lUANSMITTAL of OMABA LEAB SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: t^l^^ h Date: ^^|\io|n9 

Address: ^\ 0 S \Q 91-

Remediation Contractor: P^JU.^h ^ock. Dy^r-^ Year: Q-QO^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

oi Video of property (DVD) 

II Executive Summary 

EPA-provided property slcetch 

E Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

II Restoration Agreement 

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

i Confirmation data 

Photographs 

S As-built sketch 

0 Satisfectory restoration s^ped by Property Owner 

ffl Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleamq) criteria 

Utility clearances 

^ Property informationfrom Douglas County Assessor's Office 

D 

D 

D 

isignature Date 

30054176 

•Hi 

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

Backfill: 

Sample Area: 47296 - 5610 S 19 ST 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: 

Contractor: 

Owner Name: PRUDENT2009 S 

I 

|DELEON JOSE C Property Address: Contract Opbon 

Owner Addressl: |5610S19Sr JOPTEONT 

Zip Code: 

Owner AddressZ: [68107 

Assessment: 

117752 MARGO ST Resident Phone 

City: State: Zip Code: r~— Qualifying Group 

|OMAHA |NE |68136 |400/CHILD 

Owner Phone: Alternate Phone: 

Assessment Max XRF Value: 

1(402)884-0983 |(402) 517-6438 1 609 
Date: l4/15/2009 | Oinaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: October 

Property Address: 5610 S 19 ST 

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: 

B2 = 199 PPM @ 12"; DZ = 395 PPM @ 12"; EA = 136 PPM @ SCRAPE (~1) 

ATTACHMENTS 

1) Property sketch provided by EPA piu'suant 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. 

twm 

TKfflWDOBIBSSJMC 
TECHNOLOGIES, INC. 

Property #: ^ 72i?t' 

Date/Time: 

Quads Excavated: gl , "p^: 

EPA Property Close Out 

Property Address: 5=$ ^ S/<?St: 

Owner's Name: ^^^^rS^ O e.- /^IC >x 

Contractor Group Pnident Technologies 

Excavation General Yes No 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? t 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? 

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 

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? 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? y 

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? J 
Owners comments: 

Inspection notes: 

^» s tk>r sooeeo. 

- H K ,ol^ ' 

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

EPA Representative ^ Date: /o/2f/oj 'asa. ^ 

IA 
Property Completion Agreement 

This agreement dociunents 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 D): 

Property Address:^ ^ (0 ^ [ <^ t ^ ^ ^ 

Owner: Q^ ^ (Z^J> ^ L&)A ' 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

 I I agree restoration is completed. 

L J I do not agree restoration is completed at (noted deficiencies above) 

TAOM 

)wner's Signature 

I
Prudent Technologies, Inc. (Piudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow IMident 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 of the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact the Prudent Office for the Omaha Lead Site 

cleanup at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

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: 

(Signature) (Date) 

PROPERTY INFORMATION 

(Xa bt completed by resident and/or property owner — please print) 

RESIDENT NAME: eJ».^>A-.>JO Owner Renter 

RESIDENT ADDRESS: 

\^vt^ 9>t- (^^•>^\^ \ ^ (^^0 ^ 

IF RENTAL. PROPERTY OWNED BY:. 

0-^g^> ^ 

OWNER'S MAILING ADDRESS; f. . A a , ^ 

OWNER'S TELEPHONE NUMBER-HOME: ( > WORK: 

AGE OF HOME?: tOf > YEARS. HOW LONG HAVE YOU bWCB HERE? ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

1^ 1 BER 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.) 

ALITHORmr FOR ENVIRONMENTAL RESPONSE ACTIONSi The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess 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 of the title." 

ttA n *Hr*f*'i. -«i n..Uf.\ c t 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, EVC. SERVICES 

Property Status Form 

Address: t ? Q. IC? " ^ \ ^ ' ^ V— Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^ o Ji^Unlci Vbi^r «i3--enrv^^Dc»v~<'^-ci-fiCJSV '^^'"^^—^^xst 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes ISoyy/ 

Item NO Description & Location 

On Map 

u ^ c W-J-^- ^ '^^^t^ 

Property Prudent Employee 

Signature! Signature: 

)080 Ward Parkviray, Suite 405 5600 S lO"' Street 4242 Medical Drive, Suite 4250 

<an5as City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

'hone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

-ax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
niE.S. INC. 

AS-BUILT DRAWING 

Ot,S#:47296 

Date Kxiavatrd: 09/16/2009 

rsKPA Si|>nc(l-Otr Dote: OMAHA LEAD SUPERJtJNl) SfTE 

47296 

Oniah Exterior Paint a Lead Site • Good Site Sketch 

Sampling Addras*: S610 S19 ST n Not paint 

Sample Number Lead Sample |. _ Samples Collected 

Concentration Collected 

RYASCPXA-472ee F1 2\ \ oom S^ n Dale: L,nL.in'A 

RVB3CP)(A-t72«l 

RYCSCPXA-47296 

RYDSCPXA-472e6 

-F2-

B1 

B2 

3Sf i

GXi^

poiti

 ppm

 oom

 n

 S I

 Ca^

 n 

 \ Z 

D 

Time: iO- )•? 

Samples Analyzed 

RD2SCPXA-4729e DZ ^2. 0 > Dom B ^ D XRF unit: QS*i( i Boole: JA A 

WQZ60P)tA-47296 

nPZSCPXA 47206 -PZLab RYC8CPLA^7296 

Result 411 ppm 

ppm

ppm

Number of Samples = 

D

 D

 D 

D 

Date: T-O l

Time: _j^t l 

Staff: _t\S W 

 '0 & 

,. . - Front Right, Bl = Back Left, B2 = Back Rigm DZ -^ Drip Zone. GZ = Garden, PZ = Play 

All qua^wits un u wwad from the elreat ten^jropTly 

CONTRA a #: EP - R7^7-0 6 T0# 1 PRUDENTTECHNOLOGIES, INC. 
Omaha Lead Site 

Site Sketch 

Sampling Address: 5610 S 19 ST 

Sample Numtier 

RYASCPXA-47296 

RYD3CPXA-47290 

RYCSCPXA-47296 

RYDSCPXA-47296 

RDZSCPXA-47296 

ROii60P)(A-47£B6 

RPiZOOr'XA 47206 

Lead Sample UkB Concentration Collected 

F1 ppm D 

ppm D 

Bl ppm ET 

82 ppm D 

47296 

Exterior Paint North Arrow 

• Good 

Ea^oor 

[ 3 Not paint 

Samples Collected 

Firm: PE Tr.r. Q& T \ 

Date: L*hL,infi 

Time: 10-1? 

Samples Analyzed 

_ Lab RYCSCPLA-47296 n Staff: Result 411 ppm Number of Samples LC Li nsw • Front Right, 81 = Back Left, B2 = Back Right DZ •Drip Zone, GZ = Gatden, PZ = Play 

All quadrants are as vienwd from the strsat, < rty 

vt/AU. 

ALL'C^ 

'•••»T4';*r>" »

k 

JUN f 8 

'(^m POOi_

&1 

356 

mr 

tTiEcK 

U M C 

TC r 

;ZII 

DZ ppm D XRF Unit: GSHO Boole: ?Aft 

-SZ- ppm D D Date: _ OB 

-P2- ppm D Time: AdV\/AU<. 

S. :1*=1 3^. 0««cd. 31.DecJ)7 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner

Address

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

1814670000 

DELEON 

JOSEC 

5610S19 

ST 

OMAHA 

68107 

 ^^^^^ 

 ^ARGO ST 

OMAHA 

NE 

68136 

10-14-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Unk 

Assessor 

Website 

Link 

MORRISONS ADD TO SO OMAHA 

A 

3 

N1/2 

25X133 

0.08 

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

parc=1814670000 

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

accountno=R1814670000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/18/2009 
Page 1 of2 

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• YOUR TICKET NUMBER IS 2359829. 

Original Call Date: 9/09/09 Time: 11:01 am Op: SIVA18967 

Work to Begin Date: 9/11/09 Time: 11:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 5610 Street: S 19TH ST 

Twp: 14N Rng: 13E Sect-Qtr: 10-NW 


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: (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 


ALT872 ATTNEBRl CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 


PAETEC QLNNEIF 


Service Area Contact Phone Number 

Utility 

Type 

ALT872 WINDSTREAM 

COMMUNICATION NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day:

Alt: 

 8773668344 

httn://www.dhon.ore/irthintemet/DHONNoticer.reation/MessapeTevt asr>'?ret=<RFST TT TS Q/0/?nOQ 
Page 2 of2 

MUD02 

OMAHACOF 

0PPDGPR6 

PAETEC

QLNNEIF

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 PAETEC COMMUNICATIONS 

 QWEST LOCAL NETWORK

SANDY 

RON 

NA 


NO NEED TO CALL OUT 


EMERGENCY 


 NA 

Emerg: 8773668344 

Day: 4025047823 


Alt: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


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