TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID^: 3S280 Date: 3////^ 

Address: y2Sd0 7ejnpjp7hf\ Si ~ 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

SI Video of property (DVD) 

10 Executive Summary 

cf EPA-provided property sketch 

t / Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

i / Restoration Agreement 

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

4 / Confirmation data 

g] Photographs 

M As-built sketch 

M Satisfactory restoration signed by Property Owner 

\zf Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D 

D 

4fe^ 

40317784 

Hil l 

Superfund 
Final Report Property Check List (piease place with each file) 3^^-^^ ^ 

Hard Copy Information dS(^7~17^Mfiuhs^d7~

K^ Property Check List 

\ . Site Working Drawing Map 

\ EPA originals Map 

V Douglas County Asscs.sor's Map 

^ . Property Contact Sheet 

^Agreement 

•X Access Agteement 

2>Restoration Agreement 

IMisceHaneous Documents 

Ps^inal Map irom tiie Field 

2. Ciiange Orders 

X XRF Data 

4. Any emails or PO airrespondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3'.. Propeity Completion Agreement 

4. Any buyout info or reimbursement into 

5. Check or money order copies 

n\EPA Property Close Out Form 

NJ^Attachcd Begin Video 

Electroni c Documentatio n 

Drawings 

\ EPA original 

3v Working Drawing 

,3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

^ 

During/Exeavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

Begin Video 

\ My Movie 
f 

i(m 

Property Access Checklist 

Property ID: ^^Z^ O 

D WORK STARTED ON: _/ / 

D WORK COMPELTED ON: / / Property Add Tlz^^yn7n^s^±^£^Si\ 

Renter: 0>v.K-r: j/\^ ^ ;^ W^^VVW-H A- Addross: *J , ^ 

Phone: 

Fax: 

Cell/Pa<;cr: 

Phono Additional Information: : f,cy^-4^( 7 

Fiix: 

Cell/Pa«ei-: 

1 n Notification Letter Sent: / / By: 

[El Access A<!;reenienf Sij;ned:|0_/_4i_/cr^ ""'• Chcb.-- S Restoration Agreement Siuned: 16 / (D /0 7 ''"Chri'S 

1 1 Top.soil Samplinsi (if a|)plical)le) / / By: 

[ 3 Disposal Samplinj; (if applicable) / / By: 

O Garden Sainplin<{ (if applicable) / / By: 

[j ^ Utility Clearance 

Called: jt. / '2./ 6Tj '^y l*T I Z82.2. 

Ij ^ Video/Photos (Before) On:_a:/_^ / oT ^y Klrtfthc o- ^ 

j n Video/Photos (Durinj;) On: / / By: 

jj D Video/Photos (After) On: / / By: 

1 D Video/Photos (3()-Day) On: / / By: 

1 1 Pro|)eity Completion Ajjreement Sijined: / / By: 

1 n Einal Report Is.sued: / / By: 

Air IVIonitorinj; (as ap[)lieal)le) 

I I Community CU Crew On: Bv: 

Results: 

CD Community CU Crew On: / / Bv: 

Results: 

CU Community CU Crew On: / / Bv: 

Results: 

Omaha Lead Site 
35280 

Omaha Lead Site 46130 
35280 

Omaha Exterior Paint NorthArrow Lead Site r Owner Name: MARGIE WASHINGTON 

Sit • Good e Sketch Address: 2508 TEMPLETON ST 

Phone: ^ 

Sample Number 

RYASCPXA-35280

RYBSCPXA-35280

RYCSCPXA-35280

RYDSCPXA-35280

RDZCCrXA 35280

RPZSCP.YA 35280

W: 

Lead Sample 

Concentration Collected 

 Fl ppm 

 F2 ppm 

 Bl ppm 

 82 ppm 

^ - ppm n 

ppm • 

 E2 ppm D 

Number of Samples = , H 

• Poor ^ 

Q-H4ot paint 

Samples Collected LAB 

Firm:

D Date 

D Time 

D 

D 

D XRF Unit; 

D Date: 

D Time: 

Staff: o 

y y 

 P^ - yri^<^.7. k 

I U ^ y 

S'0(^ p^' 

Samples Analyzed 

^ A l Book: i 1 

\(^-\^.c ^ 

A 

^ 

^ 

ENTERED 

OCT 1 1 2004 

^ ? 

Z^'y ': 

-^4©» *r- V 

F ' f.. i^qo 

31X 

"tr MF 

liCTo^ ST-' 

liL ^ 

Omaha Lead Site 46130 
Douglas County Account Informatio KOTnc n Page 1 of 

Dougla s County , Nebrask a Propert y Recor d - R164415000 0 

Print Report Information is valid as of 2007-8-24 View on Map Values not finalized until after Board of Equalization Treasurer's Tax Report 

Owne r 

WASHINGTON MARGIE 

2512 TEMPLETON ST 

OMAHA NE 68111-0000 

Propert y Informatio n 

Key Number: 4415 0000 16 

Account Type: Residential 

Parcel Number: 1644150000 

Parcel Address: 

Legal Description: 

2508 TEMPLETON ST 

OMAHA NE 68111-0000 

LUKE & TEMPLETONS LOT 15 BLOCK 0 50 X 132 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$500.00 

$500.00 

$500.00 

$0.00 

$500.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$0.00 

$500.00 

$0.00 

Sales Informatio n 

Lan d Informatio n 

Acres 

0.15 

SF 

6600.0 

FF 

50.0 

Units 

0.0 

Depth 

132.0 

Width 

50.0 

Vacant 

Yes 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 10/5/2007 
CONTACT FORM 

Propeity ID # 

Property 

Address: 

Initial Contact: 

Second Contact:

Final Contact:

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

"^^yfO 

Date: 77f/^ Time: //»^^ ^ Action: 7-0 y yy-Zk^^^ 

 Date: Time: Action: 

 Date: Time: Action: 

Transmit to EPA D Other Action: D 
m a

%: 

,lt O ST.,, 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMtNTA L 

C K O U P , INC . 

EXECUTIVE SUMMARY: 

35280—2508 TEMPLETON ST 

X No Issues or Concerns Issues/Concerns 

Detail Explanation: 
t, 

As-Built Drawing 

COASTA L maha Lead Superfund Site 

r l Owner Mama:MARGIE WASHINGTON 

AddrssE: 2Saa TEMPinON ST 

Ss-Tiple Numtief 

RYASCPXA-35;80 

FTYB5CPXA-352B0 

RYCSCPXA-3S28Q 

KYDSCPXA-3529'D 

Rr>?SGPx.A asgeo 

Rl 

2aa 

Wooden fence and big 

tree located in B1 and 

B2 also there is an 

asphalt driveway 

through and a dog 

kennel located in B2. 

OLS * 

Date Excavated: 11/3/07 

Date USEPA Signed Off: 11/30/07 

35280 

Omah a Lea d Site 

Sit e Sketc h 

4<>i^n 

Legend 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contract: #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
stu EPA 

EPA Property Close Out Form 

Property #: g>'^;?^SC ^ Property Address: Zl'bOf j TfyL^p\e^j^/ \ ^f : 

Date/Time: [^ I g^ot Owner's Name: A/l/^>j<>.-P \A^ Q ^ y i ^ovf^ ^ 

Quads Excavated: Contractor Group C/'O St^^- 1 

Excavation General 

Yes No 

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

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

Gradlnc Sod and Vegetation 

Yes No 

1. Does the gradmg around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

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? 

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 property? 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retainine Walls Yes No 

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

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

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

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

Foundation, SidioK and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

I 2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

^f7 \ insyy^j^Ti^. 

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

EPA Representatiy^y^^,,^:^^^ , JL ^ Date: /f/^cp/oz 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My .signature 

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

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

Property ID: ^ ^Q L ^ Q 

Property Addre.ss: Q.60% T^^^f-h g S.t 

Owner: AloccxtV " vucAJKUvftf,^/! 

Phone: P^( ^ <J A-U\' ] ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I A I agree restoration is completed, except as noted 

 I I do nol ufjree restoration is compieled 

iy?c^r^yy^'' 7.yM-vZJ.,u.., yy^' 0 7 wner s Signgture Date "ontractor's Sisinatiire Date 

I
PROPFRTY Cl EARANCF WORKSHEET 

Dale 

Property I D ll-O^-o l 

35280^ 

Property Project OmahH Lead - l"ixed Price Addies s 25 OS T^y^p/eZc^ 

MeasuremenI XRr ID 

0107 'i l Count/Tinie 

"ield Shols 

Shot * Readin g Sampl e Are a Sho t # ; Readin g Sampl e Are a 

115 

J ^ 2 

26/ 

^6 

^A-S 

fti '^'C 

-

Sampl e Are a eA'S I n Sit u 

Cortiposit e ! Composit e Analytica l L a b Analytica l 

Readin q Averag e (Drie d & Spil t Sen t (Bag ) 

Aliquo t Composit e Reading s 

Numbe r Result s 

1 (Baq ) Sieved ) -f 

n ^ 3 

2 

/B9 in 4 

ZoJ XRF Corrected Value —> 

'5 (use calibration chart or add Z3T 2 0 % to ualue) 

Sampl e Are a Rl V-6 Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s 

L a b Analytica l Readin q 

Averag e (Drie d & Spil t Sen t (Bag ) 

Numbe r Result s 1 tS-2. (Baq ) Sieved ) •> 2 t ?7 3 •P / 7 i 77 

A 

'/(> XRF Corrected Value - > 

S IZO (use calibration chart or add h . 2 0 % to ualue) %

Sampl e Are a 

Pass/Fai l ? 

I n Sit u 

Composit e 1 Composit e Analytica l Aliquo t Composit e Reading s 

L a b Analytica l Readin q 

Averag e i (Dried & Spil t Sen t (Bag ) 

Numbe r Result s 1 

(Baq ) Sieved ) -> 2 

3 

A 

XRF Corrected Value --> 

•; 

(use calibration chart or add 

2 0 % to ualue) _ 

Sampl e Are a Pass/Fai l ? 

I n Sit u composit e Coinposit e Analytica l Aliquo t Composit e Reading s 

L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Number , Result s ! Sieved:) 

XRF Corre'cted Value --> 

Uuse calibration chart or add 

|20 % to ualue) 

Sampl e Are a Pass/Fai l ? I n Sit u Aliquo t 

Composit e Composit e Analytica l Composit e Reading s Readin q 

L a b Analytica l Averag e (Drie d & Spil t Sen t (Bag ) — Numbe r Result s (Bag ) Sieved ) 7 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to ualue) 

ni l llllll I innAt I.Ill XI'F Ic-rhninaii's Siqniliirp .Iff Dill 
Kl.^- 1^1 2. 2,-Z, y \Q2myn£y^'^ / C^ujCLcL- ^ 

35280 

Omaha Lead Site 46130 
y^ ^ "'"/.^ 

w 

COASTA L ENVIRONMENTA L 

C P 0 O F IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

/VIA^/ ^ 

Owner's Name: Daytime Phone: 

t^A57//i0^r7h7 V/^l-56<y^¥C7T 

Address of Property 'Z^t^5 ZZr^fUfatn 5 r 

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 

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

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

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soi! 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 Grantors 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 pnor 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 
y*-° "'-"v.

 /.^B^ ^M •

 • ^ 

."^'**' / COASTAL < ""O^* -

G « 0 U P IN C 

• 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 (877) 234-6270. 

algrI gran s t access to my properties

 Q I do not grant access to my properties 

-6-<^7 

signature/ - ^ Date Signature

 Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

The purpose of this agreement is to provi(Je a mutual agreement as to conditions ofthe propert} prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe propert> owner and the United States Environmental 

Protection .Agency (EP.A). 

Property ID: ^ ^ '7<3<0 

Property .Address: 'Z.'yTy^ lyy^^ y ^ T 

Owner: z77y)'7t^7^ Ciy^^-57y7xyy?7^^zy 

Phone: 

y7z)z^ ^z^-y/^yy 

On the attached diagram(s) indicate area(s) to e.\ca\ated and depth of e\ca\ation. location of all known 

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

contractor, and the direction of Nonh. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of \ iew. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

-r.'-.s. -^ cr. ' c- 5 I .-•,.,.. , _,f s ir e '_•••:"£' - ^ : u; 1;(., 

Item: ^ ^ 

jh7Zz^7rr/i^ ' 

\ Item: y ^ | 

1 y^Aycyy 

\ "^V ^ 

ll Item: j 1 | i 

' Item: j 

j Item: | 

1 

Item: 

1 Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

i J ^/J^^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I Item: 

Item: 

! Item; 

I 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 3y) 

Item: 

307Z^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3of. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Specles 

Pre-e\isiing property area, 

that uill be excavated, that Square feet 

is coxered with arass. 

Number of trees "• 2 inch Each trLink diameter 

^77i^^ 

yy Number of t.'-ees ^ Z inct: ! 

;:'Lr:k diameter i 

\\:n:\ii:\ of Sprinkle 

Zcincs. Cojiirol \':ii\'e^ 

1 :mir:-s. Heads, etc. Each 

NumiDer oi" and si/e of 

each garden llower bed 

area. Each 

Square Feet 

Page 4 of 
COAST A 

Item Quantity Unit Conditlon/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced by contractor. 

Note this \alue «ill be 

used to issue a plaiu 

voucher lo the propeny 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

\ery specific and detailed. lach 

'nJ.iJe :• -keich .^f -.verc 

c.-,ch plani i\':\\ 'oi: pk.cc^ 

.Agreed upon

propeny to be

\\ iiti iirass sod. 

area of 

replaced 

Sf 

.'^.rera off C;i i\ or Couniuniy\ ; \ / i 

P'-openy to be landscape^; /y7'/^7/^r^&^ ' 

per ilieir reauiremenis. 

Easement .•\rea. lo he 

cvcasaied 

Page 5 of. 
COASTA L 

Additional Comments / Instructions: 

^(^W/^ z^O z7^z7ey§l!> yz^^^Ttzzy 

/)7 ^ /^Tz/^ b 7€/^ :75 

im 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. 

H1^ agree n I do not agree 

L<7 7d - 6 ^(79 

Owner's SignOTure Date Contractor's Sianature 

Page 6 of