TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: W^l^ Date: I <; I 

Address: ^I V t^^ M ^ f 

Remediation Contractor: _Coastal Environmental Group_ Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

01/ 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

F 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.) 

-fr Confirmation data 

Photographs \\ i tP^P(Xlai ^ -^ bcC^Ailgt^ \ ^oi^ 

/ As-built sketch 

F Satisfactory restoration signed by Property Owner 

F. 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information fi-om Douglas County Assessor's Office 

• 

D 

D 

30218700 

Superfund 
Property Access Checklist 

1 Property ID: {„l\3\ ^ D WORK STARTED ON: / / 

1 Propers-Addr«,: qp^^ y ;r^,-^ , ^^r . D WORK COMPEL IED ON: / / 

Owner: p^y^^ ' ^ /.////fjol^ n 

Address: ^ 

"^DAMe 

Phone: M ^ 5f>l ^QftS 

Fax: 

Cell/Pager: 

n Notification Letter 

^ Access Agreement 

[^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

Q Garden Sampling (if applicable) 

- ^ UtiUty Clearance 

P^ Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

• Video/Photos (30-Day) 

Q Property Completion Agreement 

D Final Report 

Air Monitoring (as applicable) 

n Community Q Crew On:

Results: 

D Community Q Crew On:

Results: 

• Conmiunity • Crew On:

Results: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Sent: / / 

Siened: 1 1 H / 1 0 

Signed: T IZ^ I lO 

1 1 

1 1 

1 1 

CaUed:Ob / \V) / VO 

On: SL'^IJ ^ 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

/ / By:

 / / By: 

/ / By: 

By: 

By: 

Jiy.d-^Pii 

By: 

By: 

By: 

By= Oh/::i\ /l o u^tvyiiimMb 

^r-DPcK I/) 

By: 

By: 

By: 

By: 

By: 

Omaha Lead Site 

 1 
•' Douglas County Account Infoaa^o >a||^c n Page 1 of3 

Douglas County, Nebraska Property Record - R1204920000 

Print Report 

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

New Feature ^ ^ •* Auto Sales Search 

Owner 

LITTLEJOHN BONNIE S 

blAL 

4827 ERSKINE ST 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 0492 0000 12 

Account Type: Residential 

Parcel Number: 1204920000 

Parcel Address: 4827 ERSKINE ST 

OMAHA NE 68104-0000 

Legal Description: GRAMMERCY PARK LOT 25 BLOCK 2 42 X 128 

Value Informatio n 

Land Improvement Total 

2009 $5,900.00 $75,400.00 $81,300.00 

2008 $5,900.00 $75,400.00 $81,300.00 

2007 $5,900.00 $75,400.00 $81,300.00 

2006 $5,900.00 $75,400.00 $81,300.00 

2005 $5,900.00 $63,100.00 $69,000.00 

2004 $5,900.00 $57,400.00 $63,300.00 

Sales Informatio n 

Sales Date: 1996-09-24 

Deed Type: D Book: 2046 Page: 089 

Price: $59,950.00 

Grantor: 

Grantee: 

Validllnvalid: Valid 

Exclusion Reason: 

Sales Date: 1992-04-10 

Deed Type: D Book: 1925 Page: 316 

Price: $35,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo.jsp?accountno=Rl... 10/23/2009 
' Douglas County Account Infojj|Mtio ra^i i n Page 2 of 3

# 

Grantee: 

Validllnvalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5376.0 1.0 128.0 42.0 No 

Improvemen t Informatio n 

Building 1 

1 1.'2 STORY FIN 

4627 ERSKINE ST 

. ^ -I V ] ft 

JBDO** • 

tn i 5*< wm •., 

« tr 

•V 

first Floor 

" \ 

727 0sq ftjs" 

•^f.^'!-:'" Bim l BiKk a « 

CLICK TO ENLARGE IMAGE 

Square Footage: 1057.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: : 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1905 0% 1905 104 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 737.0 

Basement Minimal Finish 200.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/23/2009 
Douglas Coimty Account Infom^io ^jl|Utll n Page 3 of3 

Garage Detached 396.0 

Porch End Solid Wall 119.0 

Porch Slab Roof Ceil 126.0 

User Attic Full Finish 320.0 

http://douglasne.mapping-onUne.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=Rl... 10/23/2009 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet I Send Email j ][ 

YOUR TICKET NUMBER IS 2534157. 

Original Call Date: 7/01/10 Time: 3:25 pm Op: ELIZABETH18790 


Work to Begin Date: 7/06/10 Time: 4:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4 827 Street: ERSKINE ST 


Twp: 15N Rng: 13E Sect-Qtr: 07-SE,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 ConUct 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 1C QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irihintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/1/2010 
OLS#: 69212 As-Built Drawing A Date Excavated:7/6/2010 

Date USEPA Signed Off: 8/19/2010 

COASTA L Omaha Lead Superfund Site Area Sodden: 2475 so ft 

69212 

Omah Extenor Paint Nom An-ow a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4827 ERSKINE ST [^'^Not pamt r 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected 

I Firm 

RYASCPXA-69212 F l ppm D Date 

RYBSCPXA-69212 F2 

ppm D Time Z--10 ptn 

RYCSCPXA-69212 Bl /^«^^- ppm D 

Samples Analyzed 

RYDSCPXA-69212 B2 2 7 1 ppm D 

RDZSCPXA-69212 DZ 

22^=1^ ppm D XRF Unit: (oSHCi Book: 27 n 

nC^SCPXA 6021J 62 ­ ppm D D Date 11-Ol. -OR 

nrzocPXA-60Jia—PS- ppm D D Time 

-^Q _ 

Staff: Number of Samples = | 5 | | Q | jn^LL 

1 egend: Fl = Fronl Left, F2 = Front Rigtit, Rl = Rack I eft R9 = Rank Riptit 07= Drip 7nnP a ? = P:arf1an P7 = Pla; 

All quadrants are as viewed from the street, facing property 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area lef t bare 

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

if 

u 0^' 04 

69212 

Exterior Paint 

Q Good 

Omaha Lead Site 

Site Sketcti 

gpoo i 

Sampling Address: 4827 ERSKINE ST [ 0 Nol pamt 

Lead Sample Samples Collected Sample Number LAB Concentralion Collected Fimi rp A PB- m 

RYASCPXA-69212 F1 lLi° \ ppm D Date: /p - 3 -Q^ 

RYBSCPXA-69212 F2 

ppm Time /ly-lO ptn n RYCSCPXA-69212 Bl ppm i D r

ples Analyzed RYOSCPXA-69212 82 271 ppm D S HO Book: 27 n RDZSCPXA-69212 DZ y-z<^°i ppm 

D

nCZCCPXA 60J1J G2- ppm D Date // • Cd • Of i 

nnzscPXA eoju P2- ppm D D Time

D _&n. Staff Number o( Samples = I 5 | (^ \ nsi j 

Legend: Fl = Front Left, F2 = Front Rigtit. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ •• Plai 

All quadrants areas viewed from the street, facir>g property All^ y 

P0PP^ t 

V :iMK Ctclo d •i.S.Sep-'iN M*'^ ' • • • M- • 

A XVo 
69212 

Omaha Lead Site Exterior Paint 

Site Sketch Q Good 

• Poor 

Sampling Address: 4827 ERSKINE ST [2^ Not pamt 

Sample Lead Sample Samples Collected Number Ui,B Concentration Collected Firm fPAPB-AJ 

RYASCPXA-69212 Fl 1 (i>°l ppm D Oate 

in-3-of^ 

RYBSCPXA-69212 F2 I 8 ^ ppm D Time A L •to pm RYCSCPXA-69212 Bl /iH2 - ppm D j ~ I 

Samples Analyzed RYDSCPXA-69212 B2 2 7 3 ppm D 

RDZSCPXA-69212 DZ 22^ ^ PPnn D XRF Unit: ^5V Q Book: 27 n 

ROZSCPXA 60212 G2­ ~ ppm • D Date II • Ol, - Of i . 

nnZGGPXA-60g1g P2- ~ ppm D Time 

£ca. Staff: Number of Samples = |5 | | Q | msi j 

Legend: Fl = Front Left. F2 = Front Rigtit. Bl = Back Left. B2 = Back Right DZ = Drip Zone. GZ = Garden. PZ = Pla; 

All quadrants are as viewed from the street, facing property JL||^>y 

6CC 

?j.Idddd^^S*A^^'d^^ m . s ^ 
% 

69212 

Omaha Lead Site Exterior Paint Nortii Arrow 

Site Sketch • Good 

npoo r 

Sampling Address: 4627 ERSKINE ST [^No t paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Fimi:

Samples Collected 

 fPAr PB-AJ 

RYASCPXA-69212 F1 ppm 0. D Date: ID-3-O ^ 

RYBSCPXA-e9212

RYCSCPXA.69212

RYOSCPXA-6e212

RDZ8CPXA-69212

 F2 

 B1 

 82 

 DZ 

21- ^ 

ppm 

ppm 

ppm 

ppm i D 

D 

D 

D 

Time: Z-Z O ^ 

Samples Analyzed 

XRF Unit: 6>SHb Book: 7? o 

ncaecPXA 8oaia—62-

RPZooPXA-goaia—P2­

ppm 

ppm u 

u 

•

D 

Date 

Time 

iioi»-D( i 

£m- Number of Samples = | 5 I | Q | Staff: -casu- Legend: Fl = Front Left. F2 = Front RiQht. B1 = Back Left, B2 - Back Rigttt DZ = Drip Zone. GZ > Garden, PZ = Plai AD quadrants are at iriawed from ttw Orael.hcing property All^ y 

.CshC. .Csdrtjf 

BV^;t '¥^ iiovas 

'•CM O 

.rn- L 273 

^_, DECK: 

mi ^ ^ l 

^:D2,'?2n 

Hf: : St. 

.fl iS::, 

.7(t::^ .n­

/6^ 

!(iUl$ llejie d i«-Sei>-<« 
• . 

»*^'*lr*>* 

COASTA I INVIXONHIttTA t 

CROUP . IN C 

Consent fcf 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: ^^ , 55A/**'J ^ f\eyr4i X/A^/c/^/iju 

Address of Property ^^^ 7 cTrS^fj^f^ ST: 

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 perfonned, 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 vmtten 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 
t 

COASTA L :^ INVmONHIKTAL 

'*'-<«,o^^'^"' C « O U P IH 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 wish 

to save; 

« 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 

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

Signature yFy Date Signature Date 

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

Page 2 of 2 
C O A S T A L 

OROUP , IHC . 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe property prior to 

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

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

Protection Agency (EPA). 

Property ID; (^0|;^\;^ 

Property Address: U ?, T ? . g-Sk.V^ , <r^ 

Owner 

' Kci-hA \ .vV\lgrjoV\<v 

Plione: ^ 0 ^ 'b^ \ IQg)?) 

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

Item: 

/nd piU^fp d^> h ^ <Fc^.l A<=^ C _ 

Item: 

Item: 

Item: 

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

Item: 

/ Item: 

eiMi&s o k 0 

Item: 

y\t6(\^S d>iP dz ^ (5ci\ FZ-^ 

item: 

Page lof 3 
C O A S T A L • MVinONMINTA L O K O U P . INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

item: 

5-^'cl - f i,6lr.P^ 

item: 

< ^ i - f \,Q/,0^ 

item: 

Item: 

Landscape Inventory 

Item Quantity Unit Conditlon/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter ^ 

Nimiber of trees <= 2 inch >o 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 u 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

$ Not

used

e

 t

 thi

o issu

s valu

e a

e will

 plan

 be 

t 

er 

voucher to the property 

owner. 

Easement Area, to be Each excavated 1 fe/iJ'Mf i^<i}^id> 

Page 2 0 , 3 
C O A S T A L • NVtRONHINTA L a n o u p . INC . 

Additionai Comments / instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmentai Protection Agency (EPA) may be 

removing and replacing soii 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 withstanding 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 city of Omaha's Planning Department at (402) 444-5150. 

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

(t/e. Z-l. P s no&y ^ 

• 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. 

O I do not agree 

.j,rM^y^.d7Jy~-^';iB'P &Cjuny^ ^A'' ' 

ivXer' Date Contractor's Signature Date 

Page 3 of > 
t 

BVID# (o'^UL 

XRF PROPERTY SAMPLE SHEET 


Date 9 ­ / ^ ­ 2:^/0 Address fgz: ^ £^KIN £ vSr 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# 3^oZ.Z. sample length 30 sec 

Shot# 

/8^5 

/8iG 

\'&^• ^ 

Reading 

/or ± /s" 

I4^ t /^ 

/g- ^ t l^r 

Sample area 

n 

Depth 

4" 

Shot# Reading Sample area 

Depth 

Average 134 i /6 Average 

Shot# 

/01 ^ 

['=\00 

no( 

Average 

Reading 

[ZZ. i 16 

lOG t 15 

/34 i 11-

IZl i 16 

Sample area 

D2 

Depth 

/3 " 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# 

n^3 

n ^ 

n^sReading 

Z.Qi t iZZ,^5 i Z^ 

^5 4 1 ^f 

Sample area 

Bi 

Depth 

4" 

Shot# Reading Sample area 

Depth 

Average ZW t iZ. Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

\% ^ /ey i i^ ^ -^ EA 

1^08 

n^ )6^iy1 % 

ISjPt l ^ y y

y^Depth 

 ^ u 

Depth 

Average {\^by^n Average 

Signature i 

>^gf^ ^ 

Print !\t^(d Mf^s 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1898 

Mode SOIL 

Time 2010-08-17 18:51 

Duration 91.69 

Sequence Final 

Flags 

AVERAGE Avg of 1895-1897 

ADDRESS 4827 Ersklne st 

QUADRANT Fl 

DEPHT 4" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Supervised By: 
t 

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 101.997 

Supervised By: 

Certificate of Verification 

1895 

SOIL 

2010-08-17 18:49 

30.54 

Final 

69212 

4827 Ersklne st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

15.302 
t 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1896 

Mode SOIL 

Time 2010-08-17 18:50 

Duration 30.60 

Sequence Final 

Flags 

BVID 69212 

ADDRESS 4827 Erskine st 

QUADRANT Fl 

DEPHT 4" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 149.693 ± 17.889 

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 150.620 

Supervised By: 

Certificate of Verification 

1897 

SOIL 

2010-08-17 18:51 

30.55 

Final 

69212 

4827 Erskine st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.719 
t 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1902 

Mode SOIL 

Time 2010-08-17 18:53 

Duration 91.62 

Sequence Final 

Flags 

AVERAGE Avg of 1899-1901 

ADDRESS 4827 Erskine st 

QUADRANT DZ 

DEPHT 13" 

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 122.042 

Supervised By: 

Certificate of Verification 

1899 

SOIL 

2010-08-17 18:52 

30.61 

Final 

69212 

4827 Erskine st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.658 
• 

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 106.925 

Supervised By: 

Certificate of Verification 

1900 

SOIL 

2010-08-17 18:53 

30.51 

Final 

69212 

4827 Erskine st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.694 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1901 

Mode SOIL 

Time 2010-08-17 18:53 

Duration 30.50 

Sequence Final 

Flags 

BVID 69212 

ADDRESS 4827 Erskine st 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 134.481 17.143 

Supervised By: 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1906 

Mode SOIL 

Time 2010-08-17 18:56 

Duration 92.29 

Sequence Final 

Flags 

AVERAGE Avg of 1903-1905 

ADDRESS 4827 Erskine st 

QUADRANT Bl 

DEPHT 4" 

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 281.327 

Supervised By: 

Certificate of Verification 

1903 

SOIL 

2010-08-17 18:54 

30.65 

Final 

69212 

4827 Erskine st 

Bl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 22.538 
t 

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 275.687 

Supervised By: 

Certificate of Verification 

1904 

SOIL 

2010-08-17 18:55 

30.65 

Final 

69212 

4827 Erskine st 

Bl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 22.095 
t 

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 254.755 

Supervised By: 

Certificate of Verification 

1905 

SOIL 

2010-08-17 18:56 

30.99 

Final 

69212 

4827 Erskine st 

Bl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 21.473 
• 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1910 

Mode SOIL 

Time 2010-08-17 18:59 

Duration 91.86 

Sequence Final 

Flags 

AVERAGE Avg of 1907-1909 

ADDRESS 4827 Erskine st 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC insitus 

NOTE none 

Supervised By 
t 

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 156.691 

Supervised By: 

Certificate of Verification 

1907 

SOIL 

2010-08-17 18:57 

30.65 

Final 

69212 

4827 Erskine st 

EA 

1" 

N. LOPEZ 

insitus 

none 

± Error 

± 17.746 
t 

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 163.874 

Supervised By: 

Certificate of Verification 

1908 

SOIL 

2010-08-17 18:58 

30.55 

Final 

69212 

4827 Erskine st 

EA 

1" 

N. LOPEZ 

insitus 

none 

± Error 

± 17.607 
t 

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 150.034 

Supervised By: 

Certificate of Verification 

1909 

SOIL 

2010-08-17 18:59 

30.66 

Final 

69212 

4827 Erskine st 

EA 

1" 

N. LOPEZ 

insitus 

none 

± Error 

± 17.485 
Omaha Lead Site—Fixed Price EP-R7-07-05 

^^^w^ ^ , Coastai Environmentai Group inc, 

S^^^ ^ ¥nww.coa8taihazmat.com 

'"tPROtt'S' COASTA L INVItOMHINTAl 

G IO U r. IN C 

EXECUTIVE SUMMARY: 

BVID #69212-(4827 ERSKINE ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 8/19/10. 
EPA Property Close Out Form 

•BT 

Property #: . Propcrty Address: (^"4fil 

Date/Time: Owner's Name:. .&• yf*C . j 

Quadi Excavated: Contractor Group LA^ftJ / 

Excaration Yes No Gcnerai 

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

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

y 

GradioE Sod and VcffcUtlon Yes No 

J Does the pading around the perimeter ofthe house in excavated areas generally slope away 

from tbe house? y

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

y 

3. Does the sod appear lo be generally healthy and growing? (Only evaluate if inspected at a 30 y day time period) 

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

5. Are the Joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day y time period) 

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

7. Was damage to landscaping or plant materials avoided? 

y 

Gates. Fences and Retatolng Walls Yes No 

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

2. Were ali gates or fences taken down during restotation activiiies reinstalled? (If applicable) / 

3. Was damage to gates or fences avoided? (I f applicable) / 

4. Was damage to retaining walls avoided? (Ifapplicable) 

y 

Foundation, SidiOK and Goiters Yes No 

I Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? 

/ 

3. Was damage to windows avoided? 

y 

4 Was damage to windows or door screens avoided? y 

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

y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? -t
Ort'Dcrs comments: 

|i!n.«:pection no<es: 

Removal and restoration activales complele including the 30-day sod warranty: 

EPA Representative Qc»^ ^^^F^ Dale: Slitjio 
Property Completion Agreement 

This agreement documenls lhe complclion of remedial acliviiies perloimed on my property My signature 

will designate lhal I am satisfied wilh lhe restoration of my properly, and lhal no items are in queslions, 

now, or al any lime in the future, except Ihose ilems listed below, ifany 

Ji^E^y^MMX 

Property Address: ^^p ^ ^^^^ ^ ^ 

Phone: ^\ - 1(9 ^ 

Restoration Items in Question: 

Item: 

item: 

item: 

item: • x_ 

item: 

Item: 

^c \ I aijircc icttoralion i% completed, except as noted 

(._] ' ''0 ')o( a\>rtc resioration is compleleri 

y^p/^po £CdF^^y'^->- H I 

Cond artot's Signature Uaic 
% 'yys) 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2009/2010 

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

Property Identifier Number; (Q^ykip>., 

Propert propertyy Aaaress Address::

 ^K^- <-tk^h

^ (^ymAU^ fim,i/d.o '^T o ^ r T

Property Owner's Name; iLlitW "%44^g UJA>V> 

Instructions to the Propertv Owner; 

This form saves to record the Property Owner's assessment of perfomiance (Incentive 1 

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

to Uie 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 

Poformance Work Statement. 

The Property Owner will indicate his/her assessment of perfomiance with the contractor's 

work by checking a numerical rating on the table beiow using the numerical definitions fiom 

the rating scale below, then sign & date tiie form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

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

10 X 5 

9 4 

8 3 

7 2 

6 1 

Property Owner Additional Comments from (optional; oontiaue on back page if needed) 

Property Owner Signatut^^^/ (>dd(d ^ y£i^P/yC.y~^ Pate; A^^d " ^ O 

' .' P / 
Water Bill Settlement 

Property ID 69212 

Property Address 4827 Erskine St 

Tenant Bonnie S. Littlejohn 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 93.51 for 

water usage required to maintain the sod. 

Check Niunber 2108 

Value of Check $93.51 

Made Out To Bonnie S. Littlejohn 

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 Coastai 

Environmental Group Inc. from further obligations or liability. 

(^/j^iU^t^ ^/z^A yL 

Contractor's Signature Date 

PF-Z 2108 COASTAL ENVIRONMENTAL GROUP INC. 27-S/1O4O0O3 2411 MARTHA STREET 6247372904 

OMAHA, NE 68105 Q|n|)Q ^ DATE 

J $q5' . ^ 

a •••Hint 

«Misn>goaBik.HA. 

Nrtnlla 

FOR 

i: 101,00005ai : &Bi,7 37E=i0UN' OEio a