TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: %S)^^ ^ Date: __Li|p|aQfi 2 

Address: tAtl f^ ^ s r 

Remediation Contractor: Pl?i^ry9f.\-f lg / ^ fs|r<//^(^|gg^ / r^. j Year: r^n ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

df Video of property (DVD) 

Pj Executive Summary 

H ' EPA-provided property sketch 

B Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaijent property 

Z^ Restoration Agreement 

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

'I?r Confirmation data 

0 Photographs 

B As-built sketch 

D Satisfactory restoration signed by Property Owner 

e Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0 Utility clearances 

W Property infonnation from Douglas County Assessor's Office 

D 

D 

40313567 

D mniiiii 

Superfund 

Signature/ Dat * ^ e 
PROPERTY SUMMARY 

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

Property Address; 1617 N 29 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: 

B2 = 197 PPM @ 12"; 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/photogr^hs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall include final 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 mcluded 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 cleaniq) criteria. 

TECHNOLOGIES, INC. 
Find Record I 

Backfill: 

Sample Area: 82429 - 1617 N 29 ST 

Owner: 

D Owner Occupied 

Owner Name: 

CITY OF OMAHA 

Owner Addressl: 

|ATTH JIM THELE 

Owner Address2: 

|I819FARNAMST#111 1 

City: State: Zip Code: 

OMAHA JNE j68183 

Owner Phone: Alternate Phone: 

Clean Up Query Lead Remaining Query

Resident: 

Resident Name: 

r 

Property Address: 

[I617N29S T 

ZipCode: 

[68111 

Resident Phone n 

 Property Damage Query 

Contract: 

Contractor: 

jPRUDENT2008_S 

Group: 

Assessment: 

Qualifying Group 

|800 

Assessment XRF Date: 

Assessment Max XRF Value: 

828 
TECHNOLOGIES^ INC SER^ 

EPA Property Close Out 

Property #: S a.** 2-1 Property Address: Jbn A'2-1 ^^ 

Date/Time: Owner's Name: 

Quads Excavated: B^ Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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 ofthe 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 generally firm and evenly graded? / 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / tune 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 

Yes No 

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

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

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 

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

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? 

i / 

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? / 

2. Was damage to walkway sur&ces avoided? / 
Owners comments: 

Inspection notes: 

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

EPA Representative ^.^>a.. Date: /^fjj/op 
Oct. 16. 2008 5:21PM OMAHA PLANNING DEPT, 402-444-6140 No. 309 8 P. 3 

Property Completion Agreement 

This agieement documents the completion of removal aciivities perfonned on the below listed property. 

The property owier's signature indicates that the property owner is satisfied with the restoration of the 

subject property, and that no items are ia question, now, or at any time in the future, excluding any 

remaining wairanty (30 days total) except those items listed below, if any. 

1 Property ID: 1 

1 PropertyAddrew: /^/- 7 / / Z 9 ^ ^'^• -^. 

Owner: ^. ^ ^ f ^^^/ L 

1 Pbone: 

Restoration Items in Question: 

Item: 

nam; 

hem: 

Kern: 

Item: 

llam: 

Raqulred corrections to complsts the property; 

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

L J I do not agree restoration is completed 

a. u>. <*27^-~/ ^' A r'0^^.-6J - /o> - ry- o ^ 

Owner's Signature Date 
Sep. 17. 2008 12:13PM OMAHA PLANNING DEPT. 402-444-6H 0 No. 1051 P. 1 

PriidailTtclinologia, Inc. (Pn>dait)iB unto OQiit((ci<«ididM U. S.Eiv»incinGnalFn(eaiQa Agency (EPA) ocleai up leadcontvumiBd soils it M. numba of pcopenks locoed ia Onahv VebEislok, includkiK ibc piqpcny locaed u 

. TheEpAiniuctayottrpanl$sionodlowPnideatiopci£3i«icoilaUKnup«tihi( 

propaiy n noiove Itad-ooimninfltod toil. By sieuns ^ i ^vm. Du piaiierqr owner ffwas pcimtelon w Pnidcatfo parfbcm 

acAtnties idaicd to die deiBif nchidine toil saagpfinc icaiMil of IcadkoaBrn'msKd soil, aod lectoralian of ike TcfiMiced ptopcny. 

If you hllt« u y queraora about ifae soil cleatmp planed for your pi<)i>ety, pIcMc eontacc hudaBiTi »Aniniifrfive CltAfer the 

ftnA« Lead Site dewipi ^^f yadhwiim Oayf-n (401) 731-11M" 73j.]iM Geoenl questions about lhe ODaha Lead SxCe 

cieaai9 cnb c djicded loihcfiPAPublicfailbnnKion CCMoa tf (40Z)''3I-304S (5oud| Omaha offitt) or (402) 991-9SI3 (Nonh 

Oimlui offlce). 

PirepalyiweeuOimiedB\^/\ ^^^t ^ (A J WjU-g^/ ^ Pte-» t t^e f 

Xj 7 (Plea^ManVtaS^ 

Pwpeity 0«>naSIPMMIC: (—^--^A^^tofa^ ^ C.;<A (TAya-ar- V"^ >^ 7' " ^ ^ 

PROPERIY MFONHATION 

(TB be conplMied by r««iimt udAir propcrtir a«» r - pIcUe pkteO (IB te coBpiMM VJ rcaiwicai 

RESICNENTNAME-. \ /</.L ^'^'-^^ \« r Q,„„ R^I^^B, 

RESIDENT ADCRESS: 

IP RENTAI , PROPERT Y OWHE D BY: 

OWNER'S MAILING ADDRESS: 

OWNER'S TEUEPHONE NUMBER - ROME: t \ WORK: 

Mrl) HMM^ gy p 

AGE OF HOME?: YEARS. HOW UOMG HAVE YOU UMED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAMTSD OR COVERED WTH SIDING &MCE 187B7 YES , NO 

NUMBER OF OCCUPANTa tJNDER 7 YEARS OLD: _^ _ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL mSTRUCnOMS; (LE. DOGS. ENTRY GATES. ETC.) 

AUTHORTTY FO R ENVnONMOEKTAL RESPOKSE ACTIONS: TV aotititics b b« ioiplcveoMl by EPA wdcr thU iirccaioK 

•nsponuaKiaSeciMalM«fCERCLA.4ZO.S,C96M. £PA'(ri8lnoraK«>»n>tbepi«pcrtyi$piovidedliriDS«ciiotilM(e)of 

CERCLA, 42 U.S, C 960S(e),ttltiett provides eotry for "deicnniDlns lhe need tat itspouc;, or chooeinc or (akioK any nspoiue iictioo 

imder Otis M c or Mhertrifc enfbrcnv lhe provixiou'of lhe tda.^ 

SOW Wind Partoway, Suite 406 2S0S N. 24* StfMt, Suite 308 4242 Msdical Ditw. Suite 42S0 

Kans u City, WO M114 Omahn, NtbhKka 08110 San Antonio, TX 7B229 

Phone: (816) VSUStxa Phone: (40Z) 504^1004 PtMite: (210) 422-9508 

ftO/rdw" ilBlo'^flOnZ JI das :XBJ 
AS-BUILT DRAWING ^ 

OLS#: 82429 

Date Excavated: 9/25/2008 

Date USEPA Signed-Off: 

OMAHA LEAD SUPERFUND SITE 

82429 

Omah Ext«fiar Paint NonnAniM a Lead Site • Good Site Sketch 

Sampling Address: 1617 N 29 ST Q Not paint 

Sample Number Lead Sample Samples Collected lAB Concentration Collected RTT.: PnA FfeTl) 

RYASCPXA-82429 F1 _fiL3___PP"i D Dale:

 1-3-o 8 

RYBSCPXA-82429 F2 20 ^ Dom 

D Time: 10-la AlA 

RYCSCPXA-82429 B1 _L£Ll__Ppm 

D Samples Analyzed RYDSCPXA-e2429 B2 ft ?f t Pom n 

RDZ8ePXA-02429 OS " OPitt D n XRF Unit ^y^ O Book: 2J 3 

nozoopxA 02420—ez ~ POW D D Date-._ 

FlPZsePXA-a24£g re- •~ ppm D D Time;

_ 

Staff: mst^ Numbero(Samples =[j ^ | Cj ] 

Legend: F1 = Front Left, F2 = Frott Right, B1 = Back Lett, B2 = Back RigM DZ = Drip Zone, GZ = Garden, P2 = Play 

An quadrants are as viewed rraon the (Mel , fadma pnvaity 

' 1 • • 1.1 a.^...^m B2-197PPM ii; 12" 

•"'. •.%'*>«'i-s««^ « -^;,. TM 

JUL i 5 ^ti 

!• 

i® 

?l 

m^.im. 

1 

i ^H' 1 

M w st Rnn n Cmud a3M.y.« 

NO EASEMENT 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
Sep. 1/ . 2008 12:rJPM OMAHA PLANNING DtPl". 402-444-6140 Jo. 1051 P. 2

CHNOLOGIES,INC. — 

Property Status Form n 

Address: lU I'A N^ 1,*^^^ Si- Date: D'llltf o ^ 

Phone: BVID: 

He 2-- V^i^^' Soo" 

Plants &, PerBuneat Landbcapine 

Item# 

On Map Desciiplion and Location 

\bV­ (X co^^ 

Pre-EKJating Condition of Structures 

Does your Basenueot have a history of leaking? Yes — No 

Item# Description & Location 

OnMi^) 

Property Ovncr Prudeaot Employee 

Signature: c/t^'^'y^ , O U ( ^ Jignattue: 

-^y S08D Ward t>ar4(way, Suite 406 2S0« N. 24^ Smei, Suite 39d I 4242 m«(HcB! Driy€, Suits 4250 

Kansas Ci^.M0 641i4 Omaha, NebraskQ GBIIO ^ San Antonio, TX 78229 

PhoiTKlBIO) 303-^703 rnn/cnnj (littcn'ii onn? i i nac 
82429 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch 

n,Poor 

Sampling Address: 1617 N 29 ST Q Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Fimi: FDI ^ FfeTD 

RYASCPXA-82429 Fl Q* ^ ppm D Date: l-S-o 8 

RYBSCPXA-82429 F2 2Q* ^ Dom D Time: lOWci flM

RYCSCPXA-82429 B1 _jL^_L_Pp m 

RYDSCPXA-8242 Samples Analyzed 9 82 ft ?f t ppm n

RDZSCPXA-02429 B2 ~ ppm D D XRF Unit: 6f^ 0 Book: Z/ 3 

R023CPXA-B2429 6Z r___pp m D D Date: l-/g-0 8 

RPZSePXA-02429 PZ- •" ppm D D Time:,.,^ flilQ 

n Staff: /nSU) Number of Samples = | 4 [ | ( ^ | 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Lett. B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

AB quadrants are as viewedftom the»street, ^treet,facing l property f •:*• if-'- S 

. J ^/ L i »' ».*• >• -i 

.828i. 

Bl 

1 

M 

:. /.uui.?ij6t. 

9 

fl a 

m.^.2g<=[ y •• • »

1 

i_!ai 

N W 5t R«200S Crated' OS-Kfay-08 044701.01.23 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

2212790000 

CITY OF 

OMAHA 

1617 N 29 ST 

OMAHA 

68111 

ATTH JIM 

THELE 

1819 

FARNAM ST 

#1111 

OMAHA 

NE 

68183 

Sec-TwnRng 

Addition 

Bock 

Lot 

began 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Unk 

Assessor 

Website 

Unk 

16-15-13 

SHINNS2NDADD 

T 

6 

S 24.5 N 86.5 FT 

60X24.5 

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

parc=2212790000 

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

accountno=R2212790000 

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, 11nch = 13 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/18/2008 


Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2134551. 

Original Call Date: 9/18/08 Time: 10:24 am Op: RAMITA18967 

Work to Begin Date: 9/22/08 Time: 11:00 am 

State: "NE County: DOUGLAS Place: OMAHA 

Address: 1617 Street: N 29TH ST 

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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project 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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/18/2008 
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Day: 4067289343 


OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK NA 
 Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/18/2008