TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAm#: jCU l Date: 

Address: ^^CfLCf H'^^C ^ ^iuA 

Remediation Contractor: fy^2,^4­ ^.L^A^.. ^ .7:^ . Year: 2^)o8 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

er

B

0

y

D

la

D

0^

Q^

S^

' y

y

•

ifl

a

D 

D 

D 

 Video of property (DVD) 

 Executive Summary 

 EPA-provided property sketch 

 Signed Access Agreement for subject property 

 Signed Access Agreement(s) for adjacent property 

 Restoration Agreement 

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

 Confirmation data 

 Photographs 

 As-built sketch 

 Satisfectory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Description of areas not meeting ROD cleanup criteria 

 Utility clearances 

 Property information from Douglas County Assessor's Office 

., atun -^m 

Signature^I? " bate 

40310707 

BiUll 

Superfund 
PROPERTY SUMMARY 

Dat«: 01/23/2009 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of Dec/Jan 

Property Address; 2404 HANSCOM BLVD 

A EXECUTIVE SUMMARY 

A.1 Issues Encountered NONE 

A.2 Issues Resolved. NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infomiation. NONE 

CONFIRMATION SAMPLING DATA/RESULTS 

Bl = 30 PPM @ 6"; B2 = 373 PPM @ 6"; DZ = 146 PPM @ 13"; Fl = 143 PPM @ 6"; EA = 202 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 chp/photographs 

4) Post-Excavation digital video chp/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall includefinal lead levels v) Legend 

ll) Contamination left behmd areas vi) Contractor identification 

m) Property address vn) Date 

iv) BVID number 

7) Other items to be mcluded m the mdividual propertyfile, if available, or obtamed mclude 

i) Pre-excavation agreement details (if any are made with the property owner) 

il) Property Status Form signed by property owner 

Ul) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photographs 

iv) Signed form venfymg satisfactory restoration 

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

TECHNOLOCIES, INC. 
Find Record Clean Up Query Lead Remaining Query I Property Damage Query 

Backfill: 

Saniple Area: 16867 - 2404 HANSCOM BD 

Owner: 

n Owner Occupied 

Owner Name: 

|JONES A W 

Owner Addressl: 

r 

Owner AddressZ: 

12404 HANSCOM BLVD 

City: State: Zip Code: 

[OMAHA INE" 68105 

Owner Phone: Alternate Phone: 

|(402) 344-2685 |" 

Resident: 

Resident Name: 

JONES A WALLACE 

Property Address: 

|2404 HANSCOM BD 

Zip Code: 

|68105 

Resident Phone 

I 

Contract: 

Contractor: 

jPRUDErn2008_S 

Group: 

Assessment: 

Qualifying Group 

|800/CHILD 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

I 8iS 
TECHNOLOGIES, INC 

EPA Property Close Out 

Property #: 166^ 1 Property Address: cfiUo^f /i WKM <ro m sn;-D 

Date/Time: Owner's Name: Liate/iime: f , ^ ^ 

Contractor Group Prudent Technologies Quads Excavated: Bl/ B2- y X> Z. ,^ f" '^ ^ « 

Excavation General Yes No 

1 If necessary, were the correct quadrant(s) excavated and restored*? / 

2 If necessary, were the correct areas of dnp zone excavated and restored*? y 

Grading Sod and Vegetation Yes No 

1 Does the gradmg around the perimeter ofthe house in excavated areas generally slope away 

from the house*? / 

2 Has sod been laid m all areas that were excavated*? / 

3 Does the sod appear to be generally healthy and growmg*? (Only evaluate if mspected at a 30 

day time period) / 

4 Are sodded areas generally firm and evenly graded*? / 

5 Are the jomts between the sod strips generally tight*? (Only evaluate if mspected at a 30 day 

time period) / 

6 Was the property graded such that water will not pool on the property*? / 

7 Was damage to landscapmg or plant materials avoided*? / 

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and closefreely*? (If applicable) y 

2 Were all gates or fences taken down dunng restoration activities remstalled*? (If applicable) y 

3 Was damage to gates or fences avoided*? (If applicable) y 

4 Was damage to retammg walls avoided*? (If apphcable) y 

Foundation, Siding and Gutters Yes No 

1 Was damage to the sidmg or trun avoided*? y 

2 Was damage to the foundation avoided*? y 

3 Was damage to windows avoided*? y 

4 Was damage to wmdows or door screens avoided*? y 

5 Was damage to downspouts or downspout extensions avoided*? / 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided*? / 

2. Was damage to walkway surfaces avoided*? y 
Owners comments: 

Inspection notes: 

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

EPA Representative 9c^ iSLy Date: //g//^ji> 
Property Completion Agreement 

This agreement documents the completion of removal activities perfonned on the below listed 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, excludmg any 

remaming warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address: ZHQ ^ UAA^6OO ^ pi^iyiy 

Owner: /^qy^/Zi ^ ^^.e^o^Jj^s^ J (1 

Phone: 4/^- ^ ^^4^^^^^ ^ 

Restoration Items in Question: 

Kem: 

Item: 

Item: 

Item: 

Hem: 

Item: 

Required corrections to complete the property: 

Blagt agre i e restoration is completed, except as noted above 

L J I do not agree restoration is completed 

y^Aa<^/^P^ 

Owner's Signati Date 
Prudent Technologies, Inc (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 oflead-contaminated soil, and restoration ofthe referenced property 

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

Omaha Lead Site cleanup. Ms Deborali 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 -3045 (South Omaha ofTice) or (402) 991 -9583 (North Omaha office) 

Property Access Granted Bv RoW\Y\ vJ^Mg ^ 

(Please Print Name) 

Property Owner Signature 

(Date) 

3PERTY INFORMATION 

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

RESIDENT NAME Owner Renter fi-^ 

RESIDENT ADDRESS 

IF RENTAL, PROPERTY OWNED BY 

OWNER'S MAILING ADDRESS, 

OWNER'S TELEPHONE NUMBER - HOME _ L WORK 

f<-^h9i ?^Mw - ^t. % <: 

((To ^ 

AGE OF HOME'' YEARS HOW LONG HAVE YOU LIVED HERE' O YEARS 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? \y_yE S 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 ofthe title ' 

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 
AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

OLS#: 168(7 

Date ExcJivated: 12«»/I»0S 

USEPA Sigped-OfTDate: 

-KMI74»/0IIM FRUOENTUCHNOlOWBi^HC. coiiinwcifc'tp 
ENVIRONMENTAL & 

CONSTRUCTION 

,CHNOLOGIES, MC. SERVICES 

Address:

Phone;

Item NO 

On Map 

Item NO 

On Map 

Property Status Form 

 ^Mo M V^avv&Cx^vv^ Date: BD 

 Hog - 3H M - p 4 ^ S BVID: 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

0 |V\r^<2_ 

^ *^eG-c£<a ^ < u Si=\.<>^^ 

a V. SoJ!^ "^-ie. ~-^^^ ia ^ +• 

Bz 

^^ Pre-Existing Condition of Structures 

DoesyourBasementhaveahistor l ^ y of leaking? Yes _j No 

Description & Location 

Property Owner Prudent Employee 

Signatw^ Signature: 

C)uc>-^i-^ 

8080 Ward Parkway, Suite 405 2£0S N. 24" Street, Suite 308 4242 Medical Dnve, 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 
t 

Name: 'CKs Omaha Lead Site Date: *ihjc ^ North Anow 

Addrass: '^^O H Hc^o-.^ ^WA . Site Skatch Time: 9 ; ti t 

Phone: ^V** ^ 0^<^ < 

Team iv^^—^jC&itki — BVID# AC.gd' l XRFCode S5DI 

Lead Concentration Confinnalion Sample 

t64 •^v Yes eJ ^ No ° C^ 

'WYes D No ET 

^vYes a No Q^ 

tVvYes a No ET 

^5^es C3 No ca: 

Yes Q No CD RYASCf^lA-lOW Yes a No • Lab 

Result 819 ppm 

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http://douglasne.mapping-online.eom/assessdoc/Photos/21/R09043 800000001 .jpg^ 11/21/2008 
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 

0904380000 

JONES A W 

2404 

HANSCOM 

BD 

OMAHA 

68105 

2404 

HANSCOM 

BLVD 

OMAHA 

NE 

68105 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Unk 

28-15-13 

CREIGHTONS 1ST ADD 

5 

2 

47.5 X 127 

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

parc=0904380000 

http://douglasne.mappingonllne.com/DouglasCoNe/statlc/accountlnfo.jsp? 

accountno=R0904380000 

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 = 26 feet appraisal, survey, or for zoning verification. 

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YOUR TICKET NUMBER IS 2180219. 

Original Call Date 11/21/08 Time: 2:31 pm Op: MADHURI 

Work to Begin Date 11/25/08 Time: 3:00 pm 

State: NE County: DOUGLAS Place 

Address: 2404 Street: HANSCOM BLVD 

Twp: 15N Rng: 13E Sect-Qtr: 28-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

Type of Work: lead remediation work for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)7 


Alt. Contact: Phone: (618)4 


Work Being Done For: epa 


Depth of Excavation: 6 ft Corner Lot: N Front: 

Involves Tunneling or Horizontal Boring : N Explosives: 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNE 


Service Area Contact Phone Nuinber utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8773668344 


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LEVELS LEVELS COMMUNICATIONS, LLC NA 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY

Day:

 Alt : 

 4025047823 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON

Day:

 Alt:

 4024447197 

 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt : 888728934 3 

Emerg: 4067289343 

QLNNE 1F QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

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