'/ 

/ • . 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 30siir^ Date: ,1-10-1 f^JlQ S ^ ]^S>A\^ ^ 

Address: :^7r>7 Kj [ ^ S'fRemediation Contractor: J^-^T^Krfm'-Ut^nqifK.. \NC .J Year: ^^8-i>>»? 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0^ Video of property (DVD) . — 

^ Bxecuaves TM ,^J|| a 

^ EPA-provided property skrtch """flfpS ' 

B^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0^ Restoration Agreement 

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

0^ Confinnation data 

H' Photographs 

B^ As-built sketch 

0^ Satisfectory restoration signed by Property Owner 

0 Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0^ Utility clearances 

13^ Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

.,. Pi•^^ M^^ ^2£^ ^ 

Signature/* Date 
TECHNOLOGIESb INC 

EPA Property Close Out 

Property #: 3ao1' 0 Property Address: 370*7 Aj I'^srDate/Time: Owner's Name: 

Quads Excavated: Bo.; D"2-> F o. y Gfi Contractor Group Prudent Technologies 

Excavation General 

Yes Jio 

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 No 

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

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

7^ 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? 

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? V'­ 7.

 Was damage to landscaping or plant materials avoided? V 

Gates, Fences and Retaining Walls Yes yNb 

1. Do gates open and closefi-eely? (If applicable) i / 

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) i / 

Foundation, Siding and Gutters Yes ^No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foimdation avoided? V/ ­

3. Was damage to windows avoided? }^Z 

4. Was damage to windows or door screens avoided? ^ Z 

5. Was damage to downspouts or downspout extensions avoided? 

17 

Sidewalks and Driveways (Concrete) 

Yes/^ o 

1. Was damage to driveway surfaces avoided? 

• y 2.

 Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod yarra^ty: l u u o^uvai&a V/UIIIUICIIE; uiciuuiii ^ uic ju-ua y auu waiiaiiiy. 

EPA Representative 
PROPERTY SUMMARY 

DiM»; miMOSm Qmaha LeaA Site Remedial Action Contract '# EP-R7-Q7-06/Q(M)4 Month.of: I>ec/Ian. 

Property Address: 3707 N 19 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESUETS: 

DZ = 107 PPM @ 13"; B2 = 220 PPM @ 6"; F2 = 129 PPM @ T'; EA = 146 PPM @ SCRAPE 

ATTACHMENTS 

1) Propeity 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/photogr^hs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi). Shall, includefinal lead-levds v). Leg&ad. 

ii) Contamination left behind areas vi) Contractor identification 

iii) Properly address vii) Date 

iv) BVID number 

7) Other items to be included in the individual propertyfile, 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 

photogr^hs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record I Qean Up Query Lead Remaining Query I

Backfill: .r;-..«*«%j-^.^-'^r?;-"^'^'':-'--,---

Sample Area: 3254 0 - 370 7 N 19 ST 

Owner: Resident: 

D Owner Occupied Resident Name: 

Owner Name: |NERO DORTHY 

JCOLEMANGIZA 

Property Address: 

Owner Addressl: )3707N 19ST 

Zip Code: 
 ^••n-T-vr-; :::•;•;•:,-•;. v;-^--.-^/' 

Owner Address2: 168110 


|3707 N 19 ST 

Resident Phone 


City: State: Zip Code: I 

JOMAHA |NE {68110 

Owner Phone: Alternate Phone: | 

j(402) 933-2766 |(314) 517-8608 

 Property Damage Query 

Contract: 

Contractor: 

PRUDENT2008_S 

Group: 

Assessment: 

Qualifying Group 

NORTH 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

747.42 
Propeily Comptetion 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: ^ - 7 p- ] /^ j / ^ " ^ S' ^ 

0^"'^= ni±jQr CLUv^Aifr^ 

Phone: ^^o; r - i50'J~ ~ ^^H 5 

Restoration Items in Question: 

SOXL/^ aa-h^ mc;S/i) U ITP Vay\Oiir\ <K 

1 <i - ^ Item: ^ ^ , 

t i n hactd^Dtdr d 

Item: ' 

7 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^ Ir e^u^ ^(i.e ^^K'-ti O p ^ 

iCcd^K 

s ^ Op^LJ?- ^ 5o 4 

* i-ovce. TI3ac K^fl \irei Gaf-e. prof^^ Wx »^8»^3 

Q ^ agree restoration is completed, except as noted above. 

L J I do not agree restoration is com|:^eted 

/a/^^//)^ 

Date 
Prudent Technologies, Ine. (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 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. 

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

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

directed to the EPA Public Information Centers at (402 ,..-,) 731-3D45/Sout .Jl-3D45<;South Omaha offfice) or (402) 991-9583 (North Omaha office).

Property Access Granted By Y^Qi:F.a C .handle ^ 

I \i . ff r \ ft (Please Print Nagie) 

Property Ovmer Signatui 

(Datfe) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

R^ Ov^.v.vJ^ ^U_ Q, tlVt) 37<?'7 lO LA 4v 

IF RENTAL, PROPERTY OWNED BY: 

^ 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: WORK: 

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

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: 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 of the title." 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, 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-BUILT DRAWING ^ 

OMAHA LEAD SUPERFUND SITE. OLS«: 32S40 

Date Excavated: 12/09/2008 

USEPA Signed-OfTDate: 

UmmCbaatAC — tUktunm 

A*lrm: 3aBL^ZS*atJsMk»/iI^/sS ^ BV1D« J^gjfe 

6 

7 RYDSCPLA-32640 

Lab 

.' 811 Plan ' 

j ' - m 

OnriKLMdSie 46130 

EA = 146 PPM @ SCRAPE 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
EINVIRONMENTAL & 

CONSTRUCTION 

,CHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^o l ^ V.'^ ^ ^ ^ Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location t F/ n 

Pre-Existing Condition of Structures 

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

Item NO Description & Location 

On Map 

Property Ownei / ] f j y^den t Employ! 

Signature: 

8080 Ward Partway, Suite 405 2505 N. 24*^ street, Suits 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, 1X78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
1 Name: CUarJlo^ r Omaha Lead SUB North Allow 

SiteSketoh Tune: jiy^ff ^ 

Phone. VopL> <t33-3L'7bC 

Team Asi/ukiL/i^/o ^ BVID* !^S* 0 XRF CDcte ^'T^y ^ 

Sample Number ConfimMrtion Sample 

1 j^^i^^^^ - ^"^-^y^ FYes ° No « 

/^y^y<^fy^ ' ?g^t«»«^ No a 

Sves a No oa 

«>Yes H No ° 

^Ye s a No 59 

ppm 'Yes a No a 

RYDSCPLA-32540 ; ppm Yes • tto a 

Lab 611 ppm 

• =^ •<< AL 'Jt: 

^Afe' ^ ^ 

- 3 ^ 

IP-^ 

^ 139^ 

^^—7 ^ 2r ^Zrrtz^ff 

^ \ 

%^/l^l( ^ 3. d. ^ { ^ - ^ r 

^ ^ ^ d 7 

Ji—^ c > j ¥ ^ 4 . 

_A J wg^fek^. !e ^ : 

- ^ : 

j ^ A ^ ^ wJk"^* ^ 

'30^^7i^3 -7^7^ t^zf> 

-5^ 

fl 

^<—y^.i ^ )k ^»^- ^ ^'^—T C ';<: K 

Omaha Lead Site 46130 
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 

1512830000 

COLEMAN 

GIZA 

3707 N19 

ST 

OMAHA 

68110 

3707 N19 

ST 

OMAHA 

NE 

68110 

Sec-TwnRng 

Addition 

Block 

Lot 

Legall 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Unk 

Assessor 

Website 

Unk 

03-15-13 

KIRKWOODADD 

5 

8 

N40FT 

40X140 

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

parc=1512830000 

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

accountno=R1512830000 

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 = 29 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Count... 11/19/2008 

pr.*.,... .^-m^' -^PiS^ 

Page 1 of2 

"> 

Create Another Ticket Back to lith Internet Send Email 

• YOUR TICKET NUMBER IS 2178792. 

Original Call Date: 11/19/08

Work to Begin Date: 11/21/08

 Time:

 Time:

 4:51 pm

 5:15 pm 

 Op: MADHURIMA18 967 

State: NE 

Address: 3707 

County: DOUGLAS 

Street: N 19TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 03-SW,10-NW 

 Sect-Qtr: 

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: MADHURIMA 

Alt. Contact: 

Phone:

Phone:

 (402)733-1188 

 (618)401-2223 

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 * MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day:> 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

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Day: 4067289343 


OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: :4067289343 


Day: 4067289343 


QLNNEIC QWEST LOCAL NETWORK NA Alt: 


Emerg: ; 8887289343 


http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/19/2008