TRANSMITTAL of OMAHA LEAD SITE 

SOU- REMEDIATION FILE FOLDER 

SAID #: Date: I ^\z A (( 

Address: . "ZT^jl^ S^^O ^ ^^ ^ 

Remediation Contractor: ^Coastal Environmental Group^ Year: 2^7 7 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Jdr— Video of property (DVD) 

^ y 

G Executive Summary 

i y EPA-provided property sketch 

LLy Signed Access Agreement for subject property 

•E" Signed Access Agreement(s) for adjacent property 

L ^y^ Restoration Agreement 

-S— Settlement documents (i.e., for damage or to replace plants, etc.) 

Confiimation data 

As-built sketch 

^ Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

I—> Description ofareas not meeting ROD cleanup criteria 

y tility clearances 

Property information from Douglas County Assessor's Oflice 

/".N ^ 

^ ^ ^ 

ASQ^V '-^ ^ 

30261303 

iinmiMHi 

Superfund 
Property Access Checklist 

PropertylD; Ct\r:^i^^ 

PropertyAddress: ^ftU ^ S^^^g^)^ <,)r. 

n

D

 WORK STARTED

 WORKCOMPELTBD

 ON: / / 

ON:__/__/_ 

0^TM«^'^=i!L\nAtf\A ?A»i\d{AA

Address: -^ 

Phone: 402 . 0^^.130 0 

Fax: 

 r*5Y*nai*.viS<""«'-=

phone: 

Fax: 

Ccll/Pager: 

Additional Information: 

1 

Ccll/Pager: 

D

J[Q

0

D

D

IZI

^

D

Q

D

 Notification Utter 

 Access Agreement 

 Restomtion Agreement 

 Topsoil Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

Sent: / / 

Signed: iQ/gsL/l L 

Signed: JO AL/IL 

/ / 

/ / 

/ / 

Called: lO/ZjylL 

On: / / 

On: / / 

On: / / 

By: 

By:B.Muyrtt^ 

^y^UixftavA^ 

By: a 

By: 

By: 

By:3.U^<A 

By: 

By: 

By: 

D

D

1 D

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

On:

Signed:

Issued:

 /

 /

 /

 / 

/ 

/ 

By: 

By: 

By: 

Air Monitorine (as ai>plicablc 

O Community D Crew 

Results: 

On: / / By: 1 

D Community

Results: 

Q Crew On: / / By: . 

CD Community

1 Results: 

D Crew On: / / By: 1 

Omaha Lead Site 
IRTH One Call 

Page 1 of 1 

Diggers Hotlin* 

Of JXttl Nebraska 

Home Ticket 

Ticket Creation 

Logout 

Create Anotiier Ticket Go to Home Page 

Send Email 

• YOUR TICKET NUMBER IS 2883765 . i 

Original Call Date: 10/22/11 Time: 1:32 pm Op: WENDY187 90 


Work to Begin Date: 10/26/11 Time: 7:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2816 Street: SEWARD ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDING EASEMENT AND UP TO PEDESTAL 


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


: EMAIL ALL CLEARS TO: WLARA@COASTALGRP.NET 


: UNSURE OF CORNER LOT 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name WENDY LARA Phone: (402)991-1199 


Alt. Contact JOSE CARDENAS Phone: (402)504-0981 


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


COXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area 

Utility Service Area Name Contact Plione Numbers Code 

Type 

COXCATV 

COX COIMIVJUNICATIONS ELIVJCGX ELMCOX Day: (406)728 - 9343 

INC Alt: (406) 327 - 2936 

Emerg: (888) 728 - 9343 

LEVEL3 LEVEL3 COMI^UNICATIONS, LEVEL3 LEVEL3 Day: (877)366 - 8344 

LLC 

Emerg: (877) 366-834 4 

I^UDOl 

I^IETROPOLITAN UTILITIES SANDY MUDOl Day: (402)504 - 7823 

DISTRICT Emerg: (402) 504 - 7970 

http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=871108 10/22/2011 
N 20'1^^^^ ea/

G tSeuiard 67- Printed: Oct 28, 2011 A www.dcgis.org/dogis 
Wendy Lara ^n£ii 

From: agt_comm(girth.com 

Sent: Saturday, October 22, 2011 7:43 PM 

To: Wendy Lara 

Subject: Response to Dig Request 

To: COASTAL ENVIRONMENTAL SERVICE Attn: WENDY LARA 

Voice: 4029911199 Fax: 8776624211 

Re: Response to Dig Request 

This is an important message from Omaha Public Works replying to your request to locate our 


underground facilities in an area described on the one call center ticket. 


Ticket: 2883765 


County: DOUGLAS Place: Omaha 


Address: 2816 SEWARD ST 


OMAHACOF (Sewer): 


City of Omaha Sewer- No Conflict per info on the one call ticket 


OMAHACOF (Traffic): 


The City of Omaha Traffic Engineering Division has determined our facility is 


not in conflict with the dig site provided by the one call center. 


If you have any additional questions please contact Omaha Public Works. 


This message was generated by an automated system. Please do not reply to this email. 

Wendy Lara 3n^ 

From: I RTH. Net@qwest.com 

Sent: Monday. October 24, 2011 4:12 PM 

To: Wendy Lara 

Subject: Message from Qwest 

To: COASTAL ENVIRONMENTAL SERVICE 

Voice: 4829911199 

Re: Message from Qwest 

Attn: 

Fax: 

WENDY LARA 

8776624211 

Message from C^west 

Ticket: 2883765 


County: DOUGLAS Place: Omaha 


Address: 2816 SEWARD ST 


QLNNEIC: 


The described dig area of your locate request has been checked and is clear for 


(Jwest Communication's Local Network. If you have any questions please call 


Qwest at 1-800-283-4237. 


Message from (Jwest 


This message was generated by an automated system. Please do not reply to this email. 

Wendy Lara ^ \^ ^ / 

From:

Sent:

To:

Subject:

 IRTHNet@level3.com 

 Saturday, October 22, 2011 1:42 PM 

 Wendy Lara 

 Response to Dig Request 

To: COASTAL ENVIRONMENTAL SERVICE Attn: WENDY LARA 

Voice: 4029911199 Fax: 8776624211 

Re: Response to Dig Request 

This is an Important Message from Level 3 Communications replying to your request to locate 


our underground facilities in the area described on the One Call Center ticket. 


Ticket: 2883765 


County: DOUGLAS Place: Omaha 


Address: 2816 SEWARD ST 


LEVEL3: 


Level 3 Communications has determined our facilities are clear of the dig site 


described by your One Call Center ticket. Level 3 Communications will not 


have to locate any underground utilities at this dig site. If you have any 


questions, please contact Level 3 Communications at 1-800-441-0223. 


If you have any questions, please contact Level 3's Asset Management Team at 1-800-441-0223. 


This message was generated by an automated system. Please do not reply to this email. 

As-Built Drawing OLS#:91331 COASTAL DATE EXCAVATED:10/28/11 

DATE USEPA SIGNED OFF :11/09/11 

Environmental (iroup, Inc. AREA SODDED: 2250

Omaha Lead Superfund Site 

91331 

Exterior Patnt North Arrow/ 

I I Goo d 

Omaha Lead Site 

Site Sketch r~l Poor 

Samplin g Address : 2aijS SEyyARD^X_ [ Pj Not paint 

I 

Sample Number Lead Sample Samples Collected LAB Concentraflon Collected Firm: rO A /^VOg C 

RYASCPXA-91331 F1 / 3 ^ p pm • Dale uy t /r. ^ 

RYBSCPXA-91331 F2 / '^ 3 ppm • Time IO; IS A-^ RYCSCPXA-91331 B l 2. 1 Z . p pm Samples Analyzed RYDSCPXA-91331 B2 T 2 0 ppm • 

HDJOOPXA 01331 BZ 

ppm • XRF Unit: Cb G ^ Z . Book / 9 3 

ROZOOPXA 01331 C Z — ppm • 1=1 Date / / -^ ^ -0- 7 

nnaocpxA - P i oiaai — ppm • • Time 

Staff Number of Samples = ^ iWL 

Legend: F l = Front Left. F2 •• Front Right. B l = Back Left. B2 - Back Right DZ = Drip Zone. G Z = Garden, PZ = Play 

Alt quadrants are as viewed from th * atrattt, facing | 

CONCRETE DRIP ZONE EXCAVATED QUADRANTS EXCAVATED

AREA REPLACED WITH AREA LEFT BARE AREA REPLACED WITH SOD ROCK/MULCH 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
Q\mr 

rol^^l' ^ m^ 0 

91331 

Omaha Lead Site 

Site Sketch 

Sampling Address: 2816 SEWARD ST 

Sample Number 

RYASCPXA-91331

RYBSCPXA-91331

RYCSCPXA-91331

RYDSCPXA-91331

RDgOGPXA-01331

ROZGCnXA 01331

RP26GPXA 01331

Lead Sample LAB Concentration Collected 

 Fl ppm D 

 F2 ppm D 

 B1 ppm D 

 82 1 2 0 ppm i D

 B2 ppm D D GZ ppm D D PZ ppm D D 

Number of Samples -• ^ 

Exierior Paint North Arrow 

• Good 

• Poor 

[Pi Not paint \ 

Firm 

Date 

Time 

Samples Collected 

FDA ^V^-CC 

W 7(707 

{b'.iS a.1^ 

Samples Analyzed 

XRF Unit: 6>6HZ. Book: 795 

Date //-04 > -0 1 

Time A J± 

Staff fA^v7 

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

All quadrants are as viewed from the street, facing property 

Datvtvu -to kaYs. 

prc-eXccm p\cS­

^^ Ptir <^st- . yzyy^Ay 

(jiOftL (D- ^ 

Fl 

I3H \H3 

© 

\^ACK . 

5<w«r- ^ ST . R« CrfaltJ 9'll/3iXi7i.ii;55.:6 
%\^-^ ' u y

91331 

Omah Exterior Paint Nortti Arrow a Lead Site 

Sit • Good e Sketch • Poor I

Samplina Address: 2816 SEWARD ST [ g Not paint 

Sample Number 

RYASCPXA-91331

RYBSCPXA-91331

RYCSCPXA-91331

RYDSCPXA-91331

RDZOGPXA-01331

ROZGCnXA 01331

nPZCCPXA 01331

Lead 

Concentration 

Sample 

Collected LAB 

Finn: 

Samples Collected 

FDA ^W-CC 

 Fl 

 F2 

/3 M 

<M 3 

ppm 

ppm 

D 

D 

Date:

Time:

 1|///C> 7 

 ( b .' i S (X,tr^ 

 Bl 

 B2 

Zj- Z 

~I2 0 

ppm 

ppm 

D 

D Samples Analyzed 

 D2 ppm D n XRF Unit: GSHZ . Book: / 9 3 

 GZ 

 PZ 

ppm 

ppm 

D 

D D 

D 

Date:

Time:

 / / -ak )

 f\ H 

 -0 1 

Number of Samples = l \ Staff: y^Su / 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

m •tf r-'.r •f> O -•7 ; 

L, l i U / 

u I a 

Z/Z 

61 

vy 

)3H IH3 

(77 

v^A<Lk r 

5 € vvi«r^ . .S4 . Created, 9'll/2i: Xni.ii! ?5,2() 

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91331 

Exterior Paint Nortti Anw» Omaha Lead Site 

• Good Site Sketch 

n Poor 

Samplinq Address: 2816 SEWARD ST ( 2 Not paint } 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collectejd Fim,: FD A ^\AJ-CC 

RYASCPXA-91331 Fl _L3Ji _ ppm D Date: 11/// 6 7 

RYBSCPXA-91331 F2 _LiL3 _ ppm D Time: ( b 115 CU^ 

RYCSCPXA-91331 Bl ppm D Samples Analyzed RYDSCPXA-91331 B2 ppm i 

RDZOOPXA-0ia31 BZ ppm n XRF Unit: GiSHZ^ Book: /9 3 D ROZOOPXA 01 oai GZ ppm D Date: 11 'tjL'/ n D nPZCCPXA 01381 PZ ppm D Time: M 

n D Staff: AlSu / Number of Samples = i l \ 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed frem ttw 8treet.racin g property 

EINTEEED'. ./TK; • 

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12. 0 

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**«»not** 

Con$<?rd im Access To Pfop&rtj' 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consenls to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner's Name: Daytime Phone: 

ALLJAIOCI: TSiD^: cctAii/\/tJ^iy 

Address of Property 

covered by this 

Agreement: 

LSik—^ &uyAtLO ^ 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be perfomned, 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 Agreemenl, 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 
COfcSVfcl m-vitoawiititi 

6 1 o v*t in t 

* Remove obstructions including l>oats, trailers, vehicles, playscape ftems., vcood 

piles, dog houses, etc; 

• Remove flovi^r bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

« Water and maintain leplacement vegetation, including fertilizer application, as 

necessarj' subsequent to an inrtial watering period by EPA; 

« Abide by health and safety guidance provided by EPA; 

« If the property is rented, assist EPA in obtaining lenanl approval for access to 

the property to perform the work. 

« Allow videotaping and/or photographing of the property. 

AGREEINENT 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 lo use the property in 

such a manner. 

Should you have any quesiions about this program, please contaci Coastal 

Environmental Group, at (402) 991-1199 

^ 1 I grant access to my properties

 Q I do not grant access to my properties 

TJ-l l 

Signature Date 

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

Page 2 of 2 
VJ 

COA S T A L 

Restoration Agreement 

The purpose of this 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 111: <-^1^ [ |3^ 1 )

Property Addrenn: -^^/ ^ ^OU^.'O L 

Owner: Ur,7_'U/L ^<i„ ^

: '^lo2^'^/l^.^<hr^ 

Phone: ^;fc?2. "^(l"- "Z"}*^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

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

Item: 

^6>o e 

Item: 

Kem: 

Kem: 

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

Item: 

o/vr 

Item: 

Item: 

Item: 

Page 1 of. 
kl 

COA S T A L • NVIRONHB N T A L G • O U F . INC . 

Items to Be Removed By Contractor During Remediation and Reolaced 

Item: 

sS^S.t> 

Kem: 

^£>2' U 

Item: 

Item: 

Item 

Pre-existing property area, 

that will be excavated, tbat 

is covered with grass. 

Number of trees > 2 inch 

tnink diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Nimiber 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 

Landscape Inventory 

Quantity Unit Conditionn'ype/Species 

Quadrants 

h7 

F,nch 

A)M 

/ 

Each 

/ 

A Each 

Each 

^ Square Feet 

f $ 

Fach 

yso 

Page 2 of. 
vs 

COA S T A L • NVIKONHBNTAI . GROUP . INC . 

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 Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may l>e 

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 t>e cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removal or replacement of soil by the EPA 

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

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

n Please check this liox if you understand the information outlined above. 

[ ^ 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. 

Q I do not agree 

}o7'zi/ii 

iaia I Date 

Page 3 of. 
# 

BVID# 7/J3 I 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRF ID# 

Shol« 

/ l i 

/?3 

ll' i 

Average

Shot# 

Average 

Shot# 

Average 

Shot# 

Average 

Signature_ 

Pm\ / J

H-s--n Address 

Omaha Lead ARRA Sample time 

sample length JIOl-TReading Sample area Shot# 

LIZ'^ITL m i l ^ 

t^tlz- b Depth in 

ZTl'i^^^O 7" IIK. 

 270-0 — Z-6> Average 

Reading Sample area Shot# 

Depth 

Average 

Reading StmBliiarea Shot# 

.feeftitv 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

 f c ofO-S Lor7& ^ ^ 

Zf?{G Savj^r l ^- t 

am/pm 

30 sec 

Reading Sample area 

sytiL T7r~ 

Depth ^fltiz- BHtl l / 

Sltl L 

Reading Sample area 

Depth 

Reeding Sa'rripie area 

. .e<rptb 

Reading Sample area 

Depth 
o 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 135 

Mode Soil 

Time 2011-11-05 09:12 

Duration 91.00 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

AVERAGE Avg of 132-134 

ADDRESS 2816 seward st 

QUADRANT B2 

DEPHT 4" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE confirmation 

Pb 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 222.668 

Supervised By: 

Certificate of Verification 

132 

Soil 

2011-11-05 09:11 

30.19 

ppm 

2 

Final 

91331 

2816 seward st 

B2 

4" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 22.874 
SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 232.594 

Supervised By: 

Certificate of Verification 

133 

Soil 

2011-11-05 09:12 

30.24 

ppm 

2 

Final 

91331 

2816 seward st 

B2 

4" 

N. LOPEZ 

confirmation 

confirmation 

Error 

± 23.183 
Oi©E°Enrti® 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 224.075 

Supervised By: 

Certificate of Verification 

134 

Soil 

2011-11-05 09:12 

30.57 

ppm 

2 

Final 

91331 

2816 seward st 

B2 

4" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 20.428 
c 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

139 

Soil 

2011-11-05 09:15 

91.38 

ppm 

2 

Final 

Avg of 136-138 

2816 seward st 

EA 

1" 

N. LOPEZ 

confirmation 

confirmation 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 57.530 

Supervised By: 

Certificate of Verification 

136 

Soil 

2011-11-05 09:14 

30.52 

ppm 

2 

Final 

91331 

2816 seward st 

EA 

1" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 12.188 
SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 43.516 

Supervised By: 

Certificate of Verification 

137 

Soil 

2011-11-05 09:14 

30.29 

ppm 

2 

Final 

91331 

2816 seward st 

EA 

1" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 12.658 
SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 54.045 

Supervised By: 

Certificate of Verification 

138 

Soil 

2011-11-05 09:15 

30.57 

ppm 

2 

Final 

91331 

2816 seward st 

EA 

1" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 11.935 
i^^A^\ Omaha Lead Site—Fixed Price EP-R7-09-06 

8 ^^^ y I Coastal Environmental Group Inc. 

Vf^^J f www.coastalhazmatcom 

^^tPHOi*'^ COASTA L IHVItONMINTAL 

C • O U P, IH C 

EXECUTIVE SUMMARY: 

BVID #91331- (2816 SEWARD ST) 

~x| No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
Property Completion Agreement 

I'liiS agreemenl documenls the complciion of remedial aciivmes perloimed on my properly. My signature 

will designate lhal I am salisfied with Ihe restoraiion of my properly, and lhal no items are in questions, 

now, or al any lime in the fuluie, excepl those Hems listed below, ifany 

Property ID: ^^^^ | 

'''^"P^"^^''''^""!^^ 5(Hi\yc^ >V 

Phone: H02,

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Restoration Items in Question: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

pCJ 1 aj;''"^ iwtorniion w complcied, except as noieri 

[_J I rto nnt aurec resioration is completed 

on.-if 

-07'it 
SJfiLf 

EPA Property Close Out Form 

Date/rime: \ \ Quads Excavated: 

Contrsctor Croup fa/l<4fO . -&3^ 

Excavation General 

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

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

Gradlpg Sod and VegelatioB 

1. Does lhe grading around the perimeter ofthe house in excavated areas generally slope awfay 

from (he house? 

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

J. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected at a 30 

day time period) 

A. Are sodded areas generally firm and evenly graded? 

5. Are the joints twtween the sod strips generally tight? (Only evaluate if inspecied at a 30 day 

time period) 

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

7. Was damige to landscaping or plant materials avoided? 

Gates, Fences and Rctoinlng Walls 

1. Do gates tipen and clo.^e freely? flf applicable) 

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

.1. Was damage to gates or fences avoided? (Ifapplicable) 

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

Foundation, Sidiag and Gutle n 

1. Was damage to the siding or trim avoided? 

2. Was damage lo the foundation avoided? 

3. Was damage lo windows avoided? 

A. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions ovoidcd? 

Sidewalks and Driveways (Concrete) 

>. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

y 

Yes Mo 

/ 

y 

y 

y 

y 

y 

7 

Yes N(^ 

7 

y 

/ 

y 

Yes No 

/ 

/ 

/ 

/ 

/ 

Yes No 7 

/ 
Oft'oers cominents: 

In.<pect56n notes: 

I.-

Removal and restoration aclivales complete including lhe 30-day sod warranty: 

F.PA Representative 9 ^ ' ^ D^g. ^\\^^\'^ 
"> 7 0 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

Omaha Lead Superfund Site 

2011 

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

Property Identifier Number: Q \ 331 , , 

Property Address: f.^p p 5^ll>ar d ^ . 

Property Owner's Name: f^\)iai\[ p ^\xi\.d\f\e \ ^mvAWts.^ ^ \ 

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

Instructions to the Propertv Owner: 

This form serves to record the Property Owner's assessnient 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 ptinch list resolution, business relations, complaint 

resolution and the overall quality of work. If need be, the Property Owner may utihze this form to record 

problems and/or issues not specifically tied to an assigned address, for example, business relations that 

generally don't follow guidelines set forth in the Performance 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 de^nitions 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 —j!:^ ^ 5 

9 4 

8 3 

7 2 

6 1 

X 

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

Property Owner Signature: i\iii4^'^^^---- n'^'^^'