TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: -^•:).s\ ^ Date: 

Address: ^i\ 0 jSJ ) g- &1-

Remediation Contractor: \^Ja ^ j - HI".i>i>.J^^'^ ."TVir y Year: -2-00 P 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Ef Video ofproperty (DVD) 

ET Executive Summary 

tE^ EPA-provided property sketch 

CT Signed Access Agreement for subject property 

IlT Signed Access Agreement(s) for adjacent property 

Q^ Restoration Agreement 

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

0' Confiimation data 

cf Photographs 

0 As-buih sketch 

y Satisfactory restoration signed by Property Ovvner 

0^ Property close-out check list signed by EPA 

• Description of areas not meeting ROD cleanup criteria 

H' Utility clearances 

y Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

Signatuj* Date 
PROPERTY SUMMARY 

Date: 01/23/2009 Omaha Lead Site Remedial Action Coniract # EP-R7-07-06/0004 Montii of: Dec/Jan | 

Property Address: 3810 N18 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 86 PPM @ 6"; B2 = 127 PPM @ 7"; EA = 1 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 clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) 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 H 

Backfill: 

Sample Area: 32939

Owner: 

n Owner Occupied 

Owner Name: 

|COMBS CAROLYN G 

Owner Addressl: 

Owner Address2: 

|3902IDAST 

City: 

|OMAHA 

Owner Phone: 

|(402) 884-7498 

Clean Up Query Lead Remaining Query I

 ­ 3810 N 18 ST 

Resident: 

Resident Name: 

r 

Property Address: 

|3810 N 18 ST 

Zip Code: 

|68110 

Resident Phone 

State: Zip Code: 

|NE |68112 

Alternate Phone: 

1 ­

 Property Damage Query 

Contract: 

Contractor: 

Group: 

Assessment: 

Qualifying Group 

11200 

Assessment XRF Date: 

Assessment Max XRF Value: 

1254.2 
TECHNOLOGIES, INC &BV< 

EPA Property Close Out 

Property #: 3 ?*?i«J Property Address: 3 8( 0 ti 18 3 TDate/Time: Owner's Name: 

Quads Excavated: &h B'2.^ C'V Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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 peruneter 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 generallytight? (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) y 

Foundation, Siding and Gutters Yes No 

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

2. Was damage 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? y 

Sidewalks 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 j9c^ A ^ Date: /h^iJof 
•A 

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 future, excluding any 

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

Property ID: 

Property Address; ^^^ Q tQ \gHv ^ 

Phone: (J 

Restoration Hems In Question: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Kem: 

Required corrections to complete the property: 

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

EH I do not agree restoration is completed 

/)0 (hi,Jixr<-^Q:BK-^ 13-5(0-^? 

I Owner's Signature "* Date 
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_• Th*EPAt»q|U)byoisp«i>usBontodla(rPmilWtop«ifi)iaasDilcl»aiii9Btftds 

piop«ty to »BOT» l*ad-c(iitaauiut*d soil. ByB{pgiigMEfoiB,tMpiop«ity(nniwgnDntsp«iBiBaintoPtiid«iittop«fomi 

acti'viiitsi»lat»dtoth* dtmof swluduB soil sampling itaoral ofl«ad-coatBiiiiiut«d soil, n d nttoratioo ofth* TtSmwtA ptoputf. 

Ifyouhav* ai^qiMSlioBE aboutth* sdl cl*aii9pliain*dfwy«ispiop«ity,pl*i» contactPtud*iit'8 Adminidialiv* Clwh fbr th* 

Omaha L*Bd^t* eltaag. M8.ShannonHdt-alf402!) 304-1004. G*iMnl qiMsdons aboutfit*Omaha L*ad Sit* cltan^ canb* 

dirtcudto th«£PAPublichglaimalioaC«ot*reaL(40^ 731-3045 (JSoufhOmalB offie*) ot(402) 991-9383 (^ oithOmaha offic*). 

Ftop*itjAcMBGiantodBy: ( V^frl / n Crr - /^^n(>cs.n^ 

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P»p.ityOwn*rSignatur.: (/V.I^V<^( ^ O/Q^iJ^V^^l-^^ V Q*^ 

C ^ (Dal*) 

PROPERTY MFORBBATION 

(To l « coBflBtod b nBleHtflai^TpnpHtjr Mrwr - pkas p liaii)

(lo t« COB^MIM kyy nBUHlflSBATpi 

RESIDENT MABSE: \ / Lf C ^o-^-^J— \ C^Xr- Owner Renter 

RESIDENT ADDRESS: 

IF RENIAL. PROPERTY OJ^mED BY: 

OWHER-SKIAILMG ADDRESS: , , ^ , ^ Q l./oi . 

OWHER'STELEPHON lER'STELEPHOHEHUGBBER-HOHE E : t ) WORK: HUGBBER - H 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTIH SIDIMG SINCE 1378? YES NO 

NUHBER OF OCCUPANTS UNDER 7 YEARS OLD: NUHBER OF OCCUPANTS 7 YEARS OLD AHD OLDER 

NUNBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY H THE YARD FOR S HOURS OR ttORE PER WEEit: 

COBEKMTS o n SPECIAL INSTRUCTIOHS: (I.E. DOGS. EMTRY GATI^S. ETC.) 

AUTHORITY FOREHriRiaHMENTAL RESPONSE ACTIONS^ Th*acli7iti*Etob«impl*m«i)t*db3rEFAuiil«itfaiEBgc»«m«iit 

an pursuant to S*ction 104 ofCERCLA, 42 U£JC. 9604. EPA'tii ^ of ace*Beto th* prop*rly ispiimd«dforiBS*ction 104(*) of 

CERCLA, 42 U£. C 9603(*), which pi09id*s antryfbr "datwiiiiTriTig th* n*»dfoi r*yOUMI, or dtooang ortaking ai^tvqpanB* action 

und*r this titl*, or oflunns* (afbroBg th* pronaons ofth* titl*." 

8080 Ward Prnmof. Sulfa 405 2S0S H. 24* Sinat Suite308 4242 caedlcal Ditve. SuHs 4250 

KammCI^ . BI0 641M Omalia NobraakaGS110 San Antonio, T X 7S22S 

PliOns (816) 363-3703 PhonK (102)504-1004 PhonK pi0)8Z2-9S88 

FBQC ^16) 363-3707 Fax: (402) 604-1006 FOC (Z10)S79-6577 
• V 'VI • •_. »»t>r t - r ti j ^ 

FtiidMt Tecfawilo^b^ Inc. iEi»iasccaBiitictin<hth*U.S.EanitsiBeatalTrot»«tiaaA| tocl«aBupl*ad­ contccaiiuAi 

piopH^to 

'aeti'viiioETtlstodto tho cl«aLp iodudi:^ aol oaplia g xtsitnrd oflesd-cootHsiaEiod end, aadressUxcHtiaa ofIhs nftnow&dpiopci^. 

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OsudsaLesd ^ d*tagx M[E.Sh8gaoBHolt|-af4Q2)304-lCQ4. QtausA (pu^ooE aboutfluOaaiuL»odSit» dossaip cdb e 

dixoctodto &» EPA PublicI»fbiBatioaC«Btas8l(40:^731-3043 ^mSkOud& offieo) o(<402) 991-93S3 (Nor&Oaito o£5c«). 

PwpsrtrAccsBGisatodBy; ( ^CXQlil r\ C=r - A;/;rcvb' b ' ,­

" *^ "—' (Pl«BB»Piiat)(aBo) 

PtopntyOmutr Sigutur*:,:Onr*J^.. ^ Q/7P^-aia-^V0^ 

(Si| ») (Pat*) 

PROPERTY UFOIIUSATIIOn 

RESIDEOTCSACDE: 0(vner Renter 

I11ESMIEC3T ADDRESS: . , , , -, ' . • . 

HP laEiaTiftL. PRSHPERTVOaKlEO BY: 

0 

emUER' S in^tDLDSG AQDRE^ 

lER'STTELEPMOiaE MUCDBER - MOBE: J L %K»RE:: 

AGE OF MOCQE?: YEARS. HOeVLOUG HAVE YOU LliVEDHEIItE? YEARS. 

HAS THE EinncliUOR BEED3 (%|[3TE0 OR COCKED fmae SIUCE nsro? VES cao 

C3UC3BEDI OF OC&Um«TS UnDER 7 YEARS OLD: nU[3BER OF OCCUPAD3TS.7 VEARS OLD AOD OLOER 

UUinBER OF CHiLIDRE« UC90ER 7 YEARS OLD OHO PLAV C3 THE;VAiiD,FOti S HOURS OR C30R£ PER l^£» : 

COUEDERITS OR SPISCIAL IHSTRUCTIOCaS: (I.E. DOGS. EdTRV SiATIZS, BTt.) 

,• ^' '.^ 

' ', ; I 

•:^ ^ •• ^ •• • ^ i 

AUTHORITY FOREH7IRCMMENTALRESPONSE ACTIOHS: Tha activitiAStobeiiapIoiBtititdbyEPAuEdHtU&iisnoaeitt 

oi»puRUBatoSecdon 104 ofCEKCLA,42 USJC.9604. EPA'Eli^o f wcABStoflu{si^oiiyiBpnwidtdfariiiSocliaa 104(*)'of 

CERCLA, 42 U£. C 9303(»), T^Uchpiovid»B tattyfor''dstonaini^ tho iioedfw r47QnG^ or chooB2ig or tiih ^ 

uwtotUstiil^ 07 othanriB* «a&rassth» pnniaonE ofih» ti)tlo.* 

ess9 ^s M Pctica^. smlto oiK H.2»}°'strs3i.sigl!fo3l^. 4242 incSDee;] OiSwa, Sullfo42S0 

dOBCSCH^. £30641)14 Ogne3ia,[fle3tr£eciaGSll0 ' S o Amikiiiitii. mt 7SS29 

PiieRCC^16)SG3-S7Q3 PbOiUr. $102) 504-1034 Pnono: ^10)0Z2<998Q 

Fee (318)308-870}' FOB: (Offit) SBC-1005 Fss ^10) 678-0677 
AS ^BIOLT DRAWING '... 

. •'•'" •'•"••- . • " "•' . •'-' ' '• ' ' • • " ' •':'..*• 'y- a 

dMAHAJS^AD SlJPEitf"UND Sm f T^ OLStf: 32939 

Date Excavated: 7/11/2008 

Date US£PA Signed-OfT: 

32939 

Omaha Lsad Site Exterior PB M NonhMiow Owner Wam»: CAROLYN G COMBS Sit* Sketch • Good Address: 38ip_N 18 ST • Poor Ptionr. .H: g,^hi - i!:i5£.. w . • Not paint 

Sample Lesd Sample Samples Coltected Number LAB Concentralion Collected Firm: .fM-ilEZZii . RYASCPXA-32939 Fl ^ \ 0 ppm a Date: _£-JLfLz£___ RYBSCPXA-32939 F2 g2. 7 • ppnri Ef D Time: // ' ?P 

RYCSCPXA.32939 B1 Si D Sampies Analyzed RYDSCPXA.32930 B2 

•nozscpxA aaoac—oi 

RQZ6CPXA 32030 62. 

4tf'Z60PXA aaoao—PtIZ5*J ppm 

- PPf 

• " ppm 

~ PPW 

Ef 

n 

n 

n 

D 

n 

D 

n 

XRF Unit:

Daae:

Time:

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fl-ZA'^S" 

 AJ*1 

Staff: iu ^ 

t>\ PZ 

'ier.i 12:54 

j/yjrsr . 

I 

^ 

^L\}.f^... 

I 

I... 

WALK 

\%: -yr £A=lPP^f@ SCRAPE 

Omaha Lead Site 4ft 150 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
'-'''-&&&=£ •T ;* f.\ ^ ^ 

^M.dijvL^'-^ 'ECHNOLOGIES, INC. 

r 

Address:

Phone: 

Item# 

On Map 

Item# 

On Map 

P&-1 

Property Status Form 

'i'ilD t\l / ^ J- ^ Date: 

BVID: 3Z.f5'?' 

Plants & Permanent Landscaping 

Description and Location 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes — No 

Description & Location 

S^^-^-^^-AJZ-AM (^-^^^—-^^t-cJl ^ cle>-3eJ2^ 

Property Owner Prudent Employee 

Signature: 

8080 Ward Parkway, Suite 40-5 250-5 N. 34* Sirsst Suit-s -303 42lJ3dlC33 Sriva, Suite 42-SO 

Kansa'3 City. MO 64114 Omaha, M3bra3lHi SBHO San Antonio, TX 78229 

Phons: (81?) 3S3-3703 PhOiW: (402)S&4-!004 Phons: (210)822-9588 

Fax:(816)383-3707 Fax: (402) 554--100S Fax: (210) 579-6577 
32939 

Omaha Exterior Paint North Arrow Lead Site H Owner Name: CAROLYN G COMBS 

Site • Good SIcetch Address: 3810 N 18 ST • Poor 

Phone: H:p^y<-\qp> W: 

Q Not paint 

Sample Number 

RYASCPXA-32939

RYBSCPXA-32939

 Fl 

 F2 

Lead 

Concentration 

ppm 

ppm 

Sample 

Collected LAB 

D 

D 

Firm:

Date:

Time: 

Samples Collected 

 ^^ ^ HXT j-RoJ 

 3 ' / ^ " ^ 

//• 30 

RYCSCPXA-32939

RYDSCPXA-32939

 Bl 

 82 

ppm 

ppm 

Ef 

CET 

D 

D Samples Analyzed 

RDZSCPXA 32030

RGZSCPXA 32030

 QZ 

 GZppm 

ppm n 

D 

D 

XRF Unit: 

Date: _ 

/<g3 7 Book: Jj^L 

npzGCpyu^ 02030—P^-. ppm n D Time: _ Ajy i 

Numberof Samples = 4^ Staff: AA. 

fOLC •^QAlX£>( 

<3 

SMT 

AU6 

sliBrU 

1 1 288^ 

01 

^^? 

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i/^.if. -ST. 

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Omaha Lead Site 46130 
32939 

( 

Omaha Lead Site 46130 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

te^-s 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1512350000 

COMBS 

CAROLYN G 

3810 N18 

ST 

OMAHA 

68110 

3902 IDA ST 

OMAHA 

NE 

68112 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

03-15-13 

KIRKWOODADD 

3 

5 

S10FTLT4&N25FT 

35 X 140 

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

parc=1512350000 

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

accountno=R1512350000 

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 = 43 feet appraisal, survey, or for zoning verification. 

http://\vww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20County-Omah... 6/12/2008 

gJ2^lDi 


file:///C:/Users/lorcl|«pis%20my%20shepherd/Desktop/STREETS/., rcuao 

Create Another Ticket . i BacIc to Irth Internet Send Email 

YOU R TICKET NUMBE R IS  2077764. 


Original Call Date: 7/09/08 Time: 12:38 pm Op: RAMITA18967 


Work to Begin Date: 7/11/08 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3810 Street: N 18TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type cf Work: LEAD REMIDEATION 


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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number lype 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MIDSTREAM MAGELLAN TONYA Alt: PARTNERS LP 

Emerg: 9185747098 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl EDWINA Alt: DISTRICT 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

OMAHA PUBLIC POWER Day: 4067289343 0PPDGPR5 DISTRIC NA T 

lof2 7/9/2008 1:19 PM 
file:///C:/Users/lor(giBis%20my%20shepherd/Desktop/STREETS/. rcUSfi .

Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNElC QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

2 of 2 7/9/2008 1:19 PM