TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: H^f5^ 7 Date: \^/7r^/l O 

Address: 5Q0 7 ^ IR' S-f 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

'0^ Video of property (DVD) 

^ Executive Stmimary 

"Q^ EPA-provided property sketch 

^ Signed Access Agreement for subject property 

'B' Signed Access Agreement(s) for adjacent property 

Q^ Restoration Agreement 

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

•0' Confirmation data 

iTr Photographs 

& As-built sketch 

"Q Satisfactory restoration signed by Property Owner 

Ef Property close-out check list signed by EPA 

•& • Description ofareas not meeting ROD cleanup criteria 

0* Utility clearances 

H' Property information from Douglas County Assessor's Office 

D 

D . 

D 

1 0 iMlLy^ ^^y ^ IZ/IP/IC, Signature J _ Date 

30218037 

iiinn 

Superfund 
^v 

Property Access Checklist 

PropertylD: lfg5 q / 

PropertyAddr»,: ^^-^ ^ ^ ^ n ^ _ 

n

D

 WORK STARTED 

 WORKCOMPELTED 

ON:

ON:

 /

 /

 / 

/ 

o^"'^'-^ r-|.).]U.rnnr-) V/iU^Xp ~ 

Atldress: 

Phone: ^Q^ j B ftM ^ ( ^ ^ .^T 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

D Notification Letter 

15^ Access Agreement 

^ Restoration Agreement 

G Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicabie) 

D Garden Sampling (if applicable) 

i ^ Utmty Clearance 

Q^ideo/Photos (Before) 

1 D Video/Photos (During) 

D Video/Photos (After) 

n Video/Photos (30-Day) 

1 n Property Completion Agreement 

1 D Final Report 

Sent: / / 

Signed J1 /)LL/i29 

Signed:)! /J^/Q Q 

/ / 

/ / 

/ / 

CaUed: 1/ iWjtlCPl 

On:_LL/ V^l ^ 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By:

By: 

By: 

By: 

By: 

By: 

 |5^//4 ^ 

Air Monitoring (as appUcable) 

G Community Q Crew 

Results: 

On: / / By: 1 

0 Community

Results: 

• Crew On: / / By: 

D Community

Results: 

 Q Crew On: / / By: 

Omaha Lead Site 
Douglas County Accoimt In|Mmatio Smaae n Page 1 of2 

Douglas County, Nebraska Property Record - R0413750002 

Print Report 

NEW Faatura - Parcel Dimensions available @ 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 

FLOREZ PEDRO 

ETAL 

5002 S 18 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 1375 0002 04 

Account Type: Residential 

Parcel Number: 0413750002 

Parcel Address: 5002 S 18 ST 

OMAHA NE 68107-0000 

Legal Description: SOUTH OMAHA CITY LOTS LOT 2 BLOCK 105 ALL LOT 1 & N 1/2 LOT 2 BLK 105 

65X130 

Value Informatio n 

Land Improvement Total 

2009 $4,800.00 $34,000.00 $38,800.00 

2008 $4,800.00 $35,700.00 $40,500.00 

2007 $4,800.00 $40,000.00 $44,800.00 

2006 $4,800.00 $40,000.00 $44,800.00 

2005 $4,800.00 $40,000.00 $44,800.00 

2004 $4,800.00 $40,000.00 $44,800.00 

Land Informatio n 

4crss SF Units Depth Width Vacant 

0.19 8450.0 1.0 130.0 65.0 No 

Improvemen t Informatio n 

Buiiding 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=RO.,. 10/23/2009 
Douglas County Account Infi«matio fiKm£ n Page 2 of2 

nwif-' rr r ^ ­

Iy 

Frst Floor d

riSOsqf t 

"i %*«ir •' 

Bwnrt Bloc* 8 H 

712 0 sq. R. 

CLIC CLICK TO EN LARGE IMAGE K TO ENLARGE IMAGE 

Square Footage: 1170.0 Percent Complete: I 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Poor 

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

HVAC: Forced Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Sliingie Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1900 1992 0% 1900 109 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 fl 712.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 120.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Page 1 of2 

"> 

P-[g^1gA"°!Jhg SendJEmall •] [ T'g*^g^ - I;_ ^ Ba9!SJP['?hM^[",^J__ J 

• YOUR TICKET NUMBER IS 2507232. 

Original Call Date: 6/01/10 Time: 2:31 pm Op: ELIZABETH18790 

Work to Begin Date: 6/03/10 Time: 3:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 5002 Street: S 18TH ST 

Twp: 14N Rng: 13E Sect-Qtr: 03-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 Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF OPPDGPR6 QLNNEIF 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 


Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

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

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/1/2010 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/1/2010 
Page 1 of2 

"> 

Create Another Ticket ] [ Back to Irth Internet j Send Email 

• YOUR TICKET NUMBER IS 2413610. 


Original Call Date: 11/26/09 Time: 2:58 pm Op: ELIZABETH18790 


Work to Begin Date: 12/02/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 5002 Street: S 18TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 03-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 OF 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 LEVELS MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/IRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/26/2009 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/26/2009 
Page 1 of2 

"> 

[ Create Another Ticket ] [ Back to Irth Internet | Send Email 

• YOUR TICKET NUMBER IS 2407205. 

Original Call Date: 11/16/09 Time: 9:19 am 


Work to Begin Date: 11/18/09 Time: 10:00 am 


State: NE County: DOUGLAS 

Address: 5002 Street: S 18TH ST 

Twp: 14N Rng: 13E Sect-Qtr: 03-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: LEAD REMEDIATION 


Op: ELIZABETH18790 


Place: OMAHA 


Location of Work: INCLUDE 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 

Depth of Excavation: 4 FT Comer Lot: N 

Involves Tunneling or Horizontal Boring : N 

Front: Y

Explosives: N 

 Rear: 

CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact 

CXCATV COX COMMUNICATIONS, INC HEIDI 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Phone Number Utility Type 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Day: 4025047823 


Alt: 


Emerg: 4025047970 

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/16/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/16/2009 
Lemote ID: R page of 

s^^^^ ^ 

k.'vxc;] L-fc-bn : 

177662421 1 

^ear -baLolce-t^ . W e 

Le-b : 24XS6X O 

•-2 5 XS*K__ST 7 

s.^ X^^oib ^ ^ti%a.as- tax^d.^arg'as'^tarkdL £ai«id.Xd.bd.^ ^ d.r» ei,r» mLas^at. d, ^ ^ c»ag J.l»oiri ^z» blk ^ ^xa«» qeiX 

s^nb.^a=- b.d.alc^b. . W ^ d, ^ n<»b >»ai-v^ 49i.rk3r •umd^arg'ar^tand. gt.qd.XdLbJ.^ ^ d.x» sf^aaac ca.d.g' «k.ar«». 

: £ sr^'u >«ei.-w-«k tna r <XU«9s-bd.ons , ^Xets e cse«.XX otajc oSfio e t b 40 2 — 934—046 9 

r^^a l%ei.-v^ «t.x«.3r ^ciae»^b.d.<»i »X^ak.^^ a^n,bei.c*b or^aar X^oai X Co j id.citbd.«» ] 

-046 9 . 

^^s^l 
lemote ID: R page of 

., „_ _ BviD'.^g)'^"1 

CSOtJWS^JhJ^ ^«*'V^XS%C»9>CBt>Va^Jk2j S^X^'VXCr B Jkbb n : BIXiXSS.>k:lBa>a?H 

3«» : 67766242X 0 Vta c : 87766242X X 

Xlaisia^r&t ^ bo > Dd.a - S^^en^^A b 

K d.aft mk.rx d.nig^oaE"b«i,x«b in>i>^a»t.a ^ f ar^aam c;c»ac c:<=Muutnaz»iaaibd.^xix K arm y Xyd.r*<gr b ^ ST^*-' 

.^<3ai.b ^ oxaa r -lancX^ar^'as'^tarkd . f ak,«sd.Xd.bd.^ ^ d.r% ai. n e^as-cbai ^.^^oacd-^c^r l ^ n -bl* ^ <»z%^ c»tX X 

^^a r bd.«s3c«»b . . 97 ^ d ^ r^<»b. >k«k.ir«i «i.Txar ta.x^d^acg'ar^taxkd . f «i.«»d.Xd.bd.^ ^ d- n y^taa c lAd.g ' «aar^ei , 

Leb : 2S0723 2 

»ba r I X>^X9CHMJ^J S lPXai.C3 ^ : 

res s zV.\BOO g S [xeoyM ' S^ | 

k.a'-V : 

.^Irxd.^ d. ^ ai.x% d.xnap^arb.aix% b xnckct^atg- ^ f ac^m i CT^ac C«Mtnxcnarkd.«ici.bd.«>ra.^ ar«»i^Xyd.ng - b ^ y^-uta r ar^< 

^ ^ Xe»c»ai.b ^ ^>XAar •uiz%d.^arg'ar^'«axx«3. f tM.ctd.Xd.bd.^:s d.x% ai.rk ak.ar^«i. d.^^aard.39^<fl . <»r> blu ^ ^xx ^ qai. X 

x«»ar%-b«kar bd.c»]c«» b . VW^ d. ^ n^ b ht.-v-<a «i.n y tand.caaE-g'aro'utxa d f «Lctd.Xd.bd.«» s d. n y^taa ? c3.d.g- «i.ar^ . 

: f yo-v a 1n.ai.-v^ ai.rk y ^fTa«BSKbd.<»naK , ipX^at.^4 » dfli.X X ^taa r ^£fd.«x ^ ai. b 40 2 — 934—0 4 6 9 

-.eb ; : 2S0723 3 

ib y : D^l70»X<Jh ^

 rX«k.«* ^ : 0»<cm«Jk. 

r«»s s : 362 3 'WJnXjSVXT'F S^P 

i.^'-vr : 

Itx:^ ^ d. ^ oLx^ d.znx>^ f bsin b xn^aB^aL9« i £aro« n c;e»ac c;^>«svRvtax«ic£«k.^i^n ^ as'^X>Xyd.ni9 ' b ^ y^xaa r a?^ ­

; ^ X^d«i.ba i c^vaas- •tarkei.a»arg'aro>-«arxd, £«k.cxd.Xd.bd.^ ^ d.ra mk.xx «i.ar4a«i ca.«»aKc»ard.3»^ei. ^r^ i b>a«k ^r» ^ csfliX 

:«kra.b^a r bd.cs]c^ b . TT ^ d. ^ n.^ b y»t.'v ^ «i.n y -«arkci.^ar9ar^-tar»d . £«i.<3d.Xd.bd.^ ^ d-rx yoxaa r d.d. 9 «k.ar^. 

' .f ye»a a lr«ai.-v^ air^ y «[vi^JBbd.ox^ ^ , X>^^*^^ ^ cttX X ^taa r ^ffd.«» ^ ak.b 402-934—046 9 

:e b : 250723 6 

Lb. y : ^^X3CHsJlkJ S 9Xt«»«k : 

-ess: XS4X S 28a<H S*!* 

.oyv : • Wd. ^ d.jB at.rk d.xngj^^arb.okrk.b zn^^^«k,9-4 » f acot'xn c;e»ac C^»snnnas%d.<»ai.bd.4»T^ ^ ar^]|^Xyd.n 9 -bo* yo-ua r ac«» 

• ^ X^^aib ^ oxaa c -tazid^arg-ar^taz^d . f ««.c»d.Xd.bd.^ ^ d.rk 4Si.rk «ia7^e » 4dl«k^<»ard.39^d . oz » bl% ^ ^za« > <=»«i.X 

i^»^b.«»a c bd.«»lc^- b . TT** <9.o s^^ b >%fli.-v<» «i.x«y %a«k«Jl«ftas^g'aff^'wt«k<9. f «k.c»d.Xd.bd.^a » durk. y«»-«aac <Ad. 9 t.ar4to 

f yc^- u >iaK,-v-^ «i.z» y ^ruies^bd^oxis t , f»X^aiSK ^ CXALX X o-vtar e»£fd.o ^ ai b 40 2 — 934—046 9 

-^t a >»ai-tr«k «k.x>y ^[«aiat as b i «>r> JK X>^^*L^< ^ <=»^rxb.4iiexb «>'«aa; Xo«tai X C^a c C4»z«iarmav%^e»ak.b;L^r>JB ^ f f i o 

046 9 . 
«

^ As-Built Drawing 

COASTA L maha Lead Superfund Wte ENVmONHINTAL 

C • O U P . IN C 

OLS#: 48547 

Date Excavated: 6/10/2010 

Date USEPA Siqned Off: 7/28/2010 

Area Sodden: 3487 sa ft 48547 

Exterjprl^aint North Arrow 

Q'Goo d 

• Poor 

Q Notpaint 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area left bare 

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

L '>'^fo> 

IP 

^ : 

K/) 

- ^ 

J 

>R. 

Owner Name: PEDRO FLOR^t

Address: 5002 S 16 ST 

Phone: H:

Sample Number 

i RYASCPXA-48547 F1 

RYBSCPXA-48547 F2 

^ RYC8CPXA-49SW B l 

'RYDSCPXA-4854 7 B2 

rHC«3CRJ(A-4fl»l7 OZ 

^RG2SCPXA-?8547 G2 

RP7.sr,PXA-48547 PZ 

Lab RYBSCPLA-48547 

Result 

Omaha Lead Site 

Site Sketch 

_v 

5 

Lead Sample LAB Concentration Collected 

0 ^ D

_5L2i.PPm D _!l20ppm u 

-^3 ^ ppm n 

^ S ^ ppm D 

ppm D 

35 ppm D : 

Number of Samples = i-- 5 i 

48547 

ExteriprPainl Nonh Arrow 

QGoo d 

Q Poor > 

Q Not paint 

Samples Collected 

Firm: 9. £ C<V\ . ^ .N l • 

Date: ] 0 • ^'^•'-X 

Time: l o : 3.5 ^ Knr\ 

Samples Analyzed 

XRF Unit: % [ Q Book' ^ ?!) 

Date: 

Time: 

Staff; 

Omaha Lead Site 46130 

6dD 3^^ 6 G 
Iv ^'^lov 

# 

48547 

Omaha Exterjorl^int North Arrow Owne Lead Site r Name: PEDRO FLOFtgl 5 

Sit I^Good e Sketch Address: 5002 S 18 ST • Poor Phone: H: • > 

Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 ?. £ . cn i . -f>Ati- • 

RYASCPXA-48547 Fl _J-L3^PP m D Date: } 0 • .J-^-M 

RYBSCPXA-48547 F2 __M^Pp m D Time: IO : 33 ^ A> ^ 

'T^CSCPXA-48ai»

RYDSCPXA-48547

 i«M 

 B2 

1 3 C^ ppm 

^S ^ ppm 

n 

D Samples Analyzed 

RDZSCPXA-48647 DZ -S^H^^Pp m D %\ 0 BookR ^ 

RGZSCPXA-48547

RP7Sr,PXA-4a!547

 GZ 

 PZ 3 1 ppm 

ppm D 

D 

Lab RYBSCPLA-48547 

Result 85.1 Number of Samples = i-~5 i m 

zr 

Omalia Lead Site 46130 
48547 

r Owner Nanw: PEDRO FLOREg ' 

Addrew:S002Si8ST 

Phone: ^-

Sample Number 

RYASCPXA48547 Fl 

RYBSCPXA-48547 F2 

RyCSCPXA-48547 B1 

RYDSCPXA^8547 82 

RDZSCPXA-48547 DZ 

RGZSCPXA-48547 GZ 

RP7SCPXA-48547 PZ 

Lab RYBSCPLA-48547 

Result 36 1 ppn, 

Omaha Lead Sits 

Site Sketch 

W: 

Lead 

Conoentration Sample 

Collected LAB 

4>3)2>ppm D 

_^_2i^pp m D 

__!l^£ippm D 

g!.a^ DPm D 

?^9g \ ppm D 

___PPnr> D 

I4 H """^ D 

Exterlprrant North Arrow 

[3«>od 

• Poor > Q Notpaint 

Samples Collected 

Firm: ?. £ . fn-T.^AH -

Date: IO • Ji^' ^ 

Time: | 0 ; •JyS' /<rr\ 

Samples Analyzed 

Omaha Lead Site 46130 
,*^^*;^*V, 

COASTA l IHVIItONfllHTAt 

C R O tl r . IN C 

Consent fcr Access To Pfoperty 

RIGHT OF ENTRY TO PREMISES 

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

Environmentai Protection Agency (EPA) or its authorized representatives, collectively 

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

following described premises: . /vd^//r--),.-­

Owner's Name: Daytime Phone: 

6\or iie-rrvvG} xJaScrsi ^ ^ 

Address of Property 

covered by this 

Agreement 5"°o^ 5/5 ^ : 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil sampies 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, v\nll 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, 

contractore 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 
COASTA L tNVtnONHIKTAL 

C t O U P I K 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 

« 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. 

» Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any ofthe woric 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 

signature Date Signature 

Date 

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

Page 2 of2 
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 restoiation 

activities are completed to the satisfaction ofthe property owner and the United Stales Environmental 

Protection Agency (EPA). 

Property ID: '^T7' 

Property AddreM: C^Q Q a _ 5 . \ g) ^ ^ 

Owner: g^ ^ v"\"G /fyy ^

Phone: ^^U| ^ y^c^ ^ 

 Mg j Q^^^Z . 

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 lenoval. storage, disposal, and/or return of these itoms Is the Owner s responeibility. 

Kem: 

Kem: 

Hems to be Removed by the Contractor During Remediation and Wot Replaced 

Pagel of. 
;"^--

COASTA L 

Items to Be Removed By Contractor During Remediation and Repiaced 

Kem: 

i) ^Wbi/ ^-^ 

Kem: ' ^ / / ) 

Kem: 

Item 

Ljindscape Inventory 

Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered wfth grass. irV .%H^^ Quadrants 

Number of trees > 2 inch 

trunk diameter \ Each 

Number of trees <= 2 inch 

trunk diameter 

Each 

Number of Sprinkler 

Zones. Control Valves, 

Timers, Heads, etc. 

Aiiach :i skeiclr ol ilitf 

'•ri'i'klor l;;y'.>ui 

Each 

Number of and size of 

each garden/ flower bed 

area. 

AlUitli il skt'l'jh 1)1 rdlilivi.' 

M?fS nnd locaiiciK 

\ 

Each 

Square Feet 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Vole l!".t' \Hillc VMII hi 

csi'C 10 is;u( il 'linn! 

\oin-JH': Id llie |;ro))crl> 

u>< ncf. 

Easement Area, to be 

excavated Each 

Page 2 of. 
COASTA L 

r. h o u f , » N c 

< Additional Comments / Instructions: 

\ \ri^^Q^ W^ ^ 

0 Check the box if Owner does not want CEG to document Interior foundation walls arKJ possible 

pre-existing damage. By checkinig this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

[^ I agree O I do not agree 

Owner's Signatnre Date Coniractor's Signature Date 

Page 3 of. 
m 

BVID#<^8fbM- | 

XRF PROPERTY SAMPLE SHEET 

Date ^-/-/ ^ Address .^iCTJZ ^ 1 ft s r 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# sample length 30 sec 

Shot# Reading 

mIL M I I 

% m. NZ-f if^ 

Average l^sT) J^f a 

Shot# Reading mi iii 

ii£2. 10^ w± /CP 

ust> )?A± t r 

Average ll^tii^ 

Shot# Reading 

Average 

Shot# Reading 

Average 

Signature 

Sample area 

H i 

Depth 

HlL 

Sample area 

M. 

Sample area 

Depth 

Shot# 

Average

Shot# 

H ^ 

td^k­ ^si -

Average

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Reading Sample area 

IHL 

ll'^i- /I Depth 

//^ ^ / ^ 

/ i H >*/ ^ 

Reading Sampl barnpiee ararea 

I S ^ ^^ O 

iSrb ^lf_ Depth 

UnO^iy^ II­ Jf^J^ /l 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 458 

Mode SOIL 

Time 2010-07-01 15:38 

Duration 92.11 

Sequence Final 

Flags 

AVERAGE ^H>t 4bb-4b/ -^^^^ '-"^' 

ADDRESS )02 S 18 st 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 184.865 

Supervised By: 

Certificate of Verification 

455 

SOIL 

2010-07-01 15:37 

30.55 

Final 

48547 

5002 S 18 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.797 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 179.552 

Supervised By: 

Certificate of Verification 

456 

SOIL 

2010-07-01 15:37 

30.61 

Final 

48547 

5002 S 18 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.431 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 159.824 

Supervised By: 

Certificate of Verification 

457 

SOIL 

2010-07-01 15:38 

30.95 

Final 

48547 

5002 S 18 st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.370 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 454 

Mode SOIL 

Time 2010-07-01 15:35 

Duration 91.57 

Sequence Final 

Flags 

AVERAGE ^|^M5| S ^SS ^ ADDRESS 002 S 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Pb 

Supervised By: iCMlM^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 111.259 

Supervised By: 

Certificate of Verification 

451 

SOIL 

2010-07-01 15:34 

30.55 

Final 

48547 

5002 S 18 st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.914 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 108.253 

Supervised By: 

Certificate of Verification 

452 

SOIL 

2010-07-01 15:34 

30.51 

Final 

48547 

5002 S 18 st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.935 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 128.374 

Supervised By: 

Certificate of Verification 

453 

SOIL 

2010-07-01 15:35 

30.51 

Final 

48547 

5002 S 18 st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

16.828 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 

1^^-^ 'yj 

Supervised 

Certificate of Verification 

450 

SOIL 

2010-07-01 15:33 

91.57 

Final 

• 47=449 ^ 

r002 S 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

Error 

JS256 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 447 

Mode SOIL 

Time 2010-07-01 15:31 

Duration 30.58 

Sequence Final 

Flags 

BVID 48547 

ADDRESS 5002 S 18 st 

QUADRANT Bl 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 117.039 ± 16.409 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 113.236 

Supervised By: 

Certificate of Verification 

448 

SOIL 

2010-07-01 15:32 

30.53 

Final 

48547 

5002 S 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.136 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 112.621 

Supervised By: 

Certificate of Verification 

449 "^ 

SOIL 

2010-07-01 15:33 

30.46 

Final 

48547 

5002 S 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.224 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 446 

Mode SOIL 

Time 2010-07-01 15:29 

Duration 91.81 

Sequence Final 

Flags 

AVERAGE uri!tvg»Sf 5443i44S : 

ADDRESS 5002 S 18 st 

QUADRANT Fl 

DEPHT 4" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 150.192 18.235 

Supervised By -^AfJllU 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 151.249 

Supervised By: 

Certificate of Verification 

443 

SOIL 

2010-07-01 15:28 

30.60 

Final 

48547 

5002 S 18 st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

Error 

18.332 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 157.039 

Supervised By: 

Certificate of Verification 

444 

SOIL 

2010-07-01 15:29 

30.65 

Final 

48547 

5002 S 18 st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.538 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 142.286 

Supervised By: 

Certificate of Verification 

445 

SOIL 

2010-07-01 15:29 

30.56 

Final 

48547 

5002 S 18 st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.835 
y^> * 

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

Coastal Environmental Group Inc. 

www.coastalhazmatcom ^ ^ 

COASTAL INVIIONHINTAl 

C • O U P, IH C 

EXECUTIVE SUMMARY: 

BVID #48547-(5002 S 18 ST) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 7/28/10 
'CciSL 

EPA Property Close Out Form 

Property tf-.Mft.'^H.l , . PropertyAddreair.>jl'^|- ^jJ^i^^Ji^JJa-i. , 

Datcmme; ZZm r Ow^r'« Name:, /. % J H^-T^.^J. W^(^' ^ 

Quads Excavated: Contraclor Gronp Chq^T ^ I 

Excavatioi Yes No i Genemi 

1. If necessny, were the correct q(uuiiant(s} exca vated and restored? / 

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

Grading Sod and VeteCatioa 

Yes No 

I. Does the gnuling around the perimeter ofthe house in excavated areas generally slope away / from tbe house? 

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

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

/ day tune period) 

4. Are sodded areas genetally firm and evenly graded? / 

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

time period) y 

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

r 

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

Gates. Fences aatl RcUteinij Walls 

{ 1. Do gates open and clo!(efi««ly? (Ifappiicable) 

l-^ Were all gates or fences taken down during restoration activiiies reinstalled? (If applicable) 

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

Yes

/ 

y 

y 

 Nu 

't. Was damage to tetaining walls avoided? (Ifappiicable) 

Foupdation, SidhiRaod Gntlers 

iz 

Yes No 

t. Was damage to the siding or trim avoided? • ' 

2. Was damage to the foundation avoided? y 

Was damage to windows avoided? y 

A Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

y 

y 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes

T 

T 

 No 
Ort'Ders conunents: 

j . .. ..^c 

jlnspection notes: ^^^ 

\*« 1 

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

EPA Representative ^"^ ) ^ Date: l\z?l!Q_^ 
4 

Property Completion Agreement 

ihis agreemenl documents the complclion ol remedial activities perloimed on my property My signature 

will designale ihai I am satisfied with ihe restoralion of my properly, and ihai no items are m questions, 

now, or al any lime in the future, excepl Ihose ilems listed below, if any 

Property ID: UQ^^V-A n 

Proper ty Address. 5Q. ^ 2 !S 1 ft 5 ^ 

^''""••^^^^Uli^^f-r^^r^ ^

pho'"'=6iQ£Lj^gq- ifi^fs -^

 Ve) i

 r^og)^ n

 /c . U

 -

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

V ^y^JP^ '7 ftd I "fc c icstomlion K completed, except as noted 

^fp^/* ^ " ^ [Nr I do not atjrec restomtion i;; completed 

 < ^ ~U •Z-C^i T 

 ^M ^ 

Owner's Signature Dale Conl i actor's Sienature Dale 
i^) 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRAJfEpprrrni 

Omaha Lead Superfund Site ^*JVE D 

2009/2010 JUL 30 2010 

Remediation Contractor: Coastal Environmental Group - EP-R7-09-06 ^^^'^^^^ DlVlSTn^f 

Property Identifier Number: MB5M~ / 

Property Address: ,^Vy:)7 5 / 8 S r 

Property Owner's Name: f-^t iv\l(^r lyv^ \(n\nd^ 7 

Instructions to the Property Owner; 

This fonn serves to record the Property Owner'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 tKe 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 perfonnance with the contractor's 

work by checking a numerical rating on the table below using the numerical definitions iix)m 

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" 

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

10

9

_A )L _ 5 

4 

8 3 

7 2 

6 1 

Propertv Owner Additional Comments from rootional; continue on back page if needed) 

Property Owner Signature: ( ^ ' ^Date