TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: t^^/Q ^ Date: __iL/a|2aa S 

Address: 16/ g ^/ s^^ s j 

Remediation Contractor: PgpQfiNTTftr'ftNgfnry/RS, /MC.y Year: ^p ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

H Executive Summary 

EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

a Restoration Agreement 

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

BT Confirmation data 

^ Photographs 

\£ As-built sketch 

\£ Satisfactory restoration signed by Property Owner 

Sr Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

H Utility clearances 

Q^ Property infonnation from Douglas Coimty Assessor's Office 

D 

D ' 40313566 

D — iimiinii — 

Superfund 

^^ fA M 

Si^ti ^ Date 
PROPERTY SUMMARY 

Date: 11/19/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Oct/Nov, 

Property Address; 1618 N 35 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NOI>^ 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED, B1 BUSHES, 2'X2' @ 362 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 213 PPM @ 12"; B2 = 391 PPM @ 6"; DZ = 208 PPM @ 12"; EA = 168 PPM @ SCRAPE 

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 include fmal 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 Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record Clean Up Query Lead Remaining Query j Property Damage Query 

Backfill: 

Sample Area: 26102 ­ 1618 N 35 ST 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: 1 Contractor: 

Owner Name: 1 

j HAYNES EARNESTEEN Property Address: 1 Group: 

Owner Addressl: 

Owner AddressZ: 

|1618 N 35 ST 

ZipCode: 

[68111 

|l 

Assessment: 

[l618 N 35 ST Resident Phone Qualifying Group 

City: State: Zip Code: |800 

[OIVIAHA |NE |68111 /\ssessment XRF Date; 

Owner Phone: 

|(402) 558-6991 

Alternate Phone:

1 

| 1 

Assessment l^ax XRF Value: 

1 921.76 
TECHNOLOGIES* INC oEBV 

EPA Property Close Out 

Property#: lt,\bl. Property Address: /t/8r -^45 St" 

Date/Time: Owner's Name: 

Quads Excavated: F',&i-, P ^ Contractor Group Prudent 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 of the house in excavated areas generally slope away 

from the 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 generallyfirm 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 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 or fences avoided? (If applicable) 

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

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 

/ 

y 

Yes No 

/ 

/ 

/ 

/ 

/ 

/ 

/ 

Yes No 

/ 

/ 

/ 

/ 

Yes No 

/ 

i / 

/ 

/ 

/ 

Yes No 

/ 

\y 
Owners comments: 

Inspection notes: 

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

EPA Representative Ba„ ^jj^ Date: n/t/07 
^EPA 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the helow 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: ^^/ ^ ^ ^ :?5'>^ 

Owner: fc^^r^e.54e, en -H<^.v/.ner5 

Restoration Kems In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I Required corrections to complete the property: 

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

L J I do not agree restoration is completed 

\c^l^Jd 

Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontamin^d soils aL? number cf properties located in Omaha, Nebraska, including the property located at 

IK/ a A/ WAJ •^T ' . The EPA requests your permission to allow ftudent 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 perfonn 

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

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

Omaha Lead Site cleanup. Ms. Madhurima Duni -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) or (402) 991-9583 (North 

Omaha office). 

Property Access Granted By: 

Property Owner Signature: ^v . ^M^^\w^ Shflo?­

(Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: /^// /U 3i^ ' 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; <^ ,nA -P 

OWNER' m, S53-0?^/ S TELEPHONE NUMBER - HOME: ('^*^ 1 WORK: 

J 1 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? *Id ( T- YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? V YES NO 

NURWER 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: 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 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omalia, 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 - BUILT DRAWING ~ S 

OMAHA LEAD SUPERFUND SITE OLS#: 26102 

Date Excavated: 8/28/2008 

Date USEPA Signed-OfT: 

26102 

Omaha Exterior Paint North Arrow Owne Lead Site r Uame: EARNESTEEN HAYNES 

Site Q^Good Sketch Address: 1618 N^35 ST 2. y • Poor 

Phone: H: W; n Nol paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: FH> a ^ ft&> T o 

RYASCPXA-26102 Fl ppm D Date: Q7 - aft-O M 

RYBSCPXA-26102 F2 -a ppm Q^ D Time: WS.S' 

RYCSCPXA-26102 B1 ppm H^ D 

Samples Analyzed 

9^1 2 T. 

RYDSCPXA-26102 B2 ppm B^ D 

RDZSCPXA-26102 0 2 <=i n ppm B^ D XRF Unit: % \ \ Book: ^ \ 

nogficPXA 26103—e^ 

RPgDCnXA-2010D P2 

ppm 

ppm 

D 

n 

D 

D 

Date: 

Time: 

%'yh ^ 

Number of Samples = 5 ; 

Staff: ^ 

^ 

B1 = 2UPP M «^ 12" SKtE.REj;i 

^ 

re>t>^'Hj hiw n 2 2004 

AREA NOT EXCAVATED 

|B1 BUSHES; 2X2':a; 362 PPM| y <b' HHi; 

B2 = 391 PPM v» 6" 

, V 

% 

^ 

v^ 

m

DZ = 208PPMW 12" 

'J y n> ov-c. ^ \ ^ <3 ^ 

if 

: .0 SQL 

a. 

V 

a.. 'k' 

<< 

•H^ 

• SfdetsftU- t « M d«U..j<»JUc. 

^5 "^s^^Ai : 

EA = 168 PPM « SCRAPE 

Omaha Lead Site 46130 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
:;i ! UMmm £!^^ UiaOilliiiEi^l'iJAL & L y CWlSTRiLiCTrilOiM 

TECHNOLOGIES, WC. SEIRVlIi.'ES 

Property Stetas Ferm 

Address: /^/ / ^ 3 ^ Si . Date: 

^(o 1(0 ^R_ Phone; BVID: 

Item NO Plants & Pennanent Landscaping To Remain In Place 

On Map Description & Location \^ ^ N 4^ '\ 

l)}ci^: fin fioAi-^ i :^y^oijtsi ire^^ "idrtfi z^me can ^ re^oo^). 

Pre-Existing Condition of Stnictnreg 

Does your Basement have a history of leaking? Yes No A ^ 

Item NO Description & Location ^esvnpnon 01 i^ocauon ( . On Map 

Hr 'lekTir}7^/c(c.7iM <^n<,hk^ F^3 

fiokl /;^ / f^ccfss^^ ha,^y CQ^^^n^eyii-ec^^of-f ^i^^-f--

Property Owner Prudent Employee 

Signature: Signature: /^^/ ^ 

8080 Ward Parkway, Suite 40S 2605 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)804-1004 Phone: (210)822-9568 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
26102 

Omaha North Arrow Lead Site Extepor Paint Owner Name; EARNESTEEN HAYNES 

Site Sketch [3^Good 

r Address: 1618 N 35 ST C^^ll f • Poor 

1

Phone: H: W: 

Q Not paint 

Sampl Lead Sample Samples Collected e Number 

la 

LAB Concentration Collected Finn: Fh>f t ^R&^Tc ^ 

RYASCPXA-26102 F1 -a ppm n Date: g^i - ^e>-e> M 

RYBSCPXA-26102 F2 ppm Q^ D Time: WZS " 

RYCSCPXA-26102 B1 ppm Q^ D Samples Analyzed RYDSCPXA-26102 82 ppm B^ n 

RDZSCPXA-26102 DZ ppm B^ D XRF Unit: ^\ \ Book: ^ 

ROgccPXAaeioa—6Z ppm D D Date: _ 

RPZOGPXA-aOIOI -PE ppm 

D D Time: _ ^ ^ ^ 

Staff. Number of Samples = I ^ 

ENTERED 

•: AUG n 2 U m 

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<v %y.:9x^. 

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Omaha Lead Site 46130 
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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1641230000 

HAYNES 

EARNESTEEN 

1618 N 35 ST 

OMAHA 

68111 

1618 N 35 ST 

OMAHA 

NE 

68111 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

16-15-13 

LOWES ADD 

P 

2 

N 44 8 82 FT LT 1 

& E 20 N 44 S 82 FT 

44 X 80 

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

parc=1641230000 

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

accountno=R1641230000 

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 = 40 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/7/2008 
I&/^<V?^^ ' 



X 

••'-^U^-.,-!.:_, : 
Page 1 of2 

"> 

ri3!rfci.i to i:..i.--ii£Ss. .:}.,' -Cre^teiBriSlil'^^fl^'^t^^ Irth lajbfrjgig,,, j i^^ndCmail}^ 

YOUR TICKET NUMBER IS 2116252. 

Original Call Date: 8/26/08 Time: 8:12 am Op: RAMITA18967 


Work to Begin Date: 8/28/08 Time: 8:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1618 Street: N 35TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project for soil 


Location of Work: LOCATE ENTIRE PROPERTY 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, „^,j^ , Alt: 4029340469 
 INC 

Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 8002891901 


NO NEED TO CALL OUT MCLEODNE MCLEODUSA Alt: 
 EMERGENCY 

Emerg: 8002891901 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl DISTRICT SANDY Alt: 

Emerg: 4025047946 

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OMAHACOF 

0PPDGPR5 

QLNNEIC


CITY OF OMAHATRAFFIC.SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK


RON 


NA 


 NA 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2008