TRANSMTTTAL of OMAHA LEAD SU E 

SOIL REMEDIATION FILE FOLDER 

SAID #: )?>g/i/- Date: \nj \!^(b^ 

Address: .^?Kf C %7^ A j 

Remediation Contractor: JXj\^l ^ fJ L ' 7^Cy Year: "^rf) 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Q Video of property (DVD) 

a Executive Summary 

Q EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

• Restoration ^reement 

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

Gi Confirmation data 

21 Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

B Utility clearances 

Property information from Douglas County Assessor's OflBce 

D 

D 

D 

Signature/ Date 

30054263 

lliHI 

Superfund 
Find Recotxl Remediation Query j Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 13814 ­ 3214 S 32 AV 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: JMARTINEZRICARDOT |PRUDEMT2009_S 

JMARTINEZRICARDOT Property Address: Contract Option 

Owner Addressl: |3214 S 32 AV |BASE 

Zip Code: 

Owner Address2: |68105 Ass^ment: 

|3214 S 32 AVE Resident Phone 

City: State: Zip Code: I Qualifying Group 

jOMAHA |NE |68105 |400 

Owner Phone: 

|(402) 614-5365 

Alternate Phone: 

"1 Assessment Max XRF Value: 

r 620.81 
ipwciipitiwiry SHI Nww^MWiy 

Date; 10/15/2009 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l I Month of: September 

Property Address: 3214S32AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A ^ Issues Resolved: NONE 

A 3 Unique Findings: NONE 

A.4 other Relevant Information: AREA NOT EXCAVATED DZ/LS 18'X9' 213 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F l = 62 PPM @ 12''; F2 = 30 PPM @ 10"; Bl = 148 PPM @ 10"; DZ = 201

SCRAPE (~1) 

 PPM @ 13"; EA = 130 PPM @ 

ATTACHMENTS 

1)

2)

3)

4)

5)

6)

 Property sketch provided by EPA pursuant to contract specifications 

 Signed Access Agreement including access agreements required for crossing other properties 

 Pre-Excavation digital video clip/photographs 

 Post-Excavation digital video clip/photographs 

 Documentation - Completed Close-out Checklist 

 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. 

INDiTDJGfES.IIC 
TEOINOLOGIBS, INC 

Property #: f'J>fr(i4 

Date/Time: ^ » 

Quads Excavated: pLrXiVZ/*^^ ^ 

SERI\ 

EPA Property Close Out 

Property Address: '^'Z H $ ^ "^ 2- A A> ^ 

Owner's Name: <2.,^<: a rcl^c* fKAtfV>.A(rz_-

Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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 perimeter of (he house in excavated areas generally slope away </ from die house? 

2. Has sod been laid in all areas that were excavated? i X 

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? ^ 

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

6.

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

7. Was damage to landscaping or plant materials avoided? y -

Gates, Fences and Retainine 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, Sidins 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? 

^ 

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 w^arranty: 

EPA Representative f3L^ ^ Date: 9/fs/o<} 

7 
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: -^ 2. V M >S 3'2^'> ci ^ ^^<^ 

0^°e'-= ^tcXfl^cJ L M^cc^tn^^eL'^ 

Phone: ^ 

Restoration Items in Question: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

f I agree restoration is completed. 

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

^ 

^ - ^ 7 - J^^^; •' f'—=~ : '— 7 Date Owner's Signature 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow Prudent 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 ofthe referenced property. 

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

Omaha Lead Site cleanup. Ms. Madhurima Duru -at (402) 733-1188, 733-1455. General questions about the Omaha Lead Site 

cleanup can be directed to the EPA Public hiformation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North 

Omaha office). 

Property Access Granted By: 1\C<LH-^"JI ^ f> / ^ AI^T]\ > £"2.­

(Please Print Name) 

Property Owner Signature: y-^'p'd) ^ 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: cPJf r a r rJL o M^u r \ n A€_- g Renter 

RESIDENT ADDRESS: 

32.1M S <2>Q^f\X_ Avr ^ Cbr^hXuu V ^ C=%\^ ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

*^^^^^ ^ 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

AGE OF HOME? •.3ol YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? J;^ , ES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: Q NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 5- NUMBER 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.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(c) of 

CERCLA, 42 U.S. C 9605(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 ofthe title." 

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 
ENVfRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 3 2 IM S 32-n d ^^ e Date: Ct^<^loc ^ 

Phone: ^bT.- ^tS - c;-2.^*? BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

SeudV s:?ae. r<o ^ ^ ^ ^'-^ ^ '^"'d-^ H^AxzL . 

* p e (^ Voarvt- -4-U50 LA;€e,\^ AoKce _ lo r SckeJLuJL^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of lealdng? Yes No 

^ 

Item NO Description & Location ocro ^ ) 

On Map 

Vo CJUUL o>*^(^t^cUXe) 

Property Owner Prudent Employee 

Signature: Signature: 

/^^:x9^^9 

gno n lAlarH Darlr\ir3\/ CnifA AflJ; ocini; M Oil'" ctroot cuito '^no AOAO jiinnMi^'yi nrit.r^ Ciit n ><ocn 
fTCITN'dl nCilF.S. INX'. 

AS - BUILT DRAWING 

OI.Sr.::13i>!14 

IM'.P.VSiyncd-tMTIJutr: OMAHA LEAD SUPERFUND SITE 

Name: i?lt^r<f o J^r-Tt'te ^ Omaha Lead Site Date: North Arrow 

Addres&\2IZ5IS~^^E>?V SKe Skietch Time 

FT J wU i I ^1*7 ^^^;L^//:^^^|'7yJ^ i BviD# /^P W XRF Code 55P4 

Sample Numt>er Lead Concentration Confimiatian Sample 

^/Yes a No ^ 

g ^ +• g ^ ppm ^7Ye« a No 83 

-?/Yes a No fi3 'MPSOP^ W AlYes CD No K T 

YWYes a No Bl 

• PzatLPx:/! /» Yes CD No Bsr 

Yes • No a 

Omaha Lead Site 46130 

CONTRAa #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
Name: /^'tc^r^ o WiajrTine ^ 

Address; 32./*/ S. T^^'^^O ^ 

Phone/iy<i.) U'H-S-J.US' 

Omaha Lead Sttb 

Sits Sketch 

Date: 

Time; i: 'tat^ f 

^ 

^'' f 

North Arrow 

IffU^ ^^n^j^Lr^lCui^h ^ BviD# /gp/ y XRF Code ^P 4 

Sample Number Lead Concentration Confimiation Sample 

^/Yes a No ^ 'J:» ^ ^—"s — ppm /sxYes n No 83 

ppm -J/Yes a No «3 

ppm iSZ-Yes n No SO" 

ppm ^Ye s n No d 

ppm 

ppm 

/» Yes

Yss

 n 

• 

No

No

 l a 

• 

H>Z 

^^>WL;V>«»M. 

Omaha Lead Site 46130 
1 ag e i u i 1 

March 200? DOUGLAS COUNTY ASSESSOR T!a.''?imKE.flti...W^*3ti . -Ui,> 

32) ^ S 3 2 ..^' 

http://douglasne.mapping-online.com/assessdoc/Photos/21/R23228700000001.jpg 6/12/2009 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPreview.aspx7PrinlOpL. 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2322870000 

MARTINEZ 

RICARDO T 

3214S32AV 

OMAHA 

68105 

3214 S 32 AVE 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

33-15-13 

THOMASON & GOGS ADD 

6 

3 

W 120 FT 

45.43X120 

http://webapps.ciotcomm.org:8080/TreasTax/faces/pages 

/taxinfo.jsp?parc=2322870000 

http://clouglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R2322870000 

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 = 26 feet 
Pagel ofl 

"> 

Cfeate Anotiier Ticket Back to Irth Internet Setxl Email 

• YOUR TICKET NUMBER IS 2320456. 

Original Call Date: 7/17/09 Time: 2:44 pm Op: SIVA18967 


Work to Begin Date: 7/21/09 Time: 3:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3214 Street: S 32ND AVE 


Twp: 15N Rng: 13E Sect-Qtr: 33-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Worl<: 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 


Conpany : 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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

MUD02 METROPOLITAN UnLITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITYOFOMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.(flion.org/irthintemet/i:WONNoticeCreati<m/MessageText.asp?ret=<RESULTS... 7/17/200^ 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: 3^^^ s.jsz 

Crew: 

Date: 7* ^0* 7 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

1 Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

! Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

^ c ^ 

Au/^tigJ 

! 

1 

yL/A-

A^A 

/4fl < 

r^,A 

-^AtA 

I^COIL 

t 

/i,A­

•AtA 

Exf2£^->'t (h 

Corrective 

Hazards Action 

yOfuAfy^'e L/j'-e >^/qo 

A^Jc^a ^ 

j

{ 

Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24 street. Suite 308 4242 Medical Drive, Suite 7250 

Kansas Crty, MO 64114 Omatia, Nebraska 68110 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210) 822-95S3 

Fax: (402)504-1005 Fax: (210)S78-S5?7 


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