•0

 • • 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: r^C^n ^

 Date: ) ^ l<^t^ ^ 

Address: Z^2.h lL^ \ I fcjH ^ 

Remediation Contractor: fmAJij. rj- ^i U Tgnc Year: ^-^r^^ 

SOIL REMEDIATION 

PROPERTYFILEFOLDERDOCUMENTS 

IET Video of property (DVD) 

m Executive Summary 

a EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

[/ Confinnation data 

0 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 

D 

D 

D 

SiSatuS- ' ^^^TOT 

30054122 

IHNii 

Superfund 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 25509

Owner: 

D Ovmer Occupied 

Owner Name: 

jWAU LUTBJLLAH 

Owner Addressl: 

I 

Owner Address2: 

|3324 HAMILTON ST 

aty: 

|OMAHA 

Owner Phone: 

|(402) 991 8892

 - 3324 HAMILTON ST 

State: Zip Code: 

[NE |68131 

Alternate Phone 

[ 

Resident: 

Resident Name: 

)WALI LUTFULLAH 

Property Address: 

)3324 HAMILTON ST 

Zip Code: 

|68131 

Resident Phone 

I 

Contract: 

Contractor: 

)PRUDEMT2009_S 

contract Option 

lOPnON 2 

Assessment: 

Qualifying Group 

poo 

Assessment Max XRF Value: 

r 438.48 
miwnmmiBiwamtmBBMgy 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address: 3324 HAMILTON ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A2 Issues Resolved: NONE 

AJ Unique Findings: NONE 

A4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 22 PPM @ 6"; F2 = 531 PPM @ 13"; DZ = 69 PPM @ 12"; EA = 226 PPM @ 2" 

ATTACHMENTS 

1) Property sketch provided by EPA pixrsuant 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 includefinal 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 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 cleanup criteria. 
miDENT^fe-

^COil 

EPA Property Close Out 

Property #: ^S^O ^ Property Address: Ji3^ ^ )4r^ynJt£l ^ 

Date/Time: Owner's Name: Lc^ V.^. w]U k if^jc 

Quads Excavated: /2>l, F ^y 'i>2-^ ^2 - Contractor Group F udent Technologies 

Excavation General Yes No 

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 gener Jly 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 i ispected at a 30 

y day time period) 

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

5. Are the joints between the sod strips generally tight? (Only evaluate if inspec ted 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 naterials avoided? 

y 

Gates, Fences and Retaining WaUs 

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? (If applicable) 

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? 

/ 

2. Was damage to the foundation avoided? 

y 

3. Was damage to windows avoided? 

y 

4. Was damage to windows or door screens avoided? 

/ 

5. Was damage to dovraspouts 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 waranty 

EPA Representative ^ c . Date: jtji •/09 
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 of the 

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

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

Property ID: 

Property Address: 3 3 £H |-\-^L^^^ 1 W S ^ 

Owner: VTJFpg , ^ V._i. 3 ^ . V-JL 

Phone: 

Restoration Items in Question: 

rz Item: 

Item: 

item: 

Item: 

Item: 

Item: 

I agree restoration is completed. 

I do not agree restoration is completed at (noted deficiendes above) 

wy^- ^ 

Owner 

Dati :e 
TECHNOLOGIES. INC. 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Enviromnental 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 perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, die property owner grants pennission to Prudent to perfonn 

activities related to the cleasaq) including soil sampling, removal of lead-contaminated soil, and restoration of the referenced property. 

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

Omaha Lead Site cleanup. Ms. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public Infomiation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha ofBce), 

Property Access Granted Bv: li^rPOUAItW/ili 

please Print Name) 

Property Owner Signature: ^^i^f^i'^<^ ^MA' ^ (Date) 

^ PROPERTY INFORMATION 

(To be compkted by resident and/or property owner — PjHilf \i^*\ 

RESIDENT NAME: 

RESIDENT ADDRESS: . . A ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S RmiNQ ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

Sa f 

AOE OF HOME? : /OD ^ARS. HOW LONO HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDINO SINCE 1978? VE8 WO Qr< ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER T

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. DOOS, ENTRY OATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA'sright 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 40S 5600 S 10*^ Street 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Oniaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, D^C. SERVICES 

Address:

Phone: 

Item NO 

On Map 

^ 

^ 

Item NO 

On Map 

Property Status Form 

 S-'T^S'^^r—fct>rf-:*v-lL..^^rr:—:sA^h o Date: ^ / H / TJCT^ Of 

BVID: 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

Jbu ^ h) eSJeyJ^ , P- O . tiund ^©<^ ^{ ^ 

Br pi~o ^ e/JU-. yy u~t^ ^ ^ \_/ex.^|,<.x< 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No 

^ 

Description & Location 

Property Owner Prudent Employee 

Signature: y;7 Signature: 

0SUyUJ>yali,r7iJ.f if^ry^jj^ 

)080 Ward Parkway, Suite 405 „ . \ . r >' 5600 S 10* Street 4242 Medical Drive, Suite 4250 

<ansas City, MO 64114 ' „;~ lfi^'^i<- Omaha, Nebraska 68107 San Antonio, TX 78229 

'hone: (816) 363-3703 '­ - ' Phone: (402)733-1188 Phone: (210)822-9588 

•an: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
nKCHNOlXKilES. INC. 

AS - BUILT DRAWING 

Ol,S#:25509 

Date KxtavaU'ii: 09/1K/2U09 OMAHA LEAD SUPERFUND SITE l,SKP.\ Siencd-OIT Dote: 

Name: Ljir:>^/^LA-f& Omaha Lead Site Date: JT/Z^ ? North Arrow 

Address: .?S2. ^ ^x'/zdePtJ-W SiteSketch Time: /sf^ l 

Phone: 

Team ^JiZyTr ^ *i/yfT^f/'T ' BVID# ^S'^<^ f XRF Code 56 o\ ZZ. Sample Number Lead Concentration Confirmation Sample 

t

.atn.4 

ppm ^ / Yes D 

No B

2 ll.SP.&C(fXA-3.tinm l-S, A X Yes C 

No B — 

/S3-Yes • 

No B — 

No Q 

No Q — 

ppm No CD 

ppm Yes D No • 

ppm 

CONTRACT »: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
Mfirt^H /.v ^J^/.jLA-if f Omaha LH d Site 

S»te SkvtG^D 

Date: f/^My-y **!•«• A-TC*

/ ^ 

 —I 

Team'r>}^^^>/(-ygyrfV^^ ' BVP?* ^^^'='' 7 XRFCtrs ££ ^ 

CrsTflrrraSor Sarr: 

pprr No . 12. 

A X Y«s r i No • 

ppm 

No 5 

• - -> Yes L-J No ' II2y^ffl.:|ff^ ^ 

ptsm •'/-Ya s n No ­

ppm No ^ I 

ppm Ves r*] K3 L 
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RIL 2004 - DOUGLAS COUNTY ASSESSO 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Pmperty 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

1642090000 

WALI 

LUTFULLAH 

3324 

HAMILTON 

ST 

OMAHA 

68131 

3324 

HAMILTON 

ST 

OMAHA 

NE 

68131 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

LOWES ADD 

T 

6 

W40S107FT 

40X107 

0.09 

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

parc=1642090000 

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

accountno=R1642090000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/3/2009 

2 
Page 1 of2 

"> 

( Create Another Ticket \ [ Back to Irth Internet J Send Email 

• YOUR TICKET NUMBER IS 2361715. 

Original Call Date: 9/11/09 Time: 8:39 am Op: SIVA18967 


Work to Begin Date: 9/15/09 Time: 9:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3324 Street: HAMILTON ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: SOIL LEAD REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: FAX ALL CLEARS TO (402) 733 1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: b Front: Y Rear: 


Involves Tunneling or Horizontal Boring : ^ Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA

Day: 8773668344 

 Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES. INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: 3-J>?V /y^A^,y^i>^ 

Crew: '^V^»VM^5 L</VV^fJ^^^A/ 

Date: *r-/^ 'O'f 

Item Condition 

Overhead Lines _^nrrf^-

Gas Line ^'•teei -

Water Line 4-

Sewer Line h^*rJ 

Septic / Leech 

field Ay ^ 

Propane/Butane yy/^ -

Sidewalk ^ 'C^t» 

Foundation Peer*. 

Retaining Walls A ^ 

Fences y^ ^ 

Trees y^'lir ^ 

Structures /«^c*< 

Driveway /''^,'fifi'^^ 

Sprinkler System | ^^^^ ^ 

Other 

Cre\y7 Forema 

Hazards 

h»^/i^/ ^ .y^ ^ l*^j ^

Corrective 

Action 

j c^,'^f>rc./> s 

A»w«/ te*^ ^ 

l^ ^ '^A*­

'^s<^ /P^r*y,» ^ 

Site Safet> Officer 

3080 Ward Parkway. Suite 406 2.505 iV. 24' -Street. Suite 308 4242 Medicai Orr/e. Suite 7250 

KansasCity. MO 64114 Omaha, Nebraska 8S110 San Antonio. TX 7822S 

Phone: (316) 363-3703 Phone; (402) 504-1004 Flione: (210; 822-9588