TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAE)#: 2^62- ^ Date: [? [iS|Q i 

Address: \vt> ^ 73^P^/I ^ 9 ^ 

Remediation Contiactor: PTO^ A , ^ ^sA . -S>nc^ Year: ^ 0 T 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

E Executive Summary 

Ef EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

a Confirmation data 

0 Photographs 

nf As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-otrt check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

d Utility clearances 

d Property information from Douglas County Assessor's Of&ce 

D 

D 

D 

z/gjio 

Signature y^ DSi" 

30054129 nil 

Superfund 
Rnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 26524 - 3009 DECATUR ST 

Owner: 

n Owner Occupied 

Owner Name: 

JHATHELD RAYMOND B 

Owner Addressl: 

r 

Owner AddressZ: 

I3009 DECATUR ST 

City State: Zip Code: : 

[ NE |6811 1 jOMAHA 

Owner Phone: Aitemate Phone: 

|(402) 933-5488 |(402) 733-8401 

Resident: 

Resident Name: 

|HATI=IELD RAYMOND B 

Property Address: 

[3009 DECATUR ST 

Zip Code: 

|68111 

Resident Phone 

I 

Contract: 

Contractor: 

|PRUDENT2009_S 

Contract Option 

OFnON2 

Assessment: 

Qualifying Group 

400 

Assessment Max XRF Value: 

I 456' 
0 

iHHUbinipWfliivy *Mi wimii»iiBy 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address: 3009 DECATUR ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED BY PO'S REQUEST DZ/LS l'X3' 367 PPM 

@ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 257 PPM @ 8"; Fl = 128 PPM @ 6"; DZ = 148 PPM @ 12"; EA = 131 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 includefinal lead levels v) Legend 

ii) Contamination left 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) format and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

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

7miHNDiaKieE$,IH<L 
TECHNOLOGIES, INC. 

Property #: 9-4S2- ^ 

Date/Time: 

Quads Excavated: F) i fil.^ p ^ 

EPA Property Close Out 

Property AddressL "ICC^ J^oyJu/^ ^ 

Owner's Name: (/^(^ l4«i'^vd4 . Contractor Group: Prudent Technologies, Inc, 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

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

from the house? y 

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 a 30 

day time period) / 

4. Are sodded areas generally firm and evenly graded? / 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 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? / 

Gates, Fences and Retaining Wails Yes No 

1. Do gates open and close freely? (If apphcable) / 

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

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

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

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? J 

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? y 

2 ^ . Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

I 

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

i 

EPA Representative Bon^Mj ^Date: uki/of 
«EFW 

! 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 ofthe 

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 Addm.: ^^f l O q ^^ f r-^U. ^ S ^ 

_ 

Owner; [36 2 ^ K>^J?- ^ Id. Phone: 

L 

Restoration Items in Question: 

Required corrections to complete the property: 

H^ l agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

Cwvnener' i s ignatu •' Ky Signature' Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow Prudent to perform a soil cleamq} at this 

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

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

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

Oinaha Lead Site cleamy. Ms. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleaniq> can be 

directed to the EPA Public Infonnation Centers at (402) 731 -3045 (South Omaha office) or (402) 991-9583 (North Omaha ofBce). 

Property Access Granted By: \{f\^\n\OP D "^ ff\Pl{lS.Hf i \\f)TFl E

"JlegaePrint Name) 

L1 > 

Property Owner Signature:

RESIOENT NAIME: 

(Date) 

YAa/loV\ a CS\ i4(3cdltaJ) fl 9 " CXJ ' Q Q 

(SignatJre) 

PROPERTY INFORMATION 

(To be compkted by retident and/or property owner — pkate print) 

±ie.JC.-^ H . R . H oJrp^f^^^n.r.. . 

RESIOENTT AODRESS:- AODRESS: ^ _, < i « / \ fv- . , r ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNERS MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: _LMUJ - QlZ y WORK: 

AGE OF HOME?: ^ 0 YEARS. HOW LONO HAVE YOU LIVED HERE? J ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDING SINCE 19787 . J)«8 - ^ O ^ ^

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O 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: (I.E. DOGS, ENTRY GATES, ETC.) 

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

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

CERCLA, 42 U.S. C 9605(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, MO64114 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 Fax: (210) 579-6577 
ENVIROMVIENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Address 

Phone: 

Item NO 

On Map 

Item NO i 

On Map 

Property Status Form 

: 3 cy-c^^ ly:^ ^rt— Date: 9/ V / ^ ^ 

^33 - SMrV/^72^ - ^2.^2 - BVID: 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

y^ oJU>€L^ hcLQ^uco ^ QPSLH 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes 'So 

Description & Location 

C^oJrJw^ \^oS}X ^S S' 

l^Mt- ^*ie DZ_ \/^ ^ 

^ ^ 

u o t 

Property Owner Prudent Employee 

Signature: » Signature: 

)08b Ward Parkway, Suite 405 5600 S 10" Street 4242 Medical Drive, Suite 4250 

<ansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

'hone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

-ax: (816)363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
FrrTKnrnniEs. i\c. AS - BUILT DRAWING 

IJatf i:\i-ai;itf[!: lltV19/2i)119 

IM'.PA Siciit-.tOIT nutc : OMAHA LEAD SUPERFUND SITE 

r' Name Omaha Lead Site Date: ^- ^ -lS-o 3 North Arrow —i : -MisJ)>k««U 

Address Stta Skrtch Time: \t>«. iSft^ n : '-^tte g t^<-r.W f 

Phone: «jm>» qaa - y^fl g I 

^Iepsw5c*«w* 

Team 5fcOZ, r^t.t>V^ \<;Vr«^VL>v BVID#_2^^ ^ XRF Code 

Sample Number Ijsad Concentration Confirmation Sample 

i^t Yes IO No-sr ^ 

i(t-^6yycfx.A - de ^Z U C-i-Yes O No IS 

>?^<f * ^ ppm e,Yes • No g 

%^''" S No ^ 

No ^ 

ppm O^es 1=1 No CD 

ppm Yes a No •

RYASCPLA-26524' Yes • Lab 

456ppm 

Omaha Lead Site 4«130 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
Namo ftnurnvand ft ^^ft>t,«.iJ Oi«haLMd8lt» Data: cjXriS=i> ^ i NorthArpa —

jPtlC PhonW e .jaflaL::^ gaa - y^<M I 

Ptt>*^*'*"* 

earn r-^^^t ^ \<;W^lL ^ S^Df^ftU' S a.-< ^ XJ^F Cogc^^ggCj ^ 

Sampla Number LBffla Conoefttr9l«*i ConTirm^KN^ Sa77U>::e 

JL ^ 

)L^i^fK A 

ppm 

ta,Ye»

Yos

Yes

 ^ 

n 

a 

No » 

Na 1^ 

Na %J 

No ^ 

No C 

Oma'w'ieaiSiti • W X : 
'' 3009 DECATUR ST 

ifclMl^lf il.. 

Y 2004 - DOUGLAS COUNTY ASSESSO 
rriit:: -^••-•ji:|i>»^"-H(,-f^ 

Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Pamel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Addmss 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

2111690000 

HATFIELD 

RAYMOND B 

3009 

DECATUR 

ST 

OMAHA 

68111 

3009 

DECATUR 

ST 

OMAHA 

NE 

68111 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Tmasumr 

Website 

Link 

Assessor 

Website 

Unk 

REEDS 3RD ADD 

4 

2 

50X127.5 

0.14 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=2111690000 

http://clouglasne.mappingoniine.com/DougiasCoNe/static/accountinfo.jsp? 

accountno=R2111690000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/3/2009 

2 
Page 1 of 2 

"> 

} Create Another Ticket j | Back to Irth Internet ] Send Email 

• YOUR TICKET NUMBER IS 2361702. 

Original Call Date: 

Work to Begin Date: 

9/11/09 

9/15/09 

Time:

Time:

 8:36 am 

 9:00 am 

Op: SIVA18967 

State: NE 

Address: 3009 

County: 

Street: 

DOUGLAS 

DECATUR ST 

Place: OMAHA 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 16-NE-NW 

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 Piione: (402)733-1188 

Work Being Done For: EPA 

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

Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Nuniber Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
Page 2 of 2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: gco*?

Cre,v: 1^ 4 

Date: 5- /g,oi 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining WaUs 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

>ew Foreman 

 Of'<Lyrh^ 

Condition 

t^^^^mJi 

y 

I 

0(/'riaS 

AJ/f-

A y ^ 

yL,^ 

3 c ^ 

^ A 

«,ce«^ 

^*/l^ * 

fotyt . 

V 

Ayf­

. y ^ 

Corrective 

Hazards Action 

cttr* fii-^ia 

UyaA>c.f^ 

\ 

kt-ntl jLm^i^ 

t-** /^^/u/e*..^ 

; 

Site $afet\ Officer 

X ^ 4 V <v ^xQofi. 

8080 Ward Parkway, Suite 406 2505 N. 24"' Street, Suite 308 4242 Medical Drive. Suite 7250 

Kansas City. 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: (4091 f;/>,4..inn« 




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