TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: It 2-2^ 3 Date: l2^}X'i^)->>og 

Address: 4-r/ 7 S, Z(f I ^ 

Remediation Contractor: rv,.,^^^ TL/t^tf/ayl. ,.^Cv Year: 2J>O? T 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[/ Video of property (DVD) 

a Executive Summary 

Br EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for. adjacent property 

0; Restoration Agreement 

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

0^ Confirmation data 

[a Photographs 

IZf As-built sketch 

0 Satisfactory restoration signed by Property Owner 

[3 Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

% Utility clearances 

0 Property infoimationfirom Douglas County Assessor's Office 

a 40309556 

D 

• Superfund 

Signature f Date 
PROPERTY SUMMARY 

Date: 12/20/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Montii of: Nov/Dec 

Property Address: 4517 S 34 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Ofter Relevant Information: AREA NOT EXCAVATED GZ BRICKS 5'X5' @ 303 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

GZ = 27 PPM @ 12"; EA = 150 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-Excavatioa 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. 

TECHNOLOGIES, INC. 
Find Record I 

Bacicfill: 

Sample Area: 10223 - 4517 S 34 ST 

Owner: 

n Owner Occupied 

Owner Name: 

I PINTO EFRAIN L 

Owner Addressl: 

r 

Owner Address2: 

|4517 S 34 ST 

City: State: Zip Code: 

|OMAHA [NE [68107 

Owner Phone: Alternate Phone: 

[(402) 733-8276 I ' '. " 

Clean Up Query Lead Remaining Query I

Resident: 

Resident Name: 

PINTO EFRAIN L 

Property Address: 

[4517 5 34 ST 

Zip Code: 

[68107 

Resident Phone 

 Property Damage Quer/ 

Contract: 

Contractor: 

PRUDENT2008_S 

Group: 

Assessment: 

Qualifying Group 

I PLAY ZONE 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

I 619.18 
TECHNOLOGIES. INC. ^BV< 

EPA Property Close Out 

Property*: jDliT , Property Address: ^-^V1 S ')>U S,^ 

Date/Time: Owner's Name: 

Quads Excavated: (yi ^ Contractor Group Prudent Technologies 

Excavation General Yes No 

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

2. Ifnecessary, were the correct areas ofdrip 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? y 

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

3. Does the 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 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? 

/ 

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

Gates, Fences and Retaining Walb Yes No 

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

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

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

4. Was damage to retaining walls avoided? (IfappUcable) / 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

y 

2. Was damage to thefoundation avoided? 

y 

3. Was damage to windows avoided? 

y 

4. Was damage to windows or door screens avoided? 

y 

S. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewaiiis and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

y 

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 ><?r.^ y^ ^ Date: /W//^ ^ 
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 ofthe 

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

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

Property ID: 

Property Address: K 5 0 ^ -^M SU 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Hem: 

Required corrections to complete the property: 

L J I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

//^/^i ^ 

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 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 pennission to Prudent to perform 

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

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. Dcboralt Johnson -at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public Inforrnatiop.^enters at (402) 731-3045 (Soutlj Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By. ^ 

Property Owner Signature: 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWHEp BY: 

OWNER'S MAILING ADDRESS; A 

OWNER'S TELEPHONE NUMBER - HOME: J . _L WORK: 

AGE OF HOME?: ICA Q ^4^ YEARS. HOW LONG HAVE YOU LIVED HERE? ' ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YE6— NO =* fiSt c D 

• ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ( I 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 960S(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 ^ 

OLS#: 10223 

Date Excavated: 10/10/2008 

USEPA Signed-Off Date: 

OMAHA LEAD SUPERFUND SITE 

102.23 

Sampling Address: '•SI T S 3*4 S-K 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

g'Good 

• Poor 

Q ^Jot paint 

North Anew 

Sample Nunntser Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

P E /wc^JB.A L 

RYASCPXA-J02Z3 F1 ^ ppm D Date; <o/ )2./Q 3 

RYBSCPXA-10^^5 F 2 

RYCSCPXA-10223 B1 

RYDSCPXA-IOZ23 B2 

Sf\

4 5

ZOO

 ppm 

ppm 

ppm 

n 

n 

D 

Time: 2.'.3i4 prr> 

Samples Analyzed 

RDZSCPXA-lOZSi DZ tSfe ppm D XRF Unit: 5SO I Book: — 

RG2SCPXA-I0«3 GZ ___^13_ _ PPid D Date: <b/|-3./o ^ 

RPZSCPXA-(OZZ». PZ ^*t ppm d Time: 8:i5d m 

Number Qf Samples = | T j | Q Staff: PA J 

, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ Drip Zone, GZ •• Garden, P2 = Play 

All quaitante are as vewed IJum thstreet e stree, facin t g property \itc y 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

r 

Property Status Form 

Address: MS\ T 5 ^ ^ s\ ^ Date: 

Phone: BVID: 

MSI- ^t ^ ^ 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

• ^ : 

^e : •Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes — No .io 

Item# Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 I Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)504-1004 

Fax: (402)504-1005 

'Phone: (210)822-9588 

Fax:(210)579-6577 
102LZ3 

Sampling Address: 4SI"7 S SM* .S-f 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

[3 ^ Good 

• Poor 

• Not paint 

North Arrow 

Sample Number Lead Sample Samples Collected 

Concentration Collected Firm: PE/WC,4B.A L 

RYASCPXA-10223 F1 3S ppm D Date: ^/i'Z/o^ f 

RYBSCPXA-IOZ23 F2 5*t ppm D Time: 2.13M- p m 

RYCSCPXA-JOZZ3 Bl 4S ppm • 

Samples Analyzed RYDSCPXA-KJzas B2 "ZOO ppm 

D 

RDZSCPXA-lOZZii DZ tSfe ppm 

D XRF Unit: SSO l Book: — 

RGZSCPXA-I02.Z^ GZ 6*\*^ ppm D Date: <i>/]'Bt/o3» 

RPZSCPXA-tOZ2»» PZ *t*t ppm 

D 

Time: 8115 d m 

Staff: PA J Number Qf Samples = 7 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as vywed fjom the street, facing property i • t g - y 

f-BAR-B'© PIT 

.-ftSIT-.S •.... , 

-f—3H-S+ r- — 

PZr: J5^. 

3H;S+ 

Rev2008.BL Created: 16.Miy.0S 

046141.0123 
- K ^ yu^f^ h I02.Z3 

Exterior Paint North Arrow Omaha Lead Site Q'Good Site SIcetch • Poor 

Sampling Address: *»S1"7 S 3«4 ^-^ • Not paint 

Sample NumI >er Lead Sample Samples C ollected L^B Concentration Collected Firm: PE/vrc.JB.A L 

RYASCPXA- I0223 F1 3S ppm Date: ^i\'2Jo' ^ 

RYBSCPXA- U»223 F2 _§!. ppm Time: -Zls U

RYCSCPXA- pm tCZZ3 61 *I5 ppm 

Samples / nalyzed RYbSCPXA- B2 2.PO ppm 

RDZSCPXA-1, DZ ISfe ppm XRF Unit: 5SQI Book: —• 

RGZSCPXA- GZ ^ i q ppm Date:_ <i>/\^lo^ 

RPZSCPXA-IOZ2A PZ HI ppm Time: _ B'.lErd m 

Staff: P AJ Number c f Samples = 7 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = (garden, PZ = Play 

All quadran Is are as wwe d fxonr I fromi ththee street street , fai ling

T^3 E}2. coMc -H -»•— 

SFlgp 

<3ARA6£ • -: r-( 

*?*? 

szs Bl Q ^ ^ BAR-B-<S PIT 

B.Bl P4*!O 

•N­

:l 

.*t5J7..S: 

—7—3HS+ ^ 

Page 1 of 1 

AY 2005 - DOUGLAS COUNTY ASSESSO 

(fSI ISSHST. 

http://douglasne.mapping-oiiline.com/assessdoc/Photos/35/R04308200000001. ioe 9/25/70nX 
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 

0430820000 

PINTO 

EFRAIN L 

4517 8 34 

ST 

OIVIAHA 

68107 

4517 8 34 

ST 

OIWAHA 

NE 

68107 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

SOUTH OIVIAHA CITY LOTS 

348 

10 

50X130 

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

parc=0430820000 

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

accountno=R0430820000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not IViap Scale guaranteed. This Is not a legal document and sliould not be substituted for a title search, 1 inch = 61 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Cotmty-... 9/24/2008 


Lilil • ^1- ^ 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2147123. 

Original Call Date: 10/03/08

Work to Begin Date: 10/07/08

 Time: 10:26 am 

 Time: 11:00 am 

Op: RAMITA18967 

State: NE 

Address: 4517 

County: DOUGLAS 

Street: S 34TH ST 

Place: OMAHA 

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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: RAMITA Phone: (402)733-1455 


Alt. Contact: Phone: (402)733-1188 


Work Being Done For: epa 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI AU: 4029340469 

Emerg: 4029329757 

Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Ah: 4024445161 

Emerg: 4024445160 

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Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 8887289343 

Emerg: 4067289343 

QLNNE IF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Ah: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Ah: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/3/2008