TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: ^2>^ g Date: )njl}J2jDoE 

Address: Q7fb°i PoopLlvr, A J 

Remediation Contractor: P>^j^iu^ 'Xeiu^Jopo, _. -i^c-j Year: 2-PO ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video ofproperty (DVD) 

0 Executive Summary 

B EPA-provided property sketch 

ffl Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

l7 Restoration Agreement 

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

H Confirmation data 

ffl Photographs 

a As-built sketch 

0^ Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

IZf Utility clearances 

^ Property information from Douglas County Assessor's Office 

D 

D 

D 

3/2y/of 

Signatur^ Date 

40311353 

Superfund 
PROPERTY SUMMARY 

Date: 10/17/2008 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Sept/Oct 

Property Address: 2969 PAPPLETON AVE 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED F2 LS 10X17 FT @ 267 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2=61 PPM @ 8"; EA=77 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 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 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 ovmer 

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 

Backfill: 

Sample Area: 20398

Owner: 

n Owner Occupied 

Owner Name: 

|SANCHEZ ADALBERTO 

Owner Addressl: 

Owner AddressZ: 

2962 POPPLETON AVE 

City: 

JOMAHA 

Oean Up Query Lead Remaining Query i

 - 2969 POPPLETON AV 

Resident: 

Resident Name: 

Property Address: " - , -v ^ 1 ­

12969 POPPLETON AV 

Zip Code: 

68105 

Resident Phone 

State: Zip Code: 

|NE |6810 5 

Owner Phone: AIternate Phone: 

 Property Damage Query dose 

Contract: 

Assessment: 

Qualifying Group 

I PRIORITY ^ 

Assessment XRF Date: 

I 

/^sessment Max XRF Value: 

615.18 
EPA Property Close Out Form 

Property #: 2^5^^ ^ Property Address: '^^7_'^fe' ^ Pepp(e+c»^ A^>^ 

Date/Time: Owner's Name: /4^g<H^rV o Ct^^cU-^T^ 

Quads Excavated: p-Z - Contractor Group 

Excavation General Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? 7 

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? 

y 

Grading Sod and Vegetation Yes No 

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

fi-om the house? y 

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

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

day time period) y 

4. Are sodded areas generally firm and evenly graded? y 

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

y time period) 

6. Was the property graded such that water will not pool on the property? y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls Yes No 

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

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

3. Was damage to gates or fences avoided? (IfappUcable) y 

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

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? y 

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? 

y 

2. Was damage to walkway surfaces avoided? 

y 
Inspection notes: 

f^C£o i a pcofiC /tS-lutt.r S/<erctt /^ffO fieF/ee f feffO UotL^ /A/ T/)c OiO ^£xc/>0/,rBO 

9767of 

0 ^ 

4^ ^ 

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

EPA Representative /L^?5L ) ?^**^7 Date: 9l3ojo7 
SEPA 

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: 2 ^ ^ ^ ^ 

Property Address:

Owner: 

^C ^ ^ c:\ ' -^opple.^vv Ao/^-^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

L J I agree restoration is completed, except as noted above. 

LJ I do not agree restoration is completed 

C\ 0% 2J5i Qg 

Owner's Signature Date [.da^G^Y\-^Qr^ 
.y .V.-.',, X 

Fiudsnt T ochadogjftK, Ins. (Pm<i»n$ i^ uad»r contract rri^ife9 IJ. S. Enriiomnontal ProUrtion Ageicy (^PA) to CUEQ ^ 

coiity.iiHtad «)ils at anumbw of p:op»iti»slDcat»diBOmaha,N»braidca, iiicludingth« pioperty located at 

. ThsEPAnqussltyourpHsnisaoato allow Pludtsfl.topfrrfom ssoilcUam^iEtlhiB 

ptop«ity to nmo'ft Uad-ctrntmninifled soil. By Qgmng thiE fonn, th» piopnty ownti grants pnraisaon to PiudAat to ptifona 

sctivitisE i«lat»d to the clssn^j iacliziSsHg soil sjaaplizg. lomovri of load-contarainal»d soil, and r«Etoratiou ofthe lefeienced property. 

If you hs.ro sny queSioas about the soil cleans^ plaaaod foi yom property, please contact Pnident's Adoiiiitiislive Cleik foi the 

Om aha Lead Site cleanup. Ms. Shannon Holt-at (402^504-1004. Genend questions aboutfiu OmahaLead Site cleanup canbe 

directedto &4 EPA Pubhc Infonnation Centeis BI(40^ 731-3045 (ISouShOmaha office) oi(402) 991-9583 (J^ oith Oinaha office). 

Pioperty Access Gnailed By: //z?Zi-f .Oy-r/yO 3>%. J^-^ " t? 

(Please Pnnt T>3 ase) 

PiopertyOsmeiSignature: fJo^Cr^frO 'Q\iluky 7)7h/&{l 

(Signatffo) 7 / (Pato) 

PROPERTY IMFORMATIOM 

fTo be ceioplstBd by nrndentflni/orpioperty owner - plesse print) 

RESIDENT MAKE: 

^ iWi. Owner Rentsr 

RESIDENT ADDRESS: 

.^l^^__JabJ^€_'b.c,__a:v^bfi= OP^-S ^ M2=__^^\C3 ^ 

IF RENTAL. PROPERTY OWNED BY: /KS-I-A^ y 

OWNER'S HAILINGADDRESS; 

jo^i. P\^^ C^'^iX^ KSP CS( 0 J ' 

OWNER'STELEPHONE NUfSBER - HOfJE: ( 702) ^ 3' ^ ' - ^ ^ & ^VQRK : 

J 1 

AGE OF HOME?: \^ ^ YEARS. HOW LONG HAVE YOU LIVED HERE? B. YEARS. 

HAS THE EXTERIOR BEEN PAIMTED OR COVERED WnH SIDING SINCE 13787 YES- —»0 ^ ^ " ^ 

NUt/IBER OF OCCUPANTS UNDER 7 YEARS OLD: | U NUMBER OF OCCUPANTS 7 YEARS OLD AtJD OLDER 

NUHBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IH THE YARD FOR 5 HOURS OR E30fK PER WEEK: 

corancwTS O R SPECIAL IHSTOUCTIOMS: (i.e. DOGS , CMTI\Y GATCE , CTC.J 

AUTHORif Y FOREHVIROwwIIHTAL RESPONSE ACTIOHSi "the activities to be imploiaontedbyiLPA under this ayeeiHent 

Bie puraianl to Section 104 of CERCLA, 42 U SXI. 9604. EPA's li ^ of access to the pioperty is promded foi in Section 1 M(fi) of 

CERCLA, 42 U S.C 9605(e), which pioTTides entry foi "detei&iiningtheBeedfoiiesponse, 01 choosing or taking iny reiponse action 

undei this title, oi otheiwise enfoicingtlie pio^sons ofthe title." 

8080 wsrd Pamviw/. Suite 405 2505 N. 24*^ Street, Suite 308 4242 essdlcsl Drive. Suite 4250 

Ksf8scii}|r, Baaediia Omatia, NeDrsekaesilO ssn Antonio. TX 7922? 

Phone: (SIC) 3C3-3703 

Fm : (916)9694707 

Phone: <402) 504-1004 

FaK (4(>£) e04-100S 

Phone: (ZIO) 822-3588 

Paic (810)678-6577 
^-M^MiLiir IMMIIMS:®^ 

OLS#: 20398 

Date Excavated: 7/14/2008 

Date USEPA Signed-OfT: 

Owner Name: ADALBERTO SANCHEZ Omah a Lead Site 

Address: 2969 POPPLETON AV ^'*® Sketc h 

Phone: H: W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

R'i'A3CPXA^20390

RYBSCPXA-20398

 FV 

 F2 ^/JS ­ . ppm 

.ppm n D 

D 

RYCSCPXA-20398

RYDSCPXA-20398

 B1 

 B2 

3.^' / ppm 

'Ay'^S^^ ppm 0 ' 

D 

D 

RDZSCPXA-20398

RQZ9CPXA-2039a

 DZ 

62-

7-13 ^ ppm 

ppm 

xy 

\y 

D 

n 

RPZ3CrXA-g0090 P^- PPn> u n 

Number of Samples: 

ENTEREI) 

SEP a 7 2004 

^ L 

5^^ I Z35 

o : 

C£c< 

n: a. 

. . . 7 \ 

/>^.yirr. 

AREA NOT EXCAVATED 

IF2 LANDSCAPE, 10'X17' @ 267 PPM 

[PO REQUEST] 

y/H-K 

Otnaha Lead Sice 

20398 

Exterior Pajnt NorthArrow 

Q'Good 

• Poor 

• Not paint 

Samples Collected 

Firm 4^ ^ 1^.7^^^ 

Date. '7/.i/£'-' 

Time' !.:>• -i'C 

Samples Analyzed 

XRF Unit- ^ / ^ - Book ^" ^ 

Dale. <y-/ 3 '£^* y 

Time: /9>^' ^ 

Staff zy^j:^'^ 

F2 = 61PPM(ajS" 

^ 'i^ ' EA = 77 PPM @ SCRAPE 4ft 130 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
>RUDEN' ^TECHNOLOGIES, INC. 

Property Status Form 

Address: p.<=<t'^ '^c>5>p\e.\,'T5Y~N ^v- ^ Date: ^ ^yi^ 3ero ' 

Phone: BVID: po ^ ^ « Woa - 013?>- §4,92 -

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

C.<"C\C,V:G<^ ^td e (socxJiXd lo^ ^ "j^cJle 

V8- Z CfcxcVc^A SU e ^"^ ^ ^^^"^ ^^^'^ 15 ?*^?^ b ®*^^" 

Property Owner Prudent EmployeejjC^ j 

Signature: fiP^<!y?'t^'^0 "^Nst'':^'^ Signature: , /&y ^ ( ^ 

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 
20398 

Omaha Lead Site Exterior Paint North Arrow Owner Name: ADALBERTO SANCHEZ 

Sit H'Good e Sketch Address: 2969 POPPLETON AV • Poor 

Phone: H: w. [||] Not paint I 

Sample Number 

R'i'A3CPXA-20398

RYBSCPXA-20398

RYCSCPXA-20398

RYDSCPXA-20398

RDZSCPXA-20398

•RGZ3CPXA-20396

RPZOCP)(A-20090

( 

Ph 

F2 

B1 

B2 

DZ 

6 ^ 

P2-

Lead 

Concentration 

y?7 ^ ppm 

ppm 

Sample 

Collected LAB 

D 

n 

Firm:

Date: 

Time: 

Samples Collected 

/f^'^ cs/f C 

^/i/^ y 

fSi-SO 

Z3 ^ 

ppm 

ppm 

ppm 

ppm 

sy 

n 

n 

n 

D 

D 

XRF Unit 

Date: 

Samples Analyzed 

: ^/2 ^ Book­ ^^ 

^-73­ '^ ^ 

^ 

ppm 

Number of Samples • 

n 

m 

TimeStaff: 

/9yf ^ 

jyy^^^ 

Omaha Lead Site 46130 
20398 

Omaha Lead Site Owner Name: ADALBERTO SANCHEZ 

Site Sketch Address: 2969 POPPLETON AV 

Phone: H. W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

R'»'A3CPXA-20390

RYBSCPXA-20398

 P t 

 F2 ^7^5 ­ ppm 

ppm 

• D 

D 

RYCSCPXA-20398

RYDSCPXA-20398

RDZSCPXA-20398

 B1 

 B2 

 DZ 

^^ 7

"^3.- ^

^•73 ^

 ppm 

 ppm 

 ppm 

\y 

\y 

n 

D 

n 

RGZSCPXA-2Q398 ©2­ ppm u n 

RPZ3CPXA-20090 P£­ ppm D 

Number of Samples = : V K 

Exterior Paint North Arrow 

[3^ Good 

• Poor 

|~| Notpalnt 

I 

Samples Collected 

Firm: /l ^ ^ C5/ ^ C 

Date: ^/l/^ V 

Time: i:>- SO 

Samples Analyzed 

XRF Unit . ^/^Book - 4 ^ 

Date: 

Time: /9yi ^ 

Staff: /yy^ ^ 

l^<^m£~TriiO W\ ^ 

Omaha Lead Site 46130 
R12379600000001.jpg (JPEG Image, 640x480 pixels) http://dougIasne.mapping-online.coni/assessdoc/Photos/19/R1237%., 

ol^6^ PoppLETor^ AV 

lofl 7/2/2008 12:10 PM 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1237960000 

SANCHF7 

ADALBERTO 

2969 

POPPLETON 

AV 

OMAHA 

68105 

2962 

POPPLETON 

AVE 

OMAHA 

NE 

68105 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

28-15-13 

HANSCOM PLACE 

11 

22 

W 35 1/2 FT LTS 21 & 

35.5X100 

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

parc=1237960000 

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

accountno=R1237960000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy is not 

guaranteed. This is not a legal document and should not be substituted for a title search, Map Scale 

http://wvvw.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20Coiinty-Omah... 6/12/2008 
.r-^^ryyj^iry'^^' iT^f^V.T^-'^'-

Print Preview http://www.dogis.org/dogis alias/dogis/printPreview.aspx?PrintOpt.. 

Douglas County-Omaha, NE 

Parcel 

ID 

Owner 

Name 

Property 

AdOiess 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1237960000 Sec-Twn-Rng 

SANCHEZ Addition ADALBERTO 

2969 

POPPLETON Block 

AV 

OMAHA Lot 

68105 Legall 

Legal 2 

2962 

POPPLETON Legal 3 

AVE 

OMAHA LegaM 

Treasurer NE Website Unl< 

Assessor 68105 Website Unk 

28-15-13 

HANSCOM PLACE 

11 

22 

W 35 1/2 FT LTS 21 & 

35.5X100 

htlp://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp?parc=1237960000 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R1237960000 

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 = 32 feet appraisal, survey, or for zoning verification. 

1 ofl 6/6/2008 2:21 PM 

- S i 

r 




file:///C:/Users/lord^0is%20my%20shepherd/Desktop/STREETS/2 

, Create Another Ticket | Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS  2077055. 

Original Call Date: 7/08/08 Time: 10:05 pm Op: RAMITA18967 

Work to Begin Date: 7/11/08 Time: 7:15 am 

State: NE County: DOUGLAS Place: 0^4AHA 

Address: 2969 Street: POPPLETON AVE 

Twp: 15N Rng: 13E Sect-Qtr: 28-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidation 


Location of Work: ENTIRE PROPERTY LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (4 02)504-1005 


: UNSURE CORNER 


Company PRUDENT TECHNOLOGIES 


Contact Name RAMITA Phone: (402)504-1004 


Alt. Contact Phone: (4 02)4 52-9806 


Work Being Done For: EPA 


Depth of E.xcavation: 6ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N E;<plosives: N 


CXCATV LEVEL3 MCLEODNE MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


QWEST2 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX 

COMMUNICATIONS. INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 

COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL 

OUT EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUD02 METROPOLITAN 

UTILITIES DISTRICT EDWINA 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

I of 2 7/9/2008 1 • 17 PM 
flle.///C./Users/lord^0is%20my%20shepherd/Desktop/STREETS/ r^^ i 2 

CITY OF OMAHA- OMAHACOF RON TRAFFICSEWER 

nopr^rpPA OMAHA PUBLIC POWER .. . OPPDGPR6 NA 

QWEST LOCAL QLNNEIF NA NETWORK 

QWEST2 QWEST LONG DIST/WCE SARA 

Day: 4024447197 


Alt:' 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 


Day: 8002834237 


Alt: 3039921926 


Emerg: 8002834237 


2 of 2 7/9/2008 1:17 PM