TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: SyZCf\ Date: '-A-ZU- W 

Address ^^ ^ ki - -2.^-*^ S^ . : 

Remediation Contractor: _Environmental Restoration, LLC_ Year: _2010_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

j / Video of property (DVD) JZ^for e DAfter D Basement D 

^ Executive Summary (Final Report) 

y S EPA-provided property sketch 

J Z Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

jA^ Photographs _p^efore DCrew Photos^0T)uring Excavation D Sod 

X ^ 0-day Sod D 

j A As-built sketch 

J a Completion Agreement signed by Property Owner 

/1J Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

J a Utility clearances 

JZi Property information from Douglas County Assessor's Office 

j A Property access checklist ~ 

Contact Log _ 30261919 

j3- ^ y^r^./- //,-h Superfund 

Environm ental Restoration Signature Date •e>* 

/6-Zp-/ / 

Date 
- EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: Sl^O ^ PropertyAddress: Ho p Kl .ZS - *5yV-. 

Date/Time: Owner'sName: "?^J'^^y\JrA Cf\ong.\<w& 

Quads Excavated: "fc2. Contractor Group : Environmental Restoration (ER) 

Excavation General Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? L X 

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

Grading Sod and Vegetation Yes No 

Z house? 

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

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? , 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? l y 

7. Was damage to landscaping or plant materials avoided? 1 ^ 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (ifapplicable) m. 2. Were all gates or fences taken down during restoration activities re-installed? (if applicable) lA 

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

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

Foundation, Siding and Gutters Yes No 

I. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? \iaiiat.{—W" 

4/3^ 3. Was damage to windows avoided? 

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

5. Was damage to dovmspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? A/i 

2. Was damage to walkway surfaces avoided? f^ l 

Inspection notes: 

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

EPA Representativi Date: 
^VLO*U, , 

/ ^t®^ '^ Omaha Lead Site—EP-R7-09-05 " .^^^ o • Environmental Restoration, LLC 

S^^^^ ^ www.Bt\lc.com '-i^^Xt*" 

EXECUTIVE SUMMARY: 

57809 983 N 25 ST 

_x^ No Issues or Concerns P ] Issues/Concerns 
"> 

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

YOUR TICKET NUMBER IS 266476 L 

Original Call Date: 1/17/11 Time: 7:50 am Op: ADAM2418 6 


Work to Begin Date: 1/20/11 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 983 Street: N 25TH ST 


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


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 


: 57809 


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 inch Corner Lot: N Front: N 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 

Ah: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Ah: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD 

Day: 4025047823 

Ah: 

Emerg: 4025047970 

OMAHACOF CITYOFOMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://ww\v.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 1/17/2011 
rage zoi z 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 1/17/2011 
Contact Information Log ^1^^ SAID# 

ll Owner'sName: g6(LAAa.ts .^VoiLfiUt, | Daytime Phone: ^^-^1^16 ^ 

PropertyAddress: ^^3 , fJ 2 5'^-^-

Attempt to contact Date/time Name 

\tl^lS-/o 1 ^Ai ^ & 

iti'diZ 

<,'\qr\tO »^p n/zi^,o It], 

ir^ o 

0^-^<-- ^ Qr^^u^i;. ^ /•l7/ l A'e 
Property Access Checklist 

SAID .s- 7go<^ n WORK STARTED ON: / / 

PropertyAddress: t^R^ f^2 S f + D WORK COMPELTED ON: / / 

^^''" - 6eit/»Ao.O moltElt ^ Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: y(,2-jV2 ­ 2-6Zo Additional Information: 

Fax: 

Cell/Pager: 

E Access Agreement Sianed: / i / 2Z / /<? By: CSiA+Ltfi­

( 2 Restoration Agreement Signed: /2- /2 2 / ^ By:^.fiu+L£e 

H Video Property Before On :^^/^^/'- ^ By: x^.6. 

i s Digital Photos Before On : 0 - /i*^ / "5 By:£,A 

n Video Property After On : / / By: 

D Digital Photos After On : / / By: 

LQ^ropert y Completion Agreement Signed: 5* I^^Ki . By:f2i? 

• Final Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

D Video D Digital Photo On / / By: 

Reason: 

n Video D Digital Photo On : / / By 

Reason: 

D Video n Digital Photo On : / / By; 

Reason: 

n Video n Digital Photo On / / By: 

Reason: 
Consent for Access to Property SA1D# '^I'doi 

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: ftg^^ft^j^ twogtWO Daytime Phone: i\ox'Z^-i--Z^ip 

Address: /i „ \/Ar/\r/^r c ^ r 

Address: 

Addresses of Properties 

covered by this Address: 

Agreement: Address: 

Address: J 

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 miUion (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 property before, during, and after remedial 

activities; 

Locating equipment and machinery on-site in preparation for and in the course ofthe 

envirormiental 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 perfonn the activities, or to undertake any actions regarding the use of said 

property whjs;>h would tend to endanger the health or welfare ofthe Grantees or the environment, 

or to allp*/others to use the property in such 

I grant access to my properties 

Q I do not grant access to my properties 

Signature 

Date 
Mkf^^^^^MSSS^ 

Restoration Agreement 

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

contractor activities. This wili also serve as documentation for the purpose of assuring that restoration 

activities Eire completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

SAID: ^760^ 

PropertyAddress: ^g ^ /yy 2S" S ^ 

0^"er: |^B:/>Aff-0 f^OA-tWiJO 

Phone: ut^7.,3^-z-2BZO 

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: 

^ \jfk<j:/r/dT (L_0 7 " tt?\f\ai U;.WW ^O-D 

Item: 

Item: 

Item: 

Item: 

Item: 

1 Item: 

Page 1 of 2 
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: (5" 7 g<,q 

PropertyAddress: ^ g ^ /y 1<S-s-fOwner: Cga^^^ p r^oao/ p 

Phone: Vo^.jy^^ . 26^ 0 

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

utilities, subsurface features, surface stmctures 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: 

^fplAc e iKi'r^K SoCi 

Item: 

Item: 

Item: 

Item; 

Item: 

Item: 

Page 1 of 2 
Q I do not agree pT i agree Q f do not agree 

Attachment 

/^A / h o

Date 

 ^p^ Q ^xZTitew

Contractor's Signature 

 ^.^£>^'VV 

Date 

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 ftiture, except those items listed below, ifany. 

SAID: rySo ^ 

Property Address: c^^-^ ,J i S ^ 

Q^""*-^ 5e<2-AAac. r^v2-eHo 

Phone: t|o^-•^H'2-- 2-B20 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additionai Comments: 

[01agagrer e restoration is completed, except as noted 

I do not agree restoration is completed 

j/^^/ri 

Owner's Signature )ate 

\A\ \ agree restoration is completed, except as noted 

I I I do not agree restoration is completed 

Contractor'^ Signature Date 
Douglas County Account Infoni 'on Page 1 of2 

Douglas County, Nebraska Property Record - R0527600002 

Print Report 

View interactive GIS Map Information is valid as of 2010-11-16 Treasurer's Tax Report 

New Feature -f -> ^ Subdivision Sales Search 

Owner 

l\/IOBECO INDUSTRIES 

11413 HICKORY RD 

OMAHA NE 68144-0000 

Property Informatio n 

Key Number: 2760 0002 05 

Account Type: Residential 

Parcel Number: 0527600002 

Parcel Address: 983 N 25 ST 

OMAHA NE 68131-0000 

Legal Description: ARMSTRONGS 1 ST ADD LOT 28 BLOCK 1 S 25 W 57 FT 25 X 57 

Value Informatio n 

Land Improvement Total 

2010 $200.00 $0.00 $200.00 

2009 $200.00 $0.00 $200.00 

2008 $200.00 $0.00 $200.00 

2007 $200.00 $0.00 $200.00 

2006 $200.00 $0.00 $200.00 

2005 $200.00 $0.00 $200.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.03 1425.0 0.0 57.0 25,0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 11/19/2010 
Douglas County Account Inforc^ 'on Page 2 of 2 

The above map is powered by Googie, and is intended to provide a general idea of a property's location. If you 

require a more exact property location, you may use the Interactiye GJS Maps that are maintained by our 

office. 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 11/19/2010 
ENVIRONMENTAL ^ AS-BUILT DRAWING 

• bMAHA LEAD SUPERFUND SIT. 

RESTORATION 

57809 

Omaha Exterior Pamt North Arrow Lead Site • Good V Site Sketch n Poor 

Sampling Address: 983 N 25 ST pq Not paint 

Sample Number Lead Sample Samples Collected LJ4,B Concentration Collected Firm 02^^ inLLL. RYASCPXA-57809 Fl Z l 2. ppm D Date <\\v) [cn- RYBSCPXA-57809 F2 ppm D Time RYCSCPXA-57809 Bl Z9S­ ppm n Samples Analyzed RYDSCPXA-57809 B2 A-7/ ppm 

•RDZOCr)(A-07000 B * ppm D n XRF Unit: /oBHT . Book: /9 3 

RGZSCPXA 67800 6 ^ — ppm D n Date: / c • I / • O l 

RP^00PXJ^ S7000 -PZ — ppm D n Time A M D Staff Number of Samples = ' t^ n^w 

Legend: Fl Front Left, F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from tlie street, facing property 

LE&EtiC 

CoctfamlnaMon L«W Bahind Quadran Drio Zorw Excavated t OKcavatec 

£•«•»!»»»•»'»•'»•••'•' D'«»'»'»»~*''»"» I • / * /^AM*r'.<> * *»• C O D T A O n c 
IIIIIIIIH 57809 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

• Good 

North Arrow 

r~] Poor 

Sampling Address: 983 N 25 ST ( 3 Not paint 

Sample Lead Sample Samples Collected Number 

Concentration Collected Firm £m fcuLCL 

RYASCPXA-57809 Fl Zl Z ppm n Date 

RYBSCPXA-57809 F2 -2JLJ ppm D Time 

RYCSCPXA-57809 Bl ^^s • ppm D i Samples Analyzed RYDSCPXA-57809 B2 JS:L ppm D •RDZOCr)(A-07000 BS ppm D D XRF Unit: iiSHT . Book: /9 3 

RCZSCPXA 67800 G ^ ppm D D Date: / o - / / - 0 7 

RPZOGPX/i G7000 P i ppm D D Time AtL 

Staff; Number of Samples • hsy/ 

Legend; Fl = Front Lefl, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play I All quadrants are as viewed from the street, facing property 

E!NT ERED 

;. >Q." / --a - : ft O-T 

; ^oc-K ^ i-.© - : OCT 0 2 2f a/ 

: SocLr ^OS: 

rf^-ha./ ^y<r ^ y c ><> 

Li- .'. ... . ; ; - i ^ ; ^ • • ^ 

1 ] 

CASw xt>i . fi* 

i 

I

I •Z0S-- .VJLJ5TI 

h

6 

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s 1 c|ft3 «0 25 *^ 

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: . jvi Z5 s; L- .. . 

le\ 5 ''rcated '>2-fc2'1( 7 11 15 ;4 .146141 
57809 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch 

Q Poor 

Sampling Address: 983 N 25 ST Pl Not paint 

Sample Number Lead Sample 

Samples Collected

i 

LAB Concentration Collected Firm £ D& SbiO a 

RYASCPXA-57809 F1 Z J Z ppm D 

Date 

RYBSCPXA-57809 F2 .

ppm n Time

RYCSCPXA-57809 B1 295­ a Samples Analyzed RYDSCPXA-57809 B2 .f7( ppm n •RDZOCPXA-07009

 B i ppm n D XRF Unit: &>5H7. Book; /9 3 

Rc^6cpyu^ 678oo—G*-

— ppm n Date / O •// • 0 1 — 

n 

nrzoopxA 57000—pa . ppm n 

Time AM 

Numbe Staff; 

hS\ ^ r of Samples • 

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

All quadrants are as viewed from the street, facing property 

ENTERED 

OCT 0 2 200? 

CASc, fiUti-s. 

.KJJ51\ zas-; 

fe\. 61 

^ % rJ 25 *f 

.V -' 

^ 

Z\X ..,f^\. 

f» n 

"vifa 

(0 .zS.s:)­

('reared V-r-lMd? II 15 14 

• M l .m' m- : w AW <iirt Ml' .* 
ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

SAID#^1'?0 ^ DATE I \\§\I V 

PROPERTYADDRESS 

Q^-::^ t o • 2. 5 ^ T 

QUADRENT OR SAMPLE AREA 

redig 

DEPTH 

TIME 

XRF S/N 

AVERAGE OF RESULTS SHOT#s 

•

•

•

n

•

n

•

n

n

 F2 

 B1 

 B2 

 DZ 

 PZ 

 GZ 

 EZ1 

 EZ2 

 OTHER 

\5 

MCiFi?.. 

-i^^S^^l 2L\V-Z,l4 

SAMPLER NAME ^-gxx n 

^ 
Thenno Fisher Scientific Thermo 900 Middlesex Turnpike 

Billerica, MA 01821 

SCIENTIFI C 

Avr.H..\(;r. ADDUK.S.S .M{I:A OI'KUA rou NOIK S SAID I'h 

1 2011-01-18 16:52 Avg of211-213 983 n 25 51 B2 jimmy 13 final clearance 388.19 ± 31.19 

2 2011-01-18 16:52 1 983 n 25 st B2 jimmy 13 final clearance 57809 382.24 ± 30.95 

3 2011.01-18 16:52 983 n 25 sl B2 jimmy 13 final clearance 57809 385.15 ± 31.00 

4 2011.01-18 16:51 983 n 25 sl B2 jimmy 13 final clearance 57809 397.18 ± 31.62 

Page 1 or 1 01/19/11 10:39:25 
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