TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: lD5"b"1 Date: ?)b(o/iD 

Address: L|^D^ S - \^ ^ <l h 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD)^^:QBefore DAfter D Basement ^ X\^\yf^UinJb^ 

"*"S. Executive Summary (Final Report) Y\A/AJi^ 

"T3N 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.) 

^*B^ Confirmation data 

H^ Photographs ^S^Before DCrev^ Photos [^During Excavation D Sod 

^Ss30-day Sod D 

>^ As-built sketch 

•~Sx Completion Agreement signed by Property Owner 

"*S^ Property close-out check list signed by EPA 

in Description of areas not meeting ROD cleanup criteria 

''"^""Qs. Utility clearances 

^*Ss Property information from Douglas County Assessor's Office 

*S. Property access checklist 

I 30260411 

~- '^--i-* iliHIii i 

D • Superfund 

Environmental Restoration Signature .'Mi/ Date 

7'li'/P 

Date 
Omaha Lead Site^EP-R7-09-05 1"^ Environmental Restoration. LLC 

V wvAv,er(lc.com * 

EXECUTIVE SUMMARY: 

10567-4509 S 19 ST 

3s^^o Issues or Concerns Q Issues/Concerns 

Detail ExDlanation: 
EPA 

EPA Property Close Out Form 

Omaha Lead Site OU#2 

Property #:_ /0SG7 Property Address: 6(^ f 5/ f ^-f. 

Date/Time; Owner's Name: S«,fuctc/o r- R6eJriqu c » 

Quads Excavated: F / Contractor Group : Environmental Rest juration (ER) 

Excavation General Yes No 

I. If necessary, were the correct quadrant{s) excavated and restored? 7" 

2. If necessary, were the correct areas of drip zone excavated and restored? MkGrading Sod and Vegetation Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away from the ^ house? 

2. Has sod been laid in all areas that were excavated? y 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 finn and evenly graded? ^ 

5. Are thejoints 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 closefreely? (if applicable) ^ 

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

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

4. Was damage to retaining wails avoided? (if applicable) 7 

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? ^ 

4. Was damage to window screens or door screens avoided? 1 ^ 

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? 1 ^ 

Inspection notes: 

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

EPA Representative: Date: mUT ^ 
Page 1 of2 

"> 

[ Create Another Ticket ") [ Back to Irth Internet ] I [ Send Email 

YOUR TICKET NUMBER IS 2438560. 

Original Call Date: 3/15/10 Time: 12:29 pm Op: TRACY24186 


Work to Begin Date: 3/17/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4509 Street: S 19TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 03-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 #10567 


Company . : ENVIRONMENTAL RESTORATION 


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


Alt. Contact: Phone: (402)630-8382 


Work Being Done For: EPA 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV DIGITEL LEVEL3 MUD02 OMAHACOF 0PPDGPR6 PAETEC 


QLNNEIF 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8665624349 

TMr^iTc. LIGHTCORE A CENTURYLINK .... 

Alt: 8008509048 D^^'^E^ COMPANY ^ ^ 

Emerg: 8665624349 

Day: 8773668344 


LEVEL3 LEVEL3 COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

METROPOLITA Day: 4025047823 N UTILITIES MUD02 SANDY DISTRICT Alt: 

- A ! -.- m x_ . ..T^,.* —O..^4=^PT:?CTTT T C -^/I s/9nin 
Page 2 of2 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR6 OMAHA PUBLIC POWER 

DISTRICT ELM LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

PAETEC PAETEC COMMUNICATIONS NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: : 

Emerg: 8002891901 

QLNNE IF QWEST LOCAL NETWORK ELM LOCATING 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

*> It n ir^ f\ t r\ 
Contact Information Log 

^AlD#/g?tf^/^ 

Owner-sName:^^^,/^7^ ^ /^^y^^< i \ Daytime Phone: ^ ^ ^ 

Property Address: L/^ ^ ^ £ . f O ^ 

• : . • . . • ' ' ' . _ •

Attempt to contact Date/time : Njame .. 

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gassss^g^ ^ 

Property Access Checklist 

I Property Address:.. . 

Q WORK STARTED

iiJ WORKCiOiMPELTEp

 ON: 

 ON: 

Address:

WS^f

Phone 

Fax: 

•-'Y^i

Cell/Pager: 

 AJ~<- ^ 

^ / f 

 yiii 5JIEL 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

I S

0

l y

E "

n

n

n

U

 Access Agreement 

 Restoration Agreement 

 Video Property Before 

 Digital Photos Before 

 Video Property After 

 Digital Photos After 

 Property Completion Agreement 

 Final Report 

Siened:^;?/^^/^ 

Signed^^/^/ p 

On '.i^ l ^^1 it^ 

On : 3 / /-?/ / D 

On : / / 

On : / / 

Signed: / / 

Signed: / 7 

By: 37 ? 

By: ^/ ? 

By:-^i) 

By: ^ 

By:-

By : • . • . 

By: 

By: 

Additional Video or Digital Photo's Taken 

n Video n Digital Photo I On 

Omaha Lead Project Work Plan Page I of 19 
iiLVi^SSSiiiCiSrai i^ a 

Consent lor Access to Property SAID#//^f <^^ 

RIGHT OF ENTRY TO PREMISES 

Grantor (lhe property ovraer), consent<? to and authorizes,ine.Uriited.States EnvLrorurieritai 

PioleciioriVAgehcy (USEPA)'or its authorized represeritatives, collectively the Grantee to enter 

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

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 enviromnental response actions to be perfomied en 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 

enviromnental.response; 

c. Planning and implementing the removal action oner near Grantor's propeity. 

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 of the Grantees or the enviroimient, 

or to allow others to use the property in such 

^..-QI grant access to my properties do not grant access to my properties 

P%.L//r ^U^f^, ^T^/!^ /7 ^ 7&'^^i.^'>^: 7k7^7/o 

Signature . * Date P Signatur ignature Date 
Additional Comments / Instructions: ~1 

JP^ 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 fissureis. 

I agree Q I do EOt sgree r~| I agree n I do Kot agree ^ 

YQLP/fH ^ / 7L 

Owner's Signature ate y ^ . Contractor's Signature Date 
Restoration Agreement 

The purpose of Ihls agreement is to provide a mutual agreement as.to. conditioiiSur property pi'ibr to 

cer.tr.aLCtpr.aci!V!l!es.-Th;3 wi11 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: 

Propef-tyAddress ftvAddresI:: t Lf^fi<7 ^ / 9 ^ ^ 

Qy^^^^'-rf^Lyrt^Jhy fiac/rf^^'^ 

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

utilities, subsurface features, surface stmctures aiid laridscaping 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 ofview. 

items to be removed by Contractor and not replaced: 

Item:. = -=

<,Sr/ : 

Item: ' •--.:' [ ^ 

Item: 

Item: ' • .

Page 1 of 2 

 1 
agree • Q I do not agree y^ l 

Di agree Dido not agree 

Owner's Signature . t^\7 ^. Contractor's Signature Date 

Attachments. 

Page 2 of 2 
Property Completion Agreement 

This; agreement dccumcrits the compietioii of rerhediai 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. 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

Item: 

Addltionsl Cornm&nts: 

[_J I agree restoration is completed, except as noted I agree restoration is completed, except as noted 

I I I do not agree restoration is completed I 11 do not agree restoration is completed 

Owner's Signature *' r»«*« Dat^ eContractor's Signature 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R1755720000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vle W O n IVIap Information 1$ valid as of 2009-12-15 Treasurer's Tax Report 

New Feature ->•*• * Auto Sales Search 

Owne r 

RODRIGUEZ SALVADOR 

ETAL 

4509 8 19 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 5572 0000 17 

Account Type: Residential 

Parcel Number: 1755720000 

Parcel Address: 

Legal Description: 

4509 8 19 ST 

OMAHA NE 68107-0000 

MISSOURI AVE PARK LOT 20 BLOCK 1 40 X 130 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

$5,800.00 

Improvement 

$73,900.00 

$73,900.00 

$73,900.00 

$67,800.00 

$67,800.00 

$67,800.00 

Total 

$79,700.00 

$79,700.00 

$79,700.00 

$73,600.00 

$73,600.00 

$73,600.00 

Sales Informatio n 

Sales Date: 2001-09-28 

Deed Type: 

Price: 

Grantor: 

WD 

$73,500.00 

Boo/f; 2193 Page: 536 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.11 

SF 

5200.0 

Units 

1.0 

Depth 

130.0 

Width 

40.0 

Vacant 

No 

Improvemen t Informatio n 

tiftn'/ZHnnalncn p mnnnino-nnlin e p.r»Tn/DmiCTln<!r!nT>Jp/ctptir'./ar.f.niiTitinfr» i.<!n9flf'.p.f»iintnn=R 1 19/91 79000 
Douglas County Account Information Page 2 of2 

•'^.,'.:> ^ 

Building 1 

•*a'39S19ST 

-'•'JO 0 Sq r! 

«.« i ^, 0 1 

M p 5!) n. FIISFMS* i |*>r' 

«ff 

Eff 

j s y 1 1/2 Stoiy * lj*<ia^fl«in ; 

Eirmt BSoci: 9 ft 

ma 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1227.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

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

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinlder Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1906 0 0% 1906 104 

Deta;7 Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 880.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 

280.0 

Porch End Screen 160.0 

Porch End Screen 

120.0 

User Attic Full Finish 352.0 

S ' :•• 

• .# ? 

I'f •' & • •5%C 

httD://dou2lasne.maDDing-online.com/DouglasCoNe/static/accountinfo.isD?accountno=Rl... 12/21/2009 
ENViRONMENTAL AS-BUILT DRAWING 

'OMAHA LEAD SUPERFUND SITE^ 

RESTORATION 

10567 

Omaha Lead Site Exterior Paint North Arrow Owne r Name : SALVADOR RODRIGUEZ • Good Site Sketcl i Address : 4509 S 19 ST 

Phone : H; 402-731-5738 W: 

r i Not paint 

Omaha Lead Site 46130 

Quadrant excavalod Df to Zone Excavated Contofniination Lolt Bohlnd 

r-ws W^-9 A A Air rr^..:>..>..>..i>~*oi n.......,*..^^...^:^^^ i • 
Owne Omaha Lead Site r Name: SALVADOR RODRIGUEZ 

Site Sketch Address: 4509 S 19 ST 

Phone: H: 402-731-5738 W: 

Sample Lead Sample Number LAB Concentration Collected 

RYASCPXA-10567 F1 ppm n 

RYBSCPXA-10567 F2 / 5-^ ppm D 

RYCSCPXA-10567 B1 67 ppm n 

RYDSCPXA-10567 B2 12,^ ppm D 

RDZSCPXA-10567 DZ Z^3 ppm n 

Re£sepxA=te56f—GZ- ppm D n 

RPZOCPXA-105G7 PZ- ppm D D 

Number of Samples = [^\ o 

ENTERED LkW^'i­ De.;x\i2_: 

JUN f 'I -m\ ^' >­

^ 1 

Kj 

2.33 

D 

19^ 

^ ­ ^

5j Ih lOk '£cH­ 7/ 

f 

L^ *- c>v?^ ruTs 

L..S L Xfxjr .'^-M*-; k'^^.h .^Dtk. -J 

i.p' isrc. i^^e 

MJ^ 

^ /9 sr 

10567 

Exterior Paint North Arrow 

• Good 

D-PdoT 

^C [3 Not paint 

Samples Collected \ Firm: \ r ^ ^^ ^ 

Date: u.q• ^ 

Time: ^ : M - !\C ^ 

Samples Analyzed 

XRF Unit 9il Z Book: g y 

Date: _ f/zi'/oy 

Time: _ (> ' "^ f /^A» 

Staff: 

- ^ 

'?.\t / 

>' 

1. 

-*^: 

Omaha Lead Site 46130 
IE 

10567 

Omaha Lead Site 

Exterior Paint North Arrow Owner Name: SALVADOR RODRIGUEZ • Good Site Sketch Address: 4509 S 19 ST 

Phone: H: 402-731-5738 W: XT 

Q Not paint 

Sample Number Lead Sample 

Samples Collected LAB 

\ Concentration Collected Fimn: rj ^ /YT T <nS ^ 

RYASCPXA-10567 Fl 0*0Z - ppm D 

Date: L . <^ • ^ 

RYBSCPXA-10567 F2 ppm Time: *^

/ S~(o D . bS" j\r ^ 

RYCSCPXA-10567 Bl C> 7 ppm D 

Samples Analyzed 

RYDSCPXA-10567 B2 I ^ ^ ppm n 

RDZSCPXA-10567 DZ 

Z^3 ppm D XRF Unit: 9i f Z Book: g 7 

RGZOCrXA^IOGO? ^Z - ppm n Date: _ /^6^ y 

RPZ0CPXAH^567 -PZ­ ppm n 

Time: 

Staff: L > /^/t76^r^oi Number of Samples = O l 

ENTERED LMM^^ OteNiii 

JUN t ^ i m 

- V ­

"f,\t / 

"^ 

^ 7 

^ 6*­

iZt/ ; ^ 33 

^ ^ v.. 

5 

lA'^iJ).. .^x>uj^\ 

7 

i-.S u *^ c^A -o*: c.<^?^ 

L - S L X.XJ.'^ .y-Nj|i; 

4J 

: S^Z 

ki^vVk 

^ ; 9 r r 

Omaha Lead Site 

46130 
ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

SAID# \X>Sio ^ DATE 

3 \n \ 10 

1^0 - PROPERTY ADDRESS 

TIME 

y^mo. XRF S/N 

QUADRENT OR SAMPLE AREA DEPTH AVERAGE OF RESULTS SHOT#s 

Fl ^ ^ 

iol ^ IL> asi^a-^'X^^" 

F2 

Bl 

B2 

DZ 

PZ 

GZ 

EZl ^ ^ 5H^\ ^ 5^a«>-5.a.iv/ 

EZ2 

OTHER 

SAMPLER NAME A^ hhci. 
Thermo Fisher Scientific 

900 Middlesex Turnpike Thermo Billerica, MA 01821 

UKl'TII 

6 

6 

6 

6 

surface 

sur&ce 

sur&ce 

sur&ce 

Index 

1 

W-: :. &­ 3

^'-y:•:•" ' 

5 

6.;::^. 

7 

kmp\'.-

SCIENTIFI C 

>^tk '^.j ^ ^ 

j '"* . ± 15.56 

 ± 15.93 

 ± 15.45 

 ± 15.30 

 ± 14.73 

 ± 13.97 

 ± 14.97 

 ± 15.26 ,€"^-;/-T 

lime 

2010-03-17 10:50 

2010-03-17 10:50 

2010-03-17 10:49 

2010-03-17 10:49 

2010-03-17 10:47 

2010-03-17 10:47 

2010-03-17 10:46 

2010-03-1710.46 ,__

AV6RAGF , JADDUKSS 

Avg of 2242-224'|4509 sl9 st 

4509 »19 st 

4509 sl9 st 

4509sl9st 

Avgof2238-224(4509sl9st 

4509 sl9 (t 

4309 s 19 st 

 ^~J W V J '-. ^. 4509 sI9 st 

SAMPLE AREA

Fl

Fl

Fl 

F l •'.•.. • 

EZ

EZ 

EZ 

EZ . .••?i>:-;:a5J-.'• 

 jOrKRAlOR 

 ADAM 

 iADAM 

1 

ADAM 

ADAM 

 JADAM 

ADAM 

ADAM 

ADAM 

\OTi:s ;sAii) I'l) 1 

final clearance 66.54

final clearance 10567 70.82

final clearance 10567 66.54

final clearance 10567 62.26

final clearance 53.90

final clearance 10567 44.45

final clearance 10567 58.44

final clearance 10567 58.82

^-•i ' 

Page I of 1 03/17/10 11:50:27 

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