TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAn)#: ^O^f O Date: fr^f l<rf'^(7'r 

Address: ^^/T YriW^^ hxx^ (gi 

Remediation Contiactor: />u3g.»./- T>. L > Trrrc .j Year: ,^00* ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

[tf Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

^ Confirmation data 

^ Photographs 

^ As-built sketch 

0 Satisfectory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

[H Utility clearances 

tF Property informationfrom Douglas County Assessor's OfiBce 

D 

D 

D 

^a^:>^ alnlio 

signature'^ Date 

ir 

30054259 

Superfund 
Find Record Remediation Query I Lead Remaining Query i Property Damage Query I 

Badcfill: 

Sample Area: 40490 - 6815 MINNE LUSA BD 

Owner: 

D Ovmer Occupied 

Owner Name: 

CALLOWAY FELICIA 

Owner Addressl: 

Owner AddressZ: 

6815 MINNE LUSA BLVD 

City: State Zip Code: 

OMAHA |N E [68112 

Owner Phone: Altemate Plione: 

(402) 451-4992 

Resident: 

Resident Name: 

r 

Property Address: 

|6815 MINNE LUSA BD 

Zip Code: 

(68112 

Resident Phone 

I — 

Contract: 

Contractor: 

|PRUDEMT2009_S 

Contract Option 

JBASE 

Assessment: 

Qualifying Group 

I PRIORITY 

Assessment Max XRF Value: 

r 1788 
TECHNOLOGIES. INC. 

EPA Property Close Out 

Property #: QrOi^'iD Property Address: (jpfir (5 ^vv,•uL^^eitt^^3 Bwd^^ 

Date/Time: 1$-Lr~ o ^ Owner's Name: /^ ^ I'Oc^ Cc^\(oct/aj-y 

Quads Excavated: ^2^ , 9 -3 - Contractor Group Prudent Technolo^es 

Excavation General 

Yes No 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? y 

Grading Sod and Vegetation 

Yes No 

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? y 

3! Does the sod appear to be generally healthy and growing? (Only evahiate if inspected at a 30 

day time period) y 

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 a 30 day 

time period) y

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

y 

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

I. Do gates open and close freely? (If applicable) 

y 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) y 

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

y 

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

y 

Foundation, Siding and Gutters Yes No 

I. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

y 
0§l5 Mlf\r)^iju^o- sivd 

Owners comments: 

Inspecfion notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative Ocur>)3>^ Date: g/e/of 
gHHOHWIKIIW <NI nHWIMlHf¥ 

Date: 9/15/2009 Oinaha Lead Site Remedial Action Contract ff EP-R7-07-06 TO#l Month of: August 

Property Address: 6815 MINNE LUSA BD 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 159 PPM @ 6"; PA = 150 PPM @ 6"; EA = 99 PPM @ SCRAPE (~1) 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Buih sketchi) Shall include final lead levels v) Legend 

ii) Contamination lefl behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Other items to be included in the individual property file, if available, or obtained include: 

i) Pre-excavation agreement details (if any are made with the property owner) 

ii) Property Status Form signed by property owner 

iii) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) fonnat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

THGHMOllffleESJIN!:. 
IICHNOLQGIES.INC 

Property*: ^O^'? ^ 

Date/Time: If^G- o ^ 

Quads Excavated: ^2-, 9 0 -

EPA Property Close Out 

Property Address: ((?6r (5 *^\\Mr^iASa ^steX 

Owner's Name: F^liCtc,^ C<^\(o(^OLtA 

Contractor Group Prudent Technologies 

Excavation General 

Yes No 

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

2. If necessary, were the correct areas of drip zone excavated and restored? y 

Grading Sod and Vegetation 

Yes No 

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

y 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? (Qnly evaluate if inspected at a 30 

day time period) y 

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 a 30 day 

time period) y 

6. • Was the property graded -such that water will not pool on the property? ' y 

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

I. Do gates open and close freely? (If applicable) 

y 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) y 

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

y 

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

y 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

y 
A 5 Mfr\y>^tL^a s\ ^ 

Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative 0a/n)3^ Date: sU/af 
Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The property owner's signature indicates that the property owner is satisfied with the restoration of the 

subject property, and that no items are in question, now, or at any time in the future, excluding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address: ^ ^ ^ 5 fj^^r.^^,,^. Qr^ 

Owner: p^^f^ j ^ CjlUr.uS> 

b Phone: 

J 

Restoration Items in Question: 

Item: 

Item: 1 

Item: 

Item: 

item: 

Item: 

Required corrections to complete the property: 

Q n agree restoration is completed, except aa noted abovo. 

L J I do not agree restoration is completed 

ny^i(^ ^ 

Owner's Signature Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Enviromnental Protection Agency (EPA) to clean up leadcantaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow Pmdent to perform a soil cleaniq> at Ihis 

property to remove lead-contaminated soil. By signing this form, ^ property owner grants pennission to Prudent to perfonn 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, uid restoration of the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Admimslrative Clerk for the 

Omaha Lead Site cleanup. N/ls Siva S. .lampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public hrfonuatio formation Centers at (402) 731-304 731 -30455 (SouthOmah (SouthOmahaa office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By 

f ^ ' (Please Print Name) | 

Property Owner Signature: Yfy^y. yiybj (Signature) (Date) 

PROPERTY INFORMATION 

(To be compkted by resident and/or property owner — please prmt) 

RESIDENT NAME: ^ Qyv-c Renter ^ 

RESIDENT ADDRESS: 

tjxJ£i£- J^A n e)0 

IF RENTAL, PROPERTY OWNED BY: 

OWNER' WNER'SS MAILIN MAILINGG ADDRESS ADDRESS;

; t 

OWNER'S TELEPHONE NUMBER-HOME: ( > WORK: 

AOE OF HOME?: I UV ) "^YEARS. HOW LONO HAVE YOU LIVED HERE? y YEARS. 

^ c i 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDING SINCE 1978? YBS—— - -NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (LE. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Sectian 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to tbe property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 960S(e), which provides entry for "determining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fa v l91ftX S7«JSfi77 
EN\IRONMEMAL 

CONSTRUCTIO 

TECHNOLOGIES, INC. SERVICI 

Property Status Form 

Address: ^g| 5 f^U«^nC Lu^ ^ -^ Date: 

Phone: H ^ I - S ^ ^ 2_ BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

jv^O ^VCLN^> ^ 

Pre-Existing Condition of Structures 

Doe L/ s your Basement have a history of leaking? Yes No 

Item NO Description & Location 

On Map (LXCULM-J. J j r \ v.Ae- u>eoM W o Loh i ^ 

Property Owner Prudent Employee 

Signature Signature: 

8080 Ward Parkway, Sulta 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 7822S 

PhAna- fAIRX ^A7.t7n t Phnnn! r402\ 5Q4.1004 Phons: (210)822-9588 
EHNULUGDES , INC. 

AS-BUILT pRAWING 

OLS#:40490 

Date Excavated: 07/17/2009 OMAHA LEAD SUPERFUND SITE USEPA Slgned-OfTDate: 

40490 

Oinaha Eidanor Paint NorUiAnmr Lead Site 

Site • Good Sketcti 

Q Poor 

Sampling Address: 6815 MINNE LU3A BD Q Not paint 

Sampl Uad Sampie Samples Collected e Number LAB Concentration Colle ^ firm- Ppft tTft.fliT 

RYASCPXA-40490 Fl ifiS PPn» & . D Date: <t-e-CB 

RYBSCPXA-40490 F2 /7a PPmM D Time: 3:0O p^n. 

RYCSCPXA-40400 B l 37 Ef 2L ppm Samples Analyzed RYDSCPXA-40490 B2 _11M _ ppm f D 

ROZSCPXA-40490 DZ _J[fil__ppm D XRF Unit: CtSHD Book: 2/ ^ 

nOZOOr)(A^40490 Qg Vfm w D Date: Iti ' OU • O 0 

RPZSCPXA-40490 PZ -JU L ppm D Time: P m Lab RYCSCPLA-»0490 §' Staff: /nSLJ> Number of Samples «> | (^ | | / | 9 Result 397 ppm 

wwtfwin.!. .1— 1 IVII I L.VII, r ^ ' Front Right, B1 - Back Left, B2 " Back Right OZ « Drip Zone, GZ = Garden, PZ = Pla; 

Mqu nls«ma*tiiMiadftanll« 

R/v:ona CPCMMI is-xi^^a 

EA = 99 PPM Ca SCRAPE (-1") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
40490 

•:xtc>'ici' Paint Omaiha Lea d Site 

Site SItetch 

Sampling Addfess: 63:5 U.NNE LUSA SO (3 fict pa frt 

Sam Bie WumlMr Siimple Samples Ccflecjed US Co^cent.'alion Collected FTm P'pft rift . fla* 

RYA5CPXA-4(M30 »=•« /8 3 .PF<^ D Dace. q-8'Cf t 

RYBSCPXA't04M F2 D 

Ttme 3 0O p/^ . 

RYCSCPXA-4a490 Bl • 37Z . ppfn 

ET Samples Ana^zed RYDSCPXA-4a490 S2 I 

D 

RDZSCPXA-«043O D2 

mOZGCPXA <040Q 82 

n

• Date ib ' 0(f ' OQ 

RPZSCPXA-4C400 P? 

-Jiai-.pc"' D Tiaie pfi-t 

l.£^ RYCSCPLA-40490 Starr r0 3 Lu? Number of Ssmple* = I L J | j { •iSesjIl 307 ppm 

ifr,i f f ' 1 iwi«i (uCii r«r = Pi'jrtI Rigl«i. Bl = BJICJ? Left. 8? = Biick Ritjht DZ = Diip 2cne, CZ = Garten. PZ = Pia| 

5 .JKA'I*>AC-. Uvb-11.61^ 

S2~—:—^^1 

/rtrWf it/fo 

13a •ri»* J '<•'.* ; •< iu4>ii "I i ; 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPrevlew.aspx7PrintOpt.. 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

1750740000 

CALLOWAY 

HbLICIA 

6815 MINNE 

LUSA BD 

OMAHA 

68112 

6815 MINNE 

LUSA BLVD 

OMAHA 

NE 

68112 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

33-16-13 

MINNE LUSA 

12 

13 

47.3X120 

lTttp://webapps.dotcomm.org:8080/TreasTax/faces/pages 

/taxinfo.jsp?parc=1750740000 

http://douglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R1750740000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale 

guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 28 feet 
Page 1 of2 

. t 

Create Anottier Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2313561. 

Original Call Date: 7/09/09 

Work to Begin Date: 7/13/09 

Time: 10:50 am 

Time: 11:30 am 

Op: SIVA18967 

State: NE 

Address: 6815 

County: DOUGLAS 

Street: MINNE LUSA BLVD 

Place: OMAHA 

Twp: 16N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 28-SE,33-NE 

Sect-Qtr: 

Type of Work: soil lead remediation project 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: FAX ALL CLEARS TO (402) 733 1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN

Day:

 MAGELLAN MIDSTREAM PARTNERS LP DEBORAH Alt: 

 9185747098 

Emerg: 9185747098 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILrnES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret==<RESULTS... 7/9/2009 
Page 2 of2 

^y . 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthinteme1/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: 6:>&JS MIAJJO£ LUSA Bb 

Crew: /W^^^^ ^ l Bf.JZl.^7-^^ 

Date: ^/^gx ^ 

Corrective 

Item Condition Hazards Action 

Overhead Lines <5c ^ IccAJ iiA'HCfl'xe, us e ^/OjO 

y Gas Line K> ^ /ocWr 

Water Line i>uiim j k^»A /cc/*^*-

Sewer Line ^Cf' ^ U t ^ l€tC^ ^ 

\ Septic / Leecii 

field A/APropane/Butane A^A 

Sidewalk ^> c 

Foundation AA 

Retaining WaUs A^y 

Fences yv«. 

Trees 

Structures poott. 

Driveway 

Sprinkler System 

Other ^f « X>^ j^:^e^J _ - . 

Crew Foreman Site Safety Officer 

"tt^ . Gi.-^yfe^ J^,^ 

l/u^i/y^'^i ^ 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

2505 N. 24* Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

4242 Mecfical Drive, Soite 7250 

San Antonio, TX 78229 

Phone: (210) 822-9688 

Fax: (402)504-1006 Fax:(210)579-6577 
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