TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^I^ Q Date: n\ j ^.-jjr^t^^ 

Address: ,^-708 H 4-p-«4Yf?. 

Remediation Contractor: fh^DC•r^l/ f^rUt^ir^f ^qf^.^. INC., Year: A,3V^«- /4K^^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

/ EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Bf Confirmation data 

Photographs 

As-built sketch 

Satisfiactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property infomaation from Douglas County Assessor's Office 

D 

D 

D 

Signatu^^ •^^^^'fe40311261 

iinuiHiiii 

Superfund 
PROPERTY SUMMARY 

Datg; na^ai m l Omalia Lead Site RemcAUl AcitiQiiLCQiitcacttf EP-R7-O7-0.6/0.Q.q4. I MQftth Qt Vt^i m 

Property Address; 2708 N 45 AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Odier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

DZ = 104 PPM @ 13"; Fl = 94 PPM @ 6"; F2 = 90 PPM @ 6"; EA = 115 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/photogr^hs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Cheddist 

6) As-Built sketch ­

i) Shall includefinal lead levels. v) Legend 

ii) Contamination lefi: 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 satisfactoiy restoration 

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

TECHNOLOGIES, INC. 
- -

Find Record 

Backfill: 

Sample Area: 2128 - 2708 N 45 AV 

Owner: 

D Owner Occupied 

Owner Name: 

JALLISON SCOTT D 

Owner Addressl: 

Owner Address2: 

[2708 N 45 AVE 

aty: State: Zip Code: 

|OMAHA |NE J |68104 

Owner Phone: Alternate Phone: 

1(402)880-4221 1 • 

Clean Up Query Lead Remaining Query I

Resident: 

Resident Name: 

|RESIDENT 

Property Address: 

|2708N45AV 

Zip Code: 

|68104 

Resident Phone 

I 

 Property Damage Query 

Contract: 

Contractor: 

(PRUDEIVT2008_S 

Group: 

I- -

Assessment: 

Qualifying Group 

|800/CHILD_ 

Assessment XRF Date: 

I- ___ Assessment Max XRF Value: 

I 1108 
TECHNOLOGIES, INC &BVK 

EPA Property Close Out 

Property #: SlSf% Property Address: o?7o8 Nl^SA'^ 

Date/Time: Owner's Name: 

Quads Excavated: XJ-z. y f^O F5-y ^ft Contractor Group Prudent Technologies 

Excavation General Yes m 

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

2. If necessary, were the correct areas of drip zone excavated and restored? 

Grading Sod and Vegetation 

Yes T»o 

1. Does the grading 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 growing? (Only evaluate if inspected at a 30 

day time period) 

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

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

time period) 

6. Was the property graded such that water will not pool on the property? ^ ' J ­

7. Was damage to landscaping or plant materials avoided? ^ ^ 

Gates, Fences and Retaining Walls Yes J4o 

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

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

^ 

3. Was damage to gates or fences avoided? 0f applicable) 

^17 

/ . 

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

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

^'­ 2.

 Was damage to the foundation avoided? 

3. Was damage to windows avoided? t / 

4. Was damage to windows or door screens avoided? 1?^. 5.

 Was damage to downspouts or downspout extensions avoided? ly' 

/ L 

Sidewalks and Driveways (Concrete) Yes ^ 0 

1. Was damage to driveway surfaces avoided? 

y\ / 

2. Was damage to walkway surfaces avoided? 

Ly 
Owners comments: 

Inspection notes: 

Removal and restoration activates cpmplp^e iiicluding the 30-day sod warranty: 

EPA Representative l\Jy h ./J^l^i-T^^^-t.^^" Date: ( / ^ / ^ ( 
12-19-'08 16:54 FROM-Avantas 
 402-717-7779 
 T-289 P001/002 F-290 


SEPA 

Property Completion Agreement 

TThis agreement documcats die completion of roinoval ootivides peifbnned on the below Usted piopeity. 

The property o'«haer'8 signatuie in^cttes that the property owner is satisfied widi the restotaTion of ^ 

subject property, and that no items are in question, now, or at any time in the Aiture, eocdudlng any 

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

Property uy. 

tK^f^KtjAMtmu: :?'7o ^ ^0 MS>*^ A-oc^ 

Owner: Utfc a /iV.t\cr^ / Scof f A\U<^r. 

Phone: ^oa > g9 o .- M22.I 

Raatoratton Itonui in caiestion: 

Rem: 

Ham: 

Item: 

Item: 

RaquiradconactfonntDoompfaCa tha proparty: . 

I agree restoration is compietttd, except as noted above. 

L J I do not agree restoration is oompleted 

nr i SifBalare 

eOO/ZOOd «idgi;po gOO; Ll 93Q -.m-i 
Prudent Technologies, Inc. (Prudent) is under contract witii tlie U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow Prudent to perfonn a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, tlie property ovmer grants permission to Prudent to perform 

activities related to the cleanup including soil sampling, removal oflead-contaminated soil, and restoration ofthe referenced propeity. 

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. 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 office) or (402) 991-9583 (North Omaha office). 

Property Access Granted B; 

( ^ (Please P Print Name) 

Property Owner Signature: 

I d J (Siinamre) A ' < 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

M^>< A^ ^ /^v-^^pot^ KJ^.QBi 0 y 

IFRENTAL, PROPERTY OWNED BY:/N . / ^ 

T- OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: _L WORK: 

i^(^ ^Yh " ^^-^f 

AGE OF HOME?: {(/V 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 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 
2128 

^ - :.//.ASi BlIlM^ORiCVVINa. ^v; M 

'^fK- \ •••.•',-'r.-» ' .'y.!.-^,'-'- '-;.''"'}»'''•''•' '••••• ••."'•"'•• *"'^f ( 

OLS# ^^'^diVt^EtAiJEAkfeEifelSl^ : 2128 

Date Excavated: 11/260008 

USEPA Signed-OffDate: 

OnntM DJifior Paint MarthAaw LM d stte 

SfteSlnteh 

• Qood 

B'Poor 8«npaMlAllllre«»;270eW45AV • HctpaBt 

Simpl Sanfile Sampias CoBeoM e Number LAB Conoontnlifln Cdtocted Wnw-PCTir,, PPTl 

RYA8CPX>M128 Fl D Me:.lf2illaL 

RYB$CPW^«28 F2 _iXOfl__Ppm or D nme: ^.'0^ PM 

RYC8CPX^2t2lB B l 

Sompl«sAiiai|^ 

RVD6CPXA-2128 B2 2^Z7 wm a 

R0ZSCPXA^2S DZ D 

xwFUilit fi,Sa&_ Boefc22ft. RG2SCPXAn212B OZ _3Sa_ppm D Date / a >Q A -^g g 

nreacpx^2t2B PZ —LadL-PPm a Thna: fl«o 

Nuwbwo(Swip>as=i 8t«lt_J!3SLi ( 7 I ( QD \ 

Legml: Fl ' Fnmt Lett. F2 =.Front regM. B l •• Bx k Laft. B2 » Back Riglit OZ » Oi« Zdne. GZ - Gantai. PZ > Pta; 

M ^Mi4aMdtan VwftoMt.taiiQ nnni% 

rf—JC Jt—*FT~* 

• 

EA = 115 PPM @ SCRAPE 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC 
»RUDEN •SNVIRONMENTAL & ' CONSTRUCTION 

TECHNOLOGIES,] SERVICES 

Property Status Form 

Address: 5"lo g lO M 5 ^ A^^-e. Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

|\]0 (^/ ' ve^ 

Pre-FTiating Condition of Stmctures 

Does your Basement have a history of leaking?' Yes \ y No 

Item NO Description & Location 

On Map 

Property Owner Prudent Emplo; 

Signatures Signature:^ 

/{^^'^AI— ^ 

8080 Ward Parkway, Suite 405 2S0S N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San AntonicTX 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 
2128 

Omah Exterior Paint Notth Anew a Lead Site • Good Site Sketch 

CfPoor 

Sampling Address: 2706 N 45 AV Q Notpeint 

Sample. Number Lead Sample . Samples Collecled LAB Concentration Collected Fimi: pc IH C PPT \ 

RYASCPXA-2128 Fl ppm D Date: jJaHlOg 

RYBSCPXA-2128 F2 ppm D Time: ^••Q^ PH 

RYCSCPXAr2128 Bl ppm D 

Samples Analyzed 

RYDSCPXAr2128 B2 ppm n 

RDZSCPXA-2128 OZ ppm D XRF Unit: /n^^f l Boole 77<r> 

RGZSCPXA-2128 GZ ppm n Date: / O -Q ^ -Q g 

RPZSCPXA-2128 PZ. ppm or Time: fl<o 

Staff: <nst ^ Ni«nl»er of Samples=jj2_j . } Q j 

Legend: F1 = Front Left, F2 = Front Right, Bl - BacK Left, B2 - Back Riglit OZ - Drip Zone, GZ = Garden; PZ - Pla; 

AM quwfcarti art as vioiigd ftom Ihc sireet. facing 

•—: pf- T n n ^ 

35*) 

1227 

52 

^ & Iff 

BI = Bi 

--. i 

PZ 

Dz-:8^ -lQr ^ 5 7 

ii— * •JT 

M 

pr 

•: x : t^LS 1 1 m - 1 . . ..! ' 

fi&J. 'Fi 

WALU 

..^M&AUL 

.N:.M5. AV.. RevaUM CiMtd: 27.Ai«Ot 0U70I.0I.:3 
PRUDENT TECHNOLOGf^lNC if^l ^ . FIRST NAT10N4flkU4K OF OLATHE 

8080 WARD PARKWAY, SUi^Po jiMos S loio 2040i

KANSAS CITY. MO 6411 11 ^ 

(816)363-3703 

f 

PAY TO THE 

ORDER OF _ j/^A ^ l^f^KyJ^I $ 2-0" ^ 

.i

- ^ DOLURS % 

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y

MEMO COPY NOT NEGOTIABLE .

n'OEOUOaii' .>:iOlOOl 7 20i : WOiU RUB U»' 

PRUDENT TECHNOLOGIES, INC. 20408 

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lyy ^c^^'O---'^ \- ^ ^ 

PRUDENT TECHNOLOGIES, INC. 

20408 

562976 (3/08) 

I 
Page lofl 

11/20/2008 

AlO'i A/ V5 4/ 

http.7/douglasne.mapping-online.coni/assessdoc/Photos/04/R08116600000001 .i 

•Jpg 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

aty 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

0811660000 

ALUSON 

SCOTT D 

2708 N 45 

AV 

OMAHA 

68104 

2708 N 45 

AVE 

OMAHA 

NE 

68104 

Sec-TwnRng 

Addition 

Block 

Lot 

Legall 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Unk 

Assessor 

Website 

Link 

08-15-13 

CLAIRMONT 

4 

12 

N45FT 

45X125 

http:/Awebapps.dotcomm.org:8080/rreasTax/faces/pages/taxinfo.jsp? 

parc=0811660000 

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

accountno=R0811660000 

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. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Count... 11/20/2008 



Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

. YOUR TICKET NUMBER IS 2179298. 

Original Call Date: 11/20/08 Time: 10:52 am Op: MADHURIMA18 967 


Work to Begin Date: 11/24/08 Time: 11:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2708 Street: N 45TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 08-NW-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)733-1188 


Alt. Contact Phone: (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 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Number 

Utility 

Type 

n^rn A T^/ CXCATV COX COMMUNICATIONS, ^ ^ HEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

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Page 2 of2 

Day: 4067289343 


noor./- DD ^ OMAHA PUBLIC POWER Alt: 8887289343 


Emerg: 4067289343 


0PPDGPR5 DISTRICT ^ ^ 

•Day: 4067289343 


QLNNEIC QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/20/2008