TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^n^O'-f Date: l(|HJ^m ^ 

Address: A^ot^n 4lnp<^f^C<^ fe^yn 

Remediation Contractor: Pfjj-, n>p t^yj / ^ hNO(o(yi<^<; . f/^Cy Year: c^CoS 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[2 Video of property (DVD) 

2I Executive Smnmary 

0 EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

12 Restoration Agreement 

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

Ill Confirmation data 

B Photographs 

IK As-built sketch 

if Satisfactory restoration signed by Property Owner 

of Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

ij Utility clearances 

a Property information from Douglas County Assessor's Office 

D 

D 

Signaturev' jJate 

40312915 

Mlliiil 

Superfund 
PROPERTY SUMMARY 

Date: 11/19/2008 Omalia Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Oct/Nov. 

Property Address: 2040 FLORENCE BV 

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: 

Bl = 274 PPM @ 8"; B2 = 245 PPM @ 8"; NO EASEMENT. 

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: 90907

Owner: 

D Owner Occupied 

Owner Name: 

|MORELLO BERNARD J 

Owner Addressl: 

Owner Address2: 

111413 HICKORY RD 

City: 

|OMAHA 

Owner Phone: 

|(402) 342-2820 

Clean Up Query Lead Remaining Query 1

 - 2040 FLORENCE BD 

Resident: 

Resident Name: 

Property Address: 

2040 FLORENCE BD 

Zip Code: 

I 

Resident Ptione 

State: Zip Code: 

|NE |68144 

Alternate Phone: 

1 

 Property Damage Query 

Contract: 

Contractor: 

Group: 

Assessment: 

Qualifying Group 

11200 

Assessment XRF Date: 

Assessment Max XRF Value: 

1476 
TECHNOLOGIES, INC SEBV 

EPA Property Close Out 

Property #: To'Jo7 Property Address: 2.04.0 f^iirt*^^ &v 

Date/Time: Owner's Name: 

Quads Excavated: g/ g 3. Contractor Group Prudent Technologies 

Excavation General 

I. 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 

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 that were excavated? 

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

6.

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

1. Do gates open and close freely? (Ifapplicable) 

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

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

4. Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, Siding and Gutters 

1. Was damage to the siding or trun avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

i / 

Yes No 

/ 

y 

y 

y 

y 

/ 

i / 

Yes No 

y 

/ 

y 

y 

Yes No 

y 

y 

y 

/ 

/ 

Yes No 

y 

t / 
Owners comments: 

Inspection notes: 

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

EPA Representative i ^ y^u^ Date: io)si/o^ 
^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 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: Ao^eQ 

Property Address: ^ ^ ^ o ^\ore,t/vC e B p 

Q^°^'-= Vye^^..y.^ ^ Korpll ^ 

Phone: Mo 7 - ^ U O - 9,9^'XC? 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I agree restoration is completed, except as noted above. 

I 1 do not agree restoration is completed 

iiV:;; 

ner's Signatur ignaturee Date

I
•••--*;.••;• ••WiyJ'- V 

# • • •fl1 • X 

/ , . V,' . / V v.', Vf,V.;Vf .f t 

V'v . •' / 

Pmdtnt TtcfanfllDgtE, Inc. ([Piudtn^ isundti contiact widi th« U. S. Eaniionaitntal ProUction Agoocy (EPA) to cltaniq) Itad- * . 

contnTHiTiittd soils at anumbtr of proptrtitilociittdinQiaaha.'H tbradca, indiiiiingth* proparty located at 

^ ^_ . Th9EPArsqu«stsyourp»nnisaontoaIlo(rPiud«nttop«ifoimasoilcUasupattts 

pioptity to i«moTr« l»adrccDtaBiinA»d soil. By sigoingftnsfonn, tfa* piopsi^ ownn grantsp»niusBon to Piud«nt to ptifona 

actiTnti«s i»lat«d to tlw cltsn^ iuclucling soil sampling, nmoval of UiuJ-contaminaUd soil, and t»stoialion of tfat i»f«T»nc»d pioptity. 

IfyouhaT« any questions about ths Eoi}'cl*ati9plann«dfoiyourpiop»ity,pl«as« contact Pnidtnt'sAdmigiaraliv* Cltik forth* 

OmahaLtadSiti cUanm. Ms.ShaHnonHolt-atf402^3Q4-1004. G»n«ral qutsdonsabout&«OiaahaL»adSite cltaa ^ canb« 

diT*ct«dto &» EPA Public InfomiatiDnCtnUrs at(;40:^ 731-3043 (|5outhOmaha o£Bc«) oi(402) 991-9383 l^oithOmaha offict). 

Proptrt7AcctssGiant»dBTry- ,^<^^' ^ ^ ^ (T- fYlQ^ELJ- ^ . .., 

n ^_„_ ^ / N^ (Pitas* PnatWarn*) 

(^J2^/&? Proptity 0wn*i Sigaatur*: 

IpaU) 

PROPERTY INFORMATION 

( t* \ t cta^letod \ j reaiient ftal/*rf rt f eit^ •vaer - f kasBf riat) 

RESIDENT NAME : \ f r\ r nv.! - \_it\ \r Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL. PROPERTY OWNED BY; 

'Bei^»^a^(^—X V\C)rpUo 

OWNER'S MAILMG ADDRESS; 

r<J QI^AIM X y\t 6-. glU? 

* 

OWNER-STELEPHONE NUMBER-HOME; X WORK: 

(^g| 9Mg'-.7<^A4> 

AGE OF HOME?; YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED Wftm SDING 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 H THE YARD FOR 5 HOURS OR MORE PER WEEK: 

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

AtJIHORITY TORENVIRONMINTAL RESPONSE ACTIONS^ Ih» Bcti7iti«stob»impl»m»it»dbyEPAunii»rthisBgr»««»nt 

an Dunaunt to S»ctjon ID/ of CEKCLA, 42 U £.C. 9604. EPA's xi ^ of acc»ss to th« propMty is prorndtd for in Section 104(«) of 

CERCLA, 4.^ U S. C 960 j(«), vfaich pro^d*s «ntiy foi '^d«t«nmiing th» n««d for n^onst, oi chooang or taking any n^ons * action und«ithistitl», oi oth*nris« »nforcingth» proMisions of tht titl»." 

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

Kansas city. MO 64114 Omaha, NebraskaesilO San Antonio. TX 78223 

Phons: (SIC) 363-3703 

Fax (S1€) 353-3707 

Phone: (402)504-1004 

Fax: (482)504-1005 

Pfions: piQ) 822-3588 

Fax: 510)579-6577 
WdM / . ' .... ' \

Pmdwtt T»chB(il(>{i*i;lnc. (Prud«n$iiundM contract wi4i tfa« U. S. EnoiionmMiitalProtwtitm Agoacy (EPA)to dtaniqtUad­ coBtaminatcd soils A anmabti of pn^«iti*Elocat»din Omaha, K«biasica, includingth» propMty located at . Th»EPAT>qu*EtEyompfrniiisaontoaUoirPtud«attop«tfoim a soil cUam^ atdns 

piop»rtf tc- iMnovt l«adrccDtimin9t«d soil. By sigmng dus fozm, th» propedy ownw ^ants pumissoa to Pmd«nt to p»ifonB 

activiSi«:i:4lat*dloth« cl*iuup including soil sampling, itmoval of l«ad-contamin^d soil, a&dTeaDiatiogaafth*tefei»tic*dprop«ity. 

Ifyouhavt any questions about th* soil deamp planned foi your pioptity, please contad.Pnident'sAdmijaitliatl'ye Clericfoi the 

Omaha Lead Site deana>, Ms. Shannon Holt-at (402^ 504-1004. Gen«ial quedions about ftteOnahaLeadSite decwp can be 

directed to the EPA Public Infoiaition C eaters tf.(402) 731 -3043 (Sonlfa Omaha office) c»(402) 991-93S31^ oith Omaha office). 

Property AccessGianted By: \ A y ^ ' '^^ ^^ ''^ '"" '^ J ' • i.e . lO 

/ ^ .-T~, v-"""^—\ (ReasePnntName) 

PropertyOwnerSignature: V.r;:O^A^.-- ^ ,/^MX^ A (& I2^ ^ f^ ? 

'f^— (Signature) (Date) 

PROPERTY INFORMATION 

(T* k* nsfletod ¥y iMoinrnt Aai/txfnftxtf vwanr - fitMmfximi} 

RESIDENT NAME; V/ A r C... I -U-i. Owner R enter 

RESIDENT ADDRESS: 

S-&M4 ^ Ofe>-> C-.g, Six V-A­ r*-

IF RENTAL. PROPERTY OWNED BY; 

TSr^>>.fi f,.\ 4——VACIVP K 

o 

OWNER'S MAILMG ADDRESS; 

J 

OWNER'S TELEPHONE NUMBER-HOME: J \_ ¥VORK: J ;• • t ] 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HE»E7 %. *•' YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTlil^illiG SINCE 1978? ,-\i:YES MO 

NUMBER Of OCCUPANTS UNO^ V fEARS OLD; NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

\.. ^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY MMTHEYAttO l THE YARD,r FOR S HlOURS OR MORE PER WEEK 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E.^06^!ENTRY GATES. ETC.) 

AUTHOIUTr FOR. ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemeiledt^ EPA under this agreusent are BjanaMBt to Section 104 of CERCLA, AiU^'C. 9604. EPA's li ^ of access to the propeH^ is provided for inSection 104(e) of 

CERCLA, 42 U 5. C 9603(e), which provides entry for "detezmiaing the need for responsti, or efaoosng or taking m j rt^onse action under thistitle, or otherwise enforcing the prtmaons of the title." 

8880 Want Pamw^. Suite 405 2505 N. 24*^ Street Suite 308 4242 Medical Drive. Suite 4250 

KflneaBCitf. MO 64114 Omaha. Nehraska 68110 San Antonio. TX 78229 

PtlOlfs: (816) 363-3703 

rsx. ^IS) 3S34787 

Phone: ft02) 504-1004 

Fax: (402)504-1805 

PUona: pie)822-SK8 

Fax: <218) 579-6577 
AS ­ BUILT DRAWING ^ 

OMAHA LEAD SUPERFUND SITE 

OLS#: 90907 I B 

Date Excavated: 7/10/2008 

Date USEPA Signed-OfT: 

90907 

Omah Exterior Paint a Lead Site • Good Site Sketch 

npoo t 

Samplin g Address : 2040 FLORENCE BV [ 2 Not paint 

Sample Number Lead Sample Samples Collected LAB Cortcerttation Collecled Firm 

RYASCPXA-90907 F1 

2.^1 ppm D Date: 11 / I /D 7 

RYBSCPXA-90907 F2 

."iSi .ppm D Time 1 2 •• 2-7 ff ^ 

RYCSCPXA-90907 Bl .ppm D 

Samples Analyzed

RYDSCPXA-90807 B2 6>53 .PP"i D 

ROZSCPXA OOOOr B i ppm D D XRF unit: C>S'H2 . Book: l<^ i 

ROZoopxA-oaao?—sz ppm D a Date: n-oT-a i 

nrzocrxA-90907—PZ .ppm D Time: 2tL 

£] 

Staff: AlSu/

Number of Samples = 

Legend; Fl = Front Left, F2 = Front Right. 81 = Back Left. B2=Jack Rjght DZ = Drip Zone, GZ = Garten, PZ = Play 

All quadrants are as viewed rranithfsrrat. racing property 

@ I;NTERED 

•f;C7:Q 2 2'J7-

B 

t\ ez

Bl = 274 PPM (iij 8" B2 = 245 PPM (a; 8' 

IH7.^. M l ^ 

ZoHo Floffi'lCJe. €><s/[

t" 

• @ 

.35/.. 

a 

ZHl © t© 

pior«ji7C.e^ • ^H ' 

Ctcmcd HI'JIxrroir'lTM 

NO EASEMENT 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC 
mm rECHNOLOGIES, INC. 

Property Status Form 

Address: cPe'^O 'h\ry'T^^<e^L^ ^X^ Date: ^Jur^Jt. \<l;ieti ^ 

Phone: ^o^ - 3 M ;i. - -^S-8 Slo BVID: q^i q o 1 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

\/AC AA/T UO T 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No 

Item# Description & Location 

On Map 

Property Owner Prudent Employ! 

/ 

Signature: Ignature 

\ 

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 
90907 

Exterior Paint 

Nofth Arrow Omaha Lead Site 

Sit • Good e Sketch 

nfoo r 

Samolinq Address: 2040 FLORENCE BV [ 2 Not paint 

Lead Sample 

Samples Collected Sample Number LAB Concentration Collected Firm: 

RYASCPXA-90907 Fl 7 H I Dom D Date: 

11 / I /p y 

RYBSCPXA-90907 F2 •? 5*7 Dom 

n Time: L2-.Z.7 ft ^ 

RYCSCPXA-90907 B1 M7 fc ppm 

D Samples Analyzed RYDSCPXA-90907 B2 (o53 ppm D 

RDZSCPXA 00007 B2- ppm D n XRF Unit: dSTHT .

 Book: J9 3 

r^OZOCrXA'90907 SZ ~ ppm D D Date: I t -G ^ -6 1 

f^PgOCPXA-90907 PZ •" ppm 

D D 

Time: ?f ^ 

Staff: /HSUi/ Number of Samples = | ^ £L 

Legend: F1 = Front Lett, F2 = Front Right, Bl = Back Left, 82 = Back Riflht DZ = Drip Zone. GZ = Garden. PZ = Play 

AH quadrants are as viewed fr6mtl«^Kt , ^n g property 

I ;NT EEED \ ; ^ . 

RUV \i L Zi ;a^ 

^ . ! ;

wJ : 

mk...\ (D'^.I. 

\ i \ 

...fZ)...\ : 

;....!....35 / 

.a.i 1 \.r.2. 

Z.HU 1 ..x>^... 6^ 

i i © 

: W"\ 

f^Lc>r€jr,cii^ .0c\. 

Rev 5 Cre«ed: S/:i/2<W708;«7 54 

046141.0123 

f no*)«»ii^> >9» ic> M , M l a»i M«> la i w :«> »«; Mr n 
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 

1139040000 

MORELLO 

BERNARD J 

.^,A^^­

11413 

HICKORY 

RD 

OMAHA 

NE 

68144 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

10-15-13 

FRANKLIN SQUARE 

0 

8 

65 X 140 

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

parc=1139040000 

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

accountno=R1139040000 

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 = 41 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 7/11/2008 
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^ ' ^ ^,^•i•^^«:^^•' " . ; .^§q>*::/ . .45frt 
fi!e:///C:/Users/lord".^s%20my%20shepherd/Desktop/STREETS/2. 

Create Another Ticket Back to Irth Intemet 

Send Email 

YOUR TICKET NUMBER IS  2077053. 

Original Call Date: 7/08/08 Time: 9:55 pm Op: RAMITA18967 


Work to Begin Date: 7/11/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2040 Street: FLORENCE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW,15-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidation 


Location of Work: ENTIRE PROPERTY LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)504-1005 


: UNSURE CORNER 


Company : PRUDENT TECHNOLOGIES 


Contact Name: RAMITA Phone: (402)504-1004 


Alt. Contact: Phone: (402)452-9806 


Work Being Done For: EPA 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact

 Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 


LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Alt: 


Emerg: 8773668344 

Day: 9185747098 

MAGELLAN MIDSTREAM MAGELLAN TONYA

 Alt: PARTTMERS LP 

Emerg: 9185747098 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl EDWINA

 Alt: DISTRICT 

Emerg: 4025047946 

Day: 4024447197 
 OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

lof2 7/9/2008 1:16 PM 
file:///C:/Users/lord»^^s%20my%20shepherd/Desktop/STREETS/2... \°Mm 

OMAHA PUBLIC POWER 0PPDGPR5 DISTRICT 

QLNNE 1C QWEST LOCAL NETWORK 

Alt: 4024445161 

Emerg: 4024445160 

NA

Day: 4067289343 

 Alt: 8887289343 

Emerg: 4067289343 

NA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

i . 

2 of 2 7/9/2008 1:16 PM