TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^c..a..5>^ Date: (&:>.] r^ ^ 

Address: ^U-o a N £ q ,<i-r 

Remediation Contractor: Pb.-^rN^N-/ 'hr^Mafeyqi^J^r. . Year: tJVaft^JoAq 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ET Video of property (DVD) 

0^ Executive Summary 

H^ EPA-provided property sketch 

[fl Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

12^ Restoration Agreement 

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

S ' Confirmation data 

El Photographs 

Sf As-built sketch 

El Satisfactory restoration signed by Property Owner 

Gfl Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0 Utility clearances 

\e Property infonnation from Douglas County Assessor's OfBce 

D 

D 

D 

- ^ )ate 

40311254 

Superfund 
PROPERTY SUMMARY 

Date: 01/23/2009 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Dec/Jan 

Property Addre88: 2405 N 29 ST 

A, EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 136 PPM @ 8"; DZ = 96 PPM @ 4"; F2 = 145 PPM @ 4"; EA = 216 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 cUp/photogr^hs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall includefinallead 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 Ciean Up Query Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 28329 ­ 2405 N 29 ST 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: [UNOCCUPIED |pRupeff2ooO" 

J DUNN EMMIT 

Owner Addressl: 

r 

Owner Address2: 

Property Address: 

|2405N29ST 

Zip Code: 

|68111 ; 

Group: 

I 

Assessment: 

12405 N 29 ST Resident Phone Qualifying Group 

City: State: Zip Code: L ­ - I PRIORITY 

[OMAHA 

Owner Phone: 

J |NE J |6811 1 

Alternate Phone: 

Assessment XRF Date: 

r~—-—:. 1(402)453-7262 1(402)714-7159 Assessment Max XRF Value: 
'irBGHNQEQGIES.lS<IC 

Property*: 5*835«5 

Date/Time: 

Quads Excavated: B a / ^"^^ 4^2.^ Sft 

EPA Property Close Out 

Property Address: 9^ S H 9 ^ .ST 

Owner's Name: 

Contractor Group Prudent Technologies 

Excavation General Yes .No 

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

\y 

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? 

y 

Gradmg Sod and Vegetation 

Yes yWo 

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

fiom 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 inspected at a 30 / \ y day time period) 

4. Are sodded areas generallyfirm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 17' time period) 

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

\ y 

7" 

7. Was damage to landscaping or plant materials avoided? 

V 

Gates, Fences and Retaining Walls 

Yes JNo 

1. Do gates open and close finely? (IfappUcable) 

171 

^ 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 1 / 

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

T7' 

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

1 / 

Foundation, Siding and Gutters Yes ^ 0 

1. Was damage to the siding or trim avoided? 1/ / ­

2. Was damage to the foundation avoided? \y 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 17 

/ 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewallu and Driveways (Concrete) Yes Mo 

1. Was damage to driveway surfaces avoided? l / / 

1/' 2.

 Was damage to walkway surfaces avoided? 
Owners conunents: 

Inspection notes: 

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

EPA Representative L J A^ /X'-£^J ^ Date: / / / / Qf 
&EPA 

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: A 4^/9 < ^ i J ^f ^ ,sy. 

Owner: ^^^^ff - ^^ ^ 

Phone: 

Restoration Kems in Question: 

Required corrections to complete the property: 

<,t O b^^ty H"^ ^ ^ wM^i ^ 

I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

i>wv^^iO>^^-.^ ^l- ' n - 0^ 

Owner's Signature Date 
Prudent Technologies, Inc. (Piudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a numt>er ofproperties located in Omaha, Nebraska, including die property located at 

^H^j y K) • 0<^t ^ S4- . The EPA requests your pemussbn to allow Prudent to perform a soil cleaniq) at this 

property to remow lead-contaminated soil. By signing tfais form, the propeity owner grants peimission to Piudent to perfoim 

activities related to the cleanip including soil sampling, removal of lead«>n1aminated soil, and restoration of the tefeienced property. 

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

Omaha Lead Site cleanup. Ms. Deborah Johnson -at (402) 733-1188. General questions about die Omaha Lead Site cleamp cail be 

directed to the EPA Public Infonnation Centers at (402) 731-3045 (South Oinaha ofBce) or (402) 991-9583 (NoUfa Omaha o£5ce). 

"•"-•3*^', . 

Property Access Granted By: fc. r o r^gJg W" - V \ KT r^r\ 

(Please Print Name) 

''ryt7rvWVHQ»^V»- i^iit ' o g Property Owner Signature: 

(Signatuie) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME; ^<!6wner ^ Renter 

RESIDENT ADDRESS: 

4 ^ 

'^•i r 

IF RENTAL, PROPERTY OWNED BY: ^ 

^ 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER-HOME: JJ^^X.) I H - 7/5 9 WORK: 

( > 

AGE OF HOME?: b6 ' YEARS. HOW LONG HAVE YOU LIVED HERE? ' YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? ^YES X 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: 


JL. COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be in^lemented by EPA under this agreement 

are pursuantto Section 104 of CERCLA, 42 U.S.C. 9604. EPA's tight of access to tiie property is providedfor in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "deteiminingthe need for response, or choosing or taking any response acdon 

under this titie, or otherwise enforcing theprovisions of Ifae tide." 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suits 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: (818) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
iiiSTw^J^'.* 

',', .^(•••••••:; -;. -'V•:'f(^^-V:'.•^'^•••; ^- -.f .^-^ M 

OLSH: 28329 

Date Excavated: 11/06/2008 

USEPA Si^ied-OfTDate: 

28329 

Omaha Lead Sit* ExtariorPtikit NotmAnow

SitaSicMch 

Ca^Poor 

SmpUn s AddiMto: 2405N293T Q Not print 

Sample Numb Samples OoBected 

ConcenM ion Rim: P E C<^' f-t- RYASCPXA$8aZ9 F1 2 2 S ppm DatB:_ 'i'VC V 

RYBSCPXA48^9 F2 H3B\ ppm Time: 

RYCSCPXAiebzo B1 _529Lppm 

Sampleitts Knalyzed ^ RYD8CPXA-i B2 J1M2I ppm 

RDZSCPXA^ OZ T25 ! ppm 

XRFUnIt C^ZiCm Book: ^O T 

RcaecPWA?; -oar- .ppm Date: ^<;>-Qfi 

RP2SCPXA48I29 PZ LM L ppm Ttme: 

Number <f Samples a I fe | []_ _ staff: MSW

Legend: Fl » ADrjtLsft. F2 > Front Right, Bl -Bac k Left, B2 s Back Ri!|MDZ> Drip Zone, GZs<|cRlen.PZ*Ptay 

quilwnfcai»^aiviwioi^joinlh«jlr»tt.t«jn|gpi«ip«|y 

MAY i io 

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

CONSTRUCTIO 

TECHNOLOGIES, INC. SERVICE 

Property Status Form 

Address: ^^O ^ JO- 9-^'''- S ^ Date: /0/3//0 S 

Phone: ^ I *^ ""^'^'' ^ BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

--..,J 9 0 A- cJ?^^^ Cp«^^ ^-' ^ "''^' ^ ^^>^ 3 , 

4 - 3 cvvNcSi i503V.^ 6 ^>^ •Ar.W^5<::. P\ c...>f\­

CL-r e^oi-'S. 

> • Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No X 

Item NO Description & Location 

On Map 

Property Owner Prudent Employee 

]QMory—: 

Signature: ^CV^rYW^Aj Signature: JIM^Z ^ (3— ^ 

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 
28329 

y 

Omaha Lead Sitf 

Site Sketch 

Sampling Addiies s: 2405 N 29 ST 

Sample Niimher 

RYASCPXA-i28329 F1 

RYBSCPXA-?8329 F2 

RYCSCPXA-28B29 B1 

RYDSCPXA-|28B29 B2 

RDZSCPXA-28J29 DZ 

RGZSCPXA liagaao—GS-

RPZSCPXA-28&29 PZ 

Lead Sample 

Concentration Collected 

225. ppm 

Ji^B. ppm 

223. ppm 

442 . ppm 

I

i ppm 

ppm 

lEih ppm 

Number < if Samples = | \o j 

Exterior Paint NorthArrow 

• Good 

\SiPQor 

• Notpalnt 

Firm: 

Date: 

Time: 

Samples Collected 

PE CC > E.if. 

<-yo ? 

Iiii ^1 i\i^-

Samples \nalyzed 

XRFUnIt: Q^HL. Book: ^Q T 

Date: ^'"^ ^ -Q6 

Time: P M 

Staff: MSV / 

Legend: Fl = Fror t Left, F2 = Front Right, Bl = Back Left, B2 = Back Ri( )ht DZ = Drip Zone, GZ = C iarden, PZ = Play 

All quadrant i arenas viewBdJpom the sfreet,ft idng property 

: ENTEHEB 

MAY2C 2008': 

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Rev200g.N CwMed; 26f tb-M 044701.01.23 

1 
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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner Zip 

1035790000 

DUNN 

EMMIT 

2405 N 29 

ST 

OMAHA 

68111 

2405 N 29 

ST 

OMAHA 

NE 

^68111 

Sec-TwnRng 

Addition 

Block 

Lot 

Legall 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Unk 

09-15-13 

FAIRMOUNT PLACE 

0 

25 

SI/2 

30X121 

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

parc= 1035790000 

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

accountno=R1035790000 

ivii ilvjri III ivi VCi tiivjutivi 


I 

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Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2166799. 

Original Call Date: 10/31/08 Time: 10:46 am Op: MADHURIMA18 967 


Work to Begin Date: 11/04/08 Time: 11:15 am 


.State: NE County: DOUGLAS Place: OMAHA 


Address: 2405 Street: N 29TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

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Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2166799. 

Original Call Date: 10/31/08 Time: 10:46 am Op: MADHURIMA18967 


Work to Begin Date: 11/04/08 Time: 11:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 24 05 Street: N 29TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuinber Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNE IC QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

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