TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: lD3tiy Date: 1 W I 5 "^ I 0 

Address: ^^Si p ^ . ^ 3 S f 

Remediation Contractor: PPr-, nPrMj T^r^ N^oq i^<^^ irjc^.i Year: ^ U 1 (J 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef 

Video of property (DVD) 

af 

Execxitive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

i

/ 

Confirmation data 

d PhotoRTdphs 

^ As-built sketch 

ef Satisfiactory restoration signed by Property Owner 

/ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

i Utility clearances 

Property informationfirom Douglas County Assessor's Office 

D 

D 

D 

^ W

Signature

 2\*'" 

 Date 

30218335 

•IIHIiHI 

Superfund 
PROPERTY SUMMARY 

Date: 11/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 4526 S 32 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 65 PPM @ 13"; B2 = 280 PPM @ 18"; DZ = 66 PPM @ 13"; EA = 117 PPM @ 2" 

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 sketchi) 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 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. 

TECHNOLOCIES, INC. 
Find Record 

Backfill: 

Sample Area: 10205 - 4526 S 32 ST 

Owner: 

D Owner Ocx:upled 

Owner Name: 

I RAMOS-MORA ADAN 

Owner Addressl: 

1 

Owner AddressZ: 

|2516 G ST 

City: State: Zip Code: 

lOMAHA |NE |6810ZOwner Phone Alternate Phone: 

1(402) 731-3998 1 

Contract: 

Contractor: |PRUDEI^nZ010_S 

Contract Option JORION 1 

Remediation Query j Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Cdde: 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value [" 506.63 

Resident: 

Resident Name: 

IZAVALA EZEOUIEL & AMBER 

Property Address: 

4526 S 32 ST 

Zip Code: 

|68107-

Resident Phone 

I 
mm 

£y^ 

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 10 2-OS 

Property Address: A52 ^ S 3 2-S f 

Date/Time:/O/(>_ 

Owner's Name: Sv) &AJ tAA IH hL.\ 

Quads Excavated: p | 9-2.,62-

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

1. If necessary, were the correct quadraiit(s) excavated and restored? y 

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

Grading Sod and Vegetation Yes No 

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

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

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

time period) y 

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? (If applicable) y 

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 dainage to the foundation avoided? y 

3. Was damage to windows avoided? / 

4, Was damage to windows 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? ~y\~ 

Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

I 

EPA Representative Bo^'Q^ _Date: Jplislia 
t'HNULOGIES, INC. 

AS - BUILT DRAWING 

OLS #10205 

Date Excavated: 09/28/2010 OMAHA LEAD SUPERFUND SITE LSEPA Signed-OfT Date: 

10205 

Omaha Lead Site Owner Name: ADAN RAMOS-MORA 

Address: 4526 S 32 ST 

Phone: H:

Sample Number 

RYASCPXA-10205 F1 

RYBSCPXA-10205 F2 

RYCSCPXA-10205 Bl 

RYDSCPXA-10205 B2 

RDZSCPXA-10205 DZ 

Lab RDZSCPLA-10205 

Result 1130 ppm 

Site Sketch 

 W: 

Lead 

Concentration 

y ^ \ ppm 

Number of Samples = \ H 

Exterior Paint 

• Gopd 

Q^oo r 

[~1 Not paint 

Samples Collected 

Firm: .•/?^f-:> ^/-j//Ai 4 

Date: [Z /•z/Jo^ 

Time: l ] V2-

Samples Analyzed 

XRF Unit: '%\% Book: W M 

Date: 1- I \. n ^ 

Time: p\; M 

Staff: Ca n 

Omaha Lead Site 46130 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed pTopert>', 

The properiy 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 future, ex.cluding any 

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

Property BD: 

Property Address: L^^^ £ g ?)1.n A £tl 

Owner: Su<ft,i^ KAA^ftil< 

Phone: ^\hD^ \r^3. o - -11 8 8 ^ 

Restoration litems in Question: 

Required correctioirts to complete the property: 

agree restoration is connpleted, is 

LJ I do not agree restoration Is completed 

JbhdiJX 

Bate ' 
. \ 

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 

cJ{h2-C ^ ' S.2- 5 T cJ>Vte^w<^ . Tlie EPA requests your pennission 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 of the referenced property. 

Ifyou have any questions about the soil cleanup plamied for your property, please contact Prudent south office .for the Omaha Lead 

Site cleanup-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 Omalia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: Sur A rAainak 

Property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: <^y ^ r^yiv\^U Owner (^^^^R^^y 

RESIDENT ADDRESS: y\y uyM ^ ^^"^ ii-. a^^ly ^/g ^mr 

IF RENTAL, PROPERTY OWNED BY: 

AMy\ t£xi^d3> iy\<yyc^ 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: {(yCpj '2,2-0 -?- / ^ JfltfWtl -

J \ . 

AGE OF HOME?: ^ YEARS. HOW LONG HAVE YOU LIVED HERE? 1 YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C^ 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.) 


ALfTHORITY 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'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 5600 S 10 St 4242 Medical Drive. Suite 4250 

Kansas City.'MO 64114 Onnaha. Nebraska 63107 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402;. 733-118E Phone: (210)822-9588 

Fax; (816) 363-3707 Fax: (402i 733-1883 Fax: <210) 579-6677 
ENVfRO.MWENTALA 

CONSTRUCTION 

TECHNOLOGIES SERVICES , INC. 

Property Status Form 

Address: ^^^ C ^ . ^^^ ^ y f O^^^^^ ^ ^ ^ ^^/6 ^ ^''^'''•O'^ll^l/d 

Phone BVID: 

Ai^v^ ^%^\ -^- iS ^ 

Property Own; Prudent Employee 

Signature Signature: 

8080 Ward Parfcwa 5600 S 10 St 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 
\ y Omaha Lead Site 

\

} Owner Name: ADAN RAMOS-MORA Site Sketch Address: 4526 S 32 ST 

1 Phone: H: W; • ' 

Sampl Lead •Sample e Number LAB Concentration Collected 

RYASCPXA-10205 Fl \ ppm • D 

RYBSCPXA-10205 F2 ppm D n 

RYCSCPXA-10205 Bl n4 L PPi^T Q n ^ ^ RYDSCPXA-10205 B2 ppm D D., RDZSCPXA~10205 DZ ppm Dr 0 

Lab RDZSCPLA-10205 

ppm D n

ppm 

Result 1130 ppm D D 

Number of Samples H \ 

ir - ^ 

.•--. . t. . i I ; f I y 

i-4 t . •: ^' i • i -.:.•,-.I •••V U-v . 

I • • 

- • * - ' - ' - ^ - ^ - • - \ 

ll 

':^ 

f 

^2-^H O 

X 

A 

1/ y , ^ 

y 

r 

/• iv. 

„ y^i^ ^ i.. 

^-rty^ <y 

10205 

^ Nonh Arrow Exterior Painl 

n Good 

15> • "Poor 

Q Not painl 

Samples Collected 

Firm .y-l:z .. ,z/ i ry^i 

Date 

Time 

Samples Analyzed 

i/Tl XRF Unit; i. Y'L. Book: A_ 

Date: i- i •• r^^ ^ 

Time thy Staff yyy h=^ 

..--1 - K-*. -'. • .-"v.- .ffk.i»£ ti w V JBI ^ 

1 > V ' "7 i-w^-'^C" 

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http://douglasne.mapping-online.com/assessdoc/Photos/35/R04306100000001.jpg 9/15/2010 
452

6 S 32 St 

A Printed

: Nov 16,2010 

www.dcgis.org/dogis 
Page 1 of2 

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Create Another Ticket Back^a Ijjh Int^rnet^ Send .Email 

YOUR TICKET NUMBER IS 2594281. 

Original Call Date: 9/16/10 Time: 2:53 pm Op: SIVA18967 


Work to Begin Date: 9/20/10 Time: 3:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4526 Street: S 32ND ST 


Twp: 14N Rng: 13E Sect-Qtr: 04-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 


: 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: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO ' MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
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OPPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
TEBHNOUMRBi , mc . 

ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCnCHV 

SOLUTIONS 

SITE SAFT6:TY HAZAR D ANALYSI S 

^£7,(»^ S< '3>'Z. Address: Excavation Date: 

Crew: Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines f^y^ Gas Line ^ Water Line 7^ L

Sewer Line ^ 

Septic/Leech 

Field 

Propane/Bntane 

Sidewalk C.^<TS- J^^^^.^^ ^ Foundation a y ^ 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway ^ ^ U^g _ a:3!^/8>T&e. ^ 

Sprinkler System 

Other 

Crew Foreman Site Safety Office 

Date: 

r.Suto40S seaosiost 4242 Medical Drive, Suite 7250 

i(a|ly;MO«t114 Omata, NeboMia Cft107 San Antonio, TX T8229 

PhonK (SW) 30^^703 Pbom: (402)733-1188 Phone: (210) 822-«588 

Fax: {8^)363-3707 Faic (402)733*1883 Fax: (210) 578-6577 
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