# 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION HLE FOLDER 

SAID# : ^^(^ ^ Date: ' ^ ( 5 / i^ 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

/ Video of property (DVD) 

Wr Executive Summary 

0 EPA-provided property sketch 

p^ Signed Access Agreement for subject property 

-fl- Signed Access Agreement(s) for adjacent property 

W Restoration Agreement 

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

-^r- Confirmation data 

W Photographs ^ f^ ^ 6>^ 6\1//nWi Y ^C/^fing ^ } h" ^ 

gj / As-built sketch 

y ( Satisfactory restoration signed by Property Owner 

0 Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

M Utility clearances 

bf Property information from Douglas Coimty Assessor's Office 

D 

Signattire 

30217655 

Superfund 
# 

Property Access Checklist 

PropertylD: V^QX^'^ , 

Property Address: C^fS "X Z\ 

D

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner: 6iffft\A toA<i 

Address: 

)oana. 

Phone: ^^Q^ ^ ^^^ . -^^o^^^ 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n

[^

{^

O

Q

Q

1 3

^

Q

D

D

Q

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoil Sampling (if appUcable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 UtiUty Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Signed: 0^/^/V > 

Signed:aS_/aa/VA_ 

/ / 

/ / 

/ / 

CaUed:0^ / aH/VO 

On: C^ / «a / \£> 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

»y= v^i*.v^\«.^ 

By= vaveytol^^ 

By: 

By: 

By: 

^y- oc/aJio ^.»««J^ 

By= ViXr-Wv 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as appUcable) 

n Conununity • Crew 

Results: 

On: / / By: 

n Community

Results: 

O Crew On: / / By: 

O Conununity

Results: 

O Crew On: / / By: 

Omaha L^ad Site 
Douglas Coimty Account Inf(»^Kon Page 1 of2 

' # ' 

Douglas County, Nebraska Property Record - R1947470002 

Print Report 

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

New Feature ->->• • Auto Sales Search 

Owner 

TODD GERALD L 

ETAL 

6553 FLORENCE BLVD 

OMAHA NE 68112-0000 

Property Informatio n 

Key Number: 4747 0002 19 

Account Type: Residential 

Parcel Number: 1947470002 

Parcel Address: 6553 FLORENCE BD 

OMAHA NE 68112-0000 

Legal Description: PARKWOOD LOT 28 BLOCK 1 -EX IRREG E 263.71 FT- LOT 28 BLK 1 

Value Informatio n 

Land Improvement Total 

2009 $7,000.00 $93,100.00 $100,100.00 

2008 $7,000.00 $93,100.00 $100,100.00 

2007 $7,000.00 $82,300.00 $89,300.00 

2006 $4,000.00 $82,300.00 $86,300.00 

2005 $0.00 $0.00 $0.00 

2004 $0.00 $0.00 $0.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.25 11319.0 1.0 0.0 0.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-onUne.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/25/2009 
Douglas County Account Infqj^|tion Page 2 of2 w 5553 FLORENCE 8 0 

3 * '^J'' >*»Tg ait q B 

first Floor 

921.0 so ft 

Sfloooo Floor 

U2 0 sq. ft 

SieRoorCnImg 

lazun 

1 1/2 STORY 

Ssnmt Blocll 8 tt 

91J0wf t gSLtMgiBMiLU'imm 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1803.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: ! Composition Shingle Bedrooms: 2.0 

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 Oefa/7 Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 fl 912.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Garage Detached 480.0 

Porch Slab Roof Ceiling 192.0 

Porch Slab Roof Ceiling 96.0 

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

"> 

Create Another Ticket jfZ l ^§J^Ki°:'l!?J."Jg'"'?®J .^\ 11^_ Send Emaij^ ,| 

YOUR TICKET NUMBER IS 2501393. 

Original Call Date: 

Work to Begin Date: 

5/24/10

5/26/10

 Time:

 Time:

 4:55 pm 

 5:30 pm 

Op: ELIZABETH18790 

State: NE County: DOUGLAS Place: OMAHA 

Address: 6553 Street: FLORENCE BLVD 

Twp: 16N Rng: 13E Sect-Qtr: 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

UtiUty 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

x>MAGELLA r A /-CT T A XT MAGELLAN MIDSTREAM PARTNERS r,ciir.D A U N . p DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 5/24/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM 

LOCATING 

Day: 4067289343 

AU: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

AU: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 5/24/2010 
As-Built Drawing ^ 

C

ENVIBONMCNTA

 OASTAL L Omaha Lead Superfund Site CROUP . INC . 

OLS#: 40182 

Date Excavated: 5/26/2010 

Date USEPA Signed Off:6/10/2010 

Area Sodden: 1326 sof t 

I- Name: C^^.J } Omaha Lead SHe Date: l2--3i--3 North Arrow —i 

Address: J£S3 . Site SIcetch Time: Iz^'^--^ 

Phone: 

Team ^<rk 3."^ [ i^ * BVID# Mo 12^ XRF Code 5"5"^ y 

Sample Numtjer Lead Concentration Confimiation Sample/ r^l ^ 

1=1 Ves D No ^ 

yg-? ppm f'^ZYes i2^ No D ppm 

JJL 

ppm Oiyes • No -Q /Tyc'f<:^f9CA - j^'P'Je ^ B?Yes C] No 0 

^ ^ ^ ptYes O No B ' ppm 

ppm ;x^< ^ ppm t*Yes • No C3^ 

ppm Yes n No • Lab RYBSCPLA-40182 

'^«*"" 650 ppm 

\yv^ h t I— 

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::::::::::K^tl!;::::::::(:::::^:''::"'"':^'?'^f i.iiirT7lr.%iii... ' ; " + 

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Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch 

'fTs..' 

Area lef t bare 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc. 
Name: GiL^t-.U.

Address: ^§^ 5

Phone: 

 j ­ "i'odc! 

Mrr^^rf -

Omaha: Lead Site 

Site Sketch 

Date:

Time: 

 U-31-- 3 

\XS~L^ 

North Arrow —i 

Team wi.rk 3.X [ t^ • ! BV!D# ^g/gg y XRF Code SS^ ^ 

Sample Number Lead Concentration Confirmation Sample/ r^ ^ 

I-1 Yes n 

/=ZYes J ^ 

/?/Yes Q 

l72Yes 1=1 

ptYes Q 

t^Yes a 

Yes • 

No S -

No Q 

No -S 

No ^ 

No S " 

No £2 ^ 

ioO l3o^ Omaha Lead Site 46130 
# # # # 

Name: Gi/-a.lr).

Address: ^5^ 3

Phone: 

<- TGC^C 

1 inrenr^^ 

Omaha Lead Site 

Site Sketch 

Date:

Time:

 11-31- 1 

 iz i <-^ 

North Arrow 

Team y.<rk !>>^ [ i^ ' BVID# ^0/g?v XRF Code ^^^ T 

Sample Number Lead Concentration Confirmation Sample/ r° ^ 

1 /iy^UJ^'X'9 - -i^'g> ^^;g ­ I'l Yes ^ No S ­ ^ Vg- 3 ppm 

t^ZYes ^ No 1=1 ppm- QlYes n No -Q ppm 

ppm o;Yes ^ No S

pi-Yes n No S " ppm 

ppm tftYes n No O ^ 

7 ppm 

Yes • No •

Lab RYBSCPlA-40182 

R^s^lt / 650 ppm ^ 

Omaha Lead Site 46130 
4 # # 

Name: Ge^ol J L Tnd d Omaha Lead Site Date: lt-3l-^ 3 North Arrow 

Address: ^ST 4 /Jorr^re . Site SIcetch Time: l2tf~2-^ 

Phone: 

Team y^cA 5. ^ [ i^ «1 BV10# ^0/g3^ XRF Code ^^^V ^ 

Sample Number Lead Concentration Confirmation SampleT' / r ^

/ ^ ^ 

ppm No ^ 

ppm <«^es xa' No n 

ppm /?/Yes n No "B /Ty£^fcf9rji' '¥^yWsu 

ppm Ot?Yes CD No Q 

ppm ptYes CD No ^ ;;64» ppm t^Yes • No 42^ 

7 ppm Yes • No • 

Ub RYBSCPLA-40182 

Result 650 ppm 

=1= ^ 

—4. . 

8 ^ 

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t=fc ..^.^itu^ca:,. 

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Omaha Lead Site 46130 
j,eD»r4, 

COASTA l 

INVItONHtllUl 

c It o u r > h 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: ^D//^2^ 

^^^M^TW 

Owner's Name: Daytime Phone: 

^/S3-

Address of Property 

covered by this ^g^-^b p'Cm^'t^ Hi/cL 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 clelan 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 ali 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 
^"to"«rCOASTA L IPfVmONHIKTAl 

C « O U r IN C 

t Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

G 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. 

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 ariy questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

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

AtuU)3Ll ^ <~i.x.~/ff 

Signature Date Signature Date 

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

Page 2 of 2 
C O A S T A L • MVIMONHBNTAL a II O U P . INC . 

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; CfQl ^'Q_ 

Property Address: /^C-e;? ^ P^^^T ^ fh^^/r^L^ 

Phone: •^C^ - 9^'? ^ 

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

Hem: 

Sy^ 4 /7Jairr' -/-o h ^ ^CK /(/O^C/ e ^ 

Kem: ' 0 

item: 

item: 

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

Kem: 

/tv^sj sv^^ ^1 ^ U^f } fef^ h^l 7n J 

Kem 

Hem: 

Kem: 

Page l o f / 
C OASTA L • M VI RO N M • M TA L a II O U P . IHC . 

Items to Be Removed By Contractor During Remediation and Reolaced 

Kem: 

^ l FZ- D^ 

Kem: 9x1 ? t ' P^ 

Kem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, f^O? 

Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Z Each ­ trunk diameter 

Number of trees <= 2 inch Each 

tnmk diameter / 

Number of Sprinkler 

Zones, Control Valves, M o Each Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Ntmiber of and size of 

each garden/ flower bed Each ^ A ^ 

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 

excavated 4'2 ^ 

Each i^d^fju^ f\si.cMl4s 

Page 2 of ^ 
C O A S T A L • MVmONMIMTAI . O • O U P. IM C 

AddKlonal Comments / instructions: 

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

as driveways or vehicle parldng 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 soli 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 cKy if you use a gravel or dirt area 

as a driveway or partdng area, not withstanding any removal or replacement of soii by the EPA 

If you have any question about legalKy of a certain driveway or parking area, you may contact 

the cKy of Omaha's Planning Department at (402) 444-5150. 

Q^lease check this box if you understand the information outlined above. 

/ . . 

io v\e^ 

^1^ W-> p Uv^i Vo b 

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. 

01 agree [~] I do not agree 

Owner's Signature Date Contractor'sSignature Date 

Page 3 of _ S 
BVID# IjOlS 2— 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

Shot# 

S2E 

^ 1 

Average

Shot# 

2S: 

^21 

Average

Shot# 

Average 

Shot# 

Average 

Signature^ 

Hf'iO Acidress 

Omaha Lead ARRA Sample time 

sample length 

Reading Sample area Shot# 

^ 

llf^i - ^C Depth 

^

y.a^ 

/rx^j- u„ JLL HZ2L 

 /OC? W ^ Average 

Reading Sapple area Shot# 

WEJH i Depth lu^/'f 

/THt^-r /? - ISL 

 /<7^ ^/ ^ Average 

Reading Sample area Shot# 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

^ y Depth 

^ / 

Average 

f^.SS^ fim-y ^ fiUr ^ 

am/pm 

30 sec 

Reading Sample area 

j^e . ^ ^ Depth ff 

^ / ^ / / 7 3 ^ 

^^/ / 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

424 

SOIL 

2010-06-19 15:28 

92.07 

Final 

6553 Florence blv 

DZ 

13" 

N. LOPEZ 

confirmation 

none 
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 24.947 

Supervised By: 

Certificate of Verification 

421 

SOIL 

2010-06-19 15:26 

30.59 

Final 

40182 

6553 Florence blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 10.457 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 422 

Mode SOIL 

Time 2010-06-19 15:27 

Duration 30.51 

Sequence Final 

Flags 

BVID 40182 

ADDRESS 6553 Florence blvd 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 27.635 ± 10.659 

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 30.517 

Supervised By: 

Certificate of Verification 

423 

SOIL 

2010-06-19 15:28 

30.97 

Final 

40182 

6553 Florence blvd 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 10.942 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

428 

SOIL 

2010-06-19 15:31 

91.14 

Final 

5-427 ' 

>553 Florence blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 
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 116.142 

Supervised By: 

Certificate of Verification 

425 

SOIL 

2010-06-19 15:29 

30.48 

Final 

40182 

6553 Florence blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.042 
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 125.571 

Supervised By: 

Certificate of Verification 

426 

SOIL 

2010-06-19 15:30 

30.17 

Final 

40182 

6553 Florence blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.701 
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 126.315 

Supervised By: 

Certificate of Verification 

427 

SOIL 

2010-06-19 15:31 

30.49 

Final 

40182 

6553 Florence blvd 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.675 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 400 

Mode SOIL 

Time 2010-06-19 15:12 

Duration 91.96 

Sequence Final 

Flags 

AVERAGE Ava-^i39^=-:399l?^ 1 

ADDRESS esiSnorence blvd 

QUADRANT F2 

DEPHT 6" 

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 97.384 

Supervised By: 

Certificate of Verification 

397 

SOIL 

2010-06-19 15:11 

30.51 

Final 

40182 

6553 Florence blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.553 
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 114.839 

Supervised By: 

Certificate of Verification 

398 

SOIL 

2010-06-19 15: 11 

30.87 

Final 

40182 

6553 Florence blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.312 
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 105.060 

Supervised By: 

Certificate of Verification 

399 

SOIL 

2010-06-19 15:12 

30.58 

Final 

40182 

6553 Florence blvd 

F2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 15.929 
/^O A Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^^LI Coastal Environmental Group Inc. ^^^S? ^ 

V"^^! ^ www.coastalhazmat.com "' ^ 

^"tPRO^"^ COASTA L ENVIIONHINTAl e 1 0 u P. IN C 

EXECUTIVE SUMMARY: 

BVID #40182-(6553 FLORENCE BLVD) 

No Issues or Concerns \ ^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 6/10/10 
Ipk 

EPA Property Close Out Form 

Property #: 'AoVg>3L Property Address: <T^^ ^ H^fPnC<', Ri^ A 

Datc/Tlnic: Owner's Name:,/L.^Kfg)f ^ .. TfgiH. •.:— 

Quads Excavated: Contmclor Group 

Excavado Yes No n GenenI 

1 • If necessB/y, were the correct quadnuit(s) excavated and restored'? / 

2. If necessary, were the correcl areas ofdrip zone excavaied aod restored? 

Gradtne Sod and VcceUtion Ves No 

1 Does the CFBding around the perimeter ofthe house in excavaied areas generally slope away 

y from the house? 

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

y 

y 

___ 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 firm and evenly graded? ^y 

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

tjnw period) y 

6. Was the property graded such that water will nol pool on the property^ / 

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

Gates. Fences aad Retatolng Walls Ves No 

I 1. Do gates open and cio.se freely? (If applicable) y 

2. Were all gates or fences taken down during restoration activities reinsuiied? (If applicabk) y 

3. Was damage to gates or fences avoided? (ff applicable) y 

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

Foundation, SidlnKand Callers 

Yes No 

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

2. Was damage to the foundation avoided? / 

Was damage to windows avoided? 

_ / 

^ Was damage to windows or door screens avoided? 7 

3. Was damage to downspouts or downspoul exiensions avoided? I 

Sidewalks and Driveways (Concrete) 

Yes No 

1 • Was damage lo driveway surfaces avoided? 7 

2. Was damage to waOcway surfaces avoided? 

r 
Ort'oers comnients: 

j In.spection noies: 

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

EPA Representaiive 9^^ An , Date: 6lll^"^_ 
Property Completion Agreement 

This agreemenl documents lhe complclion ol remedial acliviues perlbimed on my properly My signaluie 

will designate ihal I am satisfied with lhe restoraiion of my properly, and thai no items are in questions, 

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

Property ID: ^|Q\jJ ^ 

Property Address: ,^.g^ ^ VV.r^r. , ^ U 

Owner: ^ ^ 

£ a \ 

Phone: C«^^^vA^^-^M?\t. 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

OffTiigrcc rcstordlion is completed, except as noted 

[M^ l do nol a|>rec restoratinn is completed 

/:^ju.JU7J^.JUI/^ ^^s^/£ ?

Owner' s Signature Dale

 (§>G<Ujuifi^

 Cuntrarlor' s Signalnrc

 G'S-fd 

 Dale 
(zi^J 

Property Owner Assessment of Performance f oriik/ i^^ i/^r ) 

American Recovery and Reinvestment Act (ARRA) /^..^ ^-^L/ 

Omaha Lead Superfund Site '^ ^ J- 2GW 

2009/2010 ^"^'/^E/^^i/^y,, . 

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

Property Identifier Number: \-\0Vy3> 

Property Address: US'S ?. ^\r.e-^^^ "^VA 

Property Owner's Name: fa^^^\ A "^cAA 

****^i^l^i^i^i^i^i^ii|l^i^l^c**^i^i*i^^iil^^iil^^liiil^:t^^^i^i^iii^iii^^ii^^i:^Ll^il^l*^iil^******** ^ 

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 docimients 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 

Perfonnance Work Statement. 

The Property Owner will indicate his/her assessment of performance v^th the contractor's 

work by checking a numerical rating on the table below using the numerical definitions fi'om 

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 C ^ 5 

9 4 

8 3 

7 2 

6 1 

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

Property Owner Signature; jC^JLy.,*^^Jf^^lh^^j / ^Date: ^—S'"^ ^ 
« » 

Property Damage Settlement 

Property ID 40182 

Property Address 6553 Florence Blvd 

Owner Gerald Todd 

Phone (402)453-7496 

1 received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $40.00 to 

compensate for the soil treatment done to the property. 

Compensation type Check 2030 

Value of Check $40.00 

Check to the order of Gerald Todd 

Description of Damaoe 

Property owner received a check for the amount of $40.00 dollars to cover for the sod treatment. 

My signature below acknowledges the issue pending with my property; further, I acknowledge that 

this work was completed satisfectory and within my and release Coastal Environmental Group, Inc. 

from further obligations or liability related to this property. 

fMMHir~ 

' w ^ ^ •' • •••"•'• i ii '•••••• >• i , • " '^V : .'^ ' 

illOi^OOOOSai : E.EU 7 37E'10I.II ' 0E03 0 

Owner's Signature »a>ate Contractor's Signatur Signaturee Date 

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