TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: Orun- ^ Date: \h\7Ji^{C^ 

Address: \? ^ *^. 7 6 S\ 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video ofproperty (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 m-bYCe{/Ar\^ , f)<^ATltfn ^ V * H

 As-built sketch 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Description ofareas not meeting ROD cleanup criteria 

 Utility clearances 

 Property information from Douglas Coimty Assessor's Office 

 4-^ 

D 

D 

^ccmm J^^^' ^

Ignature 

30054541 

I 

Superfund 
il 

Property Access Checklist 

Propert, ID: 2 0 Hl ^ 

Propert, Address: V2^Q q ^ -2 6 <SV 

D

D

 WORK STARTED 

 WORK COMPELTED 

ON:

ON:

 /

 /

 / 

/ 

O^vnci: 1 ^ ^^ ^ / { Y^ ^ ejrSOY ^ 

''''^''••'baYY\ l 

Phone: ,^M6'^12 g 

Fax: 

Renter. 

Phone: 

FtL\: 

Cell/Pager: 

Additionul Infonnation: 

Ccll/Pager. 

D Nodfication Letter 

O ^ Access Agreement 

( \ ^ Restoration Agreement 

O Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

Q Gnrdcn Sampling (if applicable) 

0 ^ Utility Clearance 

| S Video/Photos (Before) ^o^e^ W 

0 Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

Q Property Completion Agreement 

Sent: / / 

SIpicd: L' / Lb l ^ 

Signed:,^ / lO / ^ 

/ I 

1 1 

1 1 

Called: (/ IVL /C^ 

On.^lJ^jSJf 

On:^/^/j ^ 

On: / / 

On: / / 

Sipicd: 1 1 

By: 

By=fc.C. 

By: 

By: 

By: 

By: 

By:eC 

By: AJlcK. 

B.v: A * C ^ 

By: 

By: 

By: 

D Final Report Issued: / / By: 

Air Monitorine (as applicable 

D Community D Crew 

Results: 

On: / / By: 

D Communitj'

Results: 

D Crew On: / / By: 

D Communitj

ResulU: 

• Crew On: / / 1 

Omatia Lead Site 
^ # 

CONTACT FORM 

Property ID U ^^^n ^ 

Property 

Address: l^QC^ 5 2 S ^'^ 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Dale: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

(i 
Douglas Coimty Account Infi ^"9^" Page 1 of2 

Douglas County, Nebraska Property Record - R2219500000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie (5! scale 0-50 ft west of 52nd St - Vie w O n Ma p Inforrnation is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature •* •¥ ^ Auto Sales Search 

Owner 

ANDERSON MARY D 

1309 S 25 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1950 OOOO 22 

Account Type: Residential 

Parcel Number: 2219500000 

Parcel Address: 1309 S 25 ST 

OMAHA NE 68105-0000 

Legal Description: SHULLS 2ND ADD LOT 20 BLOCK 12 N 1/2 25 X 126 

Value Informatio n 

Land Improvement Total 

2009 $3,600.00 $33,500.00 $37,100.00 

2008 $3,600.00 $33,500.00 $37,100.00 

2007 $3,600.00 $33,500.00 $37,100.00 

2006 $3,600.00 $33,000.00 $36,600.00 

2005 $3,600.00 $33,000.00 $36,600.00 

2004 $3,600.00 $33,000.00 $36,600.00 

Saies Informatio n 

Sales Date: 2002-05-29 

Deed Type: QC Bodk: 2004 Page: 008982 

Price: $0.00 

Grantor: Lawrence S Anderson 

Grantee: Mary D Anderson 

Valid/Invalid: Invalid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Oeptfi Width Vacant 

0.07 3150.0 1.0 126.0 25.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinft).jsp?accoimtno=R221... 6/6/2009 

1 
Douglas County Account Inf'oj^ i " Page 2 of2 

Building 1 

ae 9aa>Ptiaott 

,20 fgiS c 

nsr 

Bnt Floor t i o 

SeO.O M|. «L BO 

3»D 3 = ^fS' ^ 

6 0 

110 

1 1/2 STORY FINISHED 

5a:>oti) t Tr. Bsmrt fM* mcl ri Tn LK XKBt f. 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 832.0 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: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Plaster Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

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 

1890 0 0% 1890 119 

Detail Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 560.0 

Basement Minimal Finish 200.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 240.0 

Porch Encl Solid Wall 240.0 

Porch Slab Roof Ceil 160.0 

Porch Slab Roof Ceil 160.0 

User Attic Full Finish 272.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfi3.jsp?accountno=R221... 6/6/2009 
http://www.dhoi n^^jgii ntemet/DHONNoticeCreation/MessageTexL.. 

Create Another Ticket Back to lith Intemet Send Email 

YOUR TICKET NUMBER IS  2300182. 

Original Call Date: 6/22/09 Time: 12:52 pm Op: ELIZABETH187 90 


Work to Begin Date: 6/24/09 Time: 1:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1309 Street: S 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Leam Remediation 


Location of Work: INCLUDE ALL EASEMENT. LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: Coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number 

Utility 

lype 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Ah: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Ah: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES 

DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day: 4024447197 

 Ah: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 


lof 2 6/22/2009 12:52 PM 
http://www.dhoa^M|hintemet/DHONNoticeCreation/MessageText.. 

% 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA Ah: 4062071494 

Emerg: 8887289343 

2 of 2 6/22/2009 12:52 PM 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

20473 

Omaha Exterior Paint North Arrow Lead Site Owner Name: MARY D ANDERSON 

Site Sketch • Good Address: 1309 3 25 ST • Poor Phone: H: 402-345-8728 W: 402-342-1074 

[^'-Tlot paint 

Samples Collected 

Firm: _ ^f'<c,c^ - / y y 

Date: . 6 yjy< o Y 

Time: 

Samples Analyzed 

XRF Uni t: &l-2 ^ Book: 5*2 -

Date: . •7//sy^tY- Time: _ /^y ^ 

Staff: . £P'^P'7*^ 

Legend 

Concret e Drip Zone Excavated Quadrants Excavated 

Azea replace d wit h D Area replace d wi1:h 

Area lef t bar e Sod Rock/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 

46130 
20473 

46130 

'puS"<-vM- C ^ 
^ 

20473 

Omaha Lead Site Owner Name: M/kRY D ANDERSON 

Site Sketch Address: 1309S^25^T 

Phone: H: 402-345-8728 W: 402-342-1074 

Sampl Lead Sample e Number 

I

I 

LAB Concentration Collected 

RYASCPXA-20473 F1 ppm D 

RYBSCPXA-20473 F2 ppm D tol 

RYCSCPXA-20473 B1 ppm D 

RYDSCPXA-20473 B2 ppm D 

RDZSCPXA-20473 DZ 5io ppm D 57/ R62SGP>(A=2IM73- -02- ppm D 

RPZSCPXA-20473 PZ -y^^S ppm D 

Number of Samples = 

Exterior Paint North Arrow 

• Good 

• Poor <e 

[3'l^t paint 

Samples Collected 

Firm: ^y<^ - T^Y " 

Oate: 6 ^J/£> Y 

Time: 

Samples Analyzed 

XRF Unit: &i' ^ Book: S ^ 

Date: ^ A S/ ^ ¥• 

Time: /^/y 7 

Staff: joy^r?^ 

Omaha Lead Site 46130 

'puS"-<-'W\ t^»4 
20473 

Omaha Lead Site Extsrior Paint htortt) Arrow r Owner Name: MARY D ANC^RSON 

Sit • Good e Sketch Address: 1309 S 25 ST 

< - Phone: H: 402-345-8728 W: 402-3C-1074 

rZk^rot paint 

Sample Number 

RYASCPXA.20473 Fl 

RYBSCPXA.2D473 F2 

RYCSCPXA-20473 81 

RYDSCPXA-20473 82 

RD2SCPXA-2D473 DZ 

R6EB6PXA=2W73 OfRPZSCPXA-20473 PZ 

Lead Sample 

Concentrafion Collected 

ppm 

ppm 

ppm t

i 3 7/ 

ppm 

5"/ ^ 

ppm 

ppm 

'UYfi^S ppm D 

Number of Samples — 

LA8 

n 

n 

D 

n 

D 

D 

n 

Samptes CoUected 

Firm: <^^fe^ - '7~^y^r 

Date: 6^^Ye>Y 

Time: 

Samples Analyzed 

XRF Unit ig/* ^ Book: 5" ^ 

Time: 

Staft JC^^TTTi 

ENTERED 

JOK tf 7 2004 

/ 

f 

/ : 

fii.Y 

Cr'T^ 

Kh 

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Omaha Lead Site 46130 
i-^' 

COASTA L ENVIKONHENTAL Vp„o^<i^ CIOUP . IHC . 

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: 

Owner's Name Daytime Phone: 

Mlntrq

4 firvlQ/y^T^A 

Address of Property 

covered by this 

Agreement: /^.^^q^. 2^. ^ 

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 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. 

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 perfomning the work. This access shall 

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

agrees to: 

Pagel of2 
o' 

f

V"**!** M' • COASTAL * J ^

 _. ^ tN»l«OHHtNTAl 

•' I PBO^* CIOUP . INC . 

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

piles, dog houses, etc; 

• 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; 

• 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. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

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

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

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

signature (yOate Signature

 Date 

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

Page 2 of 2 
C O A S S'.A L 

G n o u t 

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 Environmenta] 

Protection Agency (EPA). 

Property ID: 2JC^'^ ^ 

Property Address: |a^ q ^ 2 ^ ^ T 

Owner: U^^^ X C\vHerS^ n 

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 ofthese items is the Owner's responsibility. 

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

Item: 

^v^k %nrM ph/i-h' ut^p/t tip.kifn(i 

Item: 

Item: 

Item: 

Pagel of. 
C;^OiA S T A L IMVinONM f MTAl . C M O U P . IN C 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

-g^il - •&> -^'D? 

Item 

Pre-existing property area, 

that will be excavated, thflt 

is covered whh grass. 

Nuinber of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Numl>er of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Atiach a sketch of the 

sprinkler la\oui. 

Number of and size of 

each garden/ flower bed 

area. 

Auach a skL-tch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this \aliie <vill be 

used to issue a plant 

voucher to the propcrt\ 

owner. 

Easement Area, to be 

excavated 

Quantity 

% 

^ \

v^ 

^^o 

^ \ ^ 

V\^ 

vfes 

Landscape Inventory 

UnK 

Quadrants 

Each 

Each 

Each 

Each 

SquareFeet 

$ 

Condition/Type/Species 

'perPUhcL t2Q^^»vi^H 

Each 

Page 2 of. 
COASTA L 

a n o u ' , IN C 

Additional Comments / Instructions; 

G Check the box if Owner does not want CEG to document interior foundation wails 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. 

Ml agree G I do not agree 

>~ . >o 'o^f ZC&JiiXso lJfo/0^ 

Owner'^ignatu re Date Contractor's Slenatare Date 

Page 3 of. 
Date 

Project 

XRFID# 

Shot# 

H?.M 

tf*) ^ 

M?.l* 

H?*! 

Average

Shot# 

M 7 1 

u T V 

M1i-\ 

Mn«> 

Average

Shot# 

Average 

Shot# 

iiii. JllT. H??1> 

^ ^ M 

Average 

lab sample # 

BviD# 2nM7 3 

XRF PROPERTY SAMPLE SHEET 

u-xv^-nq Address iTipq •& -2.6 T.A 

Omaha lead FP 2nd year opilon Sample time am/gQ t^^^^ ^ 

?i2C^%<\ sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

2H<».64tl«.M HHH HH.T&t\M.%\ 

2%e.1«l 18 14 ^•*^ ' HU5 2Vo.'\'l+ n.w ^V 

n.^^l^ + \^.^^ Depth H^V^ \*a.«\-lltu.^ T Depth 

151*.c, 4 li.i- ^ \ 44 T V\ \ VM. 1%.*^ ^ 

 2'%'^ ?> t >% • 2.8 Average l^^H.^-S ± n OZ 

Reading Sample area Shot# Reading Sample area 

•sn.TJ: Xi.o«» 

•^rj-).*!!! x\. M UixJ 

57*1. ^^Sl Zfr.n Depth Depth 

Hl*1.7H+lun i \ 1 

 m5.1) % 1 2M.5 Average 

Reading Sample area Shot# Reading Sampie area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

S(,.Mltl\&.2H CmZ/ -rt.ai i u.D<^ 

l^^.<^^|fe••b^ Depth Depth 

1^.L.-<\.XM 15 

Ua^%__x \\ .q^ Average 

Lab result Sample area XRF Avg. 

Signature FeCt^mA 

Print ?!i\naMh Cacdfe^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 438 

Mode SOIL 

Time 2009-06-26 14:47 

Duration 121.12 

Sequence Final 

Flags 

AVERAGE /Avg-of3C@337D 

ADDRESS T:30 9 S 25 st 

QUAD/ZONE easement 

INSPECTOR nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb \235.293\ ± l l 8^275 

Supervised By: ^^CQiSli^CiA 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 249.538 

Supervised By: 

Certificate of Verification 

434 

SOIL 

2009-06-26 14:44 

30.26 

Final 

20473 

1309 s 25 st 

easement 

nicolas 

1 

CLEARANCE 

Error 

± 18.888 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 230.778 

Supervised By: 

Certificate of Verification 

435 

SOIL 

2009-06-26 14:45 

30.28 

Final 

20473 

1309 s 25 st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 18.242 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 223.960 

Supervised By: 

Certificate of Verification 

436 

SOIL 

2009-06-26 14:46 

30.27 

Final 

20473 

1309 s 25 st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 17.742 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 236.897 

Supervised By: 

Certificate of Verification 

437 

SOIL 

2009-06-26 14:47 

30.31 

Final 

20473 

1309 s 25 st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 18.229 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 

Certificate of Verification 

448 

SOIL 

2009-06-26 16:33 

121.38 

Final 

1309 s 25 st 

Bl 

nicolas 

6 

CLEARANCE 

Error 

{JMI S 

Supervised BrL2CMm^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 144.779 

Supervised By: 

Certificate of Verification 

444 

SOIL 

2009-06-26 16:31 

30.26 

Final 

20473 

1309 s 25 st 

Bl 

nicolas 

6 

CLEARANCE 

Error 

± 14.809 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 210.316 

Supervised By: 

Certificate of Verification 

445 

SOIL 

2009-06-26 16:32 

30.56 

Final 

20473 

1309 s 25 st 

Bl 

nicolas 

6 

CLEARANCE 

± Error 

± 17.808 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID# 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 182.971 

Supervised By: 

Certificate of Verification 

446 

SOIL 

2009-06-26 16:33 

30.31 

Final 

20473 

1309 s 25 st 

Bl 

nicolas 

6 

CLEARANCE 

± Error 

± 16.568 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 241.240 

Supervised By: 

Certificate of Verification 

447 

SOIL 

2009-06-26 16:33 

30.25 

Final 

20473 

1309 s 25 st 

Bl 

nicolas 

6 

CLEARANCE 

± Error 

± 18.901 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 476 

Mode SOIL 

Time 2009-06-27 10:38 

Duration 120.31 

Sequence Final 

Flags 

AVERAGE AAVTO F 4Z2=4J5^ 

ADDRESS ^1309 s 25 st 

QUAD/ZONE DZ 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

± Error 

Pb ± /24:492J3 

Supervised By: 

ppm 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 311.702 

Supervised By: 

Certificate of Verification 

472 

SOIL 

2009-06-27 10:36 

30.05 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

± 21.093 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 307.408 

Supervised By: 

Certificate of Verification 

473 

SOIL 

2009-06-27 10:37 

30.10 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

± 21.323 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 579.645 

Supervised By: 

Certificate of Verification 

474 

SOIL 

2009-06-27 10:37 

30.11 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

± 28.822 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 462.744 

Supervised By: 

Certificate of Verification 

475 

SOIL 

2009-06-27 10:38 

30.05 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

12 

CLEARANCE 

± Error 

i: 26.731 
f 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 485 

Mode SOIL 

Time 2009-06-27 11:06 

Duration 120.93 

Sequence Final 

Flags 

AVERAGE Avg of 481-484 ^ 

ADDRESS T309 s 25 sr^ ^ 

QUAD/ZONE DZ 

INSPECTOR nicolas 

DEPTH 15 

SAMPLE TYPE RETEST 

NOTE 

ppm Error 

Pb ^^1.985 

Supervised By: feC0Jmm 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 56.410 

Supervised By: 

Certificate of Verification 

481 

SOIL 

2009-06-27 11:03 

30.14 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

15 

RETEST 

± Error 

± 10.243 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 71.919 

Supervised By: 

Certificate of Verification 

482 

SOIL 

2009-06-27 11:04 

30.11 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

15 

RETEST 

± Error 

11.085 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 147.965 

Supervised By: 

Certificate of Verification 

483 

SOIL 

2009-06-27 11:05 

30.33 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

15 

RETEST 

± Error 

± 15.370 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm

Pb 75.630

Supervised By: 

Certificate of Verification 

484 

SOIL 

2009-06-27 11:06 

30.35 

Final 

20473 

1309 s 25 st 

DZ 

nicolas 

15 

RETEST 

± Error 

± 11.242 
# 

^••''"'•^'*! , 

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

8 ^^^ ^ a Coastal Environmental Group Inc. 

V^^^rj ? www.coastaIhazmat.com 

'^tpRoi*'^" COASTA L INVIIOHNINTAl 

GROUP . IH C 

EXECUTIVE SUMMARY: 

BVID # 20473 - (1309 S 25 ST) 

X No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

Owner claimed Coastal cracked her sidewalk in the backyard and after reviewing the preexcavation photos Coastal determined that the damages were pre-existing. 
0 § 

Water Bill Settlement 

Property ID 20473 

Property Address 1309 S 25 ST. 

Tenant Miss. Mary D. Anderson 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 21.41 for 

water usage required to maintain the sod. 

Check Number 1712 

Value of Check $21.41 

Made Out To Mary Anderson 

Description of Settlement 

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

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

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

Environmental Group inc. from further obligations or liability. 

A7^/-^^^^'^-^-»^ tO-^-O y F^O/JLtJ^nh lojnirf) 

Owner's Signature Date Contractor'ss Sienatur Signaturee Date

" I I,. " H J =wr5* T T -^'•4'^:.'••'?'^!JI>!^!.1!^}!-'^'^v 

COASTAL ENVIRONMENTAL GROUP INC. 1712 

2411 MARTHA STREET 27-6/1040 003 OMAHA, NE 6810S 6247372904

^ Kl I o^ 

PAY TO THE 

ORDER OF. 

Um ^"im^ 

DATE 

IWfotft] OK 

VMIi Fargo BtnkNA 

Nibmk i 

wH1sfirgo.CDni 

FOR 

iriouoooosai: &21.737E^OUM-'^OI?is 
w % 

^ EPA 

EPA Property Close Out Form 

Property #: "ZCM ^ Property Address:- \^r A ?^. 7rfS ^ •.>-

Datc/Tlmc: Owner's Name:. /JS/JQ ^ Qt^OOTfifin . 

Quads Excavated: ' ^ PZ. Contractor Group ClTcHMkX V'-YWi^f/ytfiVnt^ 

Excavation General 

I. If necessary, were the correct quadrant(s) excavated and restored? pf 

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

y 

CmdlBg Sod and VcgetatioB 

Yes No 

I. Does the gradrng around the perimeter of the house in excavated areas generally slope away ^y from the house? 

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

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? 

5. Arc the joints l>etween 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 propeny' 

7. Was damage to landscaping or plant materials avoided? -:3^ 

Gates, Fences and Retaining Walls 

Yes No 

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

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) w^ 

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

l y ' . _ ^ 

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

Foupdation, Siding and Gutters 

Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 2: t^ 3.

 Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) Ves ySo 

1. Was damage to driveway surfaces avoided? 'vt 

2. Was damage to walkway surfaces avoided? V­
F % 

Owners comments: 

Inspection notes: 

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

EPA Representaiive iUw i UQJVIJL ^ DaXt.S 1 3 0 ^ 
«i 

Property Completion Agreement 

riiis agreemeni documenls the completion of remedial activilies performed on my pmperty. My signaluie 

will designate lhat 1 am salislied wilh the restoration ofmy property, and that no items are in questions, 

now, or at any time in the future, excepl those items listed below, ifany. 

Property ID: ^.CH^ B 

Property Address: \2NrCi ^ '7«'& S T 

^'"'"- NAara V\YY\a&on 

Restoration Items in Question: 

Item 

Item: 

Item 

Item 

Item 

Item: 

Additional Comments: 

-d>L.A«/»U4. (yyi Int^cA tptyt J COL. (yiyjuf^U ^ f {yiy^-A-^h\y 

J 

L J I agree re<itorntton i.s completed, except as noted 

 I I cto not agree restoration is completed 

Owner's Si];i/aturo Dafc Cohtriictor's Signature ' Date 

I
Water BIII Settlement 

Property ID 20473 

Grceyv 

Property Address 1309S2SSt 

Tenant Mary D. Anderson 

I have received fiom the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $ 27.62 for 

water usage required to maintain the sod. 

Check Number 1825 

Value of Check $27.62 

Made Out To Mary D. Anderson 

Description of Settlement 

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

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

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

Environmental Group inc. from further obligations or liability. 

Owner' ner's Sieirature Date s Sigi 

27-5/10*0 003 

COASTA 8247372904 L ENVIRONMENTAL GROUP INC. MIIMARTHASTREET 

OMAHA, NE 68105 

PAY TO THB 

ORDER OF 

2,0^02 -^—"— 

i:iouoooo5fli: E.su7i^t;iuH 
391 

Account : 126429-1127564 

MARY D. ANDERSON 

Service addreaa: 1309S2STHST 

Call SMi m if you smell gas. 

No charge to check gas leaks. Have heating 

system checked every year by a qualified 

heating contractor. Keep chimneys and flues 

free of debris. 

"LiUltA 

Nov Dec Jan Fab Mar Apt May Jun Jul Aug Sep Oct 

Your Gas Use 

• Past 12 MorMi* B Past13«4 Monllia 

This Month Last Year 

Billing units: 

Use per day: 

3 

0.1 

19 

0.6 

Average cost per day: $0.57 $1.03 

Numtier of days in tMlling cycle: 29 32 

2 0 " 

1 

10­

0 . 1 I Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sap Oct 

Your Water Use 

• PBttUMonUis • Past13««Monltn 

Tills Montti Last Year 

Billing units: 18 3 

Use per day: 0.6 0.1 

Average cost per day: $1.01 $0.31 

Numtier of days In tiilllng cycle: 29 32 

J8L 

1723 Harney St • Omaha, NE 68102 • 402.554.6666 

e-mail: (XJStomer_servic8@mudomaha.com • website: www.muclomaha.com METROPOLITAN UTILITIE S DISTRIC T 

Billing date Oct 6, 2009 Live Green. 7/iM5to. 

Prevloua balance $114.00 

Payment received -Thank you 114.00 CR 

Cunent chargea 114.00 

New balance 114.00 

• Total due Oct 21,2009 $114.00 

Your budget payment of $114.00 is due Oct 21,2009. Budget variances: 

Current = -$^.76 Total = -$36.04 

Oetaito of ourrent oliarges: 

GAS RESIDENTIAL RATE A: Aug 31 to Sep 29 

Meter Number 371179 

Current read (aotuao: 5360 - Previoua read (estimate): 5357 >• 3 CCF 

Gas Use: 3 CCF x 1.023 (heat value) = 3.069 therms 

1 days 0.106 therms at 0.5283 - < $0.06 

28 daya 2.963 therma at 0.4632 - 1.37 

Service Charge 12.00 

Gas Cost > 

$13.43 

Gas Infrastructure Replacement 

3.00 

WATER RESIDENTIAL RATE W-1: Aug 31 to Sep 29 

Meter Number 2822786 Size: 5/8 -inch 

Cunent read (actual): 339 - Previous read (estinwte): 321 » 18 CCF 

Water Use: 18.000 CCF or 13,464 gallons 

9.000 CCF at 0.9614 - $8.65 

9.000 CCF at 1.3451 ­ 12.11 

Service Cheirge 4.86 

Water Cost • $25.62 

Water Infrastructure Replacement 2.00 

Gity of Omaha Sewer 10.38 

Sales Tax 3.81 

V Current Charges $58.24 

\il^ 

i