TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: M^\l^ Date: 

Address: S\o n 6> ^O "^T 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 2;SJBefore DAfter D Basement^ f^O hn^l/JlQbcr 

L> Executive Summary (Final Report) nSHCf^ 

IS EPA-provided property sketch 

"S. Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

""l3s Restoration Agreement 

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

^ Confirmation data 

y Photographs 3 i Before DCrew Photos^During Excavation D Sod 

B^O-day Sod D 

"b ^ As-built sketch 

~ ^ Completion Agreement signed by Property Owner 

^""^"H.,,^^ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

^ ^ Utility clearances 

^ ^ Property information from Douglas County Assessor's Office 

~^l5x Property access checklist 

30260060 

^SL Contact Log 

D Superfund 

Environmental Restoration Signature Date 

^4^ 
•4 - * > 

f T^©^ '^ Omaha Lead Site—EP-R7-09-05 ' ^^*^2m, f Environmental Restoration, LLC 

EXECUTIVE SUMMARY: 

48119-5107 S 40 ST 

I 1 No Issues or Concerns [ ^ Issues/Concerns 

Detail E.xpianation: 
a%. EPA 

EPA Property Close Out Form 

Omaha Lead Site OU#2 

Property #: 'A^ 11^ Property Address: S'lO'^ ^S 4 o 

^ T 

Date/Time: Owner's Name: ijViJbg/-^ P(xlrner 

Quads Excavated: j^3L Contractor Group : Environmental Restoration (ER) 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Ves No 

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

A/A­ house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at 30-day time 

period). 

4. Are sodded areas generally firm and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at 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? i ^ 

Gates, Fences and Retaining Wails Ves No 

1. Do gates open and close freely? (ifapplicable) 4 ^ 

2. Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) • 

3. Was damage to gates or fences avoided? (ifapplicable) 1 ^ 

4. Was damage to retaining walls avoided? (ifapplicable) tJPi 

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? , 

3. Was damage to windows avoided? iik 

4. Was damage to window screens 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? 

2. Was damage to walkway surfaces avoided? Ttf 

Inspection notes: 

Remedial and restoration activities complete including 30-day sod warranty: 

EPA Representatjy^rl^ ^ Date: (p/^//0 
Page 1 of2 

"> 

[ Create Another Ticket ] [ Back to Irth internet ] Send Email 

YOUR TICKET NUMBER IS 2486661. 

Original Call Date: 

Work to Begin Date: 

5/06/10 

5/10/10 

Time:

Time:

 2:41 pm 

 3:15 pm 

Op: TRACY24186 

State: NE 

Address: 5107 

County: 

Street: 

DOUGLAS 

S 41ST ST 

Place: OMAHA 

Twp: 14N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 05-SE,08-NE 

 Sect-Qtr: 

Type of Work: Excavating the entire property 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)451-1069 


: SAID #48119 


Company : ENVIRONMENTAL RESTORATION 


Contact Name: TRACY BRISTOW Phone: (402)451-1314 


Alt. Contact: Phone: (314)504-4874 


Work Being Done For: EPA 


Depth of Excavation: 12 Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWESTNE 


UNITEOM 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS. INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emera: 4029329757 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

m'uuui METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 


http://www.dhon,org/irthinternet/DHONNoticeCreation/MessageTey c 1 ^ i^f^-* f^ tfl<;n?r<^t=<-ppcT TT TO 
Page 2 of 2 

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT 

QLNNEIF QWEST LOCAL NETWORK 

QWESTNE QWEST LONG DISTANCE 

UNITE PRIVATE NETWORKS LLC • UNITEOM OMAHA 

ELM 
 Alt: 4062071494 
 LOCATING 


Emerg: 8887289343 


Day: 4067289343 


ELM 
 Alt: 4062071494 


LOCATING 


Emerg: 8887289343 


Day: 8002834237 


. Alt: 


Emerg; :8002834237 


Day: 4067289343 


ELM 
 Alt: 4062071494 


LOCATING 


Emerg: 8887289343 

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CoETifect iinfO'LjniistiO'!!"! Lo g 

5AuO# ^8H9 

OwEieir's F'-fami^: Daytime Ffaonet^i^Q^,) 73^~ M 75 8 

F!rG|p£5-ty Address: 510 7 C iJ Q C-p 

A-iitsmpt toccntsa Datc/tisTse i'iB.Wie 

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Property Access Checklist 

n WORkSTARTF.D ON: / / 

I Pronerty Address: Q WORK COMPELTED ON: __/__/_ _ HO s r 

Owner: -^^^^^ ^ j , . p^j^^ ^ Renter: 

Address: ^^^c ^ ^ ^ o 5-,. Phone: 

Fas 

i • . Cell/Pager: 

Additional Information: ^^''"^^ C40 2.b -134-H15ft 

Fax: 

Ce!!/Pager: 

( 3 Access Agreement Signed: -5 / By: (L^ 

W Restoration Agreement Signed: ~5 / 5 / / o 3y: ^JD 

O Video Property Before On : ^ I S I ll By: /e/? 

Q Digits! Photos Before Oa : S / S"/ ( to By: fty 

r~1 Video Property After On 5y: 

I I Digital Photos After On / / By: 

S Property Completion Agreement Signed: 5 / > ? / P By: CO 

I I Final Report Signed: /. Sv: 

Additional Video or Digital Photo's Taken: 

j Q Video • DlgitEl Phcto j On : 

lj Reason: 

n Video n Digits! Photo On / av 

Kesson: 

n Video n Digital Photo On : / .' 

Reason: 

n Video n Digital Flioto On ' / I B) 

Reason: 

Omaha Lead Project Work Plan Pagel of 19 
Consentto n t r Access to Property SA1D# ^^f^ f 

RIGHT OF ENTRY TO PREMISES 

Grantor (ihe property owner), consents to and duthorizes ihe United States Environmental 

Fiuteciion Agency (USEPA) or its authorized representatives, collectively the Grantee to enter 

and perform certain environmental response activities upon the following described premises; 

Owner's Name: "^oio <J'T ^*Vw 

Daytime Phone: "73 Y 'V 7 ^ ^ 

Address '• 5/ 0 7 S . ^otk s-fAddress: 

Addresses of Properties 

covered by this Address: 

Agreement: 

Address: 

Address: 

PURPOSE OF INVESTIGATION 

The purpose of the remedial activities is to remove all soils at the property Vt-iiich are 

contaminated with hazardous substances, in pailicular lead at concentrations greater than.cr equal 

to 400 parts per million (ppm). 

REMEDIAL ACTIONS 

The environmental response actions to be perfomied on said property may include the foliovving 

activities: 

a. Taking photographs snd/or video of the propeity before, during, and after rernedial 

activities; 

b. Locating equipment and machinery cn-site in preparation for and in the course of the 

enviromnental response; 

c. Planning and implementing the removal action on cr near Grantor's property. 

d. Obtaining samples from Grantor's property; 

AGREEMENT NOT TO INTERFERE 

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

equipment used to perform the activities, or to undertake any actions regarding the use of said 

property v/hich would tend to endanger the health or welfare ofthe Grantees cr the environjnent, 

cr to allow others to use the property in such 

Pj/H grant access i^ my properties 

I 11 do not grant access t<i my propertiss 

(Idy/ C£y7fu^ 5-<^/^ 

Signature Date Signature 

Date 
M 

Additions.1 Cc-~T.2ri'..- / '.-:• r.. v. 

B^hsc k this box if owner does not want E.R. to enter the residents to docurr.ent interior 

foundation wails and possible preexisting dam=ge. By checking this box E.R. is not responsib's 

for any dsmage done to 'the interior of house, induding foLindaticn crscks or fissures. 

n l^ydo n I agree n I do :iot agree i ££re e 1 do not Sgrse 

^^y<^2y ^ 

Owner's Sisr.atare Date Cositractcr's Signature Date 
r^-ifi^^rTnTK-O'^^'-W ^m 

Rs^ytcrslioii Agrsement 

T—1« r. •..»• —p055 of uiis agreement is to provide a mutual agree.m.ent as tc ccnditioiis of property prior to 

^..c,c»^.:or aciiviiies. This will also serve as documentation for the purpose of assuring that restoration 

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

Protection Agency (EPA). 

SAID: y^/r f 

Property Address: SI0 7 S- f^ ^ ^ f 

Owner: ''^^\^ { T'aUcZ r 

Fhone: -j2Y' '/7S ? 

On the attached diagram(s) indicate area(s) to be 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. 

[tems to ba removed fay Contractor and net replaced: 

Etsm: 

"R<P U^^e Ai(__. I^'TL.AW_ 

Faae 1 of 2 
m ^ a 

j /•.dditional Gc:ntn£ri.ls /'n.';.-.ruc-jvn?: j 

I ' 

i y i £grae i 11 do not agree 1 I 22ree I 11 i o riOt agr^e 

v^s^yf y^ b^^^t^ S-S'/o 

Owner's S;gP:£t!ire Bate Contractor's Signature Date 

.-..;sohments 

Page 2 of 2 
:u-S^i^a Zil 

Property Completion Agreement 

This agreement docuinents the completion of remedial activities perfonned on my property. My 

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

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

SAID: 9^/^ ^ 

Fro perty Address: ^/ Q 'y, ^ ^ c t L j^' . 

Owner: ^^oUgr / ~^a\,^ ^ ~ 

Phone: -yjl/ . y7S'S ' 

Restoration Etems in Question: 

Additional ComFT>=nts: 

\jy I sgres rsstoration is completed, except RS noted r\ i I agree restorstion is c-ompltted, e.xctpt £s noted 

I I I i a n:t ggree resto.ratio.i Is completed I I { i(y?.':ii agree restcration is co.^ipleted 

^(y^yi^i^^ 6-^-/ ^ S'-yi'/d 

Owner's Signature Date Contractor's Sig.isture Dste 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R1630860000 

Print Report 

View Interactive GIS l\flap Information is valid as of 2010-5-3 Treasurer's Tax Report 

New Feature ->-+-> Subdivision Sales Search 

Owner 

PALMER ROBERT L 

5109 8 40 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 3086 0000 16 

Account Type: Residential 

Parcel Number: 1630860000 

Parcel Address: 5107 8 40 ST 

OMAHA NE 68107-0000 

Legal Description: \ LIPTON PLACE LOT 23 BLOCK 3 40 X 120 

Value Informatio n 

Land improvement Total 

2009 $4,300.00 _ $0.00 $4,300.00 

2008 $4,300.00 $11,600.00 $15,900.00 

2007 $4,300.00 $27,000.00 $31,300.00 

2006 $4,300.00 $27,000.00 $31,300.00 

„.j . 

2005 $4,300.00 $21,500.00 $25,800.00 

2004 $4,300.00 $19,500.00 $23,800.00 

Sales Informatio n 

Sales Date: , 2002-07-19 

Deed Type: ; WD Book; ; 2218 Page: •. 168 

Price: $10,000.00 

Grantor: 

Grantee: 

Valid/Invalid: j Valid 1 

Exclusion Reason: 

Acres SF Units Depth 1 Width ! Vacant 

0.11 4800.0 1.0 120.0 40.0 No 

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ENVIRONMENTAL AS-BUILT DRAWING 

• b MAHA LEAD SUPERFUND SITEl 

RESTORATION 

48119 

Omah Eiaenor Paint North Arrav a Lead Site 

Q Good Site Sketch • Poor p 

Samplin g Address : 5107 S 40 ST [2f Not paint 

Sampl Lead Sample Samples Collected e Number 

I 

LAB Concentralion Collecled Firm P£. CC . £.K . 

RYASCPXA-48119 Fl / 2. 'S ppm D Date: I O - 2.S - 0 8 

RYBSCPXA-48119 F2 TIT . ppm D Time: 1 - 0L»- p • rA.. 

RYCSCPXA-4S119 Bl 2 .B (j ppm D 

Samples Analyzed RYDSCPXA-48119 B2 I 2 3 ppm D [y KDZ3CPXA--40110 - B 2 ~ ppm D XRF Unit: CSL5'-I 0 Book: 22 0 

-nGgGCPXj'\'40110 ~ ppm n D Date; / / • 0{ c • 0< ^ 

RPZOCPXA 1)8110 -PZ - ~ ppm n

n Time n .£ £n _ 

ra Staff Number of Samples = n 015 LJ 

Legend: F l = Front Left. F2 = Front Rigtit, B l = Back Left, 82 = Back Rigtit DZ = Drip Zone, GZ = Garden, PZ = Pla; 

Af[ quadranls are as viewed rrom the streel facing property 

>f v^—— ^ «f y • • 

[ SAID #48119 ^K-eJ 

DATE EXCAVATED 5-14-10 

DATE EPA SIGNED OFF 6-2-10 NOV 0 5 2008 

AREA SODDED 1760 SQ FT 

2S(9 125 

Bl ibi. 

F2=83PPM@4- n 

y ^ 

y ^ 

125 S22L 

F f ^ l 

V " l IV " g •I 

EZ = 51 PPM @ 1 n

S. MO :b+-

LESEN.D 

Quatjiant cxcavatod Diip2o»>e Excavated Co-ntaminatian Left Behuiti 

rr.r,*rar t i i PP.RTU^Q^* ) Environmental Restoration LLC 
(D 

48119 ^(^b^i'V (l(ArrUf 

Omah Exterior Paint Nortti Arrov/ a Lead Site -1 ^M - m^ 4 Q Good Site Sketch • Poor 

Sampling Address: 5107 S 40 ST Q'^Not paint ^-..-4 

Sample Number Lead Sample Samples Collected LAB Concenlration Collected Firm P£. C-C. £.K. RYASCPXA-48119 F1 / 2^ . ppm D Date I O - 2.q - 0 & 

RYBSCPXA-48119 F2 pp.Ti D Time r-ou p-t^ ­ RYCSCPXA-48119 Bl , i- O CP ppm D Samples Analyzed RYDSCPXA-48119 B2 J 2 5 ppm \y D 

niDZGCrXA-40119 QZ ppm n D XRF Unit: G.5H 0 Book: 22 0 

•f?CZSCPXA-48110 G2- ppm n D Date II -Oi o • O ^ 

RrZGCPXun, 10110 RZ­ ppm D n Time _am -

Staff: Number of Samples • y ca n5 u 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Rigtit DZ = Drip Zone, GZ = Garden, PZ = Pla^ 

All quadrants are as viev.'ed from ttie street, facing property 

:ims I'ic.itvj lL..,Scp''i.s 
•«IM 

Sample Number 

RYASCPXA-48119

RYBSCPXA-48119

RYCSCPXA-48119

RYDSCPXA-48119

RDZOCrXA-40119

llGZSCrXA-48110

RPZSCPy^ 48110

48119 

Exterior Paint North Aaow Omah a Lea d Site • Good Site Sketc h 

• Poor 

Sampling Address: 5107 S 40 ST [^Not paint 

Fl 

F2 

81 

B2 

BZ 

S2­

PZLegend: Fl = Front Left, F2 • 

f y ^lO oo 

% 

, vyz A 

!5 (\/\'-

Lead Sample 

Samples Collected LAB Concentration Collected Firm: P£. Q..C. £ . K • 

1 1 ^ ppm D Date: iO-2.q - 0 8 

^ 2 Z ppm D Time: I'O u ^tK . 

2.8L > ppm D Samples Analyzed / 2 3 ppm \y D ~ ppm u D XRF Unit: Cs.5H 0 Book: 22 0 

ppm n D Date; I Z OCo • O ^ 

ppm D D 

Time i>i _ 

Staff Number of Samples • 

n5L> •y ID 

Front Rigtit, 81 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Pla; 

All quadrants are as viewed from the street, facing property 

r 

sw 

NOV ;0 5 Z008 

2 6 .6R 125. 

e>2. 

125 ^2i 

f 2 . 

W A.l \ 

V n ' >^ I t r 

S. MO t»V Rev:f«.« Crcjl.;J- 16-Scp' i-447(.n.oi :3 
XRF DATA ENTRY LOG 

^^^V^in DATE ^\/5> 0 

PROPERTYADDRESS TIME 

XRF S/N 

QUADRENT OR SAMPLE AREA. 

DEPTH AVERAGE OF RESULTS SHOT #s 

redig 

Fl 

n F2 / " ¥^^\7 

u 31 

82 

DZ 

J P2 

J GZ 

n EZ1 0^ 5/i/ S 3P^-33l 

J 

OTHER 

SAMPLER NAME Ao/Q UEy^R-^^ 
Thermo 

SCIENTIFI C 

I lllll.' , 

2010-05-15 08:51 

2010-05-15 08:52 

2010-05-15 08:52 

20104)5-15 08:52 

2010-05-15 14:12 

2010-05-15 14:12 

2010-05-15 14:13 

2010-05-15 14:13 

S..\ll), 

48119 

48119 

48119 

48119 

48119 

48119 

,AI)l)l<i:SS 

5107 9 40 st 

. 5107s40st 

5107 s 40 st 

5107 s 40 st 

5107 s 40 st 

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5107 s 40 st 

5107 s 40 SI 

l-^-

F2 

F2 

F2 

F2 

EZ 

EZ 

EZ 

EZ 

MtlC.V OI'l-KATOK 

RON

RON

RON

RON

RON

RON

RON

RON

 4 

4 

4 

4 

 surface 

 surface 

 surface 

 surface 

fmal clearance 

final clearance 

final clearance 

fmal clearance Avg of 316-318

final clearance

final clearance

final clearance

final cleamnce Avg of 328-330

77,56 ±

85,75 ±

85,78 ±

 83,03 ±

 48,84 ±

 46.13 ±

 57.80 ±

 50.92 ±

 16,61 

 17,20 

 17,06 

 16,96 

 14,36 

 14.13 

 15.05 

 14,51 

Themio Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Page 1 of 1 05/15/10 16:07:46 
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