TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: rMc o Date: I ^^13.'^-/Zeol 

Address: ion r\f (^^ cH 

Remediation Contractor: YyX^,.J­ 7;j,u^.y'.>. Year; . ggp^ 

SOIL REMEDIATION 

iPROPERTY FILE FOLDER DOCUMENTS 

a^ Video of i)roperty (DVD) 

IF Executive Summary 

^ EPA-proyided property sketch 

y Signed Access Agreement for subject property 

Is Signed Access Agreement(s) for.adjacent property 

a Restoration Agreement 

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

y Confirmation data 

y Photographs 

^ As-b\]ih sketch 

^ Satisfiactory restoration signed by Property Ovmer 

M Property close-out check list signed by EPA 

D Descriptipn of areas not meeting ROD cleanup criteria 

w Utility clearances 

m Property infonnation from Douglas County Assessor's Office 

D 

40309599 

D imiynMHii 

n Superfund 

iMgnah^ Date 
PROPERTY SUMMARY 

Date: 12/20/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Montti of: Nov/Dec 

Property Address: 808 N 49 St 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Ottier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

GZ = 233 PPM @ 17"; PZ = 113 PPM @ 6"; NO EASEMENT 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

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

3) Pre-Excavation digital video cUp/photogr^hs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) 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 

photogr£q)hs 

iv) Signed form verifying satisfactoiy restoration 

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

TECHNOLOCIES, INC, 
Rnd Record 

Backnil: 

Sample Area: 51900 - 808 N 49 ST 

Owner: 

D Owner OGcupied 

Owner Name: 

|PUSCH JAN ERIC 

— — 

Owner Addressl: 

Owner AddressZ: 

|P 0 BOX 540432 

City: State: Zip Code: 

jOMAHA |NE |68154 

Owner Phone: Alternate Phone: 

j(402) 330-5781 : | ..... . . 

Qean Up Query Lead Remaining Query I Property Damage Query 

Resident: 

Resident Name: 

I RANDY & MICHELLE TODALEN 

Property Address: 

|808 N 49 ST 

Zip code: 


68132 


Resident Phone 


Contract: 

Contractor: 

|PRUDENT2008^S 

Group: 

1 

Assessment: 

Qualifying Group 

|800 

Assessment XRF Date: 

/Assessment Max XRF Value: 

I 1186 
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: (?0 ^ 

Owner: 

Phone: ? 

Restoration Items In Question: 

Item: 

Item: 

item: 

Item: 

item: 

item: 

Required conections to complete the property: 

EH I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

Owner's Signature ' Date ' 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Piotection Agency (EPA) to clean vp leadconteminated soils at a number ofproperties located in Omaha, Nebraska, including Ihe property located at 

A Oii l\itSrHt </0 ^ If . The EPA requests your pennissbn to allow Prudent to perfonn a soil cleanup at this 

property to remow lead-contaminated soil. By signing diis form, the property owner grants permisaon to Pnident to perform 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration ofthe refiaenced property. 

If you have any questions about die soil cleanup planned for your property, please contact Prudent Administrative Clericfordie 

Omaha Lead Site cleanup. Ms. Deborah Johnson -at (402) 733-1188. Gouial questions about the Omaha Lead Site cleaiup can be 

directed to the EPA Public Infonnatio InfonngiMni Centers at (402) 731-304 731-3045 (South Omaha ofSce) or (402199 (4021991-958 1 3 (North Omaha ofBce). 

Property Access Granted Bv: T3^VV ^>f^\77^ P u S ^ 

y ^ (Please Print-Name) 

Property Owner Signature: KJIU 

(Signature) (DtJle) 

PROPERTY INFORMATION 

(To be completed by reildent and/or property mrner - please print) 

RESIDENT NAME: i^Ai^fJ^j T J fk.ityss Owner Renter

RESIDENT ADDRESS: rW/ 9>o% Aj. yr ^ -S/. (),^,L, Kix 68/31^ •fIF RENTAL, PROPERTY OWNED BY; 

J/HV fUScM 

OWNER'S MAILING ADDRESS;

is p s:> /?a/^ox ^-^oyjp /9/n/j^7i,i/^ ssjs-^ 

OWNER'S TELEPHONE NUMBER-HOME: t9C^ \ ^^S-SSf l WORK: 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? -8 .YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? ^YES V ^ 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 6 HOURS OR MORE PER WEEK: 

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

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

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

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

under this tide, or otherwise enforcing theprovisions of die tide." 

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

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: (402)504-1005 Fax: (210) 579-6577 
V AS'vBlJDi.T DRAWING - >:/ ^ 

OlMg^^iHA LEAD SUIfEREUND SUE, OLSW: 51900 

Date Excavated: 12/01/2008 

USEPA SigMd-OfTDate: 

*"%, ^ 51900 

Omah a Lead Sits f Extarior Psint North Amw 

Site Sketch Q Good 

• Poor 

1 SamplinQ AddrMs: 808 N 49 ST 1 0'Nolpairt 

Sample Number Lead

Concentration

 Sample 

 Collected LAB Finn:

Samplas Collected 

 fPA P0-JP 

RYBSCPXA-SIOOO F2 

— DDm

3*) fe, ppm

 n 

y 

D 

D 

Date:

Time:

 f^~lZ~iyf k 

 \^.IS> fi m 

RYDSCPXA-5ig00 

R<VSCPXA-51000 

-B l 

B2 

GZ 

~

3H H

"

5<» B

 . ppm

 DPm

 ppm

 oom

 a . 

 r y 

 n , 

y 

D 

D

• 

D 

Samples Analyzed 

XRF Unit: ^flS^O Book:

Date: ^ iO - O S 

 2/ 8 

RPZSCPXA-51800 PZ 118 fij ppm r / D Time: ^r n 

Number of Samples =< I */ | lo Staff: /^I J 

Legend: Fl > Front Left, F2 > Front Right. 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants ars as visMml Iroin tw ilreet tadrg praoe'ty 

SEP 0 3 u : 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

nECHNOLOGIES, MC. SERVICES 

Property Status F®rm 

Address: ^(9 ^ h\Q<^ "4^^ % Date 

Phone; i^O'X) OST^-^^Sl f^r- lVo^)7^^-^^J ^ BVID: ^ / ^O O 

Item NO Plants & Permanent Landgcaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No 

Item NO 

On Map 

Also 

Description & Location 

Property Owner D K rruae Pnidnmt n^mpioye Employee l-f^rtOAt y^y^;^ d b-Tjl^ i ^' ^ 

Signature: (Ao/ n & ^ jOw l ^gnature: v;^ ^ ^ 

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

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: (402)504-1005 Fax: (210) 579-6577 
51900 
R07541700000001.jpg (JPEG Image, 640x480 pixels) ht:^)://douglasne.mapping-online.com/assessdoc/Photos/39/R0754l7... 

'^o^ N ^ ^ s r 

lof l 11/5/2008 9:37 AN 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPreview.aspx7PrintOpt.. 

Douglas County-Omaha, NE 

Parcel ID 0754170000 Sec-Twn-Rng 18-15-13 

Owner 

Name 

PUSCH JAN 

ERIC Addition CARTHAGE ADD 

Property 

Address 

808 N 49 ST Block 23 

City OMAHA Lot 11 

Zip 68132 Legal 1 E60FT 

Owner 

Address Legal 2 47X60 

Owner 

Address 2 

POBOX 

540432 Legal 3 

Owner City OMAHA Legal 4 

Owner 

State 

NE Treasurer 

Website Link 

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

/taxinfo.jsp?parc=0754170000 

Owner Zip 68154 Assessor 

Website Link 

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

/accountinfo.jsp?accountno=R0754170000 

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 = 17 feet appraisal, survey, or for zoning verification. 

lof l 11/5/2008 9:37 AlV 



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^7^^"^:' \d:<'s^d 

Page 1 of2 

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Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2181209. 

Original Call Date: 11/24/08 Time: 2:13 pm Op: MADHURIMA18967 


Work to Begin Date: 11/26/08 Time: 2:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 808 Street: N 4 9TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 18-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation work for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)733-1188 


Alt. Contact: Phone: (618)401-2223 


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 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

n^nATM CXCATV COX COMMUNICATIONS, „!/-. INC 

 „„„ i HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFF1C,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

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Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER 

DISTRICT NA 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11 /24/2008