TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^f n^?i U . Date: iZ/fO/l D 

Address: Ll?)\ Floffin^^j^ ^ d 

Remediation Contractor: Coastal Environmental Group_ Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

• ^ Video of property (DVD) 

B^ Executive Summary 

• EPA-provided property sketch 

B Signed Access Agreement for subject property 

fl~ Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

\S^ Confirmation data 

a Photographs 

M As-built sketch 

M Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

-& Description of areas not meeting ROD cleanup criteria 

B^ Utility clearances 

"sT Property information from Douglas Coimty Assessor's Office 

D 

D 

signature ^ T

 Date 

30217778 

mill 

Superfund 
0

Property Access Checklist 

Property ID: q^^ ^ D WORK STARTED ON: / / 

Property Address: ^-^ 3 1 n^^f^.^r o PSD D WORKCOMPELTED ON: / / 

0"°«^'-= Renter: ^b<Y>e.s L>esV Fer: \ 

Address: Phone: •ess: 

5P Fax: 

Cell/Pager: 

Phone: Additional Information: 

<ys1^ggn?^ 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

 Access Agreement Signed: OS / SM / lO 

By: M>c»c 

Q Restoration Agreement Signed: O T / ^M / VO 

By= v^tc t 

D Topsoil SampUng (if applicable) / / By: 

Q Disposal Sampling (if applicable) " / • / By: 

D Garden Sampling (if applicable) / / By: 

H Utility Clearance CaUed:aSL/_2fe/_iQ. By= OT/^9./, O w«iu 

Q Video/Photos (Before) On: o^ l :iM/ 10 

By: Vi«..W ^ 

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

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

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

n Property Completion Agreement Siened: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

D Community Q Crew On: / / By: 

Results: 

O Community O Crew On: / / By: 

Results: 

n Community [U Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account Injumatio ijums n Page 1 of2 

Douglas County, Nebraska Propeity Record - R1947360000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VIe W O n Ma p Information is valid as of 2009-11 -19 Treasurer's Tax Report 

New Feature ->->- • Auto Sales Search 

Owner 

LIEST JAMES K 

6731 FLORENCE BLVD 

OMAHA NE 68112-0000 

Property Informatio n 

Key Number: 4736 0000 19 

Account Type: Residential 

Parcel Number: 1947360000 

Parcel Address: 6731 FLORENCE BD 

OMAHA NE 68112-0000 

Legal Description: PARKWOOD LOT 19 BLOCK 1 W 140 FT LOT 18 & W 140 FT N 1/2 66.06 X 140 

Value Informatio n 

Land Improvement Total 

2009 $7,600.00 $54,300.00 $61,900.00 

2008 $7,600.00 $54,300.00 $61,900.00 

2007 $7,600.00 $51,000.00 $58,600.00 

2006 $7,600.00 $51,000.00 $58,600.00 

2005 $7,600.00 $51,000.00 $58,600.00 

2004 $7,600.00 $51,800.00 $59,400.00 

Sales Informatio n 

Sales Date: 1997-08-28 

Deed Type: Book: 2078 Page: n o 

Price: $46,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.21 9240.0 1.0 140.0 66.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl... 11/25/2009 
Douglas County Account IiAjpiatio n^smz n Page 2 of2 

Building 1 

«731 FLOREhlCE BD 

[••«• 1AB *0 \ 

Saeendnoor Firat Floor 71«0*q. • 7M.D»q.« s o 21« 1 •-n 1—' 

2STCMRY 

Bsffln Bntiw S fl 

704.0 aq. It. 

CLICK TO ENLARGE IMAGE 

Square Footage: 1480.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: • Average 

Unit Type: Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: i Forced Air Rooms: 10.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: ' Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1915 0% 1915 94 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 764.0 

Basement Fair Finish 60.0 

Fixture Base Fixtures 

1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch End Screen 184.0 

Porch Slab Roof Ceiling 30.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/25/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet [i_^Send Email ] 

YOUR TICKET NUMBER IS 2503445. 

Original Call Date: 5/26/10 Time: 11:26 am Op: ELIZABETH18790 


Work to Begin Date: 5/28/10 Time: 12:00 pm 


State: NE Covuity: DOUGLAS Place: OMAHA 


Address: 6731 Street: FLORENCE BLVD 


Twp: 16N Rng: 13E Sect-Qtr: 27-SW,34-NW 


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 MAGELLAN MCINEB MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM 

PARTNERS LP DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MCINEB MCI NO CALLPER 

MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.., 5/26/2010 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEAVER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

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1 

Remote ID: R page of 

;o>t 3 44 8 

O K 74103 . 4-709 8 

4-746 6 

>1 1 ow i n g OneCa l T ykgenc y di g .-ton : COASTA L ENVIRONMENTA L

 -t i clcet s

 SERVIC E 

 csi l 1 e d -i n by : 

imbei" : 877662421 1 

Number- : 877662421 0 

. t e :

d :

 2 010/05/ 2

 65283 9 

6 

>e CLEA R o- f under-gr-oun d -Pac i T i t- i e s -For-: MAGELLA N PIPELIN E 

T -i cke- t Number - Ex-csiveitor - Con-ta.c:- t Di g Addr-es s 

2 50344 5 ELIZABET H [^67^3 7 FLORENC E BLVDj ] 

I ba.v e st.rty ques-t i on s . plesLs e con-tsic- t Msige l ~1 a.n OneCa. ! 1 a.-t 918/574—709 8 
OLS#: 40530 ^ As-Built Drawing Date Excavated:6/1710 

Date USEPA Signed Off: 7/8/10 COASTAL tHVinOHMCHTAL omaha Lead Superfund Site Area Sodden: 450 sq ft S k O U P. IN C 

Name. .lAn\Sf. <rci r 

Address: t->^ / ffe^£^£^&f i 

Phone: ^o ) Vr»-i?S-iR 

Team f>^E^/raAr i /./^^ 

Sample Number 

ENJ>gC/'XA ­ >^0S3O 

gDZ.5d/^XA-• ^05*3 0 

Z&ZJSC/'KA- H05-30 

BVID»

Omaha Lead Stte 

Site Sketch 

 UaS^^O 

Lead Concentration 

/(f 3 

JLSL 

?.C>g 

/gg, n3 9 

5*8 0 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Date: (6/7/e:h 

Time: 

<eXRF Code ^^62 . 

Confirmation Sample 

T'Yes a 

."'Yes n 

£1 Yes CD 

<>-'Yes O 

/>--Yes n 

C- Yes • 

Yes • 

No Ef 

No H 

No ei 

No Q 

No 23 

No Q 

No • 

=£2J 

GZ=199PPMia8" 

DZ = 76PPM@13" 

" T 

,iji;g ^ -iL.w^rf .. 

Fif^.r-e^J'^ ej) 

Omaha Lead Site 

Legend 

irfMByMWriM 

EA = 84PPM@1" 

• b ..J. . 

46130 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with • Area replaced with Area left bare 
 Sod Rock/Mulch 

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

1^, 0^ . 

C^er.^ 

Name; J4^\S& ^i^zar 

Address: <? -7 3/ f^toAe^^ i £>i> 

Phone: fvo ) ^r> ~ ?fS^i% 

Omaha Lead Site 

Site Sketch 

Date:

Time: 

 (d/y/o^ i North Arrow 

^ ^ 

Team /•)u}£^/rj2/fzi! /^g* ^

Sample Number 

gDZ.6g/^XA - V05-3 P 

 BVID # V<:;.r^<:? 

Lead Concentration 

Mfl ^ ppnr 

708 ^ 1 

102. If? ? 

reo 

XRF Code ^5-^ 2 

Confirmation Sample 

T' Yes C^ No ' 

.''Yes n No I 

j f<;T«jf/' pd,P^ 

I--Ja2= 

vv>l v^v V rs 

rtfii'i^^<^ c~ a,o 

Omaha Lead Site i SO^ 3^0 46130 
• • 

] Name: J4/r\&i <ze-iT Omaha Lead Site Date: (6/y/c3>_ North Arrow [ 

Address: <? -? 3/ f'i c Ae^'<:£ dp Site SItetch Time: 

Phone: rwc3> ^S'i~7t^b% 

Omaha Lead Site 46130 
Name: J/hn^s. ^tg^ r 

Address: Cfi f f^^e^^eJejfiP 

Phone: (>3? V ^ »-?#•»» . 

Omaha Lead Sits 

SIta Sketch 

Date:

Time: 

 (^/y/t^ . North Arrow 

Team r>ui£^/iraAT^/^9 BVID* UoS-iO XRF Code ^"SdZ 

Sample Numt>er 

gyAS^^PJ<lA-V/>g3 Q 

e<ggc/q>cA ^ wofiSo 

gDZ.'5^:>»>eA­ ^0^ 0 

Ze--Z-'SC/>)CA­ HOS'30 

Lead Concentration 

/t> ^ 

J ^ 

?.gfl 

_t^ 

U S? 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Confirmation Sample 

nve s 

«'Yes 

-J^Yes 

P*Yes 

& Yes 

Yes 

• 

a 

D 

n 

D 

n 

n 

No 21 

No 12 

No 0 

No E3 

FitiiZB^eS £/) 

Omaha Lead Site 46130 
,<»ensr.,-,_ 

\1 

V COASTA l :>' ENVIROHHIKTAl *<«. PM'*^ ' c • 0 u r 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: „ , ^ _ 

Owner's Name: Daytime Phone: y/p2 . ^f l S'S^O ^ 

Address of Property 

covered by this U)~ib\ V\actnou BD 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 confimi that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive vtn-itten 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 
> — ** 

COASTA L INriKONHtltT/tt 

C « 0 U r t K 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; 

c 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 of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

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

Date / Signature 

Date 

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

Page 2 of 2 
x ^ 

C O A S T A L • NVmONHS M T A L 

O II O U r . INC . 

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 Enviroimiental 

Protection Agency (EPA). 

Property ID: L\(y^g,(^ 

PropertyAddressrYg-l^y p^^^^p ^ 6 Q 

Owner; ^a|V^g^^ \A9:s V 

Phone; l^^l^ Lf g-^f /^-^J " 

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. Lidicate distances, depths, material types, etc. 

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

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

ttem: 

' ^ ^ ^ ^ 

ttem: 

item: 

ttem: 

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

Kem: 

5"^ ^ / / ^kA h Ic ff ich'' 1^(3 

Kem: jJ 

Kem: 

Kem: 

Page iof 5 
^"^ 

C O A S T A I. • NVmONMENTAL GROUP , INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: j 

'^^.D ^ 

ttem: ( 

5 ^ci -^^ ; Q ^ -

Kem: 

Item: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, C/-£y|/- ^ Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each / trunk diameter 

Nimiber of trees <= 2 inch Each 

trunk diameter / 

Number of Sprinkler 

Zones, Control Valves, 

Each Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

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 Each 

excavated pm^J ^ Nc^^^ 

Page 2 M 7 
COASTA L 

AddKional 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 thsrt 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 tegatity 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. 

tyc c ^ ^ i o 1 jj e,^ ' n 

G 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. 

^ 1 agree d I do not agree 

Ow6£r's Signature Date Contractor's Signature Date 

Pages ^ ^ 
BVID#M(QSQ_ XRF PROPERTY SAMPLE SHEET 

Date ^-J^-U) Project Omaha Lead ARRA 

\ft"\?>\ RfOrr^tTP.

30 sec 

Reading 

/'^ ^ - ^ ^ 

/^^ ^ /'y

^ii^ 2^1 

mj^^ 

Reading 

Reading 

Reading 

ftO 

am/pm 

Sampl >ampiee are a a

Depth

3 ^ 

Sample area 

Depth 

Sample area 

Depth 

Sample area 

Depth 

XRF ID# 

Shot # Reading 

/g-Aft I % .i- > 12. ^i JLJ!I 

\I2 ^ 

Average 

Shot# 

i 2 ^ 

ZM. 4^2 : 

Average

Shot# 

Average 

Shot# 

Average 

Signature 

fn ^ (^ 

i<v^/y 

Reading 

i Ui

^ 

V ^ 

^ ^^5" 

Reading 

Reading 

^

Sample area 

^ ^ 

Depth 

7 7 ^ 

Sample area 

Depth 

./M. 

^ 

Sample area 

Depth 

Address 

Sample time 

sample length 

Shot# 

M 

^ 

Average 

Shot# 

Average 

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

, Depth 

^ / 

Average 

Print V[W^ [i/i/nt^j
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 

Supervised By: 

Certificate of Verification 

1231 

SOIL 

2010-06-23 12:54 

91.47 

Final 

lor^r 

EA 

1" 

N. LOPEZ 

confirmation 

none 
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 75.513 

Supervised By: 

Certificate of Verification 

1228 

SOIL 

2010-06-23 12:52 

30.50 

Final 

40530 

6731 Florence blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 13.726 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1229 

Mode SOIL 

Time 2010-06-23 12:53 

Duration 30.48 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 86.822 ± 14.456 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1230 

Mode SOIL 

Time 2010-06-23 12:54 

Duration 30.49 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 89.785 ± 14.559 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1243 

Mode SOIL 

Time 2010-06-23 13:02 

Duration 91.19 

Sequence Final 

Flags 

AVERAGE t:Avg^^^:i2?teiJ235^ 

ADDRESS 6731 Florence blvd 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

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 74.161 

Supervised By: 

Certificate of Verification 

1240 

SOIL 

2010-06-23 13:01 

30.52 

Final 

40530 

6731 Florence blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 13.953 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1241 

Mode SOIL 

Time 2010-06-23 13:01 

Duration 30.57 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 74.965 ± 14.010 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1242 

Mode SOIL 

Time 2010-06-23 13:02 

Duration 30.10 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 80.056 ± 16.168 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpllce 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

1247 

SOIL 

2010-06-23 13:05 

92.01 

Final 

3rt244- l 

673r?iorence flvd 

GZ 

8" 

N. LOPEZ 

confirmation 

none 
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 196.803 

Supervised By: 

Certificate of Verification 

1244 

SOIL 

2010-06-23 13:04 

30.56 

Final 

40530 

6731 Florence blvd 

GZ 

8" 

N. LOPEZ 

confirmation 

none 

± Error 

± 20.097 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1245 

Mode SOIL 

Time 2010-06-23 13:04 

Duration 30.90 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT GZ 

DEPHT 8" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 187.241 ± 19.427 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpil<e 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1246 

Mode SOIL 

Time 2010-06-23 13:05 

Duration 30.55 

Sequence Final 

Flags 

BVID 40530 

ADDRESS 6731 Florence blvd 

QUADRANT GZ 

DEPHT 8" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 211.469 ± 20.692 

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

I J^^^ l I Coastal Environmental Group Inc. 

S!^^j^ www.c0astaiha2mat.com 

^^tpno^*"^ COASTAL 

C no U p. I II c 

EXECUTIVE SUMMARY: 

BVID #40530-(6731 FLORENCE BLVD) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 7/8/2010 
tf% 

EPA Property Close Out Form 

Property #: M053 Q Property Address:,, 

DateHlme: Owner's Nanc : 

Quads Excavated: Contractor Group CjnQS\C 1 

t 

Excavation Geaeral 

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

2. If necessary, were the conrcl areas of drip zone excavated aod restored? 

GmdioK Sod and VcucUtkiB 

1. Does the grading around the perimeter of the house in excavated areas generally slope away 

from the house? 

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

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

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

7. Was danuge to landscaping or plant materials avoided? 

Gates. Fences and Retaining Walls 

r i.

 Do gates open and cio.se fively? (If applicable) 

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

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

1. Was damage to reuining walls avoided? (Ifappiicable) 

Foundation, Siding and Gnller* 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

?. Was damage lo windows avoided? 

A Was damage to windows or door screens avoided? 

Was damage io downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

I • Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

^ 

Yes No 

• 

/ 

^ 

^ 

^ 

/ 

y 

Vcs No 

^ 

.y ^ 

• ^ 

^ 

Yes No 

y 

^ 

7 

Yes No 

/ ' 

y 
Ort'Ders comments: 

[Jn.'ipection no<es: 

Removal and resloration aclivales complete including ihe 30-day sod warranry: 

EPA Representative A^^iU Date: 7/p/,o 
Property Completion Agreement 

riiis agreemem documenls llie completion ol remedial activities perloimed on my properly My signature 

will designate that I am satisfied with Ihe restoralion of my propeily. and that no items are in questions, 

now. or ai any lime in the future, excepl Ihose items lisied below, if any 

Property ID: L^Q^cy ^ 

Property Address:^-! 3,^ HoT^.YVg . ftO 

Owner: ^Q^p ^ ^.p ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

L

Item: 

Additional Connments: 

^ 1 I agree restoralion n completed, rxccpi as noted 

[_J I do nol «|>rrc resloration is, completed 

/yfwncr' s Signatiirr 'Dale / Cun d arior' s Signature Dale 
S'i) 

p-jiyg£> Property Owaer AssesEmeiit of FerfGrmsiEice F©rm 

KJS^* ^ American Recovery and Reinvestment Act (ARRA) 

^y)^ 3 0 20^0 Omaha Lead Superfund Site 

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

Property Identifier Number: ^065 Q 

Property Ad&rtssk7^^\ PjAff-nr/ 

Property Owaer's Name: d Ot^.!b i 1 ^'S'V^^^ 

Instructions to the Proper 

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

- Quality Assiirance 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 numericai 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 

10 5 

9 4 

8 X 3 

7 2 

6 I 

Property Owner Additional Commeiats from (optional; coatinue on back page iff needed) 

Property Owner Signature: 4 ^ Date: (ff/X^//0