TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: UwO ^ Date: \^\ ^ j l^ 

Address: L/t^1 QMI Q n 

Remediation Contractor: Coastal Enyironmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

t / Video of property (DVD) 

y Executive Summary 

EPA-provided property sketch 

/ Signed Access Agreement for subject property 

-H" Signed Access Agreement(s) for adjacent property 

U Restoration Agreement 

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

0 Confirmation data 

fer Photographs ^ ^ (r7o<%/mV|^ \v^^|^^ W f ^ 

y As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

-TT Description ofareas not meeting ROD cleanup criteria 

j / Utility clearances 

[J/ Property^iflfonjafation from Douglas Coimty Assessor's Office 

D 

D 

Signature 

30218018 

•11 

Superfund 
Property Access Checklist 

PropertylD: ^d^QQQ 

Property Address: it ^ ^ ^ 

n

n

 WORK STARTED 

 WORKCOMPELTED 

ON: 

ON: 

_/

I

 l_ 

I 

o^^^r-UW Lix^a^\^­ Cay ^-Pniu^Ki.. Renter: 

Address: 

1619 Fofn<3im SV. # Uu 

Phone: 

Fax: 

Cell/Pager: 

Phone: qqq.fSlf^O ^W'^ ^ ^6 

Fax: 

Cell/Pager: 

Additional Information: 

D Notification Letter 

I2S Access Agreement 

nd Restoration Agreement 

Q Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

D Garden Sampling (ifappiicable) 

51 Utility Clearance 

^ Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

[~| Property Completion Agreement 

D Final Report 

Sent: / / 

Signed: ^ / Zl / IO 

Signed: M /t l / 10 

/ / 

/ / 

/ / 

CaUed:oM /l^/t o 

On: Ji_/2J/ [0 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

^y­ OH/^rv/, o

^y'-D<iH\f[t^ 

By: 

By: 

By: 

By: 

By: 

 u^„dLy 

Air Monitoring (as applicable) 

• Community D Crew 

Results: 

On: / / By: 1 

n Community

Results: 

• Crew On: / / By: 

Q Community

Results: 

Q Crew On: / / By: 

Omaha Lead SKe 
Douglas County Accoimt Jj^uji^tion Page 1 of2 

Douglas County, Nebraska Propeity Record

Information is valid as of 2010-4-16 

­ R0920510000 

New Feature -> •• ^

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

 Subdivision Sales Search 

Owner 

CITY OF OMAHA 

C/0 PLANNING DEPARTMENT 

1819 FARNAM ST #1111 

OMAHA NE 68183-0000 

Property Informatio n 

Key Number: 2051 OOOO 09 

Account Type: Ex Govemment 

Parcel Number: 0920510000 

Parcel Address: 

Legal Description: 

2204 OHIO ST 

OMAHA NE 68110-0000 

DENISES ADD LOT 21 BLOCK 1 57 X 122 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$0.00 

$0.00 

$0.00 

$600.00 

$600.00 

$600.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$0.00 

$0.00 

$0.00 

$600.00 

$600.00 

$600.00 

Sales Informatio n 

Sales Date: 1992-06-19 

Deed Type: D SooJIr: 2171 Page: 633 

Price: $300.00 

Grantor: 

Grantee: 

Valid/lnvalid: Valid 

Exclusion Reason: 

Show All Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6954.0 0.0 122.0 57.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo.jsp?accountno=R09... 4/22/2010 
Douglas County Account ^M£nn» { ation Page 2 of2 

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2 Victor 

Bu'dett (0 e U) « jGranf 

Map data ©2010 £48^5^ TechnologieSGoogle - Terms oflft e 

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m Page 1 of2 

"> 

L Sendjmail ] - >. fi[gg^^QPJhg^r_Tl9!SgL-:: -J L._-JggJL^Q JJj^- JPJglD ^ I 

YOUR TICKET NUMBER IS 2473633. 

Original Call Date: 4/23/10 Time: 1:14 pm Op: ELIZABETH18790 


Work to Begin Date: 4/27/10 Time: 1:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2204 Street: OHIO ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

X

MAGELLA * A /-CT T A XT MAGELLAN MIDSTREAM PARTNERS T^cDi-vo A U N j p DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RlCHA^RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS,., 4/23/2010 
m Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon,org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/23/2010 
As-Built Drawing 

OLS#: 29000 

Date Excavated: 04/30/10 

COASTA L Omaha Lead Superfund Site 

Date USEPA Siqned Off: 05/20/10 

Area Sodden: 1909 so ft 

X^ODO 

NIamfi 6«-»^/,^ H./i J .'it.,>,if/t.>S Omaha Lead Site Date: 5-/^'(? V North Arrow 

SKe Sketch Time: /«-' Z 9 

Phone: r 

Team ^//fi//L.^i'if^ {-^^^^ BVID# I^O^ ^ 

Sample Number 

Omaha Lead Site 46130 

Legen d 

Concret e Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with Area replace d wit h W&i\ 

Sod Area lef t bar e ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
CN**©./- VV Os/^Tv 2.^00 0 

j Name; Crr,«/w H./i J Mfif^t-^S Omaha Lead Site Date: S-^-o< ^ North AiTow I-

Address: Z^^VCOir/n 9/- Site Sketch Time: lo: Z9 

Phone: 

r 1 

Team &/L/l.^.. , {M^J) BVID# "i^O^ XRF Code ^ ^ 

Omaha Lead Site 46130 

I 
t# 

x^oeo 

Name: tir,«//r Hji J /Am ,fh.'^S Omaha Lead Site Date: Sf^-C-/ . North Arrow 

Address: ZT> i C^l^ln ^ • Site Sketch Time: lo: z9 

Phone: 

Omaha Lead Site 46130 
• • a.^0CrO 

name: CiTfJt*- H.Ji,J /4>^»'fh'''S Omaha Lead Site Date: 57<^^fi></ Norti) Arrow 

Address: Z7^*/C^Uie. ^ - Site SIcetch Time: lo : Z 9 

Phone: r 

Team dtflu/lL^o ^ f-^^ Q BVID# 2^0Cf^ XRF Code e< ^ 

Sample Number Lead Concentration Confimiation Sample 

f^^f(?9^^"^^^^ 

f-wio rxA- ^1 ^ 

i6o 

SL ^ 

^'g'g. ^I* ? 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

^Ves

-fZYes

(?/ Yes

»»Yes

Yes

Yes

Yes

 n 

 CD 

n 

a 

 CD 

a 

• 

No 9 ^ 

No g ^ 

No 5 ^ 

No ^ 

No CD 

No CD 

No CD 

Omaha Lead Site 46130 
^,eosr., ^ 

COASTA l IMVIRORHf KIA l 

c ft 0 ur . IN 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: B^lP'^'ZHO^^ 

Owner's Name: Daytime Phone: uwner s 

Address of Property 

covered by this ^ZO ^ oHfo 5-r 

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 performed, the Grantor will have an 

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

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

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

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the wori(. This access shall 

remain in effect until the worit has been satisfactorily completed. The Grantor also 

agrees to: 

Pagel of2 
.^^'"*'^t . 

COASTA L 

IflVlaeilHfKTAl 

Cft O U r IR C 

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; 

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

necessary subsequent to an initial watering period by EPA; 

t 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 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 

^\ Ig grant access to my properties D I do not grant access to my properties 

t^-^l-rc^ 

Signature Date 

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

Page 2 of 2 
C O A ST A L • MVI«OMH>MTAL a • O U P . IHC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

PropertylD: ^^fjQQ 

Property Address; •2>Z^^f Ol^,f, «!?T. 

Owner: OrcY c^r QfHtH^ 6.(1 Uicmt7 

Plione: y^^- 'yiro 4^4^-^^^S 

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, disposai, and/or retum of these items is the Owner's responsibility. 

item: 

yoh ^ 

item: 

item: 

item: 

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

item: 

Kem: 

item: 

Kem: 

Pagel of. 
C OA S T A L 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: 

So. I 

item: 

^ 

item: 

Kem: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

tnmk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be 

excavated 

Quantity 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

$ 

Each 

Condition/Type/Species 

Page 2 of. 
^ 

C O A S T A I. • NViaOMMBMTAI . aaoup . INC . 

Additional Comments / instructions: 

The cKy of Omaha ordinances may prohibK 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 underiying 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 wKhstanding 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 cKy of Omaha's Planning Department at (402) 444-5150. 

|~| Please check this box if you understand the information outlined above. 

O 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. 

4^ 1 agree /] CU I do not agree 

(f\^rgAth J 

Owner's Signalure \ Date Contrac Contractor' t s Signature Date 

Page 3 of. 
BVID#_a9QC]Q 

XRF PROPERTY SAMPLE SHEET 

aacu n^ n 

am/pm 

30 sec 

Reading Sample area 

ai^ ±aa Bf\\ 

a38^5lQ Depth 

di(cZ^3i\ 

 'dii/iO ^ S\ 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Date 

Project 

XRF ID# 

Shot# 

^©GJ 

^€>1 

65« 

Average

Shot# 

\^L,fi 

\^^u>^ 

\^^Q 

Average 

Shot# 

Average 

Shot# 

Average 

f?lllllC> 

Omaha Lead ARRA 

"^oS^ 

Reading Sample area 

Sl^<^ ra 

3"\^.^ Depth 

ai^- ^ <rf" 

 ol ^ - M 

Reading Sample area 

Qcn-t at\ EATl 

lS(«t\<:j Depth 

I («^ ^^ 5^0 \ 

inn ta o 

Reading Sample area 

« Depth 

Address 

Sample time 

sample length 

Shot# 

^iciO. 

fiLp[ 

_SjLaa_ 

Average

Shot# 

Average 

Shot# 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

Signature. P(,CM!)VDh 

Prim 9Uyyy ^ C!nfflPpN 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 559 

Mode SOIL 

Time 2010-05-11 16:33 

Duration 90.33 

Sequence Final 

Fiags 

AVERAGE -Avg:5f356r.558 

ADDRESS ^•2:204Ohio st 

QUADRANT F2 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD 8.354 

Zr 498.291 ± 16.430 

Sr 155.064 ± 8.604 

U < LOD 16.244 

Rb 78.036 ± 7.082 

Th 13.764 ± 6.970 

Pb 8.983 

7795 

8.421 


Supervised By: 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

Tl-PE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm

< LOD 

481.804 

148.388 

< LOD 

77.582 

< LOD 

30.785 

< LOD 

< LOD 

< LOD 

69.922 

< LOD 

< LOD 

77.301 

< LOD 

19826.684 

434.739 

Supervised By: 

Certificate of Verification 

556 

SOIL 

2010-05-11 16:32 

30.11 

Final 

29000 

2204 Ohio st 

F2 

6" 

CONFIRMATION 

N. LOPEZ 

± Error 

8.193 

± 16.044 

± 8.369 

15.701 

± 6.970 

: 9.169 

± 9.104 

5.841 

; 12.702 

: 12.570 

± 16.228 

: 87.822 

• 30.151 

± 51.330 

I 185.275 

± 406.807 

± 91.294 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 557 

Mode SOIL 

Time 2010-05-11 16:33 

Duration 30.11 

Sequence Final 

Flags 

BVID 29000 

ADDRESS 2204 Ohio st 

QUADRANT F2 

DEPTH 6" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD 8.386 

Zr 505.564 16.549 

Sr 155.752 8.620 

U < LOD 16.269 

Rb 77.560 7.072 

Th 20.468 7.628 

Pb 26.889 8.984 

Se < LOD 6.106 

As 13.462 8.383 

Hg < LOD 12.864 

Zn 67.864 16.308 

W < LOD 90.410 

Cu < LOD 30.875 

Ni < LOD 75.102 

Co < LOD 191.307 

Fe 20172.420 ± 413.043 

Mn 377.692 i 89.078 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

ppm 

< LOD 

507.504 

161.051 

< LOD 

78.966 

15.039 

26.503 

< LOD 

14.080 

< LOD 

68.105 

< LOD 

46.395 

< LOD 

< LOD 

20639.336 

487.285 

Supervised By: 

Certificate of Verification 

558 

SOIL 

2010-05-11 16:33 

30.11 

Final 

29000 

2204 Ohio st 

F2 

6" 

CONFIRMATION 

N. LOPEZ 

Error 

: 8.483 

± 16.696 

± 8.822 

; 16.764 

± 7.203 

± 7.170 

± 8.862 

J 5.438 

± 8.413 

: 13.037 

± 16.369 

: 87.119 

± 22.226 

: 73.622 

: 194.704 

± 420.755 

± 96.727 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 563 

Mode SOIL 

Time 2010-05-11 16:36 

Duration 90.95 

Sequence Final 

Flags 

AVERAGE Ayg-0^5eei562[=ni2> 

ADDRESS 

QUADRANT <::^^^xproY\\o st 

EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD I 7.965 

Zr 390.786 ± 14.642 

Sr 158.076 ± 8.558 

U < LOD : 15.041 

Rb 76.123 ± 6.831 

Th 19.470 ± 9.340 nh 

be 

—— ^Jk U 7flA

< LOD 

7 • X ^6Si 5 

As < LOD J 28.163 

Hg < LOD : 12.767 

Zn 222.802 ± 25.120 

w < LOD • ^,58:452^ 

Cu 

Nl 

Co 

41.648 

< LOD 

< LOD /

i/ -

y: 

^^21.29 2 

72^ 7 

>/ra3.589 

Fe 18929.959 /' ± /^ 394.333 

Mn 417.983 / ^89.24 8 

^

Supervised By: y ^ i:x y
SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 560 

Mode SOIL 

Time 2010-05-11 16:35 

Duration 30.43 

Sequence Final 

Flags 

BVID 29000 

ADDRESS 2204 Ohio st 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD 7.981 

Zr 400.679 ± 14.828 

Sr 158.282 ± 8.588 

U < LOD 14.654 

Rb 79.007 ± 6.903 

Th 14.361 ± 9.141 

Pb 278.221 ± 22.047 

Se < LOD 6.268 

As < LOD 28.488 

Hg < LOD 13.189 

Zn 239.386 i 26.066 

w < LOD 92.732 

Cu < LOD 30.982 

Ni < LOD 74.079 

Co < LOD 185.772 

Fe 19101.350 ± 397.223 

Mn 399.404 ± 88.303 

Cr < LOD 313.239 

V < LOD 681.953 

Ti 3410.714 ± 2254.458 

Sc < LOD 263.850 

Ca 10799.404 ± 4638.129 

K 12106.368 ± 7012.647 

S < LOD 14524.609 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPTH 

TYPE 

INSPECTOR 

Mo 

Zr 

Sr 

U 

Rb 

Th 

Pb 

Se 

As 

Hg 

Zn 

w 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

V 

Ti 

Sc 

Ca 

K 

S 

ppm 

< LOD 

385.791 

160.482 

< LOD 

74.709 

25.831 

237.796 

< LOD 

40.359 

< LOD 

206.047 

< LOD 

40.762 

< LOD 

< LOD 

18620.768 

466.711 

< LOD 

< LOD 

2675.384 

< LOD 

12322.048 

18117.348 

< LOD 

Supervised By: 

Certificate of Verification 

561 

SOIL 

2010-05-11 16:35 

30.42 

Final 

29000 

2204 Ohio st 

EA 

1" 

CONFIRMATION 

N. LOPEZ 

: 

± 

± 

; 

± 

± 

± 

I 

± 

: 

± 

: 

± 

• 

J 

J: 

± 

: 

; 

± 

: 

± 

± 

: 

Error 

8.006 

14.553 

8.597 

15.078 

6.778 

9.612 

20.449 

6.122 

18.487 

12.229 

24.207 

86.597 

21.140 

72.482 

183.862 

390.338 

92.737 

317.845 

553.624 

1449.921 

232.325 

4808.963 

8173.829 

331.810 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 562 

Mode SOIL 

Time 2010-05-11 16:36 

Duration 30.10 

Sequence Final 

Flags 

BVID 29000 

ADDRESS 2204 Ohio st 

QUADRANT EA 

DEPTH 1" 

TYPE CONFIRMATION 

INSPECTOR N. LOPEZ 

ppm Error 

Mo < LOD • 7.907 

Zr 385.888 ± 14.545 

Sr 155.465 ± 8.490 

U < LOD : 15.391 

Rb 74.653 ± 6.812 

Th 18.219 ± 9.265 

Pb 263.323 ± 21.397 

Se < LOD 5.625 

As < LOD 28.272 

Hg < LOD 12.884 

Zn 222.973 ± 25.086 

w < LOD ; 86.056 

Cu 53.433 ± 22.082 

Ni < LOD : 71.202 

Co < LOD I 181.133 

Fe 19067.758 ± • 395.439 

Mn 387.834 ± 86.705 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

1271 

SOIL 

2010-04-29 15:16 

90.60 

Final 

_9L1268r1?7n_^ 

104 OHIO ST 

EASEMENT 

1" 

O. BARAJAS 

In-situs 

clear 
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 206.651 

Supervised By: 

Certificate of Verification 

1268 

SOIL 

2010-04-29 15:14 

30.19 

Final 

29000 

2204 OHIO ST 

EASEMENT 

1" 

O. BARAJAS 

In-situs 

clear 

± Error 

± 21.307 
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 155.534 

Supervised By: 

Certificate of Verification 

1269 

SOIL 

2010-04-29 15:15 

30.19 

Final 

29000 

2204 OHIO ST 

EASEMENT 

l" 

O. BARAJAS 

In-situs 

clear 

i : Error 

18.702 
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 167.502 

Supervised By: 

Certificate of Verification 

1270 

SOIL 

2010-04-29 15:16 

30.22 

Final 

29000 

2204 OHIO ST 

EASEMENT 

1" 

0. BARAJAS 

In-situs 

clear 

± Error 

± 19.698 
iy^^\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmentai Group Inc. vl ^ J ' Vr^^I ^ www.coastalhazmatcom 

%tp„oT*''^ COASTAL ENVIIONHINTAl 

G a o U P, IN C 

EXECUTIVE SUMMARY: 

BVID #29000-(2204 OHIO ST) 

No Issues or Concerns j ^ Issues/Concerns 

Detail Explanation: • 

DAN GARVEY WALKED THE PROPERTY ON 5/20/10 
• • 

• 4 

EPA Property Close Out Form 

Propcirtjr #: 2=^0O. Q . . Property Address-y 

Datemmc ; Owner's IHamc:..^PiM. Vjij.n^y^ . • •— 

Quads Excavated: Contractor Group ^ 

Excavation Yes No Gcnenl 

1. If necessaiy. were the conect qu8drant(s) exca vated and restored? • 

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

Yes No 

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

from the house? 

Grading Sod and Vegetettoa 

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 fimi and evenly graded? / 

5. Are the Joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / titne penod) 

6. Was the properly graded such that water will nol pool on ihe property' 

7. Was damage to landscaping or plant malerials avoided? 7 

Gates, Fences and RcuinlDx Walls Yes No 

1. Do gates open and clo."!e freely? (If applicable) y 

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

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

4. Was damage to retaining walls avoided? (Ifappiicable) / 

Foundation, SiJiflgaBd Gntlers 

Yes No 

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

2. Was damage to the foundation avoided? / 

?. Was damage to windows avoided? J 

1 Was dainage to windows or door screens avoided? 7 

2. Was damage io downspouts or downspoul extensions avoided? 7 

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage lo driveway surfaces avoided? 

2, Was damage to walkway surfaces avoided? 
• • 

Owners comments: 

jlnspection notes: 

y 

ifi fi % 

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

EPA Representative Bt0>iiM Date: ^/W*^ 
• • « • 

Property Completion Agreement 

riiis agreement documenls llie complclion of remedial aclivtiies perloimed on my property My signalure 

will designale Ihal I am satisfied wilh the resloralion of my propeily. and ihal no items are in questions, 

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

Piopcrry ID: 2<^0O O 

Property Address: 220 M OV\i O ^ . 

Owner: <^,-^y ^jj,]^ ^ C^^ p ^ DY^MOK . 

DkftavA * t.tit i ^ - , ^ . i/y \ n - ^ Jill/ / 1 1 '\ y i ^ ^ Pbone: M\x^''^{9,n ftriF ^u^'^2^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

p el 1 ayrcc restoralion is completed, except as noted 

[_J I rio nol ai;rec resloration is completed 

Owner' s Sijgnatiirr Dato OM Cbnti actor's Sienatur SignatureDale 
'.2S1 

Emd 

Property Oweer AsgessEaeitt of FerfcrMJEEice Form 

American Recovery and Reinvestment Act (AlRREpFUAID DIV/SIOM 

Omaha Lead Superfund Site 

2009/2010 

Remediation Comtractor: Co&stgl Environmental Group - EP-R7-09-06 

Property Identifier Number: T-^OOO 

Property Address: XtoM rk\^r^ SV-.. 

Property Owaer's Ncme: \^{ll IAAKQ-SK f \^ \ o f DiM/^Ktf^ 

Instructions to the Propertv Owner: 

This form 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 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 

woric by checking a numerical rsticg 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 off Performance Regarding the Contractor's Work 

10 5 

9 4 

8 y 3 

7 2 

6 

Property Owner Additiopai Comments from (optional; continue on back page if ffiecded) 

Property Owner Signature: j W >^^7^ ^ V Date: /r-A ^ '-^d/j) 
zn] 

EPA Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2009/2010 

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

Property Identifier Number: iP^dOO 

Propertv Address: 2Z0M r^V^iD ?s\-. 

Property Owner's Name: ISill LuKxiSW. 

(Above ii^ormation to befilled out by the remediation contractor prior to utilization by the EPA COR) 

:ti***4i4t4i4c4>*4'***************<t'********************************'^4>*****>l>>l>**>|i*4<*>l>**>|i 

Instructions to EPA COR: 

This form serves to record the COR's assessment of performance (Incentive 1 - Quality 

Assurance Siu^^eillance 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, EPA 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 COR 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" 

Asse ssment o f Performan 

10 5 

9 4 

8 y 3 

7 2 

6 1 

Additional Comments from EPA COR (optional; continue on back page if needed) 

EPA COR Signature: A«^t^ _ Date: tjiojio 
^ 29000 

NOTES 

RE: 2208 OHIO ST 

2204 OHIO ST 

JULY 17, 2010 

- WE RECEIVED INFORMATION FROM TODD (TODD'S SOD) STATING THAT HE SAW A BULLDOZER 

ON THE SOD, ON PROPERTY 2208 OHIO ST. 

July 19, 2010 

-ONE OF OUR SITE COORDINATORS WENT TO THE HOUSE TO INSPECT THE CLAIM AND NOTICED 

THAT THE GROUND HAD BARE SOIL,WAS LEVELED, AND ALL THE SOD WAS REMOVED, FROM 

PROPERTY 2208 OHIO ST AND ALSO FROM THE NEIGHBORING PROPERTY, 2204 OHIO ST, WHICH 

IS ANOTHER PROPERTY THAT COASTAL DID THE LEAD REMEDIATION FOR. 

"SUPERVISORS WERE NOTIFIED IMMEDIATELY*