TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: I7^U>7 Date: /2/W^^ ^ 

Address: ^ f/d/. £ ^ 9 h 

Remediation Contractor: r^'^J r 'Titi^i^yt>^t^^%it, Year: 2.oo^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

D Executive Summary 

D EPA-provided property sketch 

D Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjai^ent property 

D Restoration Agreement 

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

D Confirmation data 

D Photographs 

D As-built sketch 

D Satisfiactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

n Utility clearances 

D Property informationfirom Douglas Coimty Assessor's Office 

D 

n 40309584 

0 _ illHllDIII 

'-' : Superfund 

Signature Date 
PROPERTY SUMMARY 

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

Property Address: 3914 S 9 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Odier Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 220 PPM @ 6"; PZ = 227 PPM (@ 6"; DZ = ZERO @ 2"; NO EASEMENT 

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-Built sketch ­

i) Shall includefinal lead levels v) Legend 

h) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Other items to be incltided 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, AVMV (Windows Media Video) or SWF (Flash Player) fonnat and/or 

photographs 

iv) Signed form verifying satisfactoiy restoration 

v) Description of areas not meeting Interim ROD cleanup criteria 

ECHNOLOGIES, INC. 
Rnd Record 

Backfill: 

Sample Area: 12667

Owner: 

D Owner Occupied 

Owner Name: 

SCHIPANSKY RENEE 

Owner Addressl: 

Owner AddressZ: 

3916 S 9 ST 

City: 

OMAHA 

Owner Phone: 

Qean Up Query Lead Remaining Query I

 ­ 3914 S 9 ST 

Resident: 

Resident Name: 

|HAIZLJP JON R 

Property Address: 

[3914 S 9 ST 

Zip Code: 

[68107 

Resident Phone 

State: Zip Code: I 

|rJE [69107 

Alternate Phone: 

 Property Damage Query 

Contract: 

Contractor: 

PRUDENT2008_S 

GiX)up: 

Assessment: 

Qualifying Group 

jPLAY ZONE 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

I 493.47 
HCHNQIJOGIBSI INC &EPA 

EPA Property Close Out 

Property #: l^^^ ? Property Address: 1^/U S^-S r 

Date/Time: Owner's Name: 

Quads Excavated: P^^P^ ; B>) Contractor Group Pradent Technologies 

Excavation General 

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

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

Grading Sod and Vegetation 

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

from the house? 

2. Has sod lieen laid in all areas that were excavated? 

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

daytime period) 

4. Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generallytight? (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 Walls 

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

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

3. Was damage to gates orfences avoided? (IfappUcable) 

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

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

X 

Yes No 

/ 

/ 

X 

X 

X 

X 

y 

Yes No 

/ 

X 

X 

y 

Yes No 

y 

y 

y 

y 

X 

Yes No 

X 

u 
Owners comments: 

Inspection notes: 

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

EPA Representative Bam dSLaj Date: /ajf/os 
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 ID: 

Property Address: '-^ A i u ^H v 

. S "^h 

Owner: 

Phone: 

Restoration Items in Question: 

Kem: 

Item: 

Hem: 

Hem: 

item: 

Hem: 

Required corrections to complete the property: 

U'-NVccba-ti? 

1 ^ I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

U {-i^oi 

Date 
Pnident Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permissbn to allow Prudent to perform a soil cleanup at this 

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

activities relatedtothe cleanup including soil sampling, removal of lead-contaminated soil, and restoration ofthe refoenced property. 

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

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

directedtothe EPA PuUiCliilSrmation Centers at (402) 731-3045 (South Omaha ofBce) or (402) 991-9583 (Notfli Omaha ofBce). 

Property Access Granted 

iT ' \ (Please Pri PrintName n ) 

Property Owner Sigi 

(Date) 

PROPERTY INfOpMATION 

• V (To be complete by residen resident and/or propert property owner — pleaie print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRES RESSS :

Q>s\ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NIJIIIBER - HOME: WORK: 

AGE OF HOME?: l o > 3 YEARS. HOW LONG HAVE YOU LIVED HERE? Cd l ^EARS . 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 Vy YEn S NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: jar,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 9605(e), which provides entry for "determiningthe need for response, or choosing or tiking any response action 

under this title, or otherwise enforcing theprovisions ofthe title." 

8080 Ward Partnvay, 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 
# AS - BtILT DRAWING . 

: OMAHA LEAD SUPERFUND SITE 

OLS# ! : 12667 

Date Excavated: 11/01/2008 

USEPA Slpied-OffDate: 

12667 

Omaha Exterior Paint Nonh Anew Owira Lead Site r N«ine: JON R HAtZLIP. 

Site Sketch 

• Good Addf«»»:M14SSLST.. D^oor Phon«:.H: 402-614-4876 W: 402-293-1700 • Nrtpatrt 

Sampio Number Lead Sample Samf^es CoHected LAB Concentration Coiiected Firm: Pc ^CT ^ 6g _ RYASCPXA-12667 F l /^"Z. ppm ca- D 

RYBSCPXA-12667 F2 / 6 7 Dom E T Time; /0- ' ^ C> A M 

RyCSCPXA-12667 B1 g 6 3 aom D Samples Analyzed nYD6CPXA-12667 - B2 D D 

RDZSCPXA-12667 DZ 12<P3 oom 

0" a XRF Unit: lOJ l Book: /? g 

ROZSOPXA 12867 -62 " DDfn • Date: \2.-l4'OS ' 

RPZSCPXA-126S7 PZ ^'fa aom a Time; Pm 

Lab RYCSCPl.A-12667: Staff; Number of Samples = j i f \ ; / ; LA. . Re»«* .429 ppm _ Front Right, B1 = Back Left, B2 ^ Bade Right DZ ^ Drip Zone, GZ « Garden, PZ >= Play 

AV qutdtMit are aa viawad from the t(i««t, facing praparty 

CONTRA a »: EP - R7-07-06 / 000 4 PRUDENT TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address:-^ ^\\^ Q^ <^Vk "2 V- Date: 

Phone: ^02-^ ^fi - IVM H BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^v^cJL a^- drv'p p Ce..L e ^ 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owner Prudent Emplo; 

'^ Si&natuperY\ Signature: 

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 

Fax: (816) 363-3707 

Phone: (402)504-1004 

Fax: (402)504-1005 

Phone: (210)822-9588 

Fax:(210)579-6577 
,..i— ,».,n.iL, ,.|iMMM4jg^V i ^f.Mvt9t,<-if t . <i*m*i.J'*ti^*i»inAr«K*<VW^***ifi*^fit.Jli*ii-.'viTeiVifi»-£^i-^^JXX)i. 

12667 

Omah ExteriorPaint Noitti Arrow Owna a Lead Site r Name: JON R HAIZLIP • Giod Site Sketch Al dress: 3914 S 9 ST ^::-^ EJ-Pior 

>|lone: H: 402-614-4975 W: 402-293-17 » • N<*p*nt 

Sqmpte Number Lead Sample LAB Samples Collected 

ConcentFatior Collected Fimt: ^ /^ ^ \ 6t . 

RYA|SCPXA-12667 F1 ppm D Data: \\- 0 ^ C ^ 

RYBBCPXA-12667 F2 147 ppm Time; 10- ^ 6 fiJA 

RYclsCPXA-12667 B1 M ^ ppm D

;CPXA 12667 K Samples Analyzed ppm D D 

ROZlSCPXA-12667 DZ 12^ 3 loom D XRFUnit 

I£12 L Book: _I1 £ 

nOZDCPXA 12667 62 ppm a Date: \Z't*i-o ^ RPZ$CPXA-12667 PZ "^^TS ppm D Twne: Pm 'i lab RYCSCPLA-126e7^ Number of S amples = [ ^ j 1 / Stafh AA, Rest ft 429ppm . \ja^ie\ Front Right. B1 = B2 - Back Right DZ « Drip Zoije. GZ - Garden, PZ = Play 

ASquadFanlsaijias fram ttie atiMt Caeing prapat^ 

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t«v4. 046141.013) 
PRUDENT TECHNOLj^ES, INC. FIRST N/l^BlAL BANK OF OLATHE 

8080 WARD PARKWAV^iTE 405 -172/1010 199: 

KANSAS CITY, MO 64114 

(816)363-3703 

PAY TO THE 

ORDER OF $ f^.s^f 

DOLLARS 

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Q. MEMO 

II'O IR":] 3 IIIPRUDENT TECHNOLOGIES. INC.  «:iOlOOl?EOi : n'Oll . SI. 5 !."• 

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PRUDENTTECHNOLOGIES. INC. 

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562976 {3«6) 
Yahoo! Mail - jdenne@prud|||toveb.com 

Page 1 of2 

VUESOO i SMALL BUSINESS Print - Close Window CLASSIC 

Date: Wed, 5 Nov-2008 07:01:30 -0800 (PST) 

From: "Ramlta Shrestha" <rshrestha@prudentweb.com> 

Subject: Fwd: Re: flowers 

To: "John Denne" <jdenne@prudentweb.com> 

Note: forwarded message attached. 

Forwarded Message 

^'s^sr Date: Mon, 3 Nov 2008 04:34:51 -0800 (PST) 

From: "Renee Schipansky" <thedreamcatcherl954@yahoo.com> 

Subject: Re: flowers 

To: "Ramita Shrestha" <rshrestha@prudentweb.com> 

HTML Attachment 

There was one each for a total of 19.94. 

Renee 

— On Sun, 11/2/08, Ramita Shrestha <rshrestha@prudentweb.com> v/roie. 

V 

From: Ramita Shrestha <rshrestha(gprudentweb.com> r %&kuv*\ Kcr\Trt«.«l^ 

Subject: Re: flowers 

To: thedreamcatcherl 954(@yahoo.com -^ CUu l'fl'<:5 Date: Sunday, November 2, 2008, 9:02 PIVI 

Renee, 

Thanlcs for your correspondence. I will bring a check for you. how many day lilies we have to 

reimbursemnet 

Please let me know and quantity 

Ramita 

452-9806 

Renee Schipansky <thedreamcatcher1954@yahoo.com> wrote: 

Ramita, 1 forgot to get this information to you before they started the work on my yard. The 

plants that I will need replaced are one sedum herbfreude priced at 9.99 and the day lillies 

were 9.95 a piece. 

But I have some concerns that I would like to address. They did not dig where you said they 

were going to, they stopped right at the plants. Also they tore up my yard going up and down 

the hill. The carport was to low for them to bring the equipment up the back way. 

Can someone please call me to address these concerns. 

Renee Schipansky 

3914 S 9th Street 

612-250-1187 

http://bl l.mail.yahoo.com/ym/prudentweb.com/ShowLetter?box=Inbox&MsgId=1066_27... 11/5/2008 
Page 1 of 1 

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Parcel ID 2346970000 :|e<^-'^>^"- 34-15-13 

Owner SCHIPANSKY Addition VAN CAMPS ADD Name RENEE 

Block 7 S i^»»s^sT 

City OMAHA Lot 16 

Zip 68107 Legal 1 N1/2LTS15& 

Owner Legal 2 62.5 X 98 Address 

Owner 

Address 3916 8 9 ST I Legal 3 

Owner OMAHA Legal 4 City 

Owner Website http://webapps.dotcomm.org:8080ATreasTax/faces/pages/taxinfo.jsp? iNE State parc=2346970000 Link 

I Assessor http://douglasne.mapping- Owner 69107 • Website online.com/DouglasCoNe/static/accountinfo.jsp? Zip Link accountno=R2346970000 

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7 Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2152978. 

Original Call Date: 10/10/08 Time: 3:38 pm Op: RAMITA18967 


Work to Begin Date: 10/15/08 Time: 4:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3914 Street: S 9TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 34-SE,35-SW 


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 RAMITA Phone: (402)733-1455 


Alt. Contact 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 LEVEL3 MCLEODNE MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


QWEST2 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


nv r A TM COX COMMUNICATIONS, HEIDI Alt: 4029340469 t.ACA 1 v j^ ^ 

Emerg: 4029329757 


Day: 8773668344 


LEVEL3 COMMUNICATIONS, LEVEL3 NA Alt: LLC 

Emerg: 8773668344 

Day: 8002891901 


NO NEED TO CALL OUT MCLEODNE MCLEODUSA Alt: EMERGENCY 

Emerg: 8002891901 

MUD0 METROPOLITAN UTILITIES Day: 4025047823 2 SANDY DISTRICT Alt: 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/10/2008 
Page 2 of2 

CITY OF OMAHA- OMAHACOF RON TRAFFICSEWER 

OMAHA PUBLIC POWER 0PPDGPR6 NA DISTRICT 

QLNNEIF QWEST LOCAL NETWORK NA 

QWEST2 QWEST LONG DISTANCE SARA 

Emerg: 4025047946 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 


Alt: 


Emerg: 8887289343 


Day: 8002834237 


Alt: 3039921926 


Emerg: 8002834237 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/10/2008