TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: S-^^yi- Date: 

Address: rtf2^l J>e.c.Jtu^ SitRemediation Contractor: J^^jLu-h UJiA.J^y^,_ T^^y ^®^* ^^'^Xl 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[Zf Video ofproperty (DVD) 

0^ Executive Summary 

B EPA-provided property sketch 

^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjajent property 

0^ Restoration Agreement 

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

IZ Confirmadon data 

IF Photographs 

1? As-built sketch 

El Satisfactory restoration signed by Property Owner 

[/ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

\Z Utili'ty cleartuices 

w Property information from Douglas Coimty Assessor's Office 

D 

D 

D 

Signature^ _ D>at a e 

40310721 

liHi 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 5421 DECATUR ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Oflier Relevant Infonnation: NONE 

CONFIRMATION SAMPLING T>ATA/RESULTS: 

DZ = 65 PPM @ 12"; F2 = 48 PPM @ 4"; NO EASEMENT 

ATTACHMENTS 

1) Property sketcli provided by EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossrag 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. 

ECHNOLOGIES, INC. 
Find Record Clean Up Query J Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 84976 - 5421 DECATUR ST 

Owner: 

D Owner Occupied 

Owner Name: 

LEBEDZ STEVEN R 

Owner Addressl: 

Owner AddressZ: 

5421 DECATUR ST 

City: State: Zip Code: 

OMAHA [NE" )68104 

Owner Phone: Alternate Phone: 

(402) 551-1397 . |(402) 639-2640 

Resident: 

Resident Name: 

r 

Property Address: 

)5421 DECATUR ST 

Zip Code: 

|68104 ' 

Resident Phone 

Contract: 

Contractor: 

jPRUpENT2008_S 

Group: 

I 

Assessment: 

Qualifying Group 

[NORTH 

Assessment XRF Date: 

r 

Assessment Max XRF Value: 

I soT 
TBCHNQIOGIES. INC SEFVK 

EPA Property Close Out 

Property #: €4<?l6 

Property Address: J5^-?l L>SC fTfo/Z.s.i 

Date/Time: Owner's Name: 

Quads Excavated: ^'^ / ^^ f Contractor Group Prudent Technologies 

Excavation General Yes No 

1. 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 Yes No 

1. Does the grading around the perimeter oflhe 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) / 

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 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) / 

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

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

y 

Foundation, Siding and Gutters 

Yes No 

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

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? 

y 
Owners comments: 

Inspection notes: 

Sooi^'f Ccnoiriov j inpfiiHeO ^PB s c/ost'OniRemoval and restoration activates complete including the 30-day sod warranty: 

EPA Representative <^^ ^^ ^ Date: //af/o^ 
<s£nH 

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 Usted below, if any. 

Property ID: 

Property Address: j ^ ^:2, \ D P r cJU ^ "KVOwner; Sh\^ ^ /f. U^M-Z 

Phone: Qto-2-') ^S'l'l^' H 

Restoration tt^ns in Question: 

Item: . 

Kem: 

^ ^ . .^'' ' 

Item: 

Item: 

1 Item: 

Item: 

Required corrections to complete the property: 

S o d 

$35 " r^'^^v^^-^ejK^uivA­

; ^ I agree restoration is completed, except as noted above. 

LJ I do not agree restoration is compieted 

/2- 2 7-^dP 

Date 
DEC. 5.200 8 3;58PM NO. 473 P. 2 

Prudent Tccbuoloeies, be. (Pnident) is under oontnct vrith Cltc U. S. BDviranmcDtal Fiotcccioa Ascacy (BPA) to clcin vp Icadr 

oontflmiioRd roils BI t nu^s r ofpropcniea located in Omaha. Nebraska, ioclading ihe propeny loeaied K 

5^2 / O^CeifUr ' Sir-tf f The EPA tequesB your permission to allow Prodent ^a peiform » soil cleanup ai this 

property TO ranove lead-coaiaminaRd soil. By sigDing thit (brm, ihe properry owner grants permission to Prudent to perform 

activides ijelaied io the cleanup includins soil samplin*, leijiovai of lead-conttmioated soil, and restoration ofthe reftrenced propeny. 

If you havo any qaesnoos about the soil cleanup planned for your property, please conna Pndern /^dminigtrarive CIcrfc for the 

OmahaLead Sue cleamtp. Ms. Deborah Johnson -at (402) 733-1188. Oenoal questions aboui the Omaha Lead Site cleanup can be 

directed to the EP A Public tnfbtmation Centers at (402) 731-304S (South Omaha office) or (402) 991-9S83 (North Omaha oflEce). 

Property Access Granted By: 5"^/f^ ^.Ui>^-^ 

Properry O^mer Signature: 

(D«c) 

PROPERTY INFORMATION 

(To be eompleted by rtsidcnt and/br propeny owner — pIc«K pnof) 

RESIOENTNAME: Rentsr 

RESIDENT ADDRESSSS: \ : i n I 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; 

OWNER'S TELEPHONE NUMBER-HOME: \.4ai. \ S^S' I 'l^^ l WORK: 

^^t2,^ 2^^-4080 

AGE OF HOME?.: 6> t J ' YEARS 1 . HOW LONG HAVE YOU UVED HERE? '^ au^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? )(, YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: Q 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: 

O 

COMMENTS OR SPECIAL INSTRUCTIONS: (l-E DOGS, ENTRY GATES, ETC.) 

KiSvykOVXm POR ENVIRONMENTAL RESPONSE ACTIONS; TTie activities to be implemented by EPA under this agreement 

•re pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's tigW of access to the propcity is provided (br in Section 104(e) of 

CERCLA , 42 U.S. C 960S(e). which provides entry fbr "determining the need for response, or choosing or liking any response action 

under this title, or otherwise enforcing the provisions ofthe trtle."' 

B080 Ward Parlcway, Suite 405 2505 N. 24** Street, Suite 308 42a2 Modical Drive, Suite 4250 

San Antonio, TX 78229 Kansas City, MO fi4l14 Omaha, Nabraska 68110 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 3eM707 Fax: (402)504-1005 Fax: (210) 579-6577 
.».* ' i * •*.'. ' 

'•' :6MAI^X6ii^iSJb?ERE 

OLS#: 84976 

Date Excavated: 12/09/2008 

USEPA Signed-OfTDate: 

84976 

(1 racioecAnjRgr 

Oimha LMd site 

SUaakMcli D 

OHet 

RYASCPXArftMTO F l 

Colattail LAB 

D nmi:je£^JL£&_£JL 

RYBSCPKA«l«n

KtcecpxMtsm

RVDecn(M4978

M)iZBCPXA4«a7B

 F2 

 si 

 B2 

 OZ 

.JLfta_PPm i a 

a 

a 

a 

a 

Tane: lOMfe A.»t. 

Oeinptas Amrtj^ad 

XRF Una: 65¥ ^ Book: 213 . 

-pa- D a ^ 

Niwherofaw<fc»»r5a^ (QT I .^r&ia2-

NO EASEMENT 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
—-•^fci 

&W. lJ!iiOP|lW!HVlf.-VL i* 'jmm V t'OiVa'lfftiLiCTIlOiN 

TECHNOLOGIES, MC. SERVS'C'EiS 

Property Stotos Wmm 

Address: 5Y^ ' 'DeC/Xh-^^^ ^ ©ate: (^^/ ^ 

Phone; <$^H 13^7 BVID; i^y^7 ^ 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: Signature: 

8030 Ward Partway, Suite 40S 2S0S N. 24 Street, Suite 308 4242 MedltMl Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San AntonicTX 78229 

Phone: (816) 36S-3703 Phone: (402)504-1004 Phone: (210) 822-S588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 576-6577 
84976 

Omah Exterior Paint North AncMf a Lead Site 

Site Sketch 

Q'Poo f 

Sampling Aildra««;S421 DECATUR ST O Not paint J 

Sample Number Lead Sample Samples Collected U B Concentration Colle ^ Fjmi: PE. Q,,C £,K' 

RYASCPXA^497B Fl 

ppm D Date: <^'IO-Ot 

RYBSCPXA-84976 F2 

ppm D Time: 10'IU A.IM.. 

RYCSCPXA-8497B Bl ppm D 

Samples Analyzed 

RYD8CPXA^976 B2 no ppm 

RDZSCPXA-84S76 DZ n

ppm XRF Unit: ^5V 0 Book: 2J3 _ D ngMCPXA 9i9n 62- ppm a Date: ^ -22.'0 8 D nrgOCPXA 8*076 RZ- ppm Time: iRr>\ D 

Staff: <nS U Ntwiber of Samples =|5 i \ 0 j 

Legend: Fl = Front Left. F2 = Front Right, Bl = Bat* Left. 62 = Back Riglit OZ = Orip Zone. GZ = Ganlen, PZ - Pla^ 

Al qudrertft ttv tt vtaMndfroni ths ibMt, bdng prapirty 

ie in V • • • m )t • - y 
Page 1 of 1 

lune 1999 - Douglas County Assessor «6»,i wriffrmi^-'wi.- ".}': "••?M5i^l lyc.c^K'^ s-K 

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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 

2410440000 

LEBEDZ 

STEVEN R 

5421 

DECATUR 

ST 

OMAHA 

68104 

5421 

DECATUR 

ST 

OMAHA 

NE 

68104 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

18-15-13 

WASHINGTON HILL SUB 

0 

6 

W51FT 

51 X 127 

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

parc=2410440000 

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

accountno=R2410440000 

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://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 12/5/2008 
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Page 1 of2 

Create Another Ticket, ^ . -, Back to irth Internet Send Email <. f. . I h.' 

YOUR TICKET NUMBER IS 2186970. 

original Call Date: 12/06/08 

Work to Begin Date: 12/10,/08 

Time:

Time;

 8:58 pm 

 7:, 15 am 

Op: MADHURIMA18967 

State: NE 

Address: 5421 

County: DOUGLAS 

Street: DECATUR ST 

Place: OMAHA 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 18-NW 

Sect-Qtr; 

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 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS l7/6/9no» 
Page 2 of2 


Day: 4067289343 


0PPDGPR5 g^^LICPO^ ^ NA Alt: 4062071494 


Emerg: 4065237717 


Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 4065237717 

http://www.dhon.org/irthintemet/DHONNFoticeCreation/MessageText.asp?ret=<RESULTS 17/fi/7nf^»