TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 3-^^S \ Date: lO/(B/2>oto 

Address^ i^l2>& grs.ig-to€^ ^ ^ 

Remediation Contractor: fecopPrM'J /g•/^4^N<;)g.<:bC|l^q.^/(^/g,'? Year: '^-OiO. 

SOILREMEDLATION 

PROPERTY FILE FOLDER DOCUMENTS 

sf Video ofproperty (DVD) 

H Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja<?ent property 

d' Restoration Agreement 

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

a Confinnation data 

i 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

Utility clearances 

d Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature I5ate 

30217937 li 

Superfund 
PROPERTY SUMMARY 

Date: 10/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: October 

Property Address; 4735 ERSKINE ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 56 PPM @ 9"; F2 = 134 PPM @ 9"; EA = 238 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-excavationagreementdetails(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 Interim ROD cleanup criteria. 

TECHNOLOCIES. INC. 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 57951 - 4735 ERSKINE ST 

Owner: 

n Owner Occupied 

Owner Name: 

IFITZLER LARRY L 

Owner Addressl: 

1 

Owner AddressZ: 

|4735 ERSKINE ST 

City: State: Zip Code: 

jOMAHA )NE |68104-

Owner Phone Alternate Phone: 

1(402) 556-9086 1 

Contract: 

Contractor: |PRUDEMT_2010. .S 

contract Option |BASE 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: 

1 '

Alternate Phone: 

1 

Assessment: 

Qualifying Group jp^OO 

Assessment Max XRF Value [" 434 

Resident: 

Resident Name: 

I 

Property Address: 

|4735 ERSKINE ST 

Zip Code: 

|68104-

Resident Phone 

I 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ^1^^ ^ Property Address: 4 7 5 ^ 2rrsV:^'^e *?+. 

Date/Time: Owner's Name: | 4rr(A-f ?H-z<?*' 

Quads Excavated: F) , P 2- Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes

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 Yes 

1. Does the grading around the perimeter of the house in excavated areas generally slope away / from Uie house? 

2. Has sod been 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 

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 tliat water will not pool on the property? y 

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

Gates, Fences and Retaining Walls Yes 

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

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

3. Was daniage to gates or fences avoided? (Ifappiicable) J 

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

Foundation, Siding and Gutters Yes 

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

2. Was damage to tlie 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) 

Yes

1. Was damage to driveway surfaces avoided? 

f 

2. Was damage to walkway surfaces avoided? 

-t 

 No 

No 

No 

No 

 No 
Owners comments: 

Inspection notes: 

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

EPA Representative ^'^ ^ Date: ^\^^^ 
m CHNOLOGIES. INC. 

AS - BUILT DRAWING 

OLS #57951 

Date Excavated: 08/10/2010 

USEPA OMAHA LEAD SUPERFUND SITE Signed-Off Date: 

57951 

Omah Exterior Paint a Lea d Site 

• Good Site Sketc h 

Q^Poor 

Sampling Address: 4735 ERSKINE ST • Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: ?E IM C D&T A 

RYASCPXA-57951 Fl ppm n Date: folT/o l 

RYBSCPXA-57951 F2 ppm n Time: .) 3 0 Pr>A 

RYCSCPXA-57951 Bl ppm n 

Samples Analyzed RYDSCPXA-57951 82 IIZ- ppm D 

RDZSCPXA-57951 DZ 

111 . ppm D XRF Unit: \b9ia L Book: 2 S t 

nCZCCPXA 67061 -€ Z ppm D n Date -lo \ O ^ 

nrZ0OPXA-G79G1 -PZ- .ppm D n Time 

Staff: Number of Samples = (nsW 

Legend; Fl = Front Left, F2 = Front Rigtit. B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as vrewed from ttie street, facing property 

EES.I<<M£ 'Sn-. 

E.\= 238 PPM % SCR.\PE (~r 

r'r\^v^r \ A 0" ^ JJ.. rw \ <••» <« r\ i\ r 
Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below hsted 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 fiiture, excluding any 

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

Property ID: 

Property Address: ^ll S ^>^< ^ At. Owner: \ ^ '^^^~II ^ ^-^ \ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

SJWi agree restoration is completed. 

L J I do not agree restoration is completed at (noted deficiencies above) 

Sr-'/r-/^ 

Owner's Signatui Date 
m&.m: 

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 

Li'J^ ^ ^A>Sfc4 N ? - . The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

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

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

Ifyou have any questions about the soil cleanup plarmed for your property, please contact Prudent South Omaha Office for the Omaha 

Lead Site cleanup,_at (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office). 

Property Access Granted By: a^ ^ (Please Print Naine) ^ 

Property Owner Signature: 

PROPERTY INFORMATION 

(To be completed by_resident,and/or property owner - please print) 

RESIDENT NAME /Owneix Renter 

RESIDENT ADDRESS 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS 

• ^1^ ^ yr<;tj^ ^ 

OWNER'S TELEPHONE NUMBER - HOME : iadl\ ^^6 - '^ 0 ^£> WORK: 

J 1 

AGE OF HOME?: ^ ^<j^EARS . HOW LONG HAVE YOU LIVED HERE? _Zs2__^YEARS . 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978?-t_ ^YES _ NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C / 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: s 

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

AUTHORITY 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 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 5600 S. 10'" street 4242 IVIedical Drive, Suite 4250 

KansasCity, MO64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1455 Phone: (210)822-9588 

Fax: (818> 363-3707 Fax: (402) 733-1883 Fax: (210) 579-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Li-y^ ^ lAje_ Date: 7 j l^jTolO 

Phone: f^l - ?Z> 3 t BVID: 

Im^j^^r na=y no Li<.Lry oi~ 7^-

No fOa^k oris jyi P / or O 

Q,^, UcA/tfS hij^l/\ / n £Z Qe^mo^^ /OsJ 

CjayJC^ cp^ S/'cU (Aj^rJt uye^-f5'rJ<z ^l^cny^5i<JQ 

Property Owner Prudent Employee 

Signature Signature: 

«>fmr *i n^th r«A_-_A r^..:*.. ^n.n mnsn iia«.j:.-i n.: — r*..n,^ jAr-n 
57951 

Omah Extenor Paint North An-ow a Lead Site • Good Site Sketch 

Q^Poor 

Samolina Address: 4735 ERSKINE ST [ ] Notpaint \ 

Sample Number Lead 

Concentration 

Samples Collected 

Firm: ?£ IN 6 X>^T \ 

RYASCPXA-57951 Fl Date: iJ^lh' ) 

RYBSCPXA-57951 F2 Time: .l-30prA__ _ 

RYCSCPXA-57951 Bl 

RYDSCPXA-57951 B2 Samples Analyzed 

RDZSCPXA-57951 DZ XRF Unit: |Qft(o7. Book: 2M \ 

nCZCCPXA 570S1 GZ Date: 1 O l O ^ 

nrzocrxA-57osi—PE Time: Pnn 

Number of Samples = Staff: MSU) 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed from the street, facing property 

ENTERED 

E?.&v<m£ ST . 
Paae 1 of 1 

LflZS Lr^^ir^ Sr 

http://douglasne.mapping-online.comyassessdoc/Photos/10/R0.5323800000001.jpg 6/15/2010 
Print Preview Page 1 of2 

ISpunty-Omaha, NE 

USB* 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

0532380000 

FITZLER 

LARRY L 

4735 

ERSKINE ST 

OMAHA 

68104 

4735 

ERSKINE ST 

OMAHA 

NE 

68104 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

BAKER PLACE 

2 

10 

50X128 

0.15 

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

parc=0532380000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R0532380000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/15/2010 
Create Another Ticket Back to V r intemet Send Email 

YOUR TICKET NUMBER IS  2563735. 

Original Call Date: 8/09/10 Time: 2:55 pm Op: SIVA18967 


Work to Begin Date: 8/11/10 Time: 3:30 pm 


State: NE 

Address: 4735 

County: 

Street: 

DOUGLAS 

ERSKINE ST 

Twp: 15N Rng; 

Twp: Rng; 

Legal Given: C 

13E Sect-Qtr:

Sect-Qtr: 

07-SE,OB-SW 

Type of Work: Lead Soil Remediation Project 


Location of Work: LOCATE ENTIRE PROPERTY 


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


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: N


Involves Tunneling or Horizontal Boring : N


CXCATV MUDOl OMAHACOF 0PPDGPR5


Service Area 

CXCATV COX COMMUNICATIONS, INC

METROPOUTAN UTILITIES MUDOl DISTRICT 

CITY OF OMAHA- OMAHACOF TRAFFICSEWER 

Place: OMAHA 


Phone: (402)733-1188 


 Front: Y Rear; 


 Explosives: N 


 QLNNEIC 


Utility Contact Phone Number Type 

Day: 4029340469 


 HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 


SANDY Alt: 


Emerg: 4025047970 

Day: 4024447197 


RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


OMAHA PUBLIC POWER ELM OPPDGPR5 Alt: 4062071494 DISTRICT LOCATING 

Emerg: 8887289343 


dhon.org/irthinternet/.../MessageText.as.. 1/2 
u/ ^/ ^v^\y 


FTM 

^ay : 4067289343 

QLNNEIC QWEST LOCAL NETWORK TTC/AT>TXT^ ^Alt: 4062071494 

LOCAllNCj 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TECHNOUKSffiS, INC. 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

.jm£ j ^ ^ . 9yoy-^ Address: Excavation Date: ^yWv P/lfL^^ Crew Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines {^^y 

Gas Line ^^'pocL 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk P/Y<^< ^ 

Foundation 


Retaining Walls ///A 

Fences 

Trees 

Structures 

Driveway c^ck^. p/^ U.^^ ^ 

Sprinkler System /y/zjother 

Crew Foreman Site Safety Office 

Date: 

- ^ :.^...^.:^ ' /6 

8080 Want Pariony. Sute 405 . 5600 SIO St 4242 Medical Drive, Suite 7250 

KanasGHy. MO 64114 Omatia. Mabiatira 68107 Sail Antonio, TX 78229 

PfMfie: (816) 363^3703 PtXMie: (402) 733-1188 Phone: (210) 822T9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax:(210)579-6577