TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^MiM Date: 

Address: 1^"} \^ \)'^ ^1 

Remediation Contractor: Coastal Environmental Group_ Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

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.) 

Confirmation data 

Photographs V d 6>cO(Vi'^TL^ Y tv:6wAtl(M Y^^" ­

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

30218453 

Superfund 
^ 

Property Access Checklist 

Property ID: ^^L ] ( L| n WORK STARTED ON: / / 

Property Addres8:^<l^^a, \ j jp^ ^ f n WORKCOMPELTED ON:__/__/_ 

Owner: 5TA C j- p ^C^AA ; Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: <^^ ^ 5 ^ ' Additional Information: 

Fax: 

Cell/Pager: 

l~l Notification Letter Sent: / / By: 

A Access Agreement Signed: Z_/3./i£ ) By: 

P^l Restoration Agreement Signed:DH/O » / Vo By: 

n Topsoil Sampling (if applicable) / / By: 

l~l Disposal Sampling (if applicable) / / By: 

l~l Garden Sampling (if applicable) / / By: 

Utility Clearance CaUed: 0 \ lrf\ l\ 0 °y- OHIWA O VO^MV^ 

Q^Video/Photos (Before) On: 4 l '^ I ' ^ By: O^f/^v'tt) 

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

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

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

Property Completion Agreement Signed: d^KCZ By: fV(4:;^-v.C 

f Final Report Issued: / / 

Air Monitoring (as applicable) 

• Conmiunity O Crew On: / / By: J 

Results: 

• Community O Crew On: / / By: 1 

Results: 

• Community QCre w On: / / By: 1 

Results: 

Omaha Lead Sits 
Qouglas County Account InfdjBMion Page 1 of2 

Douglas County, Nebraska Property Record - R1601240000 

Print Report 

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

New Feature ->->• • Auto Sales Search 

Owner 

PEAK STACIE L 

2407 N 18 ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 0124 0000 16 

Account Type: Residential 

Parcel Number: 1601240000 

Parcel Address: 2403 N 18 ST 

OMAHA NE 68110-0000 

Legal Description: LAKE ADD LOT 6 BLOCK 5 S 1.66 FT LT 7 & ALL 54.32 X 140 

Value Informatio n 

Land Improvement Total 

2009 $2,800.00 $54,100.00 $56,900.00 

2008 $2,800.00 $54,100.00 $56,900.00 

2007 $2,800.00 $56,200.00 $59,000.00 

2006 $2,800.00 $56,200.00 $59,000.00 

2005 $2,800.00 $56,200.00 $59,000.00 

2004 $2,800.00 $16,300.00 $19,100.00 

Sales Informatio n 

Sales Date: 2007-06-04 

Deed Type: QC Book: 2007 Page: 062521 

Price: $0.00 

Grantor: WRIGHT DOROTHY M 

Grantee: PEAK STACIE L 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7560.0 1.0 140.0 54.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 11/25/2009 
Douglas County Account Inf<j^a|ion Page 2 of2 

Building 1 

2416N 18 

•IT 

1 1/2 story Fin 

CUCK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1821.0 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: 8.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: i 4.0 

Roof Type: Gable Stories: i 1.5 

Floorcover: Allowance Foundation: i Block 

Sprinkler Square Footage: | 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1905 0% 1905 105 

Detail Type Detail Description Units 

Add On Brick Veneer 300.0 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1157.0 

Fixture Base Fixtures 

1.0 

Fixture Bath Full 1.0 

Garage Detached 400.0 

Porch End Solid Wall 

160.0 

Porch Slab Roof Ceiling 16.0 

User Attic Full Finish 

664.0 

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

"> 

Create Another Ticket Back to Irth Intemet ] Send Email 

YOUR TICKET NUMBER IS 2459574. 

Original Call Date: 4/09/10 Time: 3:58 pm Op: ELIZABETH18790 

Work to Begin Date: 4/13/10 Time: 4:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2403 Street: N 18TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-SW,12-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 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: coastal 


Depth of Excavation: 4 ft Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


ATTNEBRl CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty 

Type 

ATTNEBRl ATT/T 

Day: 

Alt: 

Emerg 

80024136249 

80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 

Alt: 

Emerg: 

4029340469 

4029340469 

4029329757 

»*A<-T:TTAXT MAGELLAN MAGELLAN MIDSTREAM PARTNERS ^ „ ri^r^uA u DEBORAH 

Day: 

Alt: 

Emerg: 

9185747098 

9185747098 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 

Alt: 

Emerg: 

4025047823 

4025047970 

Day: 4024447197 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/9/2010 
Page 2 of2 

• 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/9/2010 
Ticket Text and Map displa^^^Ticket: # 2460630 Page 1 of2 w #

Original Call Date: 4/12/10 Time: 12:36 pm Op: BJP 

Work to Begin Date: 4/14/10 Time: 12:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2403 Street: N 18TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: BRANDY Phone: (877)662-4210 


Alt. Contact: ELIZABETH 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Ptione Number 

UtiUty 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

»*A/-TrTTAXT MAGELLAN MAGELLAN MIDSTREAM PARTNERS . „ T^CD^DAU DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DHO... 4/12/2010 
I

28414 

As-Built Drawing 

COASTA

 NVmONHINTA

L 

L Omaha Lead Superfund Site C K O U P . INC . 

Date Excavated: 4/14/2010 

Date USEPA Signed Off: 4/27/2010 

Area Sodden: 2495 sa ft 

Omaha Lead Site 46130 

Legen d 

Concret e Drip Zone Excavated 

Quadrants Excavated 

Area replaced with Area replaced with m Area left bare So d ' • Rock/bdulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
& 28414 

Ofco^r LL:. O«-A/R 

Omaha Lead Site Exterior Paint North Arrow Owner Name: DOROTHY M PEAK WRIGHT 

Sit • Good 

Address: 2403_NM 8 ST e Sketch < gPoo r 

Phone: H: W: O'^Not paint 

\-lt- f 

Sample Number 

RYASCPXA-28414 

RYBSCPXA-28414 

RYCSCPXA-28414 

RYDSCPXA-28414 

RDZSCPXA-28414 

P•Gzscpyu^ as'ii'i 

nnzccpxA g04i4 

F1 

F2 

Bl 

DZ

GZ­

-P2-

Lead 

Concentration 

ppm 

ppm 

¥^ ^ ppm 

 '7 1 ppm 

 ppm 

 ppm 

'Z.'Z.^ 

Sample 

Collectejl 

n 

Number of Samples = S 

LAB 

D 

n 

D 

D 

D 

D 

D 

Samples Collected 

Fimi: r/) A i>C/j( j 

Date; ^IS/(SC( 

Time: 12: I S 

Samples Analyzed 

XRF Unit: ^1"^ - Book: gj ^ 

Date: ^''^^'^^ ' 

Time: ^^ n 

Staff: P^> ^ 

0 

SNTEBED 

AUG € s- mh 

£ . .y;••..^....-k.,..^./,.,>^:->g ^ 

GA)?AC|.e. 

Omaha Lead Site 46130 
asK!-»iiSaS2£^SS»^S8as»1SfeS®aK^S^Siii': em •m 

28414 

Omah Exterior Paint NorDi Arrow a Lead Site Owner Name: DOROT]HYM PEAK WRIGHT 

Site • Good Sketch < Address: 2403 N 18 ST • Poor 

Phone: H: W: 

[ 3 Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collecteji Firm: V[)f\ <>Cjj<k 

RYASCPXA-28414 F1 //^ ^ ppm D Date: ^IS/cs ^ 

RYBSCPXA-28414 F2 ppm D Time: 12 : i S 

RYCSCPXA-28414 Bl ^2 ^ ppm n Samples Analyzed t'iZf RYDSCPXA-28414 B2 55 1 ppm 

QA D RDZSCPXA-28414 DZ ^ ppm XRF Unit: ^Z*^ - Book: ^ ^ D RGZscpya^a8'11^1 ppm D Date: i^''^^'^'^ ' D nPZCCPXAgOlli) P2- ppm D Time ^/ n D 

Staff: p^/-n Number of Samples = o 

SNTEEED 

0 AUG- € S- 2094i- • • • fe~^ 

/•/2-f 

px 

tP^^J/ 

V^ 

vt­ & < ^ 

^ \ 

7 ^ 

( ^ jii ^ ^ ^ —

• /• ­

:£.0 •1.8^V5T^-r-E.fX.-rr- EL_ Omaha Lead Site 46130 
28208 

Omah Bderior Paint North Arrow a Lead Site 

(3 Good Site SIcetch • Poor 

Samoiina Address: 1504 GRANT ST • Not paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Gdiected Fimi: Pt)A Pfc.TX^ 

RYASCPXA-28208 F1 ppm 

of D Date: Q'Lg-o6 

RYBSCPXA-28208 F2 

JlOfi ppm D Time: L'.IK (i^ 

RYGSCPXA-28208 B1 S73 ppm a

Samples Analyzed RYDSCPXA-28208 B2 

ppm or .£33. 

D 

RDZSCPXA-28208 DZ 155 0 ppnri n XRF Unit: (t^ b Book: 20 1 

no20cpxA-2ogoo—ez- " ppm D n Date: Q'/^'O e 

RPZOCPXA-gOgOO PZ- " " ppm D n Time: PM 

Staff: hSV/ Number of Samples = j ^ | | Q | 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, being property 

ENTERED 

JUh i 09 2 008 

* ' ' * * * * • ' • ' " * ' • • ' " " ' 

* ' • 

^ ^ • ' ' 

573 

. 1 : BzL 

• 1 i i 1

^ P 

— ' — I * ^ 

• 

1 

1

/5'o*/ Gmrtt-.f 

s. 

: 

Ki?.;55-a..:. \ 

^ 

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\ iq 

^ 

Fl • 

f 

v(M.L.te. 

...tflivhiv st 044701.01.23 
f 0 

^^..eosu,^ 

v> COASTA l INVItONHIMM l c *" C I 0 U r I h C 

Consent fof 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: ^QcP l 

Owner's Name: Daytime Phone: 

.^W3Pl3H 

^^S > NU IS3 T Address of Property 

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 

wori< 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 worit to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration wori( 

before it begins. Once the wort( 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 wort(. This access shall 

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

agrees to: 

Page 1 of 2 
# 

COASTA L 

tl<ri«ONK(KT<l 

C R 0 U r I K 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; 

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. 

e Allow videotaping and/or photographing of the property. 

AGREEMEF^ 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 

Q I do not grant access to my properties ^ . 

£Ld.dSa. ^/6//tf 

Signature Date Signature Date 

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

(4^ ^ ~rO Kjui^\^ \>\X ^^^\^ ^ , T ^ P-^-U«->^'Wi 

oJtM^ ^ ^ o -(^ "SO P Tyf 

»A,.-^^i.<r --ti ^ 1 ^c^\c^^fi-W Q v ^ A-<y >c_-« 

Page 2 of 2 
C O A S T A L 

o n o u p , 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 Environmental 

Protection Agency (EPA). 

Property ID: Z'^L j i Q 

Property Address; ^L/QfJ^ N /9i ^VT 

O^er: S^T^jp r fe^^ 

Phone: q*^\\-'y:>,C,H 

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 of the 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. 

Item: 

Item: 

Kem: 

Kem: 

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

Kem: 

KlVi^ - Kem: 

Kem: 

Kem: 

Page l o t ^ 
C OA S T A L 

Items to Be Removed By Contractor During Remediation and Reolaced 

Kem: 

1 

c>o\ 

Item: 

Hem: 

Kem: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be 

excavated 

SoD 

Landscape Inventory 

Quantity Unit Conditlon/Type/Species 

^1,62^ Quadrants 

Fach 

Each 

Each ^[( ^ 

Each 

\ Square Feet 

$ 

/ 

Each 

Page 2 of ^ 
C O A S T A L • MViaONMBNTAL a « O U P , INC . 

Additional 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 Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying 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 legalKy of a certain driveway or parking area, you may contact 

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

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

A \yyx\A^s cf< ^ QucrM-^ Sc>D. 

[^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 

f » ^DXihK. O\l\-^l^o 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
• 

By\Dn'Z.9>HIH 

XRF PROPERTY SAMPLE SHEET 

Date il-N-l 0 Address 

Project Omaha Lead ARRA Sample time 

XRF ID# sample length 

Shot# Reading Sample area Shot# 

IPS 32>^^^ ^ jii^ ^ 10^ 3^^^:fc^ M 6 Depth 

10±_ 3t//t^ ^ 7^ m 

Average 3^f ^ -^ g^cS* Average

Shot# Reading Sample area Shot# 

I2I<. ytA?^H B^ 

nr N{i> ± IJ^ Depth 

i(r Ih^-^a fo " 

Average L^^k t / ^ Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature 

PHngLyi)(^)Qa/Qyj(J^ 

-2-^67 N - If. ^ ­ am/pm 

30 sec 

Reading Sample area 

ShL 

3/y t ^<r Depth 

3^4> ^ ^S ' Ipf' 

 2) ( D ~ c^5 ^ 

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 

Pb 

Supervised By:

Certificate of Verification 

108 

SOIL 

2010-04-14 06:57 

91.35 

Final 

Avg of 105-107 

2403 N 18 st 

easement 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 25.097 

fcgg/ j^OE^ j 
Thermo 

S C I E N T I F I 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 336.089 

Supervised By: 

Certificate of Verification 

105 

SOIL 

2010-04-14 06:56 

30.58 

Final 

28414 

2403 N 18 st 

easement 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 23.706 
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 365.709 

Supervised By: 

Certificate of Verification 

106 

SOIL 

2010-04- 14 06:56 

30.20 

Final 

28414 

2403 N 18 st 

easement 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 27.722 
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 341.313 

Supervised By: 

Certificate of Verification 

107 

SOIL 

2010-04-14 06:57 

30.57 

Final 

28414 

2403 N 18 st 

easement 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 23.864 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 185 

Mode SOIL 

Time 2010-04-14 16:21 

Duration 91.60 

Sequence Final 

Flags 

AVERAGE Avg of 182-184 

ADDRESS 2403 N 18 st 

QUADRANT Bl 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 309.644 ± 24.749 

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 308.871 

Supervised By: 

Certificate of Verification 

182 

SOIL 

2010-04-14 16:19 

30.60 

Final 

28414 

2403 N 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 24.690 
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 313.801 

Supervised By: 

Certificate of Verification 

183 

SOIL 

2010-04-14 16:20 

30.49 

Final 

28414 

2403 N 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 24.812 
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 306.260 

Supervised By: 

Certificate of Verification 

184 

SOIL 

2010-04-14 16:21 

30.51 

Final 

28414 

2403 N 18 st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 24.743 
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 

Certificate of Verification 

189 

SOIL 

2010-04-14 16:23 

91.50 

Final 

I Avg of 186-188 

2403 N 18 st 

B2 

6" 

N. LOPEZ 

confirmation 

none 

ppm ± Error 

Pb 152.153 18.525 

Supervised By: ^ m w 
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 148.678 

Supervised By: 

Certificate of Verification 

186 

SOIL 

2010-04-14 16:22 

30.48 

Final 

28414 

2403 N 18 st 

B2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.503 
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 145.867 

Supervised By: 

Certificate of Verification 

187 

SOIL 

2010-04-14 16:23 

30.55 

Final 

28414 

2403 N 18 st 

B2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.200 
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 161.914 

Supervised By: 

Certificate of Verification 

188 

SOIL 

2010-04-14 16:23 

30.47 

Final 

28414 

2403 N 18 st 

B2 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 18.873 
ijOL ^^•- ^\ Omahaa I Lea .. d Site—Fixed Price EP-R7-07-0 . _. __5 

Coastal Environmental Group Inc. vl ^ V • J? www.coastalhazmat.com 

Vp„ott<^ COASTAL iNTIIONHINTAL 

c 1 0 u r, IN C 

EXECUTIVE SUMMARY: 

BVID #28414-(2403 N 18 ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
4

SEPA 

EPA Property Close Out Form 

Property #: -^^.^( H Property Address:--—-—s—"Zi i ,-. <ii. *^ 

DatemiDc: l^y]IX0lO 

Quads Excavated: ? U g-^

 Contractor Group rf^,<^JX-C^ \ 

' / 

Excavation General 

Yes No 

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

' y ^ 

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

\ y ' 

Cradln£ Sod and VegelatioB 

Yes No 

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

from the house? U^ 

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

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

day time period) 

4. Are sodded areas generally firm and evenly graded? L^ ' 

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 propen>'? 

l y ' 

7. Was damage to landscaping or plant materials avoided? 

iy ' 

Gates. Fences and Retaining Walb Yes No 

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

t^^ 

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

3. Was damage to gates or fences avoided? (If applicable) C ^ ^ 

4. Was damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gatters 

Yes No 

I. Was damage to tlie siding or trim avoided? ^ y ' 

2. Was damage to the foundation avoided? U-' 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage to downrispouts or downspout extensions avoided? \A 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? ^ ^ 
OvYJoers comments: 

Inspection notes: 

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

EPA Representative L J/TK/L>^1 ^ Date: ^ y]h(]it) 
Property Completion Agreement 

Ihis agreement documents the completion ol remedial activities perroimed on my property My signature 

will designate that I am satisfied with the restoralion of my properly, and that no items are in questions, 

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

Property ID: ^ ^ t.-) j L.J 

Property Address: 2- M O" ^ ( ^ • ^2 , fsl"' 

0^ncr:^r/\(I A ^ "P^Ak . 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

ininiwaiiimniiiiii i i •! • ii i i'»iiiiin.wii i i^iiimia i 

Item: 

item: 

Item: 

Item: 

Additional Comments; 

J 

'^grcc restoralion is completed, except at noted 

[ J I do not «i;rec restoration is complelcri 

i j ^ ^-Ul-\0 S'&e^.^ ^^U{~fd 

tier's Signature Date Cunti arlor's Signature Dale 
^PR 2 9 2m 

Property Owner Assessment of PerformaiMje Purm 

American Recovery and Reinvestment Act (ARKPfjTenF(j/\|[) QI\/IQI ^ 

Omaha Lead Superfun Superfund d Site ^'o/(J/V' 

2009/2010 

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

Property Identifier Number: '2.&M i \rj 

Property Address: ^WD 3 M • J?^'^ -

Property Owner's Name; fVToai-l^. Vi^jtxlZ. 

Instructions to tlie Property Owner; 

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

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

to the Omaha Lead Site. This form documents the timeliness of punch list resolution, business 

relations, complaint resolution and the overall quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Performance Work Statement. 

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

work by cliecking a numerical rating on tlie table below using the nimierical 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 

9 ^ ^ 2r- ^ 4 

8 Isg^ 3 

7 2 

6 1 

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

Property Owner Signature: 'jiL ^ j,.u4^-( ^
EPA Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2009/2010 

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

Property Identifier Number: •g, ^ ^ / H 

Property Address: "ZJ-jCZ A/, i^^ -

Property Owner's Name: ^A^cxC-lQ^ .QJP.(KI< 

(Above information to be filled out by the remediation contractor prior to utilization by the EPA COR) 

Instructions to EPA COR: 

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

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

Omaha Lead Site. This form documents the timeliness of ptmch list resolution, business 

relations, complaint resolution and the overall quality of work. If need be, EPA may utilize this 

form to record problems and/or issues not specifically tied to an assigned address, for example, 

business relations that generally don't follow the guidelines set forfli in the Performance Work 

Statement. 

The COR will indicate his/her assessment of perfonnance with the contractor's work by 

checking a numerical rating on the table below using the numerical definitions fix>m the 

rating scale below, then sign & date the form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable' 

3-4 "pooi^' 

1-2 "very poor" 

EPA's Assessment of Performance Regarding the Contractor's Work 

< 4 

8 3 

7 2 

6 1 

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

EPA COR Signature