TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: l/oW^^ Date: ^ohh" 

Address: M \\\' \ 4 M'''^ h< 

Remediation Contractor: Coastal Environmental Group Year: 200 _200g| 1 _ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

y 

y 

-& 

J 

y 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs m \:f(JMiy\^^^ ^ ^^l^m/ i-K 'l ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

30217899 

HHil 

Superfund 

7 Utility clearances Property^ifiMrmation from Douglas County Assessor's Office 

Signature 
Property Access Checklist 

PropertylD: 2-0^ZG ? 

n WORK STARTED ON: / / 

D WORKCOMPELTED 0N:_ / / Property Address: m q ^ c^ _<:^ f 

Owner 

PiH/TP Renter ^thcpmp^nn 

Address: 35/ / XA/DG I bjcrjh A/e Phone: 

Fax: 

Cell/Pager 

Phone: 5^/^-f^| 2 0 Additional Information: 

Fax: 

Cell/Pager 7j/- j - |59 ^ 

D Notification JLettcr 

Sent: / / 

Kl Access Agreement 

Signed: JJ_/Ja/£l ^ 

OZf Restoration Agreement Signed! ll 1 l^ 1C^ 

D Topsoil Sampling (if applicable) 1

 1 

D Disposal Sampiing (if applicable) 1 1 

D Garden Sampliog (if appiicdile) 1 1 

^ Utility Clearance 

Ca\tA:ll_l%lQ^ 

P ^ Video/Photos (Before) On:lLl%J m 

a Video/Photos (Dnring) On: / / 

D Video/Photos (After) On: / / 

a Video/Photos (30-Day) On: / / 

/jS^Praperty Completion Agreement Signed:/L/i2_/l29 

D FinalReport Issued:

Air Monitorine (as applicable) 

D Community QCrcw 

Results: 

O Commnnity • Crew 

Results: 

D Comnmnlty QCrxw 

Results: 

On: / / 

On: / / 

On: / / 

/ / 

By: 

By: 

By: 

By: 

^r-Qchyio 

By: /\nri\/ 

By: 1 

By: 

By: , 

By: /iMn^f 

^y-DC^ai/in 

By: 

By: 

By: 

By: 

By: 

_ J 

Omaha Lead Site 
Douglas Coimty Accoimt Inforni^on Page 1 of2 rni^c 

Douglas County, Nebraska Property Record - R1235860000 

Print Report 

NEW Feature - Parcsl Dimensions available (3) scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature - • -> ^ Auto Sales Search 

Owner 

THOMPSEN BRUCE A 

ETAL 

3511 WOOLWORTH AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3586 0000 12 

Account Type: Residential 

Parcel Number: 1235860000 

Parcel Address: 1119 S 31 ST 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 19 BLOCK 5 50 X 150 

Value Informatio n 

Land Improvement 7ota/ 

2009 $6,800.00 $103,800.00 $110,600.00 

2008 $6,800.00 $103,800.00 $110,600.00 

2007 $6,800.00 $103,800.00 $110,600.00 

2006 $6,800.00 $104,700.00 $111,500.00 

2005 $6,800.00 $104,700.00 $111,500.00 

2004 $6,800.00 $45,900.00 $52,700.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 10 150.0 50.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/21/2009 
Douglas County Account Infona^io rni^K n Page 2 of2 

ggi I Tff M S-Bwcrterr 

""' yJ 

2 1/2 STORV UNFINISHED 

1W8 D sn n 

CLICK TO ENLARGE IMAGE 

Square Footage: 1 1748.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Good 

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

HVAC: Central Air to Air Rooms: i 8.0 

Exterior: Frame Siding Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: : 2.5 

Floorcover: Allowance Foundation: Blocl< 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1885 0% 1885 123 

Detail Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Add On Unfinished Attic W/floor 948.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 948.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Garage Detached 744.0 

Porch Slab Roof Ceil 56.0 

Porch Slab Roof Ceil 172.0 

Porch Slab w/Steps 56.0 

User 2 apt conv 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/21/2009 
Page 1 of2 

"> 

Greate Another Ticket_ _ ] r Back to Irth Internet Send Email J 

• YOUR TICKET NUMBER IS 2403267. 

Original Call Date: 11/09/09 Time: 2:13 pm Op: ELIZABETH18790 


Work to Begin Date: 11/12/09 Time: 2:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1119 Street: S 31ST ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-SW,28-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLtJDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: Coastal Environmental Group 


Depth of Excavation: 4 feet Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl MUD02 OMAHACOF OPPDGPRS 0PPDGPR6 


QLNNEIC QLNNEIF 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://vmvi^.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /9/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPRS OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1F QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://vmvi^.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/9/2009 
OLS#: 20826 

Date Excavated:11/11/09 

Date USEPA Signed Off: 12/22/09 

As-Built Dravi^ing 

COAST A L ENVIKONMCNTAL Omaha Lead Superfund^ite Area Sodden: 270 sq ft C II O U r . I M r 

Name: li^,'^yc^c."'tvpr-p5«rv 

Address: tli<Mi. 'm-^ . 

Phone: 

Omaha Lead Site 

Site Sketcii 

Date:

Time:

 ^-^.0- eJ 

 ///0 

Nortii Arrow I 

Team Al/UJ,H'c JfC) BVID# 2.?^^ ^ XRF Code (5%fol 

Sample Number Lead Concentration Confirmation Sample 

y:eapm nrry ^ PP"" 

mi^;gm 

^'Yes a 

''•^Yes tn 

'S/Yes n 

^,<Yes CD 

tiiYes n 

pAYe s CD 

Yes • 

No

No

No

No

No

No

No

 S 

S 

 [^ 

 13 

 BL 

 ; a 

D 

S 3i^ ^ 

Omaha Lead Site 46130 

Legen d 

Concret e Dri p Zone Excavate d 

Quadrants Excavate d 

Area replaced with Are a replace d wit h 

Are a lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
 V 

11/ li)7 ^ 

] Name; JAft^^c"^'»J''^p5<-L»N. Omaha Lead Site Date: ^-X^ ' PJ North Arrow

Address: l/i«l5. iis-^. Site Sketch Time: UIQ 

Phone: 

S 3 1-'^ 

Omaha Lead Site 46130 5^A 

- ^ 
(J/ i\vf t 

] Name: l'if./<ie"^Kp<>-^it.i»^ Omaha Lead Site Date: ?-/? ' OJ North Arro w V 

Address: (/C^iS. Tij-^ . Site Sketc h Time: /// ^ 

1 Phone: 

Team Ai/u-J,ll'c (^£ ) BV1D# ICSZ ^ XRF Code (5$Q^ I 

Lead Concentration Confirmation Sample 

% t '5- ± ri'b PP"" 

£ ai ^ ppm 

'•'Yes

/^.^Yes

^/Yes

 n

 a

 •

 No ED 

 No E) 

 No ra 

^te^nn m fl<Yes CD No t ^ 

CrCib% CD No 13 

ppm PAYes CD No J S 

ppm Yes CD No D 

H — 

^H . 

yWf 

S. 3 1 ^ 

Omaha Lead Site 46130 
Name:

Address:

Phone: 

ftf.«ietkp»».paM/^ 

 IlilS . •7i/»>. 

Omaha Lead Site 

Site Sketch 

Date:

Time:

 ^-X0-0 3 

 / m 

North Arrow 

Team Al/OOill'c if^ ) BVID# 2c>g2-fe XRF Code 65dSi\ 

Sample Number Lead Concentration Confiimation Sample 

ppm 

ppm 

ppm 

'•'Yes a 

/^Yes a 

^/Yes C] 

B<Yes CD 

^Ye s D 

PAYes n 

Yes • 

No E 

No SI 

No C? 

No 1^ 

No I3L 

No iS 

No a £ 

S^^3l 

U(,±44, 

LQlAlQ.... 

y 

y 

n 

j^.z.^. / y / Y / r j y / 2 

y a 

•y. 

y\ 

/"c^L 

tf itiii^.. 

S. 3 N-' 

Omaha Lead Site 46130 
y^^^^^ 

( # 

COASTA l ffftrlltOMHIKTA l 

CROUP . IH 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: 

Owner's Name: Daytime Phone: . 

'^r^(J^S^\r^QT^ f ^>f v 

Address of Property iiioi ^.- y y \ 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

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

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

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

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

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

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

the Grantor in-person to discuss the work to be perfomied, 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 
8 

COASTA L HtVINONHIKTAl \^o y CROU P IMC 

t 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; 

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

necessary subsequent to an Initial watering period by EPA; 

c Abide by health and safety guidance provided by EPA; 

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

the property to perform the work. 

c Allow videotaping and/or photographing of the property. 

AGREEMENT NOTT O 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 

rant access to my properties Q I do not grant access to my properties 

f .Qinnntii Signaturm ' naie / e Date X Signature

 Date 

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

Page 2 of 2 
c .> ^ s T > L 

I M r 

RestofatEOPi Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe 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). 

PropertylD: "Z-C} ^ Z 4 

Property Address: j / / Q S 3 / 6 ^ 

O^er: ^f^^ A ^UoV^ ^ 5Z^\r ^ 

Phone: ^jg.^ , 1 / tf ^(S'^ 3 oVW/- 4o^-'^H(>-5'^^Q 

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, materia) types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

items to be Removed by the Ovifner before Start: of Remediation: 

I 'ds :c-r:ovg.i. glorscie, ois>TJS£l, enci/oi retcr.i o^ Irhegfe items if tne Uwnei s rgspcngibiliiy. 

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

Item: 

Page 1 of. 
C J A S T A L 

Items to Be Removed By ContractGr During Remediation and Repiaced 

ttem: -^ e^ C^ y n 

\ Item: 

Landscape Inventory 

Item Quantity Unit Condttion/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that V­ is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter 

Number of trees <= 2 inch Each 

\ trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

Atiach n sl<eicli tjt Ihe 

>rv>,iHci li;M'.ui 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Aiuicli il slvcicii 111 relrni\e 

Sizos anci loc;llioll^. 

Agreed upon value of plaot 

materials not to be 

replaced by contractor. 

•JS"!' :c ijs'jc c. iilun' 

ipiKl.i'J 1(1 >'H' pi-npci:* 

Ois ntr. 

Easement Area, to be 

u Each 

excavated 

Page 2 of. 
'"AST/ " U 

UOO" , IN C 

rAdditional Comments / Instructions: 

Xheck 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. 

Grc\^^ 

Qiagfj n I do not agree agree 

.^.^-y /y(^ f f ryir<!jj2^ d, k 

Owner's Signati / Date ' y Contractor'sSignature Date 

Page 3 of. 
BVID# 20Q>ZJ[o 

XRF PROPERTY SAMPLE SHEET 


Date JI-ll^D<^ Address ti n <>. 3/ s-l-- Project Omaha Lead ARRA Sample time am/pm 

XRF iD# sample length 30 sec Ti^ P^ ^ 

Shot # 

-^TTL 

Reading 

/S5 ^17 

Sample area 

^1A 

Shot# 

CMn 

Reading 

^Z-ilS 

Sample area 

V>z 

32. ^ 

32.H 

JS/ 1^1^ 

llolo^- iC 

Depth 

1 " 

i,HS 

bH^ 

^8t/3 

3^ t 13 

Depth 

15" 

Average i?Q t; ^ Average ^oiS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sampie area Shot# Reading Sampie area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Signature^AMp ! A 

phm_£Wi^^bi2MJl&b 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 650 

Mode SOIL 

Time 2010-01-28 16:03 

Duration 90.19 

Sequence Final 

Flags 

AVERAGE 1647-649 > 

ADDRESS 3t : 

QUADRANT PZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb <(y^ ^ •—±—y^r^i i 

Supen^ised By: 8^CM^_ ^ Jl ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 647 

Mode SOIL 

Time 2010-01-28 16:01 

Duration 30.05 

Sequence Final 

Flags 

BVID 20826 

ADDRESS 1119 S 35 St. 

QUADRANT PZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 42.048 ± 12.679 

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 38.322 

Supervised By: 

Certificate of Verification 

648 

SOIL 

2010-01-28 16:03 

30.05 

Final 

20826 

1119 S 35 St. 

PZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 12.576 
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 39.338 

Supervised By: 

Certificate of Verification 

649 

SOIL 

2010-01-28 16:03 

30.09 

Final 

20826 

1119 S 35 St. 

PZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 12.608 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 325 

Mode SOIL 

Time 2009-11-11 11:20 

Duration 91.65 

Sequence Final 

Flags 

AVERAGE l^y q of 322-3241 

ADDRESS 1119 s 31 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb CZ1ZZ236I3 (17.366-

Supetvised By: r^0iMj2di S 
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 185.927 

Supervised By: 

Certificate of Verification 

322 

SOIL 

2009-11-11 11:19 

30.53 

Final 

20826 

1119 s 31 st 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

17.864 
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 181.142 

Supervised By: 

Certificate of Verification 

323 

SOIL 

2009-11-11 11:20 

30.60 

Final 

20826 

1119 s 31 st 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 17.504 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 324 

Mode SOIL 

Time 2009-11-11 11:20 

Duration 30.52 

Sequence Final 

Flags 

BVID 20826 

ADDRESS 1119 s 31 st 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb 166.140 ± 16.729 

Supervised By: 
# 

/\,A^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I Coastal Environmental Group Inc. M 

V • j ^ www.coastalhazmat.com 

%p„o^<!^ COASTAL ENVItONMEMTAL S lO U r, IN C 

EXECUTIVE SUMMARY: 

BVID #20826-(1119 S 31 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
st^ 

EPA Property Close Out Form 

Property #: ^^<fJtu > Property Address:-J J.) ^ ^ ..^ )2^ ' 

Date/Time: 

Quads Excavated: rowtractor Croup C/^'^l ^ ' ^ 

Excavatio Yes No n General 

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

y 

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

t ^ 

GmdlBK Sod and Vegetation 

Yes No 

1. Does the grading around the perimeler ofthe house in excavated areas generally slope away y from the house?

 ; 

2. Has sod been laid in all areas that were excavated? .y 

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

y day time period)

 __^____ _ 

4. Are sodded areas generally Arm and evenly graded? y 

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

time period) y 

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

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

Gates, Fences anil Retaining Walls 

Yes No 

1. Do gates open and close fteely? (If applicable) y 

2. Were all gates or fences taken down duringrestoraiion aclivities reinstalled? (If applicable) y 

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

4. Was damage to relaining walls avoided? (Ifapplicable) 1 / ' 

Foundation,SidlnKand Gutters 

Yes No 

1. Was damage lo the siding or trim avoided? ^ 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? ^ 

4 Was damage to windows or door screens avoided? , ^ 

5. Was damage to downspouts or downspout extensions avoided? • 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? •" 

2. Was damage to walkway surfaces avoided? 
owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranry: 

EPA Representative ^<^ j(U Date: 'Jt/lf/.'TL 
Property Completion Agreement 

1 Ins agreement documenls the complclion of remedial activities perionned on my properly My signature 

will designale ihal 1 am satisfied with lhe restoration of my properly, and thai no items are m queslions. 

now, or al any tune in the fijture, excepi Ihose items listed below, if any 

PropertylD: JQ'^IX ^ 

Property Address: .^ i ^ Q ' S yb{ ^ . 

Owner: )OL "TVSorfi^^cn 

Phone: oQ m\{yS?j:) '^^(MoQl/^-IS'^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

1 ^ 1 Ryrcc I'C.ttarfllion i% completed, except as noted 

[_J I do not ai;rec restorntinn is completed 

Owner's Signatinf Date r's Signature Dale 
® 

Property Owner Sstisfaction Survey 

Omaha Lead Superfund Sit 

2008 NOV 2 3 2009 

Remediation Contractor: Coastal Environmental Group 

Property Identifier Number; 

ZOhlKo SUPERFUND OIVISION 

Property Address: i 11 Q ^ ,?)1 (St 

Property Owner's Name: ftnKX lWnnn^;^r i 

(above information to be filled out by remediation contractor prior to deliverv of form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

lhe work performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's worlc by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return It to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

9-10 "excellent" 

^ ^ "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property Owners Satisfaction Rating Reeardin£ Contractor's Work 

5 

_9_ 4 

8 3 

7 2 

6 1 

Additional Comments from Property Owner (optional: continue to back of page if neededl 

Property Owner's Signature 

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