TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: U<il Date: ^hji i 

Address: ^K<i yo^'^Hdbu Ui/i^ 

Remediation Conlractor: CoastaJ Environinental Group_ Year: _2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d Video of property (DVD) 

td, Executive Summary 

EPA-provided property sketch 

d 

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 

•^y ~ 

•y 

t/ 

Photographs I K

As-built sketch 

 (y^^^rru ^ -V C^o^ATl m ^ f ^ 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

Superfund 
Property Access Checklist 

PropertylD: |^35/( ^ D WORK STARTED ON: __/__/_ 

Property Address: -^^^ Fn/^len.il^^. Rh/rJ n WORK COMPELTED ON: __/__/_ 

Renter: Owner: ^^^Y^ A PnA^AP P 

Address: Phone: 

Fax: 

SAMe Cell/Pager: 

Additional Information: 

Phone: (^2,-2,-)qrt 0 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

] ^ Access Agreement Signed: 1 / 1J / /O By: 

JTS* Restoration Agreement Signed: 4^/3/jj^ . By: 

Q Topsoil Sampling (if applicable) / / By: 

1 1 Disposal Sampling (if applicable) / / By: 

• Garden Sampling (if applicable) / / By: 

[^ Utility Clearance Called: Oh I (T^ I \ 0 »y= ok>/o^ko WVNA4 

^ Video/Photos (Before) On:C>b/ OZt vo 

By=^f^^. . 

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

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

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

• Property Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

• Community • Crew On: / / By: 

Results: 

• Community • Crew On: / / By: 

Results: 

1 1 Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 
>Douglas County Account Info^|tio b^t i n Page 1 of2 t 

Douglas County, Nebraska Property Record - R0811540000 

Print Report 

NEW Feature - Parcel Dimensions availabie @ scale 0-50 ft west of 52nd St - Vle W O n Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->->-> Auto Sales Search 

Owner 

BANTNER JOHN S 

ETAL 

2451 FONTENELLE BLVD 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 1154 0000 08 

Account Type: Residential 

Parcel Number: 0811540000 

Parcel Address: 

Legal Description: 

2451 FONTENELLE BD 

OMAHA NE 68104-0000 

CLAIRMONT LOT 32 BLOCK 3 50 X 125 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$63,700.00' 

$63,700.00 

$63,700.00 

$63,700.00 

$44,400.00 

$40,400.00 

Total 

$70,100.00 

$70,100.00 

$70,100.00 

$70,100.00 

$50,800.00 

$46,800.00 

Land Informatio n 

Acres 

0.14 

SF 

6250.0 

Units 

1.0 

Depth 

125.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
'' Douglas County Account Info|^|tion 

Page 2 of2 •j^ti t 

MSI FONTETCUE BD 

10 

II ff 

llS.O«q.l. 10 

«"l 

• > I«<l94 * 

—JJ * 

3ST0RY 

BlimStKliSI t 

0409 0 n 

<?ygtST9 ENLARGE IMAG^ CLICK TO ENLARGE IMAGE 

Square Footage: 1439.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinlder Square Footage: 0.0 

Year Percent Adjusted Year Year Built 

Physical Age Remodeled Remodeled Built 

1915 0% 1915 95 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 fl 624.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 240.0 

Porch End Screen 180.0 

Porch Slab Roof Ceil 192.0 

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

) 

"> 

^M\^'- b-^sWo 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2513399. 

Original Call Date: 6/07/10 Time: 6:00 pm Op: ELIZABETH18790 


Work to Begin Date: 6/10/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2451 Street: FONTENELLE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 08-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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day:

Alt: 

 4025047823 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 /Ut: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/7/2010 
Ticket Text and Map display ihr Ticket: # 2513399 Page 1 of2 Si 

Original Call Date: 6/07/10 Time: 6:00 pm Op: ELIZABETH18790 

Work to Begin Date: 6/10/10 Time: 7:15 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2451 Street: FONTENELLE BLVD 

Twp: 15N Rng: 13E Sect-Qtr: 08-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 0PPDGPR5 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 

QLNNE IC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

View Map Close Map 

http://www^.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticelD=DHO... 6/7/2010 
As-Built Drawing 

COASTA

• MVIKOHMCHTA

L 

t Omaha Lead Sttperfund Site • R e U r. IH C 

OLS#: 63516 

Date Excavated: 6/15/2010 

Date USEPA Signed Off: 7/14/2 

Are 63516 a Sodden: 4770 sa ft 1 III 

Omah Extahof Pairt a Lead Site 

0 Good Site Sketch • Poor 

Sampling Address: 2451 FONTENELLE BD Q Not paint 

Sample Lead Ssmpto Samples Collected Number LAB Concenlralion Colected Fim»: 

RYASCPXA-63516 F l ppm D Date: i-ii>-oi> 

RYBSCPXA-63516 F2 ppm D Time: 3:1 0 fW i 

RYCSCPXA-635ie B l HU3 ppm n Samples Analyzed RYDSCPXA^3516 B2 ppm i 

ROZSCPXA-e3516 OZ ppm XRFUn*. 6y5*f O Book: 22. 6 

Date: 

n 

ppm D 10 -zo-oe 

ppm i n 

201 q D Time: .fin_ Staff: Number of Samples = [ fD j \ \ Q | nsu? 

Legend: F1 = Fnont Left. F2 = Front Rii ick Right DZ = Drip Zone, GZ = Garden. PZ = Pla; 

Ai [•at, fadng prapcfty 

R«%'3UUt OMIttt. 2i>-.\l*08 

Legen d 

Concrete m Drip Zone Excavated Quadrants Excavated 

Araa replaced with Area replaced with Area lef t bare Sod Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group In c 
) ^ 

,\\ ^ ' p 1^ ( l " 

63516 C\e^ f ^\ . O^ lo'^} VO 

Omaha Lead Site 

Ext^ior Paint 

Site [P] Good Sketch • Poor 

Sampling Address: 2451 FONTENELLE BD [ ] Not paint 

Lead Sample Samples Collected Sample Number LAB Concentration Collected Fimi: FZ»V PB - A J 

RYASCPXA-63516 Fl Hlt i ppm D Date 

1-li>-Dt 

RYBSCPXA-635ie F2 —5513—ppm D Time Z-I O pfrt 

RYCSCPXA-63518 Bl *^3 0 ppm D Samples Analyzed RYDSCPXA-63516 82 .^2 . I t ppm D 

ROzscpxA-essie OZ 20 1 <^ onm D XRF Unit: (pS'i O Book: 22. 6 

GZS-fci- I J 5 ppm D Date: 10 -zo-oe 

nPgCCPXA 63616 -PZ- ppm D D Time: Br, 

Staff: fTK O Numberof Samples =1 ^ | | Q [ 

Legend: Fl = Front Left, F2 = Front Riqb PZ = Pla< 

n ^j»^> ^ 

i/; .^•.•'J. 

• - ^ ' 

SoOHMO'y 
r 

63516 

Omaha Lead Site Ex^or Paint 

Site Sketch 13 Good 

• Poor 

Sampling Address: 2451 FONTENELLE BD Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Finn:

Samples Collected 

 FO^- PB- A J 

RYASCPXA-63516 

RYBSCPXA-63516 

RYCSCPXA-83516 

RYDSCPXA-63516 

Fl

F2

Bl

B2

 HU 3 ppm 

 _5]13_ppm 

 ^3 0 Dom 

 j? 2 (p ppm 

I D 

D 

D 

D 

Date:

Time:

 -?-/^-^g 

 3 : /<? /?/yi 

Samples Analyzed 

RDZSCPXA-63516 DZ 2.0 1 "^ ppm D XRF Unit: (ttSH O Book: 2Z a 

GZf-k f f 3 ­ 5 ppm D Date: /Q -Z O -0 & 

nrzocPXA easig -P i — ppm 

Number of Samples = [ ^ |

D 

 | Q | 

Time: 

Staff: 3n. msu? 

Legend: Fl = Front Left, F2 = Front I Garden, PZ = Pla' 

l\ T^^ 

%y'd ^ y^- RevlfiXt Crenled 2<>-AIIB-4W 
iiiiiiii il l II 63516 

Omah Exterior Paint North Arrow a Lead Site 

(g Good Site Sketch • Poor 

Samolina Address: 2451 FONTENELLE BD • Not paint 

Sampl Lead Sample Samples Collected e Number 

i 

LAB Concentration Collected Firm 

RYASCPXA-63516 Fl ppm 

D Dale i-/i>'Oe> 

RYBSCPXA-63516 F2 ppm D 

Time 3:lOpnt 

RYCSCPXA-63516 B1 ppm D 

Samples Analyzed 

RYDSCPXA-63516 82 ppm D 

RDZSCPXA-63516 DZ 201 q ppm D 

XRF Unit: (DS'J O Book: ll. h 

GZS-hi 145 ppm D Date: /0-ZO-O & 

nrzccpXA sosio -Pi ppm D Time: By> •__ 

Staff: fT K O Number of Samples = [ ^ 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Ganjen, PZ = Pla; 

All quadrants ar« as vievjed from the straat, facing proparty 

^araojt 

I f f 

I OCT I 5 2008 .JZlf .HSO 

h i>\..l...H 

t 

M pt 

DZ' '^}% •.n. 

Z%t .fcnhritlie,: 

.^k. 

-.i—'( , 

.FL. 

5^5 

WAf^V 

.ft>MTfe/y.<'AH£. .?P: Irr.TlirJ- >i-.\n^-i>S 
• ^ 

COASTA l 

INVIROHM I KTAl 

t PflO^t^ C It O tJ r . IM C 

Consent fcF Access To Froperl^ 

RIGHT OF ENTRY TO PREMISES 

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 perfornn certain environmental response activities upon the 

following described premises: / ^ , 

?yS/( 

Owner's Namee Daytime Phone: J^'^'/z^ O 

Address of Property 

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 perfonmed, 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 
% 

'••i motv^ 

- » 

COASTA L IHVIHOMHIKTA L 

C K O U > I W C 

« Remove obstructions including boats, trailers, vehicles, playscape items, wo

piles, dog houses, etc; 

od 

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

to save; 

ish 

f Water and maintain replacement vegetation, including fertilizer application,

necessary' subsequent to an initial watering period by EPA; 

 as 

c 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 

•^ 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 Q I do not grant access to my properties 

hlHd 

Date Signature Date 

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

Page 2 of 2 
COASTA L 

Restorataon Agceemsnt 

The purpose of this agreement is to provide a mutual agreemem as to conditions ofthe properly 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: \^'^f^]( ^ 

Property Address: 2.^,^ ) \=h/tfm ^ 11 f , P)W H 

Owner: ^\c^r \ t^VtMgj^ ^ 

Phone: q^:^-\Q^O 

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 Stari of Remediation: 

T•he i ; riova;. storaqe, disposal, and/or return of these itoms is ths Owner's '•espon£ibiiity. 

item: 

:>(li2_ 

. . / 

ttem: 

j 

Item: 

/ 

Items to be Removed by the Contractor During Remediation and iV]ot Replaced 

Item: 

f^oKlC 

Item: f 

Item: 

\ 

Item: 

L 

Pagel of 
COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

em: ^ , ^ 

Ke;emm : ^

-^Af7 ^ g;^/:?^ 

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. 

Aiinth ;i s^L'icli ol ilic' 

'•rr'r-'kioi l;!\'.ui. 

Number of and size of 

each garden/ flower bed 

area. 

All;i(.li .1 skoich 1)1 rc!;ilivf 

jiZfS nnd loc;iiiiMii 

Agreed upon value of plant 

materials not to be 

replaced by contractor, 

•^'clc ;li' \Y.\\\Q vui! ni 

usri. 10 \-^:v\ .: fi!i:n; 

mii'v/L- 1(1 he i;;-c:;)r':\ 

VIM ntr . 

Quantity 

H " ­

f 

^ 

\ 

^ 

Landscape Inventory 

Unit Condition/Type/Species 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

S 

Easement Area, to be Each 

excavated 1^^ 7^Ac\; Y\ <s 

Page 2 of. 
COASTA L 

I Additional Commente / Instructions: 

^4(ys 

Q 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. 

Q I do not agree 

"Dat 7 ' ^ Sienaturr Date 

Page 3 of 

Owner's Sign Datee / ' Contractor' Contractor'ss Signature 
BVID# ^3S[U) 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

Shot# 

vtns 

liit^ 

10,1^ 

Average

Shot# 

1X1^ 

\^&0 

(^ie\ 

Average

Shot# 

\7.«B3 

\aB4 

ixgS 

Average

Shot# 

Average 

Signature_ 

on[ [^iT^oTo 

Omaha Lead ARRA 

^^/) ^ 2-

Reading Sample area 

^n. t \ 0? ^/ V 

^$ ^. \ u Depth 

\l ^ t 5 v 

 \T O X \ C/ / 

-^M^ ^ l T-ofimmitg ^i\^ 

30 sec 

Reading 

5"^ t z 

41 i l-z 

4 ^ 1 IX 

S\.±\ x

Reading 

33 i 10 

^ ^ 5^ \ 0 

S I t. v\ 

 -9 ^ JI \ (^

Reading 

Reading 

am/pm 

Sample area 

B 

Depth 

((? " 

/ 

Sample area 

VIDepth 

B" 

/ _ 

Sample area 

Depth 

Sample area 

Depth 

Reading 

^ n tV?) 

\'^ ^ t ( ^ 

\5Sti e 

 \^ 1 "r,

Reading 

[D3 t a 

1 2 t\ 3 

ii)M t ^ 

 1^(^ 5 l 3

Reading 

^ ] 

y / 

Sample area 

Fl 

Depth 

^ " 

 \ ^ i / 

Sample area 

X-T 

Depth 

U)'' 

'^_ 

Address 

Sample time 

sample length 

Shot# 

n^n 

\^6^o 

t-W 

Average 

Shot # 

1-2^^1^ 

\30 ^ 

\2,01 

Average

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1278 

Mode SOIL 

Time 2010-07-19 08:49 

Duration 91.73 

Sequence Final 

Flags 

AVERAGE Avg of 1275-1277 

ADDRESS 2451 Fontanelle blvd 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

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 122.016 

Supervised By: 

Certificate of Verification 

1275 

SOIL 

2010-07-19 08:48 

30.60 

Final 

63516 

2451 Fontanelle blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.133 
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 125.252 

Supervised By: 

Certificate of Verification 

1276 

SOIL 

2010-07-19 08:49 

30.57 

Final 

63516 

2451 Fontanelle blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.311 
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 114.080 

Supervised By: 

Certificate of Verification 

1277 

SOIL 

2010-07-19 08:49 

30.56 

Final 

63516 

2451 Fontanelle blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.937 
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 

1282 

SOIL 

2010-07-19 08:52 

91.72 

Final 

Avg of 1279-1281 

2451 Fontanelle blvd 

Fl 

6" 

N. LOPEZ 

confirmation 

none 
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 157.872 

Supervised By: 

Certificate of Verification 

1279 

SOIL 

2010-07-19 08:51 

30.58 

Final 

63516 

2451 Fontanelle blvd 

Fl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.067 
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 139.850 

Supervised By: 

Certificate of Verification 

1280 

SOIL 

2010-07- 19 08:52 

30.55 

Final 

63516 

2451 Fontanelle blvd 

Fl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.270 
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 158.864 

Supervised By: 

Certificate of Verification 

1281 

SOIL 

2010-07-19 08:52 

30.59 

Final 

63516 

2451 Fontanelle blvd 

Fl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.130 
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 

Pb 

Supervised By 

Certificate of Verification 

1286 

SOIL 

2010-07-19 08:55 

91.44 

Final 

Avg of 1283-1285 

2451 Fontanelle blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 
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 63.628

Supervised By: 

Certificate of Verification 

1283 

SOIL 

2010-07-19 08:54 

30.48 

Final 

63516 

2451 Fontanelle blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 12.862 
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 72.162 

Supervised By: 

Certificate of Verification 

1284 

SOIL 

2010-07-19 08:55 

30.48 

Final 

63516 

2451 Fontanelle blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 13.379 
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 64.717 

Supervised By: 

Certificate of Verification 

1285 

SOIL 

2010-07- 19 08:55 

30.48 

Final 

63516 

2451 Fontanelle blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 12.884 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By 

Certificate of Verification 

1290 

SOIL 

2010-07-19 09:01 

91.47 

Final 

Avg of 1287-1289 

2451 Fontanelle blvd 

Bl 

6" 

N. LOPEZ 

confirmation 

none 
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 57.992 

Supervised By: 

Certificate of Verification 

1287 

SOIL 

2010-07-19 09:00 

30.54 

Final 

63516 

2451 Fontanelle blvd 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 12.606 
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 47.710 

Supervised By: 

Certificate of Verification 

1288 

SOIL 

2010-07-19 09:00 

30.49 

Final 

63516 

2451 Fontanelle blvd 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 12.044 
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 48.685

Supervised By: 

Certificate of Verification 

1289 

SOIL 

2010-07-19 09:01 

30.44 

Final 

63516 

2451 Fontanelle blvd 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 12.150 
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 

1302 

SOIL 

2010-07-19 09:11 

91.66 

Final 

Avg of 1299-1301 

2451 Fontanelle blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 33.593 

Supervised By: 

Certificate of Verification 

1299 

SOIL 

2010-07-19 09:09 

30.56 

Final 

63516 

2451 Fontanelle blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 10.968 
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 29.996 

Supervised By: 

Certificate of Verification 

1300 

SOIL 

2010-07-19 09:10 

30.52 

Final 

63516 

2451 Fontanelle blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 10.707 
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 37.488

Supervised By: 

Certificate of Verification 

1301 

SOIL 

2010-07-19 09:11 

30.58 

Final 

63516 

2451 Fontanelle blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 11.322 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

\ • ^ www.coastalhazmat.com 

%PRo-(*^ COASTA L ENVIRONHENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY: 

BVID #63516-(2451 FONTENELLE BLVD) 

\ No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

DAN GARVEY WALKED THE PROPERTY ON 7/14/10 
EPA Property Close Out Form 

Property ff: 

Date/Tline: 

Quads Excavated: 

J^252(^ Property Address:'-z^'j ' 

Owner's Name:./^_^£^^^ ^ 

Contractor Group 

ExcavatioD General 

I. If necMsar>', were the correct quadrant(s) excavated and restored? 

Yes

y 

 No 

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

GradioK Sod and Vettetation 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from lhe house? 

Yes 

• 

No 

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

3. 

4. 

5. 

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

day time period) 

Are sodded areas generally Finn and evenly graded? 

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

time period) 

.y 

y 

y 

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

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

Gates, Fences snd Relainlne Walls 

B 

I 1. Do gates open and close freely? (Ifapplicable) 

V «

y 

 Nu 

2, Were all gates or fences taJten down during restoralion acliviiies reinstalled? (Ifapplicable) y 

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

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

FouDdstion,SidioKand Gutters Ves .No 

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

2. Was damage to the foundation avoided? y —1 

3. Was damage lo windows avoided? y 

4 Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspoui extensions avoided? y 

Sidewalks and Driveways (Coocrele) Yes No 

Was damage to driveway surfaces avoided? 

2. Was damage lo walkway surfaces avoided? V 
OM'tier^ comments: 

Hns pectjon no<es: 

Removal and resloration activates complele including the 30-day sod warranry 

EPA Rcpreseniaiive B^ ^ Date: TJHI'^ 
Property Completion Agreement 

I'his agreemem ciocumenls. lhe complclion ot remedial acliviiies perCoiineci on my properly. My signature 

will designate ihal I am satisfied with (he restoralion of my properly, and thai no ilems are in queslions. 

now, or al any lime :n the future, excepl ihose ilems hsled below, if any 

'''"p^ ' ^y ^^ ISL^JM 

Property Address: ^g^ j fi^ j^^,^, ^ ^G; ^ 

Owner: -$ ^ U ^ '^AyyJeY^JlA^ 

Phone: ^h^ - MO) 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Cedents : {?^;5t,^ejpJ?C > ^ \fi ^ TzP^iSCe J ''\£-l-( ( 

\V\ j ayrcc restoration is completed, except as nolerl 

[ I I rio nol ai>rfc restoration is completed 

)wiicr' s Signature Dale Conti actor's Signatur Sipnalmee Dale
3^o 

UPI^p,j^Tp,|Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

JUL 12 2010 Omaha Lead Superfund Site 

2009/2010 

SUPERFUND DIVISION 

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

Property Identifier Number: ^3S7(g a . 

Property Address: ^U^ \ ~PiTy\X&^UX ^ l^jU ^ 

Property Owner's Name: ^^J6u i ^^VvT/fy/jZA^ . 

Instructions to tlie Property Owner: 

This form serves to record the Property Ovmer's assessment of performance (Incentive 1 

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

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

relations, complaint resolution and the overall 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" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

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

6<~^VAP ja ^ ( , if] 

iy)oWy ^^ ^ ^-^#ie<^ 

Property Owner Signature: V^4^,e^i ^ 
(0^ Water Bill Settlement 

Property ID 63516 

Property Address 2451 Fonteneile BD 

Tenant John Bantner 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 30.32 for 

water usage required to maintain the sod. 

Check Number 2093 

Value of Check 30.32 

IVIade Out To John Bantner 

Description of Settlement 

To reimburse tenant for estimated water ctiarges on their MUD monthly invoices. 

My signature below is acl^nowledgement of the receipt of the sum listed above, which t further 

acknowledge to be fair compensation and full payment for the above, and release Coastal 

Environmental Group Inc. from further obligations or liability. 

(^C^u^^y^ fw J 

yi6v/ntr^s Sig\ Signatur i e Date Contractor's Signature Date 

COASTAL ENVIRONMENTAL GROUP INC. 2093 

2411 MARTHA STREET 27-5/1040 003 

OMAHA, NE 68105 6247372904 

'^\^\]0 

DATI 

- TM,\-'jQhn h(yx^mir %^& ­

nV\A>iPUtund^^li<n) 

VMIIlFacgollink.NA 

(Mxaska 

«vctbfif9}.cofn 

-gVlt) Ifl^lt^ 2^\'^\i(^^-j^^hOtn^ (L6€ ^ ^ FOR 

i: IDUOODOBai: E)a»,737E10Uii* 0Ed 3 
Water Bill Settlement 

Property ID 63516 

Property Address 2451 Fontenelle Bvd 1 

Tenant John S. Bantner 

I have received from the contractor, Coastal Environmental Group hic. (Coastal), the sum of $ 60.69 for 

water usage required to maintain the sod. 

Check Number 2044 

Value of Check $60.69 

Made Out To John S. Bantner | 

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. 

9nrnccii^nr^ "^1 In jit) 

Contractor's Signature ' Date 

2044 

OMAHA, NE 68105 

MJAKL 

27-5/1040 003 

6247372904 

DATE 

\\m 1 ^ $ld3 

. OOLIARS fi ! S 

WHIi Fargo Bank. N A 

Nebcaika 

wcltsfatgo.com 

i:ioi,oooD5fli: &51,737Eqoun- 050m, 
Property Damage Settlement 

PropertylD 63516 

Property Address 2451 Fontenelle BD 

Owner John Bantner 

Phone 402.933.1900 

I received from the contractor, Coastal Enviroimiental Group hic. (Coastal), the sum of $100.00 to 

compensate for removal of a Pfitzer bush done during the remediation of lead impacted soil from the 

property. 

Compensation type Check 2070 

Value of Check $100.00 

Check to the order of John Bantner 

Description of Damage 

While excavating 2451 Fontenelle BD (BVID 63516) Coastal presumably damaged a variety of flowers. 

Property owner received a check for the amount of $100.00 dollars for the replacement ofthe flowers. 

Coastal reviewed the pre-excavation photos and determined that the flowers had been removed. Coastal 

agreed to pay a pre-determined amount for the replacement ofthe flowers. 

My signature below acknowledges the presumed damage on the interior wall; further, I acknowledge 

that this work was completed satisfactory and within my and release Coastal Environmental Group, 

Inc. from further obligations or liability related to this proper 

COASTAL ENVIRONMENTAL GROUP INC 27-5/1040 003 

6247372904 2411 MARTHA STREET 

OMAHA, NE 68105 

^h\l^ DATi 

$ (Xf PAY TO THE . 

ORDER OF 5K i(iiltlBQ^%,— 

a 0«<alM on . DOLl ARS B*ck 

WelKFar90Bank.NA 

weRsfargacom 

,: 101.000058.: g,!i.737aioi..' OBO7D 

y ­

Owner's Signature Date Colitractor's Signature Date 

Page 1 of 1