TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: yl^i p I Date 

Address: l^<7l< H ^ Ol^\)\Ah ^ f 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

1/ Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

1/ Signed Access Agreement for subject property 

-B^ Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

-B- Settlement documents (i.e., for damage br to replace plants, etc.) 

"B" Confirmation data 

[ / Photographs \ k (>C0^Pch^ > tr/AvM?0vi-) " ^oi ^ 

| / As-built sketch 

M Satisfactory restoration signed by Property Owner 

(Z Property close-out check list signed by EPA 

-B - Description of areas not meeting ROD cleanup criteria 

i Utility clearances 

Property information from Douglas County Assessor's Office 

Superfund 
^v 

Property Access Checklist 

PropertylD: g^£^ k \ 

Property Address: '^t^g ^ MtxJiM^l^->^ 

n

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

l_ 

^^^^'' h^As^

Address: ^-i 

Phone: ^ ^ ^ 5 ^

Fax: 

Cell/Pager: 

 Srkii^ 

 T-^. ^ 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n Notification Letter 

ISk Access Agreement 

[ ^ Restoration Agreement 

G Topsoil Sampling (if appUcable) 

Q Disposal Sampling (if applicable) 

0 Garden Sampling (if applicable) 

^ UtiUty Clearance 

D Video/Photos (Before) 

n Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

n Property Completion Agreement 

D Final Report 

Sent: / / 

Sifinedp^ / )'^l/ D 

^\^tA:3Zll±llU} 

1 1 

1 1 

1 1 

CaUed: Cr\/\>/\ o 

On: / / 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

^^'•O^h\l\ 0

By: 

By: 

By: 

By: 

By: 

By: 

 Wtncl.4 

Air Monitoring (as appUcable) 

• Conmiunity Q Crew 

Results: 

On: / / By: 

n Community

Results: 

 Q Crew On: / / By: 1 

D Community

Results: 

 QCrew On: / / By: 1 

Omaha L.ead Site 
Douglas Coimty Account InfoaM^on Page 1 of4 

Douglas County, Nebraska Property Record ­ R1803940000 

Information is valid as of 2010-7-1 

New Feature ••••• • 

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

Subdivision Sales Search 

Owner 

SILVA ANDRES D 

ETAL 

3025 NICHOLAS ST 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 0394 0000 18 

Account Type: Residential 

Parcel Number: 1803940000 

Parcel Address: 

Legal Description: 

3025 NICHOLAS ST 

OMAHA NE 68131-0000 

MONTCLAIR ADD LOT 180 BLOCK 0 47 X 120 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

Improvement 

$72,600.00 

$72,600.00 

$72,600.00 

$72,600.00 

$72,600.00 

$72,600.00 

Total 

$75,100.00 

$75,100.00 

$75,100.00 

$75,100.00 

$75,100.00 

$75,100.00 

Sales Informatio n 

Sales Date: 2009-09-14 View Document 

Deed Type: 

Price: 

Grantor: 

WD 

$90,000.00 

FENNELL MADALINE L 

Booilr: 2009 Page: 113395 

Grantee: SILVA ANDRES D ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1995-12-23 

Deed Type: 

Price: 

Grantor: 

$41,000.00 

Book: 2026 Page: 523 

http://douglasne.mapping-online.com/DouglasCoNe/static/accovmtinfo.jsp?accoimtno=R18... 7/14/2010 
Douglas County Account In £^B^on Page 2 of4 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Lan d Informatio n 

>4cres 

0.12 

SF 

5640.0 

Units 

1.0 

Depth 

120.0 

Width 

47.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

3Q:S t^choli: St 

TWO STORY 

IHM d 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1712.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 0 0% 1920 90 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 840.0 

Fixture Base Fixtures 1.0 

Fixture Batii Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18... 7/14/2010 
Douglas County Accotmt In: ijjgon Page 3 of4 

Garage Detached 252.0 

Porch Cvrd Wood Deck 166.0 

Porch Wood Deck 28.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R18... 7/14/2010 
Page 1 of2 

" > 

Create Another Ticket _^ ] Backjg Irth internet^ _ ] je^nd EmaH ] 

YOUR TICKET NUMBER IS 2546397. 

Original Call Date: 7/17/10 Time: 3:14 pm Op: ELIZABETH18790 

Work to Begin Date: 7/21/10 Time: 7:15 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3025 Street: NICHOLAS ST 

Twp: 15N Rng: 13E Sect-Qtr: 16-SE-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


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


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHA'RAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/17/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/17/2010 
As-Built Drawing 

COASTAL Omaha Lead Superfund Site 

OLS#: 24861 

Date Excavated: 7/22/2010 

Date USEPA Sianed Off: 9/9/2010 

Area Sodden: 3060 so ft 

Name: /^/v^<r-^ / . , , Omaha Lead Site Date: 0td..^o ^ NorthArrow —i 

Address: 3<i>-ZjS- yv/cyxiA^ . Site SIcetch Time: ^^3.<r 

Phone: i 

Team r^lZXr^y-j/jTig^T ^ BVID# 2.^?^ / XRFCode SSOI 

Sample Number l.ead Concentration Confirmation Sample 

ppm / ^ Yes n No H^ C 

ppm /^2. Yes n No S1F7/ yWk i /•y /?/ Yes n No S^TS­ 'SstL ppm SZ Yes ^ No B^73 

ppm No B-^;s;/ 

ppm ^Yes a No n 

ppm Yes • No D 

B2 = 185PPM@4" 

^lll^4.S^a(j.2(fh 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
0 siii^ 

Name: /^///o-t^/ - / . , > 

Aridress­ 3<t>:Z ^ /y/cy><i>/y^

Phone: 

 S f 

Omaha Lead Site 

Site Sl(etch 

Team ^:JlXi^J-^>y'/~rr/t^T'

Sample Number 

 BVID # :Z^^ /

Lead Concentration 

2 

ppm 

ppm 

Date: ^ NorthArrow —i li^£3 

Time: / ^ Q-X -i. XRF Code S^SO l 

Confinnation Sample 

/ 7 Yes a No Hl^y-p 

/ r £ Yes Q No S^7 / 

^ / Yes Q No f3^7P­

^ 2 Yes O No 13^7 3 

Af//)Yes n No ^^7 4 

Yes n No a 

Yes • No n 

'i?4.st|s4.a/f» 

?-^ i^yiaja l —-Lltj._'jji.. . ' I l ' ' II ' " — ' 

Omaha Lead Site 46130 
Name: /^WA/^^/ - , , 

Address: 3<i>'2.S' yycy^/y^. ^ 

Omaha Lead Site 

Site Sitetch 

Oate: 

Time: >^Q- < 

3 Nortli Arrow 1 

Phone: 

^ 

Team r^Z^.ra/s/rm&/r ^ BVID# ^ ^ ^ / XRF Code SS9\ 

Confirmation Sample 

/^ / Yes O No I21?7«5^ 

^. It I^.¥ '^^"^ ^2 ^

^ /

 Yes

 Yes

 Q

 n

 No

 No

 B1?7 / 

 t3^7 ^ 

J r /^jZ^'^ * ppm ^ 2 Yes n No &W7 3 

^//)Ye s O No B^Z^ / 

ppm Yes CD No a 

ppm Yes a No • 

L-...^..-- L. J : y/yyiyzjcyy:i...-. '\ / X. y \ / jy A ^\ X L i x J

! 5 ;b.i. A / V 7 y i /' — 7 ^ TT .x'^ r /'^—74- j i.l^4^4x.lJ:l..X...^.^ \ 

ai.Q(fi 

Omaha Lead Site 46130 
Name: f ^ Azizs'/-C . , . Omaha l.ead SK* Date: North Anow 

Address: 3<i>-ZS ytZ/cM/tails' SttftSkotch Time: iiii l Phone: 4^ 

Team rZ^%jij-^>i/X?agyr^ BVID# X^?^ / XRF Code £3^ 1 

Sample Number Confirmation Sample 

/ 7 Yes CD No E^' ' 

^2 , Yes Cl No ETiF?/ 

ffl Yes • No H1>7;i 

32. Y08 l-D No B973 

Af/V>Ye8 a No BT?;^ / 

Yes D No 1=1 

Yes a No • 

'^/^(es 

/^/o^*A (Si^Aii^^j C^fidfC ^ Id 

^ ^ bmt.-pifey'^ 

^ ^ 2.il: M ^ 

6^?4-5t af\3/fn 4 

^ •. 3^ 

i r -

V 

' i 

^ 

fl=^^O^t fHJ ^^l^ff s 

i>tj6:Kf ^ 

SfL ^^4l\ C 

fif£/)oAs s r .._^ 

Omaha Lead Site 46130 
COASTA I ENVIROHHIHTAl ^ l PRO^ ^ C « 0 U r IM C 

Consent fcF Access To Properiy 

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: 

/J/Jrc ^ y'/tyv< ^ 

Address of Property 

covered by this "ioT^ /Urc/oi^^^^-^ ^T' 

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, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor wilt 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 Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor aiso 

agrees to: 

Page 1 of 2 
COASTA L 

tRVI«ONH(KTl l 

C K O U r IK C 

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

piles, dog houses, etc; 

G Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

c Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

c Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

e Allow videotaping and/or photographing of the property. 

AGREEMEI^ 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 

M j grant access to my properties 

D I do not grant access to my properties 

?//^//^ 

7 ^ Signatura Date Signature 

Date 

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

Page 2 of 2 
C O A S T A L aMVIMONHBHTAt. O n O U P . INC . 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe property prior to 

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

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

PropertylD; £ H^ d 

Property AddressT fS^ 5 / j / ck o / W i" f 

Phoii«f^42i "^id^-C C :? y 

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, disposai, and/or return of these items is the Owner's responsibility. 

Kem: 

Tf ^y^ 0 [o^^J ^ ^ ^ ^e ^ ,rcx/i^<xj 

Item: 

Hem: 

Hem: 

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

Kem: 

/-a v /?l<^t^yj le^J-'f })<.Jilncf 

Page lof ^ 
C O A S T A L • MVinOMMBMTAL a • o u r. INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Hem: 

^ o r .0(./?^.Q^.^ / 

Hem: 

r^ c^ Sf, gZ,.P2,f / 

Hem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Niunber of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

S)z,f-\ 

€r 

y 

€r 

Quadrants 

Each 

Each 

Each 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

-d- Each 

Square Feet 

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. 

y $ 

Fa.sement Area, to be 

excavated I Each f<.\i<^\'^3 K^so h 

Page 2 cA 
C O A S T A L 

o n o u p, 

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 be 

using as a driveway or vehicle parking area. If this Is the case, you should underetand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cKed by the city if you use a gravel or dirt area 

as a driveway or paridng area, not wKhstanding any removal orreplacement of soil by the EPA 

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

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

[ V Please check this box if you understand the Information outlined above. 

c e^ 

•^ ^,^ e ^y^" ^ ^"'^ ^ 

Q 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. 

^JH l agree O I do not agree 

^QHUAM ^My> 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
XRF PROPERTY SAMPLE SHEET 

Date /- 24 ' ZOi( Address 

Project Omaha Lead ARRA Sample time 

XRF ID# a°oci sample length 

. 

Shot# Reading Sample area Shot# 

Z-C'n a t t /•=! EA m 

uo f^a i /^ Depth ns 

^M /4<i i IS / " m 

Average 16Z J3 l/. 

Average

Shot# Reading Sample area Shot# 

Z.C75" m i R S^ ^ 

Z ^ l^D i ZO Depth 

' ^ 

Z0'\ {")"] i Li 4a 

M 

Average IBS '- ZO / Average 

Shot# Reading Sample area Shot# 

Z^l /51­ i iq­ 4" 

^^x : izs t ^g Depth 

Z0 5 K( t 18 Si 

Average 141 18 / Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth ^^— ) 

/ ^ / 

Average Average 

Signature_ 

Print V\hLC, Ufyjy^ 

BVID# Z4^i>l 

3oz ^ /^<c*«>L^ 

am/pm 

30 sec 

Reading Samplearea 

310 i 3 0 VI, 

316 i LG Depth 

30 L t 2:6 /3" 

 33 ^ t Z^^ fc/ 

Reading Sample area 

V3 i- // 

P» 

2 R ^ M 

Depth 

1 / " 3 9 ^ IS 

2-?! / y 

Reading Samplearea 

Depth 

Reading Samplearea 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By 

Ceitificate of Verification 

212 

SOIL 

2011-01-24 15; 22 

90.68 

Final 

Avg of 209-211 

3025 NICHOLAS ST 

EA 

1" 

C.PADILLA 

CONFIRMAT 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 172.264 

Supervised By: 

Certificate of Verification 

209 

SOIL 

2011-01-24 15:20 

30.19 

Final 

24861 

3025 NICHOLAS ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 19.556 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 167.768 

Supervised By: 

Certificate of Verification 

210 

SOIL 

2011-01-24 15:21 

30.27 

Final 

24861 

3025 NICHOLAS ST 

EA 

1" 

C.PADILU 

CONFIRMATION 

CLEAR 

± Error 

19.329 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 146.809 

Supervised By: 

Certificate of Verification 

211 

SOIL 

2011-01-24 15:22 

30.22 

Final 

24861 

3025 NICHOLAS ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.682 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

208 

SOIL 

2011-01-24 15:19 

91.04 

Final 

Avg of 205-207 

3025 NICHOUS ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 176.986 

Supervised By: 

Certificate of Verification 

205 

SOIL 

2011-01-24 15:17 

30.57 

Final 

24861 

3025 NICHOLAS ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

± 17.752 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 180.243 

Supervised By: 

Certificate of Verification 

206 

SOIL 

2011-01-24 15:18 

30.19 

Final 

24861 

3025 NICHOLAS ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.547 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 199.484 

Supervised By: 

Certificate of Verification 

207 

SOIL 

2011-01-24 15: 19 

30.28 

Final 

24861 

3025 NICHOLAS ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.815 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

204 

SOIL 

2011-01-24 15:16 

91.03 

Final 

Avg of 201-203 

3025 NICHOLAS ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 157.935 

Supervised By: 

Certificate of Verification 

201 

SOIL 

2011-01-24 15:14 

30.60 

Final 

24861 

3025 NICHOLAS ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 17.424 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 125.960 

Supervised By: 

Certificate of Verification 

202 

SOIL 

2011-01-24 15:15 

30.25 

Final 

24861 

3025 NICHOLAS ST 

B l 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.240 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 141.681 

Supervised By: 

Certificate of Verification 

203 

SOIL 

2011-01-24 15:16 

30.18 

Final 

24861 

3025 NICHOLAS ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.746 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

200 

SOIL 

2011-01-24 15:13 

90.87 

Final 

Avg of 197-199 

3025 NICHOLAS ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 390.757 

Supervised By: 

Certificate of Verification 

197 

SOIL 

2011-01-24 15:11 

30.33 

Final 

24861 

3025 NICHOLAS ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 30.075 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 316.659 

Supervised By: 

Certificate of Verification 

198 

SOIL 

2011-01-24 15:12 

30.27 

Final 

24861 

3025 NICHOLAS ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.301 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 302.417 

Supervised By: 

Certificate of Verification 

199 

SOIL 

2011-01-24 15:13 

30.27 

Final 

24861 

3025 NICHOLAS ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

.± 26.233 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 5 

Mode SOIL 

Time 2011-03-01 14:25 

Duration 90.91 

Sequence Final 

Flags 

AVERAGE Avg of 2-4 

ADDRESS 3025 NICHOLAS ST 

QUADRANT Fl 

DEPHT 4" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 43.252 

Supervised By: 

Certificate of Verification 

2 

SOIL 

2011-03-01 14:23 

30.46 

Final 

24861 

3025 NICHOLAS ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

11.311 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 28.629 

Supervised By: 

Certificate of Verification 

3 

SOIL 

2011-03-01 14:24 

30.32 

Final 

24861 

3025 NICHOLAS ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 11.421 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 39.937 

Supervised By: 

Certificate of Verification 

4 

SOIL 

2011-03-01 14:25 

30.13 

Final 

24861 

3025 NICHOLAS ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 13.176 
/lA. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^y, I Coastal Environmental Group Inc. 

Sl^y^Z ^ www.coa8talhazmat.com 

'iiPHO ^ COASTA L eNVIHONHINTAL 

OROUP , INC . 

EXECUTIVE SUMMARY: 

BVID #24861-(3065 NICHOLAS ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-DON BAHNKE WALKED THE PROPERTY ON 9/9/2010 
S : ^ 

EPA Properfy Close Out Form 

Property ff: _ Property Address: 

Date/Time; Owner's Narae:. / ^ 

Quads Excavated: Contractor Group 

Excavatio Ye* No n Generai 

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

2. If necessary, were the correct areas of drip zone excavaied aod restored? ^ ^ 

Grading Sod and Vegetollon 

Yes No 

I. Does the grading around the perimeier ofthe house in excavated areas generally slope away ly-' from tbe house? 

2. Has sod been laid ui all areas that were excavated? y y 3.

 Does the sod appear to be ganerally healthy and jaowing? (Only evalusAe if iiupected at a 30^ 

day time period) ()t<ittiut /y/>/> l^t k 'Sfytittj .<ha/Cl r^MlA, 

4. AIC sodded areas generally firm and evenly graded? C<ro ^

^ 

S. 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 propeny'' l^- " 

r 7. Was damage to landscaping or plant materials avoided? 

Gates. Fences aad Remalng Walls Ves No 

r' 1. Oo gates open and close freely? ((f applicable) 

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

3. Was danuge to gates or fences avoided? (Ifapplicable) u y ' 

4. Was damage to reuining walls avoided? (Ifapplicable) ^ ' 

Foupdation, Sidianaiid Gnllers 

\t i .No 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? y 

?. Was damage to windows avoided? 

6. Was damage to windows or door screens avoided? y 

5. Was damage io downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrcu) Yes No 

1. Was damage lo driveway surfaces avoided? X-i 

2. Was damage to waDrway surfaces avoided? 
I 

41 

CM'oers comnients: 

!!n.«!pection noies: 

Removal andrestoration activales fcluding the 30-day sod warranry 

EPA Represenlaiive h^Grtt^ 
Property Completion Agreement 

riiis agreement documenls lhe complclion of remediai acliviiies perloimed on my property My signature 

will designate lhal I am satisfied wi(h (he restoradon of my propeily. and lhal no items are in questions, 

now, or al any lime in the future, except Ihose ilems listed below, ifany 

Property rP: ^^( g | 

Property Address: ^Q(^ y yy/CJUy ^ ^rf " 

Ownc: /^^yy^^^ji^ %\y ^ 

Phone: -^^•^ ^zrrz^ 

Restoration Itenns in Question: 

Item: 

Item: 

Item; 

Item: 

Item: 

Item: 

••pCLl xyrcc restoralion \s completed, rirccpl as noted 

[_J I do not a^rcc restoration is completed 

^6(hcyyu^ ^/2yl(c) 

Owner's Signatiirr Date Cond actor's Signature Dale 
(4^1 

Property Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARJ^|yr;TpTyp|^ 

Omaha Lead Superfiind Site 

2009/2010 AUG 17 2010 

Remediation Contractor: Coastal Environmental Group - EP-RTSBBS^^^^^^^ ^ DIVISION 

Property Identifier Number: 'T^^l o I 

Property Address: ^^(pC ^ //A'^^.^^ ^ '^ ^ 

Property Owner's Name: /yC-r^./^t^^ "^/( / ( ^ 

Instructions to the Property Owner: 

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

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

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

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

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

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

Performance Work Statemmt. 

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

work by checking a numerical rating on the table below tising the nimierical definitions from 

the rating scale below, then sign & date fhe 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 thc Contractor's Work 

10 5 

9 ___ ^ 4 

8 \ X 3 

7 2 

6 1 

Propertv Owner Additionai Comments from (optional; continue on back page if needed) 

y 

/

•fy/yjj/i ^ ^Date: S-/lohr \ Property Owner Signature: