TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^y^ ^ Date: 

Address: /p^ QL U 2 ^ -^ r 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) JlSBefore DAfter \l , Basement D 

IS» Executive Summary (Final Report) 

Q EPA-provided property sketch 

N. Signed Access Agreement for subject property 

N Signed Access Agreement(s) for adjacent property 

S Restoration Agreement 

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

^ Confirmation data 

D Photographs DsPefore DCrew Photos^ During Excavation \1 Sod 

D 30-day Sod D 

N As-built sketch 

^Ss. Completion Agreement signed by Property Owner 

^ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

^S ^ Utility clearances 

^ S Property information from Douglas County Assessor's Office 

^ Property access checklist 30237924 

H Contact Log 

Superfund D 

Date" 

S'Z7'li 

Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: Mb^^g*^ PrcpertyAddress: (^^fSL A^ 'j^H "Sf 

Date/Time: Owner'sName: \/)aiCO^ l^i^i-l 

Quads Excavated: fei Contractor Group : Environmental Restoration (ER) 

Excavation General 

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

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

Yes 

y 

y 

No 

Grading Sod and Vegetation 

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

house? 

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

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

period). 

4. Are sodded areas generally firm and evenly graded? 

5. Are thejoints between the sod strips generally tight? (Only evaluate ifinspected 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? 

Yes 

^ y 

y 

y 

w ^ 

y ^ 

No 

Gates, Fences and Retaining Walls 

1. Do gates open and close freely? (ifapplicahle) 

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

3. Was damage to gates or fences avoided? (ifapplicahle) 

4. Was damage to retaining walls avoided? (ifapplicahle) 

 (ifapplicahle) 

Yes 

1 ^ 

u^ 

t ^ 

fOA 

No 

Foundation, Siding and Gutters 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

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

5. Was damage to downspouts or downspout extensions avoided? 

Yes 

K ^ 

. ^ 

,_, 

^ ^ 

, 

No 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes 

^ 

*-^ 

No 

Inspection notes: 

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

EPA Representativ^i'V^%.ly/7y7^%A>x^ ^ . yJa ^ Date: 7//s//< ^ 
fi^y Omaha Lead Site—EP-R7-09-O5 ^ ^^^Zm . ? Environniental Restoration, LLC 

^T"^^ ^ www.er1lc.com 

EXECUTIVE SUMMARY: 

40959-6912 N 24 ST 

No Issues or Concerns Q] Issues/Concerns 

Petail Exoianation: 
ENVIRONMENTAL 

RESTORATION 

PROPERTY ACCESS SIGN-OFF 

OMAHA LEAD 

Property ID #_i/29:£ ^ 

Property Address ^9^ ^ y ^y^ ^ cizLZ.zz.<>j^A^^ ^ ^ j ^ 

Owner Name bJ^ai/-lAzS^j/i jz ^ 

Date S^-3>}-JL) 

Comments 

Owner of property has agreed to allow ER to cross their 

property to gain access to the adjacent property where 

excavation work will be performed. ER will restore this 

property to its original condition after work is 

completed. 

Owner Signature AA^JM^ f^^y^/i^l 

Contractor Signature 
Page 1 of3 

"> 

[ Create Another Ticket 1 [ Back to Irth Internet ] Send Email 

YOUR TICKET NUMBER IS"^2569893? 

Original Call Date: 8/17/10 Time: 12:06 pm Op: TRACY2418 6 

Work to Begin Date: "8/19/10' Time: r2:30 pk 

State: NE County: DOUGLAS Place: OMAHA 


Address: 6912 Street: N 24TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-NW-SW,04-NE-SE,09-NE-SE,10-NW-SW 


Twp: 15N Rng: 13E Sect-Qtr: 15-NW-SW,16-NE-SE,21-NE,22-NW 


Twp: 16N Rng: 13E Sect-Qtr: 27-SW,28-SE,33-NE-SE, 34-NW-SW 


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 #40959 f 


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 CRGHTON CXCATV DOCOINFS ENERGY LEVEL3 

MAGELLANP MCINEB METRO MUDOl OMAHACOF OPPDGPRS PAETEC 

QLNNEIC 

Service Area Contact Phone Number 

Utility 

Type 

ALT872 WINDSTREAM 

COMMUNICATION ELM LOCATING 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CRGHTON CREIGHTON UNIVERSITY DAVE MCATEE 

Day:

Alt:

 4022802780 

 4025101995 

Emerg: 7125454616 

Day: 4029340469 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/17/2010 
Page 2 of 3 

CXCATV 

DOCOINFS 

ENERGY

LEVEL3 

MAGELLANP 

MCINEB

METRO

MUDOl 

OMAHACOF 

OPPDGPRS 

PAETEC

QLNNEIC

COX COMMUNICATIONS, INC 

DOUGLAS COUNTY 

FNFORMATION SERVICES 

 ENERGY SYSTEMS CO 

LEVEL3 COMMUNICATIONS, 

LLC 

MAGELLAN MIDSTREAM 

PARTNERS LP 

 MCI 

 METRO COMM. COLLEGE 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC,SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 PAETEC COMMUNICATIONS 

 QWEST LOCAL NETWORK 

HEIDI 


ALLAN 


DAVE WOODS 


NA 


DEBORAH 


NO CALL PER MEMO 


CHRIS 


SANDY 


RICH/TRAFFIC 


ELM LOCATING 


NO NEED TO CALL OUT 


EMERGENCY 


ELM LOCATING 


Alt: 4029340469 


Emerg: 4029329757 


Day: 4025107242 


Alt: 4024447188 


Emerg: 4025107242 


Day: 4023469066 


Alt: 4023469128 


Emerg: 4023469128 


Day: 8773668344 


Alt: 


Emerg: 8773668344 


Day: 9185747098 


Ak: 


Emerg: 9185747098 


Day: 8002893427 


Alt: 


Emerg: 8002893427 


Day: 4024572307 


Alt: 4026727033 


Emerg: 4024572313 


Day: 4025047823 


Ah: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Ak: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 


Day: 4067289343 


Ak: 4062071494 


http://v^ww.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/17/2010 
Page 3 of3 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/17/2010 
Contact Information Log 

SAID#^^y<9^ 

Attempt to contact Date/time Name 

/-.l9-//>/ f/:^0/> ^ /C.cLinw.'s 

S'3/'/^ f(^^ ftb 
Property Access Checklist 

I SAID: ^ 5?^~-y p WORKSTARTF.D 

I Prnnerty .Address:

I =7. Llll

 / < 

 bL. G WORKCOMPELTED ON: / / j 

Owner: kJctrr-c^ "~pc*^' Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: V^;i ^ -J/^-^^ ^^^--g - Additional Infortnation: 

Fax: 

Cell/Pager: 

pT Access Agreement Signed: / /A/ / / p By^ ^ . A 

M Restoration Agreement Signed: I f^ 1/ / ^ ^y- 'P.p • 

S Video Property Before On ' } I XH I By: / ^ 

I ^ Digital Photos Before On *) / 1-il (» By: /y5 

I I Video Property After On / By: 

D Digital Photos After On / / By: 

[ S Property Completion Agreement Signed: 1 / 7 / /& By: ez/ 

Q Final Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

n Video n Digital Photo T On : / 

Omaha Lead Project Work Plan Pagel of 19 
tgigtfsisj 

Consent tor Access to Property SAID# Vb 9^ ^ 

RIGHT OF ENTRY TO PREMISES 

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

Fioleciion Agericy (USEPA) or its authorized representatives, collectively the Grantee to enter 

and perfonn certain environmental response activities upon the following described premises: 

cigM i^ Daytime Phone: </eJI. ­ </S^S — j'tf &" ^ j 

Address: /y^/:^ /^^ysr/ . Address: 

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 wliich 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: 

Taking photographs and/or video of the propeity before, during, and after remedial 

activities; 

Locating 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. 

Obtaining samples from Grantor's property; d. 

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 

n I grant access to my properties 

LJ I do not grant access to my properties 

(f„y^^., y.iy ^ y 2-i^ m 

Signature Date Signature 

Date 
^J^^gg ^ ^ 

Additional Comments / Instructions: 

n 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. 

0I I agree n I do not agree FI agree n I do not agree 

^ uMx^ f. f^l-Z{^)d /';A/,/t> 

Owner's Signature Date 
Restoration Agreement 

The purpose of Lliis agreenient is to provide a mutual agrep.rnent as tc conditions uf property prior to 

contractor acliviiies. Tnis 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). 

1 SAID: ¥7>9/r'^ 

Property Address: (Ar/JL AA ^ ^ 

%4 

Owner: 

/t//c^ n l^tS^I 

Phone: 

^z>:>. - VAS - as&^'S' 

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

utilities, subsurface features, surface stmctures ahd landscaping features, access location(s) to be used by 

contractor, and the direction ofNorth. 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: 

K-e./y^i^-e. u/iTh. yciM 

Item: 

Page 1 of 2 
Additional Comments / Instructions: 

\7\1 agree n I do not agree agree cn I do not agree 

L:£77L 

Owner's Signature Date Date 

Attachments 

Page 2 of 2 
Property Completion Agreement 

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

signature will designate that 1 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: fof ^ - ^ 

Property Address: (^'J/^ // . Q^/7£ ^ . 

Owner: UJ^rrtA '7^-K . i 

Phone:

• TASJ'AT^^ ^ 

Restoration Items in Question: 

jJC) I agree restoraiion is completed, except as noted Nj I agree restoration is completed, except as noted 

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

/y7ZM?^j7 9-9-/A 

Owner's Signature rimDatee Contractor's Signature Date 
Douglas County, Nebraska Property Record - R1748490000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 tt west of 52nd St - Vle W OP Ma p Information is valid as of 2009-12-15 Treasurer's Tax Report 

New Feature ->->- • Auto Sales Search 

Owner 

TEAL WARREN R 

ETAL TR 

6912 N 24 ST 

OMAHANE 68112-0000 

Property Informatio n 

Key Number: 4849 OOOO 17 

Account Type: Residential 

Parcel Number: 1748490000 

Parcel Address: 

Legal Description: 

6912 N 24 ST 

OMAHANE 68112-0000 

MINNE LUSA LOT 3 BLOCK 3 46 X 120 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

$4,500.00 

Improvement 

$58,700.00 

$58,700.00 

$54,500.00 

$54,500.00 

$54,500.00 

$42,100.00 

Total 

$63,200.00 

$63,200.00 

$59,000.00 

$59,000.00 

$59,000.00 

$46,600.00 

Land Informatio n 

Acres 

0.12 

SF 

5520.0 

Units 

1.0 

Depth 

120.0 

Width 

46.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 12/22/2009 
1 ay e z U l Z 

691:^14 St 

I I.C Stc<v <J*r 

• • <^1 :^=­ fc",­

:4i<­

i;<r 

ac 

Cff 

.t-) 

"^7?'*' 

CUCK TO ENLAF?GE IMAGE 

Square Footage: j 1104.0 Percent Complete: i 100.0% 

Perimeter 1 0.0 Quality: i Average 

Unit Type: Condition: ! Average 

Built As: < Ranch Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 88 

Detail Type Detail Description Units 

Add On Unfinished Attic W/floor 228.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1056.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 180.0 

Porch Encl Solid Wall 96.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 12/22/2009 
ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE |r-ii^„.,..j.^.-•••^•^.^,... , ;-T-- » 

-•yj t 

RESTORATION 

40959 

Omah Exterior Paint a Lead Site • Good Site Sketch 

[]J Poof 

Sampling Address: 6912 N 24 ST Q Not pamt 

Lead Sampie Samples Collected Sample Numtjer LAB Concentration Collected Firm: T^ XNC, P & TA 

RYASCPXA-40959 Fl ppm n Date: lnl2^] M 

RYBSCPXA-40959 F2 ppm n Time: INOSAh A 

RYCSCPXA-40959 Bl 1 p.°l ppm n 

Samples Analyzed RYDSCPXA-40959 82 ppm D 

RDZSCPXA-40959 DZ A ll ppm D XRF Unit: fnfl& Z Book: 2.^(o 

ncgecpxA 40050 -€2 - ppm D D Date Tf3-o q 

RrgGOr)(A-40950 P2- ppm D D Time 

CttL. 

Staff: Number of Samples = _Q_ nsW

Legend: Fl = Front Left, F2 • Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed from the street, facing property 

N.2M Sr. 

I^QENP 

Quadrant cxcav.itcd L| Dfip Zono Excavatod Contammation Left Bohind 
lim 40959 

Omaha Lead Site Exterior Pamt North Arrow 

Site Sketch • Good 

Of'^Poor 

Samoiina Address: 6912 N 24 ST Q Not paint 

Sampl Lead Sample 

Samples Collected e Number LAB Concentration Collected Fimi: TV TMC. D 5 TA 

RYASCPXA-40959 F1 

ppm D Date: lo\l^\cf l 

RYBSCPXA-40959 F2 ziy\ ppm n Time; II^O.^AtA 

RYCSCPXA-40959 B1 ppm 

•7 fi^ 

n Samples Analyzed RYDSCPXA-40959 82 

ppm I

RDZSCPXA-40959 DZ \y 

D 

ppm 

XRF Unit: /Qgfc l Book: mi o 

RGZSCPXA 400€0 GZ-

ppm u n Date: T / ^ -Q ^ 

RrZSCrXA-40059 P2- ppm D 

Time: [tol. D Staff: Number of Samples •-

nsW £L 

Legend: Fl = Front Left, F2 • Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed from the street, fadng property 

ENTERED 5K- ^ ^ >e- t 

JUL 0 6 2009 

< 

.&Z a 

<3 218 

&i 

-\97\ 

px 

DZ-= .1!%. •z 

A • £> .

^'. 

g "'H^ 

-Z: 

VZ 

a-' 

.3. K 

/ 

Ul 

n •Fz . 

..:F2. > 

2Z^ O 

Cre.lted: 06-Kov-f.i8 I:M47OI 01, ; 3 V/AU tz 
m Itllliiliill 40959 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch 

O'^Poor 

Sampling Address: 6912 N 24 ST \~] Not paint 

Sample Number Lead Sampie Samples Collecled LAB Concentration Collected Fimi: "Fk TM C 1)5 TA 

RYASCPXA-40959 F1 [ Ig l ppm D Date: l.o\^7m 

RYBSCPXA-40959 F2 22- ^ ppm Time: l^05A^A 

RYCSCPXA-40959 81 a 1 P>'^ ppm 

D Samples Analyzed 

RYDSCPXA-40959 82 2./ fi ppm 

RDZSCPXA-40959 DZ t'i 1 8 ppm D XRF Unit: jDPjhZ Book; 7H(<? 

RGZSCrXA-400SQ GZ- "~ ppm D D Date; ~l • Ai 'O ^ 

RrZCCPXA-40959 PZ- ~ ppm n D Time; Prv, n Staff: f^sW Number of Sampies = ^ XL 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pia; 

All quadranis are as viewed from the slreet, facing property 

ENTERED %. ^ I 7­ - H ^ 

JUL; 0 6 2009 

< 

y / '.t^i^^TTi'if Tl < 

218 7 •}.H O 7 

7S^ VZ H 

u. 

-.(- fc J,!% <J y ^ im rHH 

5 ^ w- g

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E 

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Ul Fs. hi.. Fz. > 

2Z^ P 

Re\^ 2i'C»S' Createii; t:i<>-}\ov4.iS 

N1.2M ST. 
C 

ENViRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

SAID #<AO'^^A DATE <^ \ 2. W O 

PROPERTYADDRESS TIME 

XRF S/N ^^TV ^ 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOT#s 

redig 

n Fl 

D F2 

D B1 4 (ZiSt '^ '2.l?A-7.l?.<j> 

D 82 

D DZ A u t n •Z.\-*n- a.\"Ln 

D PZ 

D GZ 

a EZI j^jbio_E:t 

D EZ2 

D OTHER 

SAMPLER NAME "TS . '^^=:^T-:>^ ^ 
Thermo 

SCIENTIFI C 

liiile.v 1 line 

1 2010-09-02 10:12 

2 2010-09-02 10:12 

3 2010-09-02 10:11 

4 2010-09-02 10:11 

5 2010-09-02 10:04 

6 2010-09-02 10:04 

7 2010-09-02 10:03 

g 2010-09-02 10:03 

AVKU.\<:i . ADOUK.SS 

Avg of2i37-213'.6912n24st 

6912n24st 

6912n24st 

6912n24sl 

Avg or2133-213;6912n24st 

6912n24st 

6912 n 24 SI 

6912 n 24 st 

.S.-\MI' 

DZ 

DZ 

DZ 

DZ 

Bl 

Bl 

Bl 

Bl 

LKAItKA ()l'i; 

jimmy 8 

jimmy 8 

jimmy 8 

jimm> 8 

jimmy 4 

jimmy 4 

jimm> 4 

jimmy 4 

Hnal clearance 

final clearance 40959 

final clearance 40959 

final clearance 40959 

final clearance 

final clearance 40959 

final clearance 40959 

final clearance 40959 

96.20 ±

98.24 ±

100.08 ±

90.29 ±

122.81 ±

119.51 ±

120.41 ±

128.49 ±

 17.39 

 17.56 

 17.72 

 16.90 

 18.93 

 18.70 

 18.88 

 19.20 

Thenno Fisher Scientific 

900 Middlesex Tumpike 

Billerica, MA 01821 

Page 1 of I 09/03/10 10:01:49 
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