• Community

Results: 

• Crew On: / / By: 

• Community

Results: 

• Crew On: / / 1 

Omaha Lead Site 
Douglas County Account InfoaB^ion Page 1 of2 

% 

Dougla s County , Nebrask a Propert y Recor d - R132091000 0 

Print Report 

NEW Fnatiirn - Pamel Dimfinsinns availahlfi iH) sralfi O-Sd ft west of .')2nd St - ViO W O H Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->-»- » Auto Sales Search 

Owne r 

HODGES MAXINE 

1308 SUNSHINE BLVD 

BELLEVUE NE 68123-0000 

Propert y Informatio n 

Key Number: 20910000 13 ., 

Account Type: Residential 

Parcel Number: 1320910000 

Parcel Address: 3604 OHIO ST 

OMAHA NE 68111-0000 

Legal Description: HITCHCOCKS 1ST ADD LOT 19 BLOCK 10 50 X 120 

Valu e Informatio n 

Land Improvement Total 

2009 $1,000.00 $0.00 $1,000.00 

2008 $1,000.00 $0.00 $1,000.00 

2007 $1,000.00 $0.00 $1,000.00 

2006 $1,000.00 $0.00 $1,000.00 

2005 $1,000.00 $0.00 $1,000.00 

2004 $1,000.00 $0.00 $1,000.00 

Sales Informatio n 

Sales Date: 2006-03-20 

Deed Type: Q C M Book: 2006 Page: 042250 

Price: $8,000.00 

Grantor: Steven King Etal 

Grantee: Maxine Hodges 

Valid/Invalid: Invalid 

Exclusion Reason: Non Bono with Doc Stamps 

Sales Date: 2002-11-08 

Deed Type: SWD Book: 2003 Page: 153847 

Price: $300.00 

Grantor: LRC 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/23/2009 
Douglas County Account Inft|ja^io h^jH^K n Page 2 of2 

Grantee: Steven King 

Valid/Invalid: Invalid 

Exclusion Reason: Sale by Govt Agency 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 6000.0 0.0 120.0 50.0 Yes 

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

• # • «

"A"^^ ^ 

Greate Another Ticket Back to Irth Internet ! Send Email 

. YOUR TICKET NUMBER IS 2536833. 

Original Call Date: 7/06/10 Time: 4:25 pm Op: ELIZABETH18790 


Work to Begin Date: 7/08/10 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3604 Street: OHIO ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-SE,09-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF OPPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, 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... 7/6/2010 
72062 

As-Built Drawing 

C

ENVmONHENTA

 OASTAL L Omaha Lead Superfund Site C K O U r , INC . 

OLS#: 72062 

Date Excavated: 7/10/2010 

Date USEPA Signed Off: 8/26/j 

Area Sodden: 3960 sq H 

Omah Exterior Paint a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 3604 OHIO ST 13 Not pairit 

Sample Numtier Lead Sample Samples Collected UB Concentralion Collected Firm: <P/> n ^ . JP 

RYASCPXA-72062 F1 __L3J_PPm i D Date: 8-U-o 6 

RYBSCPXA-72062 F2 ) RL> ppm D Time V-/ f f>^ 

RYCSCPXA-72062 Bl H3 ^ ppm D Samples Analyzed RYDSCPXA-72062 82 SB ^ ppm n 

r>DZOCPXA-72062 B * ppm n XRF Unit: f^SHb Book: 2l8 _ RGgCOPXA 7D06a 6 2 ~ ppm D D Date: _

Rr>ZOCP>(A-7200i! PS- ~ ppm D

D D Time _Pra_ 

E Staff: Number of Samples = t^w 

Legend: Fl = Front Left. F2 = Front Right, B1 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, facing property 

EA = 108PPM@r;>.„„ ^ I 

!()08 Created. 0l-Ma>'-U8 \ .. V / /• 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bare 

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

u^ 72062 (n/oe> iiiiii 

Omah Exterior Paint ^4o^1h Arrow a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 3604 OHIO ST ( 3 Not paint 

Lead Sample Samples Collected Sample Number LAB Concentration Collected f^irm 

RYASCPXA-72062 Fl ppm 

D Date 8 II-08 

RYBSCPXA-72062 F2 

ppm D Time ^••IS / W 

RYCSCPXA-72062 B l ppm D 

Samples Analyzed RYDSCPXA-72062 B2 ppm I D

nDgOCnXA 7200? BB ppm D XRF Unit: (pSH O Bool<: 2J3 -

RCgCCPXA 72002 G i ppm D D Date: ^ 5 • O B

rxpzocrxA-noGi pa- ppm D D Time D 

Staff :m_ Number of Samples • E mw

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ •• Play 

All quadrants are as viewed (rem the street, facing property 

So\) V^^ 
m 

Omaha Exterior Paint Lead Site 

Site Sketch 

Sampling Address: 3604 OHIO ST 

Sample Number 

RYASCPXA-72062 

RYBSCPXA-72062 

RYCSCPXA-72062 

RYDSCPXA-72062 

r^DZOOPXA-72062 

RGZeCPXA 72062 

nPgOCPXA-72002 

Lead Sample 

Concentration Collected 

F . ppm 1 i^l 

F2 J 6 ^ ppm 

81 ^3e . ppm 

82 5QV . ppm 

I 

- B ^ . ppm D , ppm 

-PS- D

.ppm D 

Number of Samples = | ^ \

• Good 

• Poor 

[ 3 Not paint 

72062 

North Arrow 

Samples Collected LAB 

Firm 

n Date 

D Time 

D 

D 

D XRF Unit: 

D Date: _ 

D Time: 

 | Q | Staff: 

8-11-08 

^•is /W 

Samples Analyzed 

UEHb Book: 2JB _ 

°\-5oB 

JEm 

MSW 

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

All quadrants are as viewed from ihe street, facing property 
iiilllliiiillll 72062 

Omah Exterior Paint North Arrow a Lead Site 

Site • Good Sketch i • Poor Samoling Address: 3604 OHIO ST r ^ Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected 

I 

Firm 

RYASCPXA-72062 F1 __L3J_Pp m D Date a-ii-os 

RYBSCPXA-72062 F2 I P>IJ> ppm D Time ^•/^ f ^ 

RYCSCPXA-72062 81 M3 ^ ppm D Samples Analyzed RYDSCPXA-72062 82 SB ^ ppm 

RDilOCPXA 720G2 " ppm n XRF Unit: ff^SHO Book: Zt 8 

f^CZOCPXl^ 72063 ~ ppm D D Date: '^ 5 • OB 

f^PgQCrXA-72002 ~ ppm D D Time: r m D D Staff: KS W Number of Samples = | ^ \ [ ^ | 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from (tte street, facing property 

Rcv2lX)8 Crtratcd; 0?-Muy 
^^ttO Sf< , 

COASTA l 

[NvmoNnr KTAI 

" ' PBO""*-^ C K O U r . IN C 

Cortsent for Access T© Prapgrty 

RIGHT OF ENTRY TO PREIVJISES 

Grantor (the property' owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatK'es, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: ^7ACn ^ 

Daytime Phone: ^^Cjl-Oj^ ^ 

Addres

covered

s

 b

 o

y

f Propert

 this 

y Mb4 DhfoSJ­ 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 perfonned, the Grantor will have an 

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

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

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

completion, the Grantor 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 
„lt D S>4,, 

fv.^ % 

COASTA L irtYiKONHtKrA i 

C It O U r I w c 

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 w

to save; 

ish 

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

necessary' subsequent to an initial watering period by EPA; 

f Abide by health and safety guidance provided by EPA; 

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

the property to perform the work. 

 to 

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 

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

Si/^/d 

Signature Date 

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

Page 2 of 2 
COASTA L ENVinONHENTA L C » O U P , IMC . 

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: '^Q.O^gi^ 

Property Address: >^^Q ^ Q\r^\ Q SV . 

Owner: V\x-V * ng. Jt^ ^ 

Phone: C'A.Oa^ 3L*\\- Q-^ IT 

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 retum of these items Is the Owner's responsibllh 

Item: 

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

Item: , 

Item: 

item: 

Item: 

Page 1 of 
COASTA L fNVtflOMHCNTAL . 

c a o u p . INC . 

Items to Be Removed By Contractor During Remediation acid RepBaced 

Landscape Inventory 

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 by contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be 

excavated 

Quantity 

B,l^ ^ 

/ 

f 

'f' 

IK 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

$ 

Each 

Condition/Type/Species 

fe^h^^y 

Page 2 of 
COASTA L ENVIRONMENTA L 

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. 

[^Chec k 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. 

[0.1 agree n I do not agree 

fiir^ 

Owner' iture jy ^ Date Contractor's Signature s Signature Date 

Page 3 of. 
1^01^2^ 

3{tf0»-^ j^^Jsy ^ 

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5"/^ 

Oeoih 

^If_iJTSLli^ZEj: 

A'-'eraqs 10<^ 1 \S ( / rragf 

ue;j:ri 

Shot ii RrraoifiQ I Sample area bnoi i Readi: Sampis efes 

ail -ij<^>ir j .jv j 

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anil 

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RET'EST AREM S 

j "jIlOl h'V'anif ;o SamoR: :,rsn 

l%)t^ iM^i 
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 

286 

SOIL 

2011-02-07 16:22 

91.64 

Final 

Avg of 283-285 

3604 OHIO 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 128.046 

Supervised By: 

Certificate of Verification 

283 

SOIL 

2011-02-07 16:19 

30.60 

Final 

72062 

3604 OHIO ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.988 
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 105.138 

Supervised By: 

Certificate of Verification 

284 

SOIL 

2011-02-07 16:21 

30.86 

Final 

72062 

3604 OHIO ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.675 
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 93.473 

Supervised By: 

Certificate of Verification 

285 

SOIL 

2011-02-07 16:22 

30.18 

Final 

72062 

3604 OHIO ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.905 
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 

282 

SOIL 

2011-02-07 16:16 

92.01 

Final 

Avg of 279-281 

3604 OHIO ST 

B2 

13" 

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 630.406 

Supervised By: 

Certificate of Verification 

279 

SOIL 

2011-02-07 16:14 

30.66 

Final 

72062 

3604 OHIO ST 

B2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 36.091 
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 600.963 

Supervised By: 

Certificate of Verification 

280 

SOIL 

2011-02-07 16:14 

30.65 

Final 

72062 

3604 OHIO ST 

B2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 36.169 
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 

XRFTECH 

MISC 

NOTE 

ppm 

Pb 632.208 

Supervised By: 

Certificate of Verification 

281 

SOIL 

2011-02-07 16:16 

30.70 

Final 

72062 

3604 OHIO ST 

B2 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 38.158 
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 

278 

SOIL 

2011-02-07 16:12 

9i:65 

Final 

Avg of 275-277 

3604 OHIO ST 

Bl 

13" 

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 172.296 

Supervised By: 

Certificate of Verification 

275 

SOIL 

2011-02-07 16:10 

31.24 

Final 

72062 

3604 OHIO ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 17.775 
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 173.961 

Supervised By: 

Certificate of Verification 

276 

SOIL 

2011-02-07 16:11 

30.20 

Final 

72062 

3604 OHIO ST 

Bl 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.908 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 277 

Mode SOIL 

Time 2011-02-07 16:12 

Duration 30.21 

Sequence Final 

Flags 

BVID 72062 

ADDRESS 3604 OHIO ST 

QUADRANT Bl 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 177.235 ± 21.121 

Supervised By: 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

'" t PHO-tt'=' 

.<P* www.coastalhazmat.com 

COASTA L ENVIRONnENTAL 

C R 0 U r , INC . 

EXECUTIVE SUMMARY: 

BVID #72062-(3604 OHIO ST) 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 8/26/10. 
EPA Property Close Out Form 

Property ft: ~] ^ C>ii>^^ , Property Address: 

Date/Time: Owner'ss Name Name:: /,^__—-.^ , ^^E^UiOiSrSOaQ^ ^

 > ^ ­

Quads Excavated: Contractor Group ^j^'^C \ \ 

Excavatio Yes No n General 

1. If necessBiy, were the correct qiiadi3nt(s) excavated and restored? y 

2. If necessary, were the correct areas ofdrip zone excavated and restored? y 

Grading Sod and VcRctation Yes No 

1. Does the grading around the perimeter 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 / 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 /

time period) __. . 

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

7. Was damage to landscaping or plant materials avoided? 

Gates. Fences and Retaining Walls \ K NU 

r Do gates open and close freely? (Ifapplicable) V 

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

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

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

Foundation, Siding and Gutters Ves .No 

1. Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

I Was damage lo windows avoided? 

4 Was damage to windows or door screens avoided? y 

« Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Ves No 

1. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 
# 

O^'ners comments: 

iln.«; pection no<es: 

Removal and resloration activates cornplele including the 30-day sod warranry: 

EPA Rcpreseniaijve %o^ 

^ Date: ^\ti\^ 
Property Completion Agreement 

Ihis agreemeni docuinenls the complclion ot remedial acliviiies perloimed on my pioperty. My signature 

will designate ihai I am salisfied wi(h (lie resloralion of my properly, and thai no ileins are in queslion.s. 

now, or al any lime in the future, excepi those items listed below, if any 

P.opcrtym:-|.^^^- ; 

Property Addr».:0^^^ ^ ^^^^ ^ ^^ . 

Ownei': 

Maxim \-^C)d^^ 

Phone: ^ i m . ^q/ . D-iFv^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

u / ] 1 ayrcc rc.^toriilion is complcled, riccp l as noted 

U ' flo "o ( a^^rec restoration is complelcrl 

<2 m,/o 

Date (oj' s Signadii t Dale 
Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2009/2010 

Remediation Contractor: Coastal Environmental Group - EP-R7-Q9-06 

Property Identifier Number: 'H^i'Oi f^ 

Property Address: ^^yy-A <OVl iCi 

Property Owner's Name; MoVmo. V\rAOj23 

Instructions to the Property' Owner: 

This form serves to record the Propert>- Owner's assessment of perfonnance (Incentive 1 

- Qualitj' 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 quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Performance Work Statement. ""^ 

The Property Owner will indicate his/her assessment 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, then sign & date the form. 

9-10 "excellent" ^^CElVED 

7-8 "very good" 

5-6 "acceptable" AUG 2 3 2010 

U "ve^'poor" SUPERFUND DIVISION 

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

10 n / 5 

9 '' 4 

8 3 

7 2 

6 1 

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

Property Owner Signature: / \//i},u.S-y7Kb~fjJ^ Date: I'i Aua^ 

0