TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SATO #: KO^TL^ Date: J^jr ^ 

Address: ZU ^ M • U<^. ^ -

Remediation Contractor: ^i/l/:rtV 'T^ll) IW^^ Year: f^D f f) 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Bl Video of property (DVD) ^ 

Ql Executive Summary 

a EPA-provided property sketch 

Q Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

111 Restoration Agreement 

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

[i 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 mformationfrom Douglas County Assessor's Office 

Signature ' Date 

30260730 

lillil 

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

Backfill: 

Sample Area: 69220 ­ 2204 N 48 ST 

Owner: Resident: Contract: 

n Owner Occupied 

Owner Name: 

jWHUED CHRISTOPHER K 

Owner Addressi: 

Resident Name: 

I 

Property Address: 

[2204 N 48 ST 

Contractor: 

(PRUDEm7009_S 

Contract Option 

[BASE 

Owner Address2: 

|2204 N 48 ST 

City: 

[OMAHA 

State:

[NE

 Zip Code: 

 [68104 

Zip Code: 

(68104 

Resident Phone 

I 

Assessment: 

Qualifying Group 

[1200/CHILD 

Owner Phone: 

((402) 708-3376 

Alternate Phone: 

|(402) 612-7204 

Assessment Max XRF Value: 

I 1562 
PROPERTY SUMMARY 

Date: ^15/2010 | Omaha Lead Site Remediaj Action Contract # EP-R7-67-06 T0#1 I Month of: Q u fS: 

Property Address: 2204 N 48 ST 

A EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED PER P.O. REQUEST 

- F2/LS (4'X4') = 354 PPM @ SCRAPE; 

- UC (25'X2') = 285 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 386 PPM @ 6"; DZ = 238 PPM @ 6"; EA = 149 PPM @ SCRAPE (~1") 

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 (ifany 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) Descriptionof areas not meeting Interim ROD cleanup criteria. 

TEGHNOLGGIES, iNC. 
••[©RUOEM^ 

TECHNOLOGIES, INC. 

Property #: [ol^3. 0 

Date/Time: l^^^fi fQCf 

Quads Excavated: 

'r?=*hi S 

EPA Property Close Out 

Property Address:ciijot/ AJ. QSSri~ 

Owner'sName: dk^^c^^cf>^^- i<J". v-e<^ 

Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessary, were llie correcl quadrant(s) e.xcavated and restored? / 

2. If necessar)-, were the correct areas of drip zone excavated and restored? 

y 

Grading Sod and Vegetation Yes No 

1. Does tlie grading around the perimeter of the house in excavated areas generally slope away 

y from the house? 

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

3. Does tlie 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? y 

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

time period) / 

6. Was the propeny graded sueh tliat water willnol pool on the property? / 

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 apphcable) 

y 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 

y 

4, Was damage to relaining walls avoided? (Ifapplicable) 

y 

Foundation, Siding and Gutters Yes No 

1. Was damage lo the siding or trim avoided? y 

2. Was damage to tlie foundation avoided? y 

3. Was damage lo windows avoided? 

y 

4. Was damage lo windows or door screens avoided? y 

-"i. Was damage lo downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 

ty 
Owners comments: 

Inspection notes: 

,.W ^ ''''^ 

-n'^ ...cJl 

. - • ^ ' " ^ ^.-^ ­

wir* 

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

EPA Representative 9o^ ^ Date: 4|n|io 
] • / I'l '^V 

" ^ yZ " Jhys 

00 

..y. 

Property Completion Agree!nent 

This agreement documents the completion of removal activities perfqrmed on the below listed property 

The property owner's signature indicates that the property owner is latisfied with the restoration of the 

subject property, and that no items are in question, now, or at any time m the future, excludmg any 

remainin: : warranty (30 days total) except those items listed below, if ai y 

Property ID: 

Property Address: oi^^ ^ ^ 

Owner: 23S^^^ \3^^ y^

Phone: Ud% -70^3 2yb 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property 

dujner yt? ^c^^ J/si/j^^ CP//"-4/?/ ^ ^ r-eAAaueJ, 

, agrfee restoration is completed. 

D I do not agree restoration is completed at (noted deficiencies abjove) 

\l/>^/^ 

Owner' Signiature Date 
Prudent Technologies, Inc. (Prudent) is imder contract with the U. S. Enviromnental Protection Agency (EPA) to clean up leadcontaminated soils at a rmmber of properties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow iWlent 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. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prtident's Administmtive Cleik For the 

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

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

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature; /Zi:^LM^ 0>///7^ 

(Date) / ^ (Signature) 

PROPERTY INFORMATION 

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

RESIDENT NAME; Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: ( 1 Cl^ - "^ TZ. ^ ^ WORK: 

-Tt)«- 33-7fe 

AGE OF HOME?: 1^^- * YEARS. HOW LONG HAVE YOU LWED HERE? I 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.) / 


AtJTHORITY 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 aiiy 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 
ENVKONMENTAL & 

co^•STRUC^o ^ 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Z2.@gL [\1 ^ S ^*^ S\- Date: (2,[ 11 \G'=< 

Phone: ^o 2 - loS - '2>?)nf= BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On iMap Description & Location 

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Pre-Existins Condition of Structures 

Does your Basement liave a history of leaking? Yes No t 

Item NO Description & Location 

On Map 

1 

Property Owner Prudent Employe 

Signatur zy-r^ Signature: 

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

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, t X 78229 

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

Fax: fai 61363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
IES. NC 

OL,S#:6922D 

Uate Excavated: 07/07/2009 

USEPA Signtd-OfP hte: 

Omaha Lead Site Exlerior Paint North Arrw 

Site Sketch 

Sampling Address: 2204 N 48 ST I # N& mnt / ,Y ' I 

Sample Number Lead Sample Samples Collected 

Concentration Collected LAB Firm: TQk w&- 

RYASCPXA-69220 F1 -3 (Q 4 PPm d Date: \ \-,j-,-og 

RYBSCPXA-69220 F2 15 (o 2 ppm a Time: 1:s 

RYCSCPXA~Q~O BI 29 9 ppm 13 CI . - PPm 0 0 Samples Analyzed 

- RDZSCPXA49220 DZ 1 PW Gi' 0 XRF unit: &qb BOO^:^ - - PPm Date: 12./2-0& - PPm Time: Rlr, 

~umbr of samples = m5 

Legend: Fl = Front Lefl, F2 = Front Right, 01 = Back Lefl, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = PI6 

.................................. A" quad- are vl- !mm the *?! (ad!? .. itky., ................. 

AREA NOT EXCAVATED: 

1 

KOT EXCAVATED; FZIIS 

: : . .sf .:, . / (CX4') = 3% PPM (9 SCRAPE (-1") I ...................... .- . 

EA - 119 PPM 12' SCRAPE (-1") 

CONTRACT #: EP - R7-07-06 TO#1 PRUDENT TECHNOLOGIES, INC. 
69220 

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Orna:h ^Ji:r^. ifi w a Lead Site • C-ocd Site Sketch 

QP-,oi .^b . 

Samp ling Adtdr^ss: ?iWJi£Hj[2_

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Sample Nuiiiter 

vtiin^Sriljari:.:*-! 

RVASCPXA-6922 0 r l .:^i^q ppm H-if, rg^S 

ppm 0 D Time; 

RYC3'C-PXA-6J3220

R¥DaC.PKA-:rJ2J0

 81 

 9*­ — ppjn 

fipHfl 

Ef 

D 

D 

a cSamples An3lyz€d 

ROZSCPXA-692^

-RGZSGPXA-USSd

-RP.ZS6P«A-&S=Ke

 DZ 

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1 2<^5 

— 

Pl>:n 

Pfjin 

ppm 

tar 

D 

D 

D 

D 

a Time; i^f> o „, ^ 

Nui!'i»er Of SaiViplfea = rl m 

L^ger^a: F1 = fram Lett, rZ = front fcghl, 91 = BscK LP1I. a2 = Ba^ck Righl OZ = Dnp Zono. GZ = GarcJL-n. PZ = Pis; 

itll (ii»!l::irli -ire is •.•Jr.ved Ircm ^.c stiMt, iscTiu prcpwty Al't v . . . - - ^ 7 •••••. > 

ENTEEED 

OEC 1-1 2038 
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httD://douelasne.maDDina-online.com/assessdoc/Photos/41/Rl 2050000000001 .ipg 6/12/2009 
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Print Preview http;//www.dogis.org/dogis_alias/dogis/printPreview.asp.x?PrintOpl., 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

1205000000 

WHITED 

CHRISTOPHER K 

2204 N 48 ST 

OMAHA 

68104 

2204 N 48 ST 

OMAHA 

NE 

68104 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legai 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

07-15-13 

GRAMMERCY PARK 

z • - 1 

5 

50X132.9 

lTttp://webapps.(Jotcofnm.org:8080/TreasTax/faces/pages 

/taxi nfo.jsp?parc=1205000000 

http://clouglasne.nnapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R1205000000 

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 = 27 feet 
• 

Pagel of2 

"> 

E iE 

• YOUR TICKET NUMBER IS 2294794. 

Original Call Date: 6/15/09 Time: 2:50 pm Op: SIVA18967 

Work to Begin Date: 6/17/09 Time: 3:30 pm 

State: NE County: DOUGLAS Place:. OMAHA 

Address: 2204 Street: N 48TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 07-SE,08-SW 

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: (301)919-6745 


Alt. Contact: 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAEFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 
% 

Page 2 of 2 

QLNNEIC QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Address: ,22G*-{

Crew: 

Date: ^ ' iSo' n 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Drivewav 

Sprinkler System 

Other 

Crew Foreman 

iS 

 ^ ^ H ^ ^ 

Bf. L/7-7 

Corrective 

Condition Hazards Action 

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Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medicai Drive, Suite 7250 

KansasCity. MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

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

Fax: (402)504-1005 Fax: (210)579-6577 
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