TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FIL E FOLDER 

SAID#: ^n f ' Date: U^/Z/Jo ? 

: Address: /^ f Si JZ^ ^H 

Remediation Contractor: Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

0^ Executive Suminary , . 

' ^ EPA-provided property sketch 

M Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

21 Confirmation data , 

y Photographs ' ' 

As-built sketch . , 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

Ihy 

^M Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information fi-om Douglas County Assessor's Office 

D 

D . 

^4M­ 40317867 

IHiHi 

Superfund 
i3a^ S <3o "Sr^-

Final Report Property Check List (piease place with each nie) 

Har d Copy Information 

IQ Property Check List 

]2l Site Working Drawing Map 

3. EPA originals Map 

13/ Douglas County Assessor's Map 

|5!] Property Contact Sheet 

Agreement 

iH Access Agreement 

|23 Restoration Agreement 

Miscellaneous Documents 

^TJFinal Map from the Field 

yzi Change Orders 

P7 XRF Data 

4. Any emails or PO correspondences 

Property Completion 

IT] Executive Summary 

2. AS BUILT 

|2l Property Completion Agreement 

^ Any buyout info or reimbursement info 

Q Check or money order copies 

^ EPA Property Close Out Form 

iT) Attached Begin Video 

Electronic Documentation 

Drawings 

jl] EPA original 

\Z^ Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

•^egin Photos 

v^During/Excavation Photos 

v'Sod Photos 

v^O-Day Sod Photos 

Scanned Documents 

•^inal Documents 

VExecutive Summary 

V^eos 

HBegin Video 

7My Movie 
Property Access Checklist 

PropertylD: ^Qj'^ l D WORK STARTED ON: / / 

Pn.perty Addrcs.s: / ^^ ^ ^ ^ ^1/^5 ^ n WORKCOMPELTED ON: / / 

Owner Renter: : l)^^Q^dk 7iiznylltr 

Addrc.s.s: f-^ ^ ^^^ ^ ^_ ^ 

Phone: 

Fax: 

Cell/Pa^cr: 

Additional Information: 

•'"""- 3^i-3Dby Fax: 

Ccll/PaRcr: 

® Notification Letter Sent: G / ;3 / (^7 Bv: ^.Jk 

CT Access Ajjrccmcnt Signed: (O 1 /3 l 0' 7 By://,^^/ ^ 

Q Restoration Agreement Siened: 6 //,3 l07 B.V: /Z/cU 

[U Topsoil Sampling (if applicahlc) 1 1 By: 

n Disposal Sampling (ifapplicable) 1 1 By: 

O Garden Sampling (ifapplicable) 1 1 By: 

Q Utility Clearance Called: (i? /5 " / ^ 7 By: -y j i6iy-, 1'[/ 

>9?>6ili :y [3- Video/Photos (Before) On: ll_li±l Cyi ^r-fUcy 

H Vi<leo/Photos (During) On:J_'Al' (^'T By: 

H Video/Photos (After) On:^/Lg./_07 By: 

6 Video/Photos (30-Day) On: ^ / i^ f O f By: 

^ Property Completion Agreement Sinned: 7 / 3i / ^ 7 By: 

1 1 Final Report Issued:

 / / By: 

Air IVIonhoring (as applicahle) 

n Community \//\ Crew On: / / By: 1 

Results: 

n Community CD Crew On: / / By: 

Results: 

n Community CH Crew On: / / By: 

Results: 

 ^-.^^ 

Omaha Lead Site 

.-t
Property Classification: 800 

Description of post excavation areas: Fl,ft-ont yard left-hand quadrant; F2, front yard right-hand quadrant; 81, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ. drip zone (1-3 foot area of soil around the foundation of the house). 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2218890000 

KITZMILLER 

DEBORAH C 

1329 S 26 ST 

OMAHA 

68105 

1329 S 26 ST 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Blocif 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

27-15-13 

SHULLS 2ND ADD 

10 

15 

50X127 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R2218890000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 228 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/9/2007 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

}^i\7iU)^ 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

^oni 

/i ^ S.t^O^S-h. 

 Date:]^J_l>__Time: \lV(/ Action: K<^^^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

5^1 >Sz. 

1 
y^ir:% 

COASTA L ENVIRONMENTA L 

CROUP . INC . 

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, collectlvely 

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

following described premises: 

Owner's Name: >t:^C^^^iT2-yw ( LU ^ Daytime Phone: 5 41 ' 3 <^ 3c X 

Address of Property / 3X^ 5. 3e ^i^. 

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, 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 finished, the Grantor vvill 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 also 

agrees to: 

Page 1 of 2 
.# 

C O ASTAJL \ y ENVIRONMENTA L 

GROUP , 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; 

Ifthe 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. 

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

C -IP..^ 7 

Signature \) Date Signature Date 

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

Page 2 of 2 
!^M7\ CLCGe& 

C^ y aammi ^ COASTAL 

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: 

Address of Property '\by\ s.auiyf: 

covered by this 

Agreement: LadHss-b ha iKicthbOK) 

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 wli^^e restored to itspriglnal condition. This 

work Is being performed under the Om^^'OeadtiSif^rlviW $lte?l|^n5i^ia'tiQ}] pcpgram. 

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 Ijeglns. 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 also 

agrees to: 

Page 1 of 2 
COASTA L \ y ENVIRONMENTA L 

GROUP . 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; 

Ifthe 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. .. . -;:. 'v . /y / ^ •:• 

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

Environmental Group, at (877) 234-6270. 

CiL Acccu 4o \y2fi $,ic r ©^*^ 

n I grant access to my properties D I do not grant access to my properties 

Signature ure Date 

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

Page 2 of 2 
% 

COASTA L • M V IROM MX NrAL a n e u r . INC . 

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 ID: ^ m \ 

Property Address: \l^l ^ tC^^^- ^ y 

Owner: \y\oV ^ iJlTirAiLLfct 

Phone: 

Mv y% 

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

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

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

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

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

01b ^ ^ 

Hem: 

hem: r 

./hAjfWlo^/ ~"~~^, Item: J 

Hem: 

^ ^ - ^ " 

Hem: ^.^-^' ^ 

Hem: ^^ ^ 

Hem: ^,.y ^ 

Page 1of y 
t 

Items To Be Removed Bv Contractor Durina Remediation An d Not Replaced 

(Use additional sheets as necessary) 

Item: . 

4l(/iri/t/ftL(^ 

Hem: 

\ ) ^ 

Hem: 

i^v [^j^^o^Pnyf] Uv - iy? ^^i H(rf ^p, ^ 

Hem: 1 

"^•Uo^ ^ %\ ^ hv 

Hem: 

Item: 

ix ( \ik ] ^ 

y 

Hem: 

, hof"^ \ ^'^(y y ^ 

Hem: y 

Hem: 

x ^ 

Hem: 

X 

/ 

Item: 

Hem: ^ 

Hem: y y 

Hem: y 

Page 2 of yi 
t 

C O A S T A C • N V I RONM * NTA L 

C It O U f> . INC . 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Hem: 

^ ^ c _ " ^ 

Rem: 

/ 

Hem: / 

Item: 

/ 

Item: 

/ 

Hem: 

Item: 

Hem: 

Item: 

Item: 

/ 

/ 

Item: / 

Hem: / 

Hem: / 

Hem: / 

Hem: 

Page 3 of. 
% 

COASTAL . INViKONMCNTAL anour . INC . 

Landscape Inventory 

(Use addKional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diaineter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

•;-ii 

9 

y 

Unit 

Square feet 

Each 

Each 

Each 

1 

Each 

Square Feet 

Condition/Type/Species 

te>^ ^i^y" '^^' ^^^^ 

Page 4 of U 
COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

propert>' to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area(s) 

Easement Area, to be 

excavated 

Quantity Unit 

$ 

Condition/Type/Species 

r Each 

^^11 SF 

r 

r^ 

SF 

SF 

'^l\?^llr 

\ioA-e 

^l^&i/02^;uyiB'yiy^^^^y ^ 

Pages of_^ 
% 

COASTA L 

Additional Comments / Instructions: 

- fl) UyiLt C(t< ^t\(.^\&>^

^ ^H (^h<^t tur n (^

y( 7Q \]9y/(Ayt^ 

 (y\(>W

 ^^^i^u 

 i-^ UC69(, 

m 

a 

• 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. 

I agree n I do not agree 

0 ^ '^vVtvj(ia/ (,-i2>-^1 :^^s ^ 6 |>i 

Owner's Signature/ Date ntractor's Signature Date 

Page 6 o'-U 
COASTA L ENVIRONMENTA L 

CROUP . INC . 

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 ID: ^ n \ 

Property Address: I'l'^,^ Cj 'Zh' ^ ^ f 

Owner: 

Phone: ^.^1- V ? 

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

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

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

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

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

Oi l ^ ^ 

Item: 

fm 

Item: 

{c,cy \\UMU, [Cyi^^Wi\/^ . lhAA^(MA^. Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

\/\^hM ^li/J^W^ ^ 

Item: 

Wu \)r 

Item: 

Spli\77] fv (iv^^^^l Uv -vy? k W Vidf^ 

Item: 

^y\^i y Item: 

W^\Y %\ y i^v 

Item: 

fir(fv ^ \}j^o\/ 

Item: 

W^1?7 1^7 • ~y Item: 

'ii4/3iZ^ , foOi^^ ] ^Ow 

Item: y 

Item: y 

Item: y 

Item: y 

Item: X 

Item: X 

Item: 

/ 

/ 

Page 2 of I? 

1 
COASTA L ENVIRONMENTA L 

CROUP . IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

t^JiJ _ . - , — > 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: 

/ 

Item: 

/ 

Item: 

Item: / 

/ 

Item: / 

Item: / 

Item: / 

Item: 

Pages of i/^ 
(^fe 

COASTA L ENV I RONMENTA L 

CROUP , INC . 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number 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. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

• ^^1 1 

S 

y 

y j o' 

Unit 

Square feet 

Condition/Type/Specles 

Each 

Each 

Each 

^ 

Each 

Square Feet 

tv^^ ^ Hi W 1^ ^ KV^ ' 

Page 4of U 
COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

reolaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit 

$ 

Condition/Type/Species 

I. 

/ 

7r Each 

y\ SF 

y SF Vi^Ai^ 

y SF 

^l^^i^l^,^^,^,y::^^^^M^^^^kr^^ 

Page 5 o f ^ 
COASTA L ENVIRONMENTA L 

GROUP . INC . 

Additional Comments / Instructions: 

h m 

lo^y. CMy>­

<?Q \]pi/k^h^ 

n 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. 

I agree n I do not agree 

6-/ 3 ^^7 

Owner's Signaturftj Date 

Page 6 ofj^ 
55 

OlIlQlOl /329 3oy>(j-^ ^^o/il ) 

GA^LJ <rPr)7/nS (/[Ifb/J (/7 .^^T) OtO-7-5/ 

/1b£m^6 7^yi7/,77^7pon c X 

7t9qy y/m /m"^ )^0 

^im^ i^o/^ yt7Qiu^o 

^"^•^^0 7:^7^/ ^ Qy:tu/ 

7^^971^^/Z7r fM^ ^ 

^ m m/?7(/'' , iCTy^^ 

im-8UMyJ2££^ 

^/ m /^}/r)^/7­ y^i6^57 

Mm Riin^y ^f7)Uf) 

m/)p Rijyy

^^m N mi

 r9,^±b^ 

 r^7AtI^ 

^cw RUM?. m±sq 

i^OSMM: 

:0% Blioir m^S7 

. ^ 

M^ffLBUML^^kylkk H RE '"r^er l\-(Zc-n:eo£_ 

Mi i j3f tn-/2 i/i(±m. ^•a-ry^e. SZi-^o-:?­

mnJ2lM77l^-^JMz(d. C- lAiui^^-^yL CtA^'=^£. 

-J^lOatify}? tin ^90 .. /t^2^ 7 -^ ^ 

M- Etrn ^01' 65 

Mi M. 19^3 * &Q 

ym 

M l 

Rl/AiP

inJL 

 V^-^83 i^A 

:kf ^ 

HoS

^30

 ^ 6-^ 

t ^ / 

jte^ H-cc^ 

V\\\^ (My> , , j^-, , ' u^<2<d<>=> 

^ 1^9 f V £ Total Quadrant Square Footage to be Excavated = 525 

Property Classification: 800 Total Drip Zone Linear Footage to be Excavated = 11 

KGs^Hxt^ Hoy) ' 

f^O 

Descripiion of post excavalion areas, Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant; 81. backyard lefl-hand quadrant; B2. backyard right-hand quadrant; 

DZ, drip ione (1-3 foot area of soil around the foundation ofthe house) 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID onw^irn 

^nni 

Property Project 

Omaha Lead — Fixed Price Address \51Q fV^ c9iD^'^ 

Measurement XRF ID 

0107-51 Count/Time 

Field Shots 

Sliot # Reading Sample Area Shot # Reading Sample Area 

i:/.^y - t i 

_^[ca 

J7-/M^ 

MO ^ ^r^-i?*" 

^14 10 >7." 

Sample Area '7^4'(c- I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Bag) Sieved) 7 

2 

Py^ ftP 

4 

3 M ^:1'3. as i(D C^- ^ 

XRF Corrected Value - > 

5 aq (use calibration chart or add 

20»/o to value) 

y 

Sample Area Pass/Fai l ? 

I n Situ F\^y Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) 

Number Results 1 yyl ^ 

(Bag) Sieved) 7 

2 f SQ 

3 

4-"^ 

4 y ] TS 

55 1? XRF Correcte k^ d Value - > ^ & 

Co/ 5 

{use calibration chart or add 

20% to value) 

Sample Area 

Pass/Fai l ? p7 ip.~iay I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Baq) Sieved) 7 

2 

Q4 

3 

(oin 

4 

gq \CV XRF Corrected value - > 

5 (use calibration chart or add 

20% to value) 07 

Sample Area Pass/Fai l ? 6tiCH^" I n Situ 

Composite Composite Analytical Aliquot Composite Readings Lab Analytical 

liOSL Average (Dried & Spilt Sent (Bag) 

Number Results 1 

n (Bag) Sieved) 7

^m^ m m 

XRF Corrected Value —>

ai<^ (use calibration chart or add 

20% to value) 

m 

Sample Area jA7, I/>IZ" Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 ^ ^ 

(Baq) Sieved) 7 

3 

2 ^ U 4r^ 

4 ^(^Z 4i7i 4/4 

\ ^ ^7A XRF Corrected Value --> 

5 ^ 0 \ (use calibration chart or add 

20% to value) 

4*^7 u s t ADDITIOHAL SHEETS IF 

XRF Technician's Signiture 

JiiJ^Cyyn)iAMj'-y HEEDED 
' It 

'i • 1 . -

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # cPO|l^l 

Property Address /^^f' -5 ^/^5 r 

Owner Name Z^/^^s^/t^ Mz/eTz 

Date yr/^'Oy 

Comments 

/^^Mous- ra p /^^/c/^axJ) nfr<^ f/^-n7^ P"/^ F ^ 

Owner Signature ^jpi^ \^^L 

Contractor Signature 

V 
Property Classification: 800 

•on of po«( excavation areai Fl. front yard left-hand quadrant F2. front yard nghl-^and quadrant. Bl. backyard lefVhand quadrant B2. backyart nght-hand quadrant 

oe. drtp zone (1-3 foot area of sol around «ie foundMon of ttie house) 
• ( # 

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

Coastal Environmental Group Inc. 

www.coastalhazinat.com 

COASTA L ENVIRONMENTAl. 

GROUP , INC . 

EXECUTIVE SUMMARY: 

th 20171—1329 South 26'" ST 

I I No Issues or Concerns [V| Issues/Concerns 

Detail Explanation: 

Property Owner was issued a gift certificate # 2525 in the amount of $300.00 as reimbursement for 

various flower bead, bushes and shrubs removed from the property during excavation. 
As-Built Drawing A 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated = 5257 

Property Classificalion: 8(X) Total Drip Zone Linear Foolage lo be Excavated = 114 

Bl = 182 PPM B2 = 409 PPM 

DZ = 89 PPM .,.4--. 

rf 

"South 26 Streef 

'^" ^ OLS#: 20171 North Arrow Omaha Lead Site 

Omaha. Netiraska y Dateiektj^vated: 7/19/07 

Daite USCP*"Sfped Off: 8/8/07 Property Number 

OLS- 20171 I . . i Existing Stiuciure Scale Property Address »—•—•* Fence 1 Inct) - 20 feet or 1 grid = 5 x 5 ft 

1329 S 26 ST ^ ^ Permanent Landscaping 

— — — Quadrant Boundary .•^"X Post Excavation Concentrations (ppm) 

Street Boundary A Fl B2 Play Area / • HGL F2 OZ Easement 

// > Tree/Stioib ^ : t^nW*^ B1 Garden Other 

Omcripticv^ ol post RKcavation afMs Fl . fronl yaid lefl-iMnd quadrani: F2 Iionl yard nghl.|iandquadrant. B1. badtyard left-hand quadrant. B2. bacityard nghl-tiand quadrant. 

DZ. tlnp zone (1.3 Itxjt area ral sol amund v-rn foundalion dt HiB Kousa) 

Legend 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
EPA Property Close Out Form /j ^ f ^ ^ J^^. ^ 

Property #: ^7^ 1 i ^ I Property Address: 

I>atc/rime: Owner'i Name: 

Quadi Excavalrd: Contractor Group 

ExcavatioB Genenl 

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

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

Grading Sod and Vecetation 

1. Docs the grading around the perimeter ofthe house in excav ated areas generally slope away 

frDm 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. .\re sodded areas generally firm and evenly graded? 

5. Are the joints berwccn the sod strips generally tight? (Only evalaate if inspected at £ }0 da> 

time period) 

6. Was the property graded such that water v, ill not pool on the propeT)"' 

". 'A'as damage to landscaping or rla.nt —aterials a^ cided'^ 

Gaicv FtDccs anc ReiainiDt '^^ai'is 

1 Do gates apcn and close freely';' (Ifapplicable) 

2. 'V^'ere all gates or fences laken dov.-n during restoralion actis itjts -eir.sialle-d'? .Taprlicable) 

i 3. Was damage to gates or fences avoided? 'ifapplicable) 

4 "A'as damage tc retaining vt-alls avoided"? (Ifapplicable) 

Foundation, SidiBg and Gutters 

1. Was damage to the siding or triin B\ oided? 

2. wi s damage to the foundation avoided? 

3. Was damage to VN indows avoided? 

4. Was damage lo windows or door screens avoided? 

5. Was damage to do^^^lspouts or downspout extensions avoided? 

Sidewalks and Drivewtys (Concrete) 

1. 'y^'as damage to driveway surfaces avoided? 

2. Was daraage to walkway surfaces avoided? 

'?7 ^ 

Yes No 

\ y 

t . y 

Yes !So 

^ 

y 

y ^ 

y 

- ^ 

y 

y 

Yes No 

1 

^ 1 

y 

^ \ 

^ 

Ves N'c 

y 

. y 

> y 

y 

1 

1 y 

Yes No 1 

y 

y 
Owners comments: 

I Inspection notes: 

Remc\al and resloration acti\£tes corr.r'ete incl'adir.e ihe 30-da\' sod •^•'.arrar.n 

EP.'^ Representative V^^X£.^=X^Daie: S'^'7) 7 
Property Completion Agreement 

TiiKs agreement documenls tlic complelion of remedial aclivilies performed on my properly. My 

signaUirc will dcsignalc lhal I am salisricd wilh ihc rcsloialion of my properly, and lhal no items arc in 

questions, now. or al any lime in Ihc fuUiic, cxccpl those ilcms listed below, if any. 

Pmperly ID; 'zy/y7 

Property Add rcs.s: J-^-^ ^ < 7 7 ^ ^*^7 ~ 

Ovvner: D^y^^^_^ /^yT^y^yy^/C 

Phone: ^/- ^^r 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

r I 1 ;if;iw rrstorHlion is voiiiplrtrd, cxvcpt as noted 

\ I J I <l<> iiol at;re<' irstoratioH i.s coii)ple(e<l 

\ hM 

Owncr''x Sij;naturc Dale Coiilnictor'.s Sienature Date 
Omaha Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Deborah Kitzmiller 

Property Address 1329 S. 26 St 

Property Identification Number 20171 

Material Removed Replacement Value 

1 Rosebush Flower bed area 

Trees 

3 bushes Itemized 10 bushes shrubs/bushes 2 evergreen 

Total 300.00 

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

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

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

the government or it's contractors. 

The total amount of $ 300.00 has been received by the owner in the form of a gift 

certificate, #2525. to be utilized at 1329 S. 26*^ St. . 

Iti/ .A0 7-M'^ 7 y ,2W^^ 

Property Owner's Signature Date Contractor's Signature Date