TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 5"t^M0 I Date: 

Address: TjK^I 0 \ ^ \ ^ ^ ^ 

Remediation Contractor: Environmental Restoration, LLC_ Year: _2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

JZ!^ Video of property (DVD) jaiSefore D After D Basement D 

J2^ Executive Summary (Final Report) 

jd^ EPA-provided property sketch 

y d Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

ja^ Restoration Agreement 

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

y ^ Confirmation data 

J3^ Photographs _^Before DCrew Photos.0T)uring Excavation D Sod 

^0-da y Sod D 

CK As-built sketch 

27 Completion Agreement signed by Property Owner 

yZ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

^ Utility clearances 

2i Property information from Douglas County Assessor's Office 

j d Property access checklist 

30262200 

^ Contact Log 

/ 

Envirronmenta a l Restoration Signature Date 

/EP A COR signature / Date 
EPA Property Close Out Form 

Omaha Lead Site 

^l^rA 

Propert Property Address: ^Dl O M H 1>r y #: SCiHo 

Dateyrime: Owner's Name: 0. ^ of Omi^ 

Quads Excavated: m^ Contractor Group : Environmental Restoration (ER) 

\llkCAUr U)r Yes No Excavation General 

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

v ^ 

2. [f necessary, were the correct areas of drip zone excavated and restored? 

7/A 

Gradin Yes No g Sod and Vegetation 

1. Does the grading around die perimeter of the 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 if inspected at 30-day time 

period). ^ 

/ ' 

4. Ase sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evahiate if inspected at 30-day time period). 

6. Was the property graded such that water will not pool on the property? 

7 

7. Was damage to landscaping or plant materials avoided? 

VL 

Gates Yes No , Fences and Retaining Walls 

I. Do gates open and close freely? (if ^plicable) 

2. Were all gates or fences taken down during restoration activities re-instolled? (if applicable) ^ 

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

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

Foundation Yes No , Siding and Gutters 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

-\1HJ^^ QI -

Trf* 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 No Sidewalks and Driveways (Concrete) 

I. 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 Representative: ^^JzdU >^^ ^ JL? ^ I>ate: P/^/ / io 
^^^^r ^ 

-i Omaha Lead Site—EP-R7-09-05 

\taSiiiCii!rm, ^ Environmental Restoration, LLC 

V j ^ www.crllc.com 

EXECUTIVE SUMMARY: 

50401-2070 N 18 ST 

No Issues or Concerns QJ Issues/Concerns 

Detai l Rxniannrirtn: 
Page 1 of2 

[ Create Another Ticket • j [- . Back to Irth internet ; Send EmajL , 

YOUR TICKET NUMBER IS 2626049. 

Original Call Date: 10/25/10 Time: 6:39 pm Op: ADAM24186 


Work to Begin Date: 10/28/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2070 Street: N 18TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW,15-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead soil removal 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: 50401 


Company : ENVIRONMENTAL RESTORATION 


Contact Name: ADAM Phone: (402)451-1314 


Alt. Contact: Phone: (636)288-9616 


Work Being Done For: EPA 


Depth of Excavation: 24 in Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/25/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/25/2010 
i^^ff^ 

Contact Information Log 

E _M 

Owner's Name; Li-iii^ O ^ 

i?ICni^lr\ 

Daytime Phone: V^ '

Property Address: Z-Qn o AJ • <.% S. T 

SAID#

 7 5 40* 

 SZ)^/^/ 

D 

Attempt to contact DateAime Name 
^:^ . 

•^f'O^ 

Property Final Report 

SAID: n WORK STARTED ON: __/__/_ i^m>v 

Property Address: D WORK COMPELTED ON: / /

^7^^ ^ ^ > f ^ ^- ^ 

Renter: ^^"^••^ OA^ o ^ Omr^l^.. 

Address: ^ Phone: 

Fax: 

Cell/Pager: 

Phone: //yVl (/^ ^ Additional Information: 

Fax: Y^yd^/y 77¥, o 

Ceil/Pager: 

[Zl Access Agreement Siened: 5?/2^f O By: J 6 

IZJ Restoration Agreement Signed: ^/2^/i a 

By: vJ 5 

\2d Video Property Before On :_3./il2/J O 

By= r)l 5 

0 Digital Photos Before On : 9 //'O / VO 

By: O g 

D Video Property After On :_/_/ _ By: N/A 

n Digital Photos After On : / / By: 

Ss? Property Completion Agreement Signed: 11 / /(b/ (O By: -j^/? 

D Final Report Signed: / / By: 

EXECUTIVE SUMMARY 

Omaha Lead Project Work Plan Pagel of 19 
Consent for Access to Property SAID# S^^o f 

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 perfonn certain environmental response activities upon the following described premises: 

Owner's Name: Daytime Phone: (_{jJil- tX2ti^ i l l % - ^ 

Zl 

Address: 11070 Kl. 18"- .5/ 

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 enviroiunental 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. Locating equipment and machinery on-site in preparation for and in the course of the 

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 wdth 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 

n I do not grant access to my properties 

> 

^^('-dlujud-'^\,(\ 

Signature D^te Signature 

Date 

1 
Additional Comments / Instructions: 

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

•Toundation 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. 

JgfIl agree n I do not agree ^ I agree n I do not agree 

•^'^-\ ^ 

Owner's Signature E^(e Contractor's Signature Date 
Restoration Agreement 

The purpose 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). 

SAID: So^o I 

Property Address: zx)70 A/. /<?• s r 

Owner: Cl -<?>>x<>>^ U, £. ^ <W^/^- ^2,V ^ 

On the attached diagram(sj 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: 

jdf^[ci,cJ l t ^ , / CD O 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 2 
Additional Comments / Instructions: 

\%Ji agree n I do not agree Kli agree [H I do not agree 

Owner's ^gfl^ Date Contractor's Signature Date 

Attachment 

Page 2 of 2 
"Nov. 16. 2010 7:57Ar" ^ OMA^LANNIN ^ ^ L G OEPT. 402-444-6140 Jo. 0157 P. l/l^oa/"^ : 

Proporty Completion Agreement 

This Agreement documenla the completion of remedial actlvitiefi performed on my proper^. N4iy 

signature 'will designate that I am satisfied witli die resftozatiDn of my property, and tiiat no items are in 

quesdon, noyr, or at any time in the fiiture, except those items listed below, ifany. 

SAID: *^'^c4e i I 

Property Address: 

2JSir > A/ . If f .tTQ>ifiktg: 

J^ftl y f ^ ^K^t-VA^,, 

''''o"'' ^^^U^af i 

^

i 

Restoration Itann In Question: 

Rem: 

Itofn: 

Nam: 

Itam; 

Mom: 

Item: 

Additional Comments: 

^ I Bgre« rcatoratiOA is compkted, txcapt w noted I agreo restoration is completod, except aa noted \ 

O I do netagreo rtitorBtian is completed L ] I ulo not agree restoraHoa ia compieted 

7/'/<^d0 

Contractor'g Signature Data 
ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND 9h. 

RESTORATION 

Owner Name: J^HQAddress: 2070 

Phone: H; 

Sample Number 

RYASCPXARYBSCPXARYCSCPXARYDSCPXA­

•RDZSGPXA­

-RGZSGPXA

-RPZSGPXA­

.^.J,«. 

 F1 

 F2 

 Bl 

 B2 

 DZ­

 &Z­

-PZOmaha Lead Site 

Site Sketch 

W: 

Lead Sample LAB Concentration Collected 

ppm 0' D 

ppm n 

ppm n 

ppm D 

ppm D n 

ppm D n 

ppm n 

Number of Samples = V 

So^c i 

North Arrow 

Finn;

Date:

Time: 

Samples Collected 

 .^-^it S 

 '^'•?^-<S^ 

^-V/ 

Samples Analyzed 

XRF Unit: ^ / O Book: ^3 -

Date: _ - //2,7a^ 

Time: _ 

Staff: 

Quadrant OKcavatod ContMnination LirW Bahtnd 

Contract #: EP-R7^9-05 Environmental Restoration LLC 
i ^ ' Td y^j\ / 

Omaha North Arrow Lead Site Owner Name: jCtitL Site Sketch Address; ,?C70 A,; J_ i _ _ _ "xj. 6s.S! (O 

Phone: H: W: 

Sample Number Lead 

Concentration 

Sample 

Coliected LAB 

Firm 

Samples Collected 

RYASCPXA­ Fl I CTl ppm ET D Date 

RYBSCPXA­ F2 7^0 ppm n Time 9-7/ 

RYCSCPXARYDSCPXA­ Bl 

 82 

j^fLL 

(2.\Z 

ppm 

ppm Ef 

n 

n Samples Analyzed 

-RDZSGPXA­ ppm D n XRF Unit S7C> Book: ^. 3 

-RGZSGP-XA­ ppm D n Date ^ 7/Z^7d^ 

-RPZSGPXA--­ -P^­ ppm D a Time PdM 

Number of Samples • U Staff; Td j 

'-" d Ad ^ 

]fi . j 1^ 

h .} • ­ 1 • 

i^ 

1 ^ 9Jb'-H 

T 

\^ t .V 

d^d I / 

^iPfT, \<i^£>0 

C'- II0. s 10 ' 

^ I 

\d • s • t " .p 

^i* " 

Omaha Lead Site ' j >> ' 46130 
• Sot^c\ 

Omaha North Arrow Lead Site Owner Name: ^_CHA . Site SItetch Address: _Z070j V "ri 6081 (O 

Phone: H: W : 

Sample Number 


RYASCPXA-


RYBSCPXA-


RYCSCPXA-


RYDSCPXA­

-RDZSGFXA­

-RSZSGPXA-


RPZSGPXA­

 F1 


 F2 


 B1 


 B2 


B ^ 


 -G2­

-FZ-


Lead Sample 

Samples Collected LAB Concentration Collected Firm: _ 

jCo l ppm (zr 

n Date •S^-a'y' : 'i ' 

^ 0 ppm n Time: y-v/ 

^ ^ ppm 

D Samples Analyzed (g| Z ppm Yd n 

ppm D n XRF Unit S7C> Book: j^3 _ 

ppm D n Date: _ '7/2-7 ^ 

ppm n n 

Time: _ 

Staff: PJU 

Number of Samples = 7 

Omaha Lead Site 

TTT 46130 
ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

.-* 

SAID#Q7^D ^ DATE I(l)\ 2. \ l-O 

PROPERTY ADORE 

2ono Kl. 

QUADRENT OR 

redig • 

D 

D 

n 

n 

n 

n 

n 

n 

SS 

SAMPLE ARE/S 

Fl 

F2 

B1 

82 

DZ 

PZ 

GZ 

EZ1 

F7? 

OTHER 

DEPTH 

X^ 

^JQ e?-

TIME 

XRF S/N 

AVERAGE OF RESULTS 

V7V 

•6^130 

SHOT#s 

mz-l^^ ^ 

SAMPLER NAME '"^.(^/^(-g.t^ C 
Thermo Fisher Sclentiric Thermo 900 Middlesex Turnpike 

Billerica, MA 01821 

SCIENTIFI C 

Index linic AV i:k.\(.;K ADDKI'.SS .SAMIMJ' A UK A OI'CUA TOU DKI'll II |^()ll•;,s SAM) IM) 

1 2010-11-02 18:11 Avg of 1882-188'2070 n 18 SI B2 venlry 13 final clearance 46.99 ± 13.51 

2 2010-11-02 18.11 2070nl8s t B2 venhy 1.3 final clearance 50401 .54.49 ± 14.12 

3 2010-11-02 18:10 2070nl8st B2 venlry 13 final clearance 50401 46,41 ± 13.49 

4 2010-11-02 18:09 2070 n 18 st B2 venlry 13 final clearance 50401 40.09 ± 12.91 

Page 1 of I 11/02/10 18:04:05 
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