TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 4US^ ^ Date: 

Address: S^Q;\g <,. '^\ ^ST 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) "^^^35 ^ DAfter D Basement^" /U) AlSCM^^. 

^ Executive Summary (Final Report) /\^££$ici. 

• EPA-provided property sketch 

^S»^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

H Confirmation data 

Hi^ Photographs _[!>^efore DCrew Photos DsDuring Excavation D Sod 

'•S^O-day Sod D 

Dv As-built sketch 

^ Completion Agreement signed by Property Owner 

• \ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

1^ Utility clearances 

N ^ Property informationfrom.Douglas County Assessor's Office 

^>D Property access checklist 

^ 30237635 

^ ContaCLog ||||||[|j ­ 0 Superfund 

Envirormiental Restoration Signature Date 

7 ' ^'f { 

Date 
? tW r '^ Omaha Lead Site—EP-R7-09-05 

S ^\^^ ^ S Environmental Restoration, LLC 

V* "V www.or1lc.coni ••«»«io*' ' 

EXECUTIVE SUMMARY: 

46553 - 5826 S 21 ST 

[\^| No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
EPA 

EPA Property Close Out Form 

Omaha Lead Site OU#2 

Property #: v\Li^€^ ^ Property Address: ST-^'a.Lg "^ 2.] " ^ 

Date/Time: Owner's Name: £,»r>\\>'a^ 'XtAVC^ 

Quads Excavated: Pa. Contractor Group : Environmental Restoration (ER) 

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? y 

Grading Sod and Vegetation Yes No 

1. Doestiie grading around the perimeter ofthe house in excavated areas generally slope awayfrom 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 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 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? y 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and closefi-eely? (if applicable) t ^ 

2. Were all gates or fences taken down during restoration activities re-installed? (if applicable) \ y 

3. Was damage to gates or fences avoided? (if applicable) ty^ 

4. Was damage to retaining walls avoided? (if applicable) A MT 

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? ^ 

2. Was damage to the foundation avoided? , y 

3. Was damage to windows avoided? • 

4. Was damage to window screens or door screens avoided? y 

5. Was damage to downspouts or downspout extensions avoided? t ^ 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? ^ 

2. Was damage to walkway surfaces avoided? ^ 

Inspection notes: 

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

EPA Representaj ^7;:^'M/f^r.^^J ^ Date: ^p^jnQ 
Page 1 of2 

"> 

[ Create Another Ticket J [ Back to Irth Intemet ] 11

! k

 Send Email 1 > 

• YOUR TICKET NUMBER IS 2478423. 

-^*«'a. - 'T "tr- I'-i'i M -1^-—r'iiTf*fti' r -

Original Call Date: 4/28/10 Time: 5:38 pm Op: TRACY2418 6 

Work to Begin Date: 5/03/10 Time: 6:15 pm 

State:. NE County: DOUGLAS Place: OMAHA 

Address: 5826 Street: S 21ST ST 

Twp: 14N Rng: 13E Sect-Qtr: 10-NW-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Excavating the entire property 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: SAID #46553 


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 


ALT872 ATTNEBRl CXCATV DIGITEL LEVEL3 MUD02 OMAHACOF 


0PPDGPR6 PAETEC QLNNEIF QWESTNE SPRINTNE 


Service Area Contact Phone Number 

Utility 

Type 

ALT872 WINDSTREAM 

COMMUNICATION ELM LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

Day: 8665624349 
 LIGHTCORE A CENTURYLINK DIGITEL NA COMPANY Alt: 8008509048 

/ » «• , . . I" -.-O..-J ^rUTTlT TT T^O A l^ O l^f\^ f\ 
Page 2 of2 

LEVELS LEVEL3 COMMUNICATIONS, ^ ^ 

MUD02 

OMAHACOF 

0PPDGPR6 

PAETEC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC.SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 PAETEC COMMUNICATIONS 

SANDY 

RICH/TRAFFIC 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING 

SPRINTNE 

QWESTNE QWEST LONG DISTANCE 

SPRINT COMMUNICATIONS 

CO 

Emerg: 8665624349 

Day: 8773668344 


Alt: 


Emerg: 8773668344 

Day: 4025047823 


Ah: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Ah: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002834237 


Alt: 


Emerg: 8002834237 

Day: 8005210579 


Ah: 


Emerg: 8005210579 

h/r»tjnxrMAtiPf.rrRatmn/MessaaeText.asp?ret=<RESULTS... 4/28/2010 
Contact Infonnation Log 

SAID#y^5TJ 

Owner's Name^pr/J^Z^ <l j^^Jj ^/^ | Daytime ^^^0^^:^ ^f^JT^-^T^-^f^Ui^. 

Property Address; ^^' ^ 5- 2(^ ^ 

Attempt to contact Date/time Name 

-/^/.L'ir^i]/5cn^^-^ w^/^-y//^^ S 

Cfil^L r/r>cJ. fji t f^ 

i-rl-lo-H: 3iO 5/3 

)4ii-id 2:h d 3 J ^ 

V^Pfe P'f' Uii-I^- I -.S/y SJl. 

'^]^'>h OiD i^. 

S'T '^> HK^W C PI« » liy 

5

b^ ^'l-lD iL 
Property Access Checklist 

SAID; V^^^J 

n WORK STARTED ON: / /_ 

Property D WORK COMPELTED ON:  Address:^^;^^ ^ ^ l ^rr 

I I 

Om^^f-JO-LL Renter: t f,l^pl.i p 

Phone: . ^%z&^^i^r-

Fax: 

Cell/Pager: 

Piione: Additional Information: 

Fax: 

Cell/Pager: 

^ Access Agreement Signed: _^/^/JE . By- 2icKfv>>t/>. 

{71 Restoration Agreement Signed: V i I t 1 ib 

By= L^^' ^ 

0 . Video Property Before On :Jj_lll'lj2_ By= ^-,0. f^<s.u?. 

^ Digital Photos Before On : </ / Zfl I ' 

By= tg,cJL Pii.WL. 

n Video Property After On : / / By: 

n Digital Photos After On : / / By: 

^ Property Completion Agreement Signed: $ 1 1^1 {0 By: '^D 

n Final Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

n Video n Digital Photo On : / / By: 1 

Reason: 1 

n Video D Digital Photo On : / / By: 1 

Reason: 

n Video D Digital Photo On / / By: 

H Keason: 

D Video D Digital Photo On : / / By: 

1 Reason: 

Omaha Lead Project Work Plan 

Page I of 19 
Consent for Access to Property SAID#V(^ 55 J 

RIGHT OF ENTRY TO PREMISES 

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

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

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

Owner's Name: Y ^ //,£7 ^ /^ m^f ^ Daytime Phone: 

Address:^ ^^^ _ ^ ^ f ^ ^ 

Address: 

Addresses of Properties 

Address: covered by this 

Agreement: 

Address: 

Address: 

PURPOSE OF INVESTIGATION 

The purpose of the remedial activities is to remove all soils at the property which are 

contaminated with hazardous substances, in particular lead at concentrations greater than, or equal 

to 400 parts per million (ppm). 

REMEDIAL ACTIONS 

The environmental response actions to be performed on said property may include the following 

activities: 

a. Taking photographs and/or video of the property before, during, and after remedial 

activities; 

b. Locatmg equipment and machinery on-site in preparation for and in the course ofthe 

environmental response; 

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

d. Obtaining samples from Grantor's property; 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or 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 which would tend to endanger the health or welfare ofthe Grantees or the environment, 

or to allow others to use the property in such 

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

"i/A^ ^ f^ 

Signature Date Signature 

Date 

1 
Additional Comments / Instructions: 

^Check this box if owner does not want E.R. to enter the residents to document interior 

foundation walls and possible preexisting damage. By checking this box E.R. is not responsible 

for any damage done to the interior of house, including foundation cracks or fissures. 

[Xl I agree ^ I do not agree n I do not agree 

t-K^it/l V/g>/^t3y»-) ^^L. Owner's Signature Date Contractor's Signature ifate 
Restoration Agreement 

The puipose of this agreement is to provide a mutual agreement as to conditions of property prior to 

contractor 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). 

^•"^ ijC.S'i ? 

propmyAdaigsijyg;^^ S ${l sr -

Owner: JhLLe^ ^ i^&l t^A 

Phone: 

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. 

Items to be removed by Contractor and not replaced: 

Item: 

|-^;r^ € u Fl d>z 

Item: 

item: 

Item: 

Item: 

Item: 

item: 

Page 1 of 2 
Sketch of additional instmctions. 
Additional Comments / Instructions: 

RI I agree n I do not agree 0 - 1 agree CHI do not agree 

Owner's Signanire ' Date ntractor's Signature Date 

Attachments 

Page 2 of 2 
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 

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

SAID: "/(SS^J 

Property Address: f^^/C ^ S ^ / ^ ^ 

Owner: ^^^g ^ f y^ S I f/ 9 

Phone: 

Restoration Items in Question: 

Kem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

IXl I agree restoration is completed, except as noted r \ I agree restoration is completed, except as noted 

1 1 I do not agree restoration is completed L J I do not agree restoration is completed 

/^J.-.^A c.KJ/QJ,r> flLM?/' V ^ . ^-'^1-/0 

Owner's Signature"-^ Date Contractor'ss Signatur Signaturee Date 
Douglas County Account Infornjation Page 1 of3 m^tr 

Douglas County, Nebraska Property Record - R2026530000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-SO ft west of 52nd St - Vie W O n Ma p infomiation is valid as of 2009-12-1 Treasurer's Tax Report 

New Feature ->••- > Auto Sales Search 

Owner 

TELLEZ EMELIA 

5826 S 21 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 2653 0000 20 

Account Type: Residential 

Parcel Number: 2026530000 

Parcel Address: 5826 S 21 ST 

OMAHA NE 68107-0000 

Legal Description: POTTER & COBBS 2ND ADD LOT 7 BLOCK 7 50 X 130 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land Improvement 

$4,900.00 $84,500.00 

$4,900.00 $84,500.00 

$4,900.00 $71,900.00 

$4,900.00 $71,900.00 

$4,900.00 $71,900.00 

$4,900.00 $54,500.00 

Total 

$89,400.00 

$89,400.00 

$76,800.00 

$76,800.00 

$76,800.00 

$59,400.00 

Sales Informatio n 

Sales Date: 2004-03-30 

Deed Type: 

Price: 

Grantor: 

QC 

$45,000.00 

DANEIL TELLEZ 

Book: 2004 Page: 043299 

Grantee: EMELIA TELLEZ 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 1998-04-02 

Deed Type: 

Price: 

Grantor: 

$49,500.00 

Book: 2086 Page: 455 

. ^r»/^„rri opr'rt"M(»/c+atir/ar.r.niintinfo.i SD?accoimtno=R2... 12/17/2009 
Douglas County Account Inforn^io rn^^ o n Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6500.0 1.0 130.0 50.0 No 

Improvemen t Informatio n 

Building 1 

1 1/2 STORY FIN 

£a2SS21 ST 

MItBMXMK tjx nw 

»,. CP t ; » '" > fte- 1 i3C' H Sf 

First Floor Second Floa •^.•y r, c »c u.. 1003.Dsq. H. S34^«q fl' 

1 ^ ­ •? 

.^B ^ 

9 f 1 gT»;t m^^ 0 ' 

lOca.Osq.fl. ra-i jr-kSiT ^T'T^itf-USTTi ih i ?-S.f. *«r>« -i f 1^i r t 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: \ 1537.0 Percent Complete: j 100.0% 

Perimeter i 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Stiingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1918 0 0% 1918 92 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1003.0 

Basement Finished 300.0 

Fixture Base Fixtures 1.0 

-i.,„r^.,\T^/^+.,f;^/^.,^^,,„tinfn isr)?accountno=R2... 12/17/2009 
Douglas County Account Inforn^on Page 3 of3 irn^o 

Fixture Bath Full 1.0 

Garage Detached 220.0 

Porch End Solid Wall 48.0 

Porch End Solid Wall 176.0 

. . .^.•kT-/_..„.i:_/ t:„f^ :o«9a^^r>„ntnr»=R9 17/17/7.009 
ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

RESTORATION 

liiliillilliillliillliiill 46553 

Omali Exterior Paint North Arrow a Lead Site 

Q Good Site Sketch • Poor 

Samplin g Address ; 5826 S 21 ST 

• Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: 

RYASCPXA-46553 Fl ^ftZ , 

ppm n Date: ^ ^^^o8 

RYBSCPXA-46553 F2 S 3 0 ppm n Time: LI--10 p- M 

RYCSCPXA-46553 Bl 1'=)^ ppm a^ Samples Analyzed RYDSCPXA-46553 82 2.3 1 ppm 2/ n 

RDZSCPXA-46553 DZ ll R ppm n XRF Unit: /p5i Q Book: 

ROZ3CPXA-40553 SS- ppm D n Date: ^ - 2^-Q g nPP-.nCPXA-46553 PE- — ppm n n Time: Jh 

Lab RYCSCPLA-45553 Staff: i'n^^-j Number of Samples _"• Result 281 pp;-n 5 J 

Legend: 1-1 = f-ront Lett, h^ Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ Play 

-^'iJSuadrants are as viewed frofn the street, facing property 

-V —'——Y V 

Rtv 2mH frcawd; 'l!.M 

Quadrat*! oxcavatcd DrlpZooc Excavated Contaminjtton Left Behind 

C«*ft#IW^fc«%«W%^^V»*«kl D^^««44<^»'%Ai^V»« 11/ ^ r^^^*^^^^* u. CD o-r na ne 
(? 

^{^^^(^^^ex ^ #.111111 III II 46553 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch Q Good 

• Poor 

Samolinp Address: 5826 S 21 ST Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 TDI Q pP),J p 

RYASCPXA-46553 Fl ppm D Date: P,-Z\- ^ 

RYBSCPXA-46553

RYCSCPXA-46553

RYDSCPXA-46553

 F2 

 Bl 

 B2 

ppm 

ppm 

ppm 

n 

n 

Time: UM Q p. W\ 

Samples Analyzed 

RDZSCPXA-46553 DZ ppm n XRF Unit: /o5H Q Book: Z\ ^ 

RQZ3CPXA-40553 &t - ppm a n Date: ^ • 1 ^ ' 0 6 

nn/.ncPXA-46553 p^­ ppm n n Time: f^ m 

Lab RYCSCPLA-46553 

-Result 281pp,-n 

Number of Samples 5 Staff: Pl^LT ) 

Legend: Fl = hront Lett, hz = Front Right. B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed frofn the street, facing property /j \ [fU 
i 

III! 46553 

Omah Exterior Paint North Arrow a Lead Site 

Sit Q Good e Sketch 

Q Poor 

Sampling Address: 5826 S 21 ST Q Not paint 

Sample Number 

RYASCPXA-46553 Fl 

RYBSCPXA-46553 F2 

RYCSCPXA-46553 B1 

RYDSCPXA-46553 82 

RDZSCPXA-46553 DZ 

RQZ3CPXA-40553 62 -

nP7.f|CPXA-46553 P2-

Lab RYCSCPLA-46553 

_-Result 281 ppm 

Legend: Fl = Front Lett, t d 

Lead Sample 

Samples Collected LAB Concentration Collected Firm: fr}f\ Pi3rJD 

ppm n Date: i^-z\-^ 

JSJ^O ppm D Time: 

2SH ppm I Samples Analyzed 2 3 / 

ppm D 

Hl B 

ppm D XRF Unit: foS'lO Book: Z\ ^ 

ppm D D Date: ^ - 2S • 06 — ppm D D 

Time: /-fro 

Staff: pn6U) Number of Samples = S I 

Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed frofn the street, facing property ri \[fU 

Ri:v ; I'reaied 

0447OI.0I.:: 
e 

-Mmmm^m^ XRF DATA ENTRY LOG 

! ' • • . . . ' • . • ! ; ' • 

1 • • . • " ! ; 

SA!D# /^ ^o. 5 DATE S xl3 V )o 

PROPERTY AD ORE TIME 

^ • 

XRF S/N 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOT#s 

redig n Fl 

n F2 y" ^^i/S" 7^-75^ 

D B1 

n B2 

n DZ W'liCf 7?-^«P 

n PZ 

D GZ 

u F71 f f ^9?-^ ^ cD-c^ ^ 

D F7? 

n OTHER 

SAMPLER NAME Xo/v /kiy^^-^ 
Thermo 

SCIENTIFI C 

1 2010.0] 1307:46 

2 2010.0] -13 07:47 

3 2010.0J­•13 07:47 

4 2010-OJ­ 13 07:47 

5 2010.05­ 13 07:51 

6 2010.0]. 1307:]2 

7 2010.0J. 13 07:J2 

8 20I0.OJ. 13 07:52 

9 20104]. 13 07:5] 

10 2010.03­ 13 07:J6 

II 2010.0]­ 13 07:56 

12 2010-0]. 13 07:]6 

46]53 

46]]3 

46]S3 

46]]3 

46553 

.465]3 

46553 

46553 

46553 

5826 s 21 St 

5826 s 21 St 

5S26a2lst 

5826 B 21 St 

5826 s 21 St 

5826 s 21 St 

5826 8 21 9t 

5826 s 21 St 

5826 > 21 St 

5826 s 21 St 

5826 s 21 SI 

5826 8 21st 

F2 

F2 

F2 

F2 

DZ 

DZ 

DZ 

DZ 

EZ 

EZ 

EZ 

EZ 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

RON 

4 

4 

4 

4 

6 

6 

6 

6 

surface 

surface 

surface 

'surfitce 

final clearance 

final clearance 

final clearance 

final clearance Avg of75-77 

final clearance 

final clearance 

final clearance 

final clearance Avg of79-81 

final clearance 

final clearance 

final clearance 

final clearance Avg of 83-85 

66.24 ±

53.30 ±

55.40 ±

]8.32 ±

123.60 ±

118.21 ±

116.42 ±

119.41 ±

241.43 ±

267.64 ±

237.34 ±

248.80 ±

 15.30 

 14.01 

 14.52 

 14.61 

 19.0] 

 18.83 

 18.32 

 18.73 

 24.74 

 2J.84 

 24.47 

 2J.02 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

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