TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

' • ' • . - ' • • . • . • ^ 

SAID#:" / 7^^977 . . Date:' ^/s/^0 7 

Address: JlTk) ^ /jZ^nSCl^/n 

Remediation Contractor: Coastal Environmental Group_ Yean 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Z Video of property (DVD) 

Executive Summary 

y EPA-provided property sketch 

W Signed Access Agreement for subject property 

D Si^ed Access Agreement(s) for adjacent property 

W Restoration Agreement 

5r Settlement doctmients (i.e., for damage or to replace plants, etc.) 

rA Confirmation data 

Photographs be^Qne, ^ (JarinQ ) ^Q<n^ 3DMr,J ^ 

fl^ As-built sketch d 

V Satisfactory restoration signed by Property Owner 

^ - Property close-out check list signed by EPA 7/^2/^2^^ 

Q- Description of areas not meeting ROD cleanup criteria 

D . Utility clearances 

0 Property informationfix)m Douglas County Assessor's Office 

a C ^ 

^xJjTJy y^^^^^i^rX^ ^'/^/j^ 7 

Signature Date 

40317124 fllil 

ouperfund 
Property Access Checklist 

PropertylD: l']'7^[ ) D WORK STARTED ON: / /_ 

Property Address: ^M ^ HdnS/ > 0)}i ^^^/VAI n WORKCOMPELTED ON: / / 

0.yucr:.^ lO m 71^71)^ 1 M Renter: 

Address: 

Phone: ^^l^-I5i£ 0 

Fax: 

Cell/Pii)ier: 

D Notification Letter 

^ Access Agreement 

1 ^ Restoration Agreement 

C] Topsoil Sampling (ifapplicable) 

n Disposal Sampling (if applicable) 

n Garden Sampling (if applicalile) 

"SL Utility Clearance 

Q L Video/Photos (Before) 

CS'^ Video/Photos (During) 

S^Video/Photos (After) 

n Video/Photos (30-Day) 

CH Property Completion Agreement 

1 1 Final Report 

A ir Moniioring (as applicable) 

M Communit y LJ Crew O n :

Results: 

n Communit y \Z\ Crew O n :

Results: 

D Communit y Q Crew O n :

Results: 

Phone: 

Fax: 

Cell/Pajjcr: 

Additional Information: 

Sent: / / 

Signed: 5_/M/. ^ 

Signed: S iB^I U l 

1 1 

1 1 

1 1 

Called: 5" l3 0 lO l 

On: S - 1 ^ % 0-1 

On:_liL/ii/X)1 

On:_i£/Ji£/J)l 

On: / / 

Signed: / / 

Lssued: / / 

/ / By: 

/ / By: 

/ / By: 

Omaha Lead Site 

By: 

^yyJ?fS^'A/(^/Z05 

»•>'= fUZirco5 

By: 

By: 

By: 

^yy^/sh^y 

By: 0c y 

By= nA(^ 

By: (liOA. 

By: 

By: 

By: 
 Tota Total C^^Mnt Square Footage to be Excavated = 2635 

Property Classification: 800 Tot^^ J Zone Linear Footage to be Excavated = 51 ,%% h . l ( A 

Description of post excavation areas; F1, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

OZ. drip zone (1-3 foot area of soil around the foundation of ttie house). 
CONTACT FORM 

Property ID # iWo 

Property 

Address: MAytkiisdo/zi ^ y 

Initial Contact: Date: oJ^3/c7 Time: gg30 Action: l^ ^ \^r2oc.k^i 

Second Contact: Date:Jo Time: i^^o Action: ^1/^M^ HC& ^ 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: ^ 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

Villi Uv^h\ \\^ i \^ ^ "[- Pu^^^ fM/ir 
£Tt 

Consent For Access To Property 

RKHIT OF ENTRY TO PRFMLSHS 

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 perfomi certain environmental response activities upon the following descnbed 

preinises: 

Owner's Name: 

Daytime Phone: 

lA r>\ . Ui/J^^nr.JA v.)A 9V^ - /.y/.o 

Address: 2IPS ' y^ n <,&(y^ o) ( u<S> 

Address: 

Addresses of 

Properties covered by Address: 

this Agreement: Address: 

Address: 

PuRPosi: or Ri-:.sp()Nsi- ACTIVITII-S 

The EP.\ is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of arsenic and/or lead and may pose a health hazard. The soil 

will be removed and the excavated area(s) will be replaced with clean materials and 

restored. This work is being performed under the Omaha Lead Site Superfund Site 

remediation program. 

An EPA representative 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 fmished, 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. 

ENVIRONMFNTAI. Rr-.spoN.si.-: AcrioN.s 

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 pertbrining the work. This access shall remain 

in effect until the work has been satisfactorily completed The Grantor also agrees to: 

«Property_ID» Page 1 of 2 
•^KlBi^ 

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

piles, dog houses, etc; 

• Remove Hower 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; 

• 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 if EPA is unable to obtain such access; and 

• Allow videotaping and/or photography of the property including exterior and 

interior areas ofbuildings. 

AC.RI:I-:MI:N i' Nor To 1NTI:RFI:R[-: 

The Grantor agrees not to interfere or tamper with any of the activities or work done, or 

the equipment used to perform the activities, or to undertake any actions regarding the 

use of said property which would lend to endanger the health or welfare ofthe Grantees 

or the environment, or to allow others to use the propenv in such a manner 

Should you have any questions about this program, please contact 

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

y'l / r /4:£^Ly>^^^^i-n JAJ^ 

Signature Date y Signature Date 

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

Page 2 of 2 

«PropeL-r.y_ID: 
m^ 

Restoration Agreement 

The purpose of this agreement is to pro\ide a mutual agreement as to conditions of property prior to 

remediation aclivilies. This will also ser\e as decontamination for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property o\\ner and the United States 

Environmental Protection Agency (EPA). 

Properly ID: C^^^D 

Property Address: ')2c< r l4 •Aig ^co..'.— J3k 4 ^ 

Owner: 

e>v-»-^ [M./L >A~».A c^l f 

Phone: 

^e>7\ ^^( ^ ' l^f^C P 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used hv 

contractor, and ihc direction ofNonli. Indicate distances, depths, material t}pes. etc. Indicate digital phot.^s 

hv referencing the photo-log number VK ith an arrow indicating direction of\ iew. 

Items To Be Ramoved By Owner Before Start Of Re.T.ediatior.: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Ovvner's .'•sspcr.sibillty. 

Item: 

V>U/v>^^ .'/\ 'j>oU. I A^ v^-^wVO^ t^-X fi^MACItem: 

Item: 

Item: 

Item: 

Item: 

Page 1 o\Jl_ 
Items To Be Removed By Contractor During Remediation A 

(Use additional sheets as necessary) 

Item: 

A ll r>^^^-U t ^ ^/?,.-^^ -^^•n > 4-^ ^ {/yx^^WZ \ 

Item: r 

Item: \ 

Q -P 

j2i^ ^ ^vSll t9n..^V^«^r? /l/^>^. /2^-^tAv ?3 / i ^ Z 

item: 

4.\g/? ^ I CI/o9 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Paqe 2 of i / 
v^ 

Item 

Pre-existing property area 

that is covered with grass. 

Number of trees '• 2 inch 

trunk diameter 

« 

Number ol'troos • ^ 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Conlrol Valves, 

Timers. Heads, etc. 

Attach a skeich of the 

sprinkler lavout. 

Number of and size of 

each garden' flovser bed 

area. 

Attach a sketch of rclalive 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Specles 

Square feet 

. 

^Oo.<; C^%f4^^ ^ 

Each 

• 

llach 

^ 

i Each 

Each 

^6 0 Square Feet 

Page 4 of (/ 
v5r^ 

Item 

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. 

Agreed upon list of plant 

malerials that will be 

replaced by contractor. Be 

ver\' specific and delailed. 

Include a sketch of were 

each plant vsill be placed 

bv the coniracior. 

Area of Ciiv or Couiiiy 

propertv lo be landscaped 

per their requiremenis. 

Include a sketch o'l the 

area (s) 

Quantity Unit Condition/Type/Species 

Each 

GAAIJ^ ^C^-T^* ? 

'^^•^/^ ^ 

SF 

SF 

Paqe 5 of G 
Additional Comments / Instructions: 

© o 

[g^ec ^hecl 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. 

^ I s^srce I I I do not agree a"rec D I ag I I ! do not agree 

Am ^7^9 7o9­ Owner's Si<'tiiiturc Date 
Total Q' uare Footage to be Excavated = 2635 

Property Classification: 800 Tota Unear Footage to be Excavated = 51 

Dasafption of post excavation areas: F1. fiont yard let(4iancl quadrant F2. tnont yard ri^n-hand quadrant: 61. backyard left.tiand quadrant; 82. tiackyard fi^-hand quadrant: 

DZ. drip zone (1-3 Ibal area 01 soil around the foundation of the house). 
m 

:=!.CrEPT^ C:SAR.iNC= ACF.KS'-EET 

Date 

O(o\\io\a= Property ID h 

Property Project Omaha Lead -- Fixed Price Address 

Measurement XRF ID OICTT-^/ 

Count/Time 

Field Shots 

Sho t # Readin g Sampl e Are a Shot # 

24-^ ^ ^ 

•^5rn 

^ ^ f^Z <4-tr?' 

.^^<ry^ 6 A i?-ig' 

Sampl e Are a V7 i^'IU'^ 

I n Sit u 

Composit e Aliquo t 

Composit e Reading s Readin g 

Averag e (Bag ) (Bag ) 

jQb-

• ^ 

XRF Corrected Value --> 

(us

;C'».'

e

c

 calibratio

 tc va'uel 

r ct-zrt o- ic : Q? 

Sampl e Are a F^ 4-(n 

In Situ 

i Composit e ^^qJC t 

Ccrpcsrt e Reading s Readin a 

Averag e (Bag ) CBag) 

^ J _ 4Zu 

92 

iflO­ 'XRF Corrected Value -- > U^ (use calibratior. chart or cc c 

20'^c to value) 16 

Sampl e Are a fiA iZ'iU" 

I n Sit u 

1 Composit e Aliquo t 

Composit e Reading s Readin g 

Averag e (Bag ) fBag ) 

4- j I 

M

s 

4 

I XRF Corrected Value —> 

(use calibration chart or add 

'20 % to value) 5 

sample Area | \^ 2 U)-^ " 

In Situ Composite Aliquot 

Composite Readings Reading 

Average (Bag) 1 1 ^ ^ 

(Bag)

Confidentia l 

5/2/07 

* • 

JJ39Q 

.^o 5 1-W^.ircm RLO 

Reading Sample Area 

! 

i 

Pass/Fai l ? 

Composit e Analytica l Lab Analytica l (Drie d & Spil t Sen t Numbe r Result s Sieved ) 7 

Pass/Fai l ? 

Icmposit e Analytica l 

Lab , .'knaiytiCa! (Drie d & jSpiK Sen t 

Resii'tE Sieved l ! ? 

Pass/Fai l ? 

 | Composit e Analytica l Lab i Anaiytica l 

(Drie d & Spil t Sen t 

Number i Result s Sieved ) 

Pass/Fail ? 

 Composite Analytical Lab Analytical (Dried & Spilt Sent Number Results Sieved) 

C=- p • - ' T 
^ q^ w 3

XRF Co^Hk^Mu e --> 

(use caiiOTatio iliilrationn ch chart or add 

2 0% to value) 

Sample Area fA7\ i X } 

I n Situ Aliquot Composite Readings Reading (Bag) 1 

2 ZIZ 

3 i J l 

4 3-7 

XRF Corrected Value ~ > c (use calibration chart or add 

20O/fe to value) 

:C'".r,:c'ans S'sritu' 

Pass/Fail ? 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent Lab 

Number 

Analytical 

Results 

75 1 i| 

A /nZ ^ 

Confidential 
m> XRF DAILY CAUBRATIO N WORKSHEET 

^-^-nn\{in\Cr{ 

Project Omaha Lead — Fixed Price 

XRFIDQl^-^^-X^I 

Measurement Count/Time 

Calibration Verification Checks 

Reading Blank Low Med 

True Value 0.0 ppm 18.9 ppm 1162.0 ppm 

120% 22.7 pom 1394.4 ppm 

80% iS. l rem 929.6 ocm 

(Oin 

\npy) 

Precision Measurements 

Average 

Precision Measurement Check 

Replicate Blank Low Med 

1 q g n 

2 <?¥! 

3 [iCT) 

4 iCEn 

5 f250 

6 ) i m 

7 mn 

Mee'- :.'ve:-::=:i:G'-

Scancarc Deviaton 

Restive Sra.ncarc: De^'ict.on 

Re:s:ve S-.c~zi-z ZiJ izz ' -ess 

the- 20'"; 

Confidence Interval (5) .95--> -VALUE! 

Method Detection Limit rVALUE! 

Average Confidence Interval jrVALUE! 

High 

5532.0 ppm 

5638.4 ppm 

4^125.6 pom 

c^^/y-) 

^^? n 

High 

5 5 ^ 

.'=^17/) 

FBin 

mt) Wsn 

Qvn 

mn 

= VALUE' 
• • • • 

fit 

.-P" 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID #_ yv/b 

Property Address yios^ UAJ^^ CQ- n h> UA 

Owner Name J^m httirmn^t^f' 

Date C/H 167 

Comments 

Kr^^2.)T 4-if^ iZ y^^u.ih iJjc.y 7 ^ g ^ i 

Owner Signature 

Contractor Signature^^-^^H^A 
y^^ \ 

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

\ y 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVtItONMENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY: 

17990—2205 Hanscom Blvd 

No issues or concerns X Issues or concerns 

Detail Explanation: 

PO was compensated for flower beds that were removed during excavation with a gift certificate from 

Indian Creek Nursery in the amount of $350.00. 
As-Built Drawing 

COASTA t Omaha Lead Superfund " c 

Total Quadrant Square Footage to b« Excavated • 2635 

Property C»»««iCcJi>ion- 800 Total Dr<p Zonv Unear Footaflo to be Excavated « 51 

Alley 

Hanscom Boulevard 

,!^ f " ^ OLS#:17g90 

ty ^ Date Excavated:6/16/07 

'bate USEPA Signed Off-.7/2/07 

NorthArrow Omaha Lead Site 

Omaha. Nabraaica 

Propefty Number 

OLS-17990 

Scale 

» » »

PermarwcU Landscaping 

 F«nc* 

11rfcti > 20 feet or 1 grid > S x 5 ft Property Address 

2205 HANSCOM BLVD 

— — — OuadranI Boundary ^^•H v Post Excavation Concentrations (ppm) 

<Q>

Street Boundary 

 Tr««/Sh«ut> 

Fl . 

F2 

Bl 

B2

OZ

Cardan

 Play Area 

 Easement 

 Otttar 

Qu«»«n2 rj . ttont yard nj^.»»(wd qua^an r 81 ttackyw^ fc»«.h««l qsi»*.«rn 02 . oacltywtf n^tt-tMniS 9uwKar4. 

DZ. dnp x«n * (1.3 tool M«« of %o» mtotMid Vm ' 

Legend 

Area not: Exca\rated ^ Dripzone Excavated Quadrants Excavat«dl 

Contrac t #: EP-R7-07-05 Coastial Environmental Group Inc . 
m» 

Property Completion Agreement 

This agreement documents the completion of remedial activities perfonned on my properly. My 

signature will designate that I am satisfied wilh tlie restoration of my properly, and that no items arc in 

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

Pnipcrtv ID: n'y^o 

Pmpcrty Address: ^0 6 HzuwLZYi fblzrl 

Owner: -^om HinmjizX 

Plione: ?)^b- 15U0 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

^_J I iifii'cc restonition is (-oinpletc<l, except as noted 

 I I do not aprco i-estoration is completed 

7, A 67 21^7 

Owner'* Signature Date Contractor'.s Signature Date 

I
( ^ 

Omaha Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Wz^(ZfV\a,ij,f Ic nry\ 

Property Address g^<^s- ti ./^•^^c^cnr^ '(^i->\ 

Property Identification Number W'^'^C/ 

Material Removed Replacement Value 

Flower bed area ^ 3s-o.'° 

Trees 

Itemized 

shrubs/bushes 

Total %Sa. ^ 

The acceptance of the replacement certificate and the signature below is fiill 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ JSQ.*" has been received by the owner in the form of a gift 

certificate, #^^S ^ , to be utilized at ^v^.L.\^^ C/UAJC / ItA^/L'sc.d-'r • 

Property Owner's Signature Date Contractor's Signature Date 
SEPA 

"P A Property Close Out F^ i 

Property #: Property Address: 99D57kU%C0f n /3lz d 

Datc/TlBic: Owner's N.»e;-^^/? 7 /-^^ADMy^ y 

Quads Excavated: Contractor Group 

ExcavatioB General Yes No 

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

2. If necessa^, were the correct areas of drip zone excavated and restored? t-^ 

Gradinc Sod and VcfcUtion Yes !So 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away L-^ from the house? 

2. Hassodbeenlaidinallareasthatwereexcavated?^ ^/^^S^''^'^ ^ ''•^^ ^ri:P^ / ^ 

3. Does the wd appear to be generally healthy and growing? (OnK evaluate .f '.nspected at a 30 

day time period) 

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

5. AJT the joints between the sod strips generally tight? (Only esaloate if inspected at z 30 day 

time period) 

6. Was the property graded such that water will not pool on the prope'n ? ( ^ 

7. Was damage to landscaping or pla.nt materials avoided? l ^

Gates, FCDCCS aaa Rctainiot Waiis 

!. Do gates open and close freely? (Ifapplicable) 

^z 

Ves .No 

2. Were all gates or fences taken down during restoration aciiv ities rein siallec?

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

4 \*'a£ damage to retaining walls avoided? (Ifapplicable) 

 ,ifapplicable) y 

i / 

(y

1 

i 

Foundation, Sidiit and Gutters Ves No 

1. Was damage to the siding or trim s\ oided? i ^ 

2. W ^ damage to the foundation avoided? \ ^ 

3. Was damage to windows avoided? L ^ 

4 Was damage to windows or door screens avoided? ^ 

5. Was damage to downspouts or downspout extensions avoided? 

t^ ^ 

Sidewalks and Driveways (Concrete) 1 

1. Was damage to driveway surfaces avoided? A ^ 

\ n No 

2. Was damage to waUrway surfaces avoided? y 

1 

1 
Owners comments: 

Lnspecic oe,«. , Ur SZ ^3St> {Z f U ^ ^- ^ '^-^ ^ 

/^OfLckv 6J^d LOci^l^f ^<^ ^ 

Removal and restoration acii\ ates complete includir.e the 30-dav sod 'v^'arranr^'; 

EPA Representativ Date: 7 / <y yA^ 7