TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^i^O ^ Date: \\] \ \\ 

Address: l ( 1 (9 <4flMr ^ ( 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Siunmary 

\Z EPA-provided property sketch 

^ Signed Access Agreement for subject property 

-& Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

—B Confinnation data 

• Photographs \ U (X^^H^ n >( t!^^.Al/Aruvi Y "^^^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

-B-' Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property infonnatinn from Douglas Coimty Assessor's Ofiice 

/ - •• - -

D A y / y ° /c Wn/u 

< Signatur ^ -

e *~^ (Dat4 y 

30218087 

MHIlii 

Superfund 
v\ 

Property Access Checklist 

PropertylD: T^^TjQfi D WORK STARTED ON: _/ I 

Property AddrestJ \^OirAt & ^ t n WORKCOMPELTED ON: / / 

Owner: Renter: f.rnc:^t fo^ 

Address: 

Phone: 

Sam Fax: e 

Cell/Pager: 

Phone: -], ^ ^^j^g ^ Additional Inforniation: 

Fax: 

Cell/Pager: 

n Notification Letter 

Sent: / / By: 

)\ \ Access Agreement Signed: i_/25/_/{) By: 

Q Restoration Agreement Signed:Ol /^A l\0 By: 

D Topsoil Sampling (if applicable) 1 / By: 

D Disposal Sampling (if applicable) 1 1 By: 

D Garden Sampling (if applicable) / 1 By: 

[S Utility Clearance CaUed: CM/o«5 / \0 

Q/Video/Photos (Before) On:ji / T-/ ICi By: b(yiy^i(^ 

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

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

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

n Property Completion Agreement Slimed: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

Q Community Q Crew On: / / By: 

Results: 

• Community [H Crew On: / / By: 

Results: 

• Community Q Crew On: / / By: 

Results: 

Omaha Lead Site 
Douglas Covmty Account In on Page 1 of3 

Douglas County, Nebraska Property Record - R0917230000 

Print Report 

NEW Feature - Parcel Dimensions available iS; scale 0-50 ft west of 52nd St - VIe W OH Ma p Infonnation is valid as of 2009-11 -19 Treasurer's Tax Report 

New Feature -»->-> Auto Sales Search 

Owner 

ROY ERNEST W 

ETAL • . . . . 

1510 GRANT ST 

OMAHA NE 68110-0000 

Property Inforniatio n 

Key Number: 1723 0000 09 

Account Type: Residential 

Parcel Number: 0917230000 

Parcel Address: 1510 GRANT ST 

OMAHA NE 68110-0000 

Legal Description: DARR PLACE LOT 30 BLOCK 0 40 X 96.2 

Value Informatio n 

Land /mproi^efnenf Total 

2009 $2,100.00 $1,000.00 $3,100.00 

2008 $2,100.00 $1,000.00 $3,100.00 

2007 $2,100.00 $1,700.00 $3,800.00 

2006 $2,100.00 $1,700.00 $3,800.00 

2005 $2,100.00 $1,700.00 $3,800.00 

2004 $2,100.00 $2,200.00 $4,300.00 

Sales Informatio n 

Sales Date: 1998-07-29 

Deed Type: D Book: 2097 Page: 660 

Price: $6,000.00 

Grantor: 

Grantee: 

Valld/lnvalld: Valid 

Exclusion Reason: 

Sales Date: 1993-01-16 

Deed Type: D Book: 1943 Page: 681 

Price: $4,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 11/25/2009 
Douglas County Account In^MM^on Page 2 of3 

Grantee: 

Valid/lnvalid: 

Exclusion Reason: 

Valid 

Lan d Informatio n 

Acres 

0.08 

SF 

3840.0 

Units 

1.0 

Depth 

96.0 

Width 

40.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

1510 Grant 

9tn <J5 !• 

FMPtoor 

MO.flSq.n. 

12 f EB Ranch 

et»«fiGfcifkdr enj0f.,, FI 

CLICK TO ENLARGE IMAGE ] 

Square Footage: 860.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 4.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Plaster Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: ! Blocl< 

Sprinkler Square Footage: i 0.0 

Year Built year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1905 0% 1905 105 

Detail Type DefaiV Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 800.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 11/25/2009 
Dojaglas Coimty Account Infgaution ^^ ^ Page 3 of 3 

Garage I Detached I 400.0 

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

"> 

Create Another Ticket Back to Irth Intemet i^^Send Email ] 

• YOUR TICKET NUMBER IS 2487502. 

Original Call Date: 5/07/10 Time: 12:40 pm Op: ELIZABETH18790 


Work to Begin Date: 5/11/10 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1510 Street: GRANT ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SE-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 Tvinneling 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 CALL PER 

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... 5/7/2010 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 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... 5/7/2010 
As-Built Drawing ^ 

COASTA

ENVIRONHCHTA

L 

L Omaha Lead Superfund Site C a O U P. IN C 

OLS#: 28205 

Date Excavated: 5/21/2010 

Date USEPA Siqned Off: 7/13/2010 

28205 Area Sodden: 3050 sa ft 

Omaha Lead Site Exterior Paint Owner Name: ERNEST W ROY 

Site Sketch [ 3 Good 

Address: 1510 GRANT ST • Poor 

PtMne: H: |~| Not paint 

Omaha Lead Site 46130 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
y^-^y I.­ 28205 

Omaha Lead Site Exterior Paint North Arrow Owner Name: ERNEST W^OY 

Sit Good e Sketch Address: 1510 GRANT ST 

Phone: H 

\ 

U// 

'^Y 

4613(1 3ol 3^6>i 
• • • # 

28205 

Omaha Lead Site 46130 
28205 

Omaha Lead Site Exterior Paint Noiti Arrow Owner Name: ERNEST W ROY 

Sit [5l Good e Sketch Address: 1510 GRANT ST • Poor 

Phone: H; 

w [ 2 Notpaint f

Sample Lead Sample Samples Collected Numt>er LAB Concentration Collected Firm: Ffef t \ft<.\t^fv ^ 

RYASCPXA-28205 F1 £li_l.ppm D Date: QT - a.e> -e ^ 

RYBSCPXA-28205 F2 ka3.2iPPm D Time: \a' . M O 

nvGoopxA-aogos—w ppm D 

D Sampies Analyzed nvDoopxA-aoaoo—BS _ppm D 

DZ n RD2SCPXA-28205 5MI fPPm ET XRF Unit: ^ \ \ Book: ^ P 

>t6Z8ePXA-2a20S -GZ _ppm D D Date:. *gl t -Q 4 •RrzacpxA-zozoo - PZ _ppm D Time:. D Staff: Number of Samples = 

D ft L_J t

BNTlSRfiD 

JUL 2 2 W 

r-^ 

•o* ^ O ' o 

. • ( ^ r v c:i.r«>^-^t: su. 

^ y 

^l^ . C^ r«> 

\ 0 

\ ^ 

t)v4 a3~7u> a : p]r •^^^ 

/ 

. / 

cf 

5\% 

<3 ^ fte-\u>ciLJU.^^ 

?> .CJ^*:f.'>!r 

Omaha Lead Site 46130 
1

28205 

Exteiior Paint Nortti Am m 

HGood 

• Poor 

Q Notpaint 

Samples Coilected 

Firm: Ffef t \ft&\I>rv> 

Date: O l - A O -e* i 

Time: \a'.Mr> 

Samples Analyzed 

^ U Book: I X 

Owner Name: ERNEST w ROY

 Address: 1510 GRANT ST

Phone: H:

Sample Numt>er 

RYASCPXA-28205 

RYBSCPXA-28205 

fTYoecpxA-aeaos 

RYDOOPXA'aoaOB 

ROZSCPXA-28205 

R6Z3CPXA'ge205 

•RPZ3CPXA'20205 

Fl 

F2 

-fri 

-B2 

DZ 

-OZ 

-PZ 

 W: 

l.ead 

Concentration 

SiLiPPm 

ppm 

ppm 

c3 .^ n 1-pPPm 

ppm 

ppm 

 Omaha Lead Site 

 Site SlieiCh 

Sample 

Collected 

0 ' 

D 

D 

D 

D 

LAB 

D 

D 

D 

D 

D 

D 

D 

Omaha Lead Site 46130 
if^^''*'t ^ 

COASTA I 

[HVItOHHIHTAI 

C K O U r IN C \ y 

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: C^Qyjs^^ 

Owner's Name: f2/< i 1 / Daytime Phone: ^ /L ( • "J ^ ^Z ' ^ 

Address of Property \^[G <^eAJ^F 

covered by this 

Agreement: 

PURPOSE OF RESPONSE A GTMTIES 

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) wili 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 written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

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

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

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

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

agrees to: 

Page 1 of 2 
.*^!1!'"*. 

COASTA L HtVmOHHfltTAl •"iPROlt'- C R O U r IK 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; 

e 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. 

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 

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

OAJL'^'fa 

signature Date Signature Oate 

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

Page 2 of 2 
9830S-

COASTA L 

ENVIRONMENTAL 

GROUP , INC . 

OWNER CHANGE REQUEST FORM 

PROPERTY ADRESS \5iO 6rct^k6+ 

owNER NAME c. rYie^SA l\y> y 

CHANGES REQUESTED: ll /y f/,yiec/o^^y-^^-^^ y^' 

OWNER SIGNATURE <^Z^ . , r^ ^^^j^^ ^ 'O^ ' (^ ^ ^/ U 

AaiO N TAKEN: 

SUPERVISOR INITIAL /3 ^ 
COA S T A L • NViaOHMBHTAL O • O U P , IH C 

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). 

PropertylD; Z32^ ^ 

Property Address: |t5'(G (SiC^W T T T 

Owner; -aCj^^^ T R-O ^ 

Phone: nitfc ^ ^ % ^ 

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 ofthese items is the Owner's responsibiiity. 

Kem: 

Item: 

Mi^, ( 00%. 

Item: 

Kem: 

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

Kem: 

. "^i/v ^ >v2^ut.H- ^ T^~2_ -

Kem: 

Kem: 

Kem: 

Pagel of 22. 
COA S T A L 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: 

<A>^y> 

Kem: \ 

Kem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

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

is covered with grass. 

Number of trees > 2 inch A Fflch . trunk diameter 

Number of trees <= 2 inch Ffloh 

tnmk diameter 1 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. \^l^ 

Attach a sketch of die 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. k 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 ^AD 

Page 2 of. 
C OAST A L • NViaONHeMTAl . a II o u p . IN C 

AddKional Comments / instructions: 

The city of Omaha ordinances may prohibK 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 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 iiiegai driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the cKy if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removai 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. 

iS^iease check this box if you understand the information outiined above. 

.c^ ' <y* ^ 

4 $LoP^ xpy^y -

WcChec . k 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. 

W agree O I do not agree 

y. OZ-^'^'fO • ^ ^7 ^ 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
7 

9t 

XRF PROPERTY SAMPLE SHEET 

Date -y - / ^ - / O Address

Project Omaha Lead ARRA Sample time 

XRFID# .-^cy^a^i - sample length 

Shot# Reading Sample area Shot# 

s V 2 / / I ^ I& n ss\ 

^H<J fn l y IG Depth ssx 

^ws- IOO t l ^ (k'l ?AS^ 

Average j 0 ^ ^/ 6 Average

Shot# Reading Sample area Shot# 

fT,V5- 12^2_±J1. J2a. <:;5-? 

g's 6 Depth l7Q A n <r6o 

r.V 7 l/Z^^T7 JLI // s ^ / 

Average nct n Average

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot # . Reading Sample area Shot# 

Depth ^-1 

y / . ... 

Average Average 

lAft^C IM/^^1 

BVID f^A32os 

 / ^ / H OS ro o ^ .-.^ 

am/pm 

30 sec 

Reading Sample area 

?^ i-/,^ fa. 91 Depth :^ ^5 

y3 :^ /3- e ^ / 

 9« S i t ^,S^ 

Reading Sample area 

/S/ / i' ^ D€ 

/^ ^ i:/ ^ Depth 

/W5 ^ /r3 ' . ^ " . 

/ V ^ — I O 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
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 

546 

SOIL 

2010-06-19 17:50 

91.58 

Final 

1510 Grant st 

Fl 

6" 

N. LOPEZ 

confirmation 

none 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 543 

Mode SOIL 

Time 2010-06-19 17:48 

Duration 30.55 

Sequence Final 

Flags 

BVID 28205 

ADDRESS 1510 Grant st 

QUADRANT Fl 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 112.670 ± 16.380 

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 101.039 

Supervised By: 

Certificate of Verification 

544 

SOIL 

2010-06-19 17:49 

30.51 

Final 

28205 

1510 Grant st 

Fl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

15.563 
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 99.918 

Supervised By: 

Certificate of Verification 

545 

SOIL 

2010-06-19 17:50 

30.52 

Final 

28205 

1510 Grant st 

Fl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.577 
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 

554 

SOIL 

2010-06-19 17:56 

91.99 

Final 

1510 Grant st 

F2 

6" 

N. LOPEZ 

confirmation 

none 
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 96.380 

Supervised By: 

Certificate of Verification 

551 

SOIL 

2010-06-19 17:54 

30.56 

Final 

28205 

1510 Grant st 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.278 
^ 

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 97.152 

Supervised By: 

Certificate of Verification 

552 

SOIL 

2010-06-19 17:55 

30.85 

Final 

28205 

1510 Grant st 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.089 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 553 

Mode SOIL 

Time 2010-06-19 17:56 

Duration 30.58 

Sequence Final 

Flags 

BVID 28205 

ADDRESS 1510 Grant st 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 92.671 ± 14.997 

Supervised By: 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 558 

Mode SOIL 

Time 2010-06-19 18:00 

Duration 91.95 

Sequence Final 

Flags 

AVERAGE C7gggaf-555r5i 

ADDRESS 1510 Grant st 

QUADRANT Bl 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Supervised By 
# 

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 125.007 

Supervised By: 

Certificate of Verification 

555 

SOIL 

2010-06-19 17:58 

30.47 

Final 

28205 

1510 Grant st 

Bl 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.729 
• • 

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 125.804 

Supervised By: 

Certificate of Verification 

556 

SOIL 

2010-06-19 17:59 

30.91 

Final 

28205 

1510 Grant st 

Bl 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.585 
% % 

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 128.025 

Supervised By: 

Certificate of Verification 

557 

SOIL 

2010-06-19 18:00 

30.57 

Final 

28205 

1510 Grant st 

Bl 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.816 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 562 

Mode SOIL 

Time 2010-06-19 18:02 

Duration 92.06 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 1510 Grant st 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

Supervised By: 
t 

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 141.431 

Supervised By: 

Certificate of Verification 

559 

SOIL 

2010-06-19 18:01 

30.56 

Final 

28205 

1510 Grant st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.649 
• • 

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 149.868 

Supervised By: 

Certificate of Verification 

560 

SOIL 

2010-06-19 18:02 

30.56 

Final 

28205 

1510 Grant st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.026 
% # 

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 144.631 

Supervised By: 

Certificate of Verification 

561 

SOIL 

2010-06-19 18:02 

30.94 

Final 

28205 

1510 Grant st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.659 
y^j'*'^^. 

/ jQk^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc. 

SL^^^J ^ www.coastalhazmat.com 

^pnattJ ^ COASTA L 

INVIIONNIIITAl Ciour . IN C 

EXECUTIVE SUMMARY: 

BVID #28205-(1510 GRANT ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: • -

DAN GARVEY WALKED THETROPERTY ON 7/13/10 * .-^^-->.­
0% 

EPA Property Close Out Form 

;KV>I^, ^ Properly #: "2. ^^?P ^ Property Addresr. -J-^i^^^T-- ^ 

Date/Time: Owner's Nttm:. /42t£ rsiLDf£. 

Quads Excavated: ^ Contractor Croup fjy^V(7 ^ 

Excavatio Yes No n General 

1. If necessuy, were the conect quadnint(s) excavated and reslored? / 

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

Gradinc Sod and VcseUtioB Yes ^o 

Does Ihe grading around the perimeter ofthe house in excavaled areas generally slope away 

Gnm the house? y — 

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

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

day time period) y 

Are sodded areas generally finm and evenly graded? y 

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

y tinw period) 

Was tbe property graded such that water will not pool on the propeny 

y 

Was dainage to landscaping or plant materials avoided? y 

Gates. Ftpcei and Retataitng Walb Ves No 

I 1. £>o gates open and close freely? (Ifappiicable) y 

2. Were all gates or fences taken down during restotation activiiies reinstalled? (If applicable) j y 

3. Was damage to gates or fences avoided? (tfapplicable] 

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

Foundation, SidiBK and GttMers Yes .No 

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

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? • 

A Was damage to windows or door screens avoided? / 

2. Was damage to downspouts or downspoul extensions avoided? y 

Sidewallu and Driveways fCoocrcte) Yes No 

1. Was damage lo drivevray surfaces avoided? y 

2. Wat damage to wallcway surftces avoided? y 
OM'oers comments: 

jlnspection notes: 

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

EPA Representative Qf^^^^ Date: r/is/io 
Property Completion Agreement 

riiis agreement documenls lhe complclion ol remedial acliviiies perfonned on my property My signature 

will designate lhat I am satisfied wilh the restoralion of my propeily. and thai no items are in queslions. 

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

Property ID: g^-^og " 

Property Address: /^ / Q QjCCKyr ^ f S J^ ' 

Owner

Phone: nf

: ^rH-g.

H " "5^

^ 

I 

3 S " M

Restoration Items in Question: 

Item: 

Pl\/^+- f\ y 4^>4W) ^ 6 ^ 6.s>iAW -s>)ckz^ ocPkc3i^<,s^ 

Item: * 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

. 

^ ^ 1 H^rce r tutor til ion K completed, rxccpi as noteri 

[_| I rio not acrec resipmtion it completed 

y.^y oC-IJ^-i<a> - Date !^nt i arior's Signature Dale Owner' s SiQnatnre V^ 
@l/ 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superftind Site -DvnvjXTVT^ 

2009/2010 luacisiVlSD 

JUN 18 2010 

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

Property Identifie Identifier Nnmber; "2-^ Z.05 X.05 ^" SIH^ERFUND DIVISION

Propert rropertyy Address Address:: /.'^/0 /A^/O ~ inrrKi/\J^ C:nnrM/\-V^- ^y' ^r 

Property Owner's Name; ^^^^1^5^+- (^-C^~ 

Instructions to the Property Owner; 

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

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

to the Omaha Lead Site. This form doctmients 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 donH follow the guidelines set forth in the 

Perfomiance Work Statement. 

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

work by checking a numerical rating on the table below using the numerical definitions from 

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

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

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

10 . 5 

9 y 4 

8 3 

7 2 

6 1 

Propertv Owner Additional Comments from (optional; continne on back page if needed) 

Property Owner Signature: <^^y^>^^^ y* ^ ^Date; _^4o^5Vf 
b 

Water Bill Settlement 

Property ID 28205 

PropertyAddress 1510 Grant St 

Tenant Ernest Roy 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 7.14 for 

water usage required to maintain the sod. 

Check Number 1965 

Value of Check $7.14 

Made Out To Ernest Roy 

Description of Settlement 

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

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

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

Environmental Group Inc. from further obligations or liability. 

Iwner's Signature Date Contractor' Contractor'ss Signatur Signaturee Date 

COASTAL ENVIFtONMENTAL GROUP INC. 2411 MARTHA STREET 27-5/1040 003 

OMAHA/N 6247372904 E eSIOfr 

U\99J^0 

DATE 

PAY TO THE 

ORDER Of 

'^ F'^AftsV \M. RfibV $ 1 ^ 

§fj)giAOLnd'^lj»i a 0«Ull* on ktk . 

«WtliFagciBanlt,UA^ 

ftofmilu 

FOR 1Btfin282(fe \6l0farQn1~ ^f^UZi^TW Cl&O^I^V<^ 

i:;oi»oooo5ai: E.51.737E^omi* onE.5