TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: .^qqa ^ Date: (^l j c^,?,j ^Qn^ 

Address: ^7/<) y ^^ ^-f 

Remediation Contractor: 1^/^, i rvs n^l9zUi\intnqff-JL. It^Oj Year: ^<^^9-JPofl^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0^ Video of property (DVD) 

13^ Executive Summary 

B^ EPA-provided property sketch 

\s Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

[T Restoration Agreement 

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

12^ Confiimation data 

B^ Photographs 

B^ As-built sketch 

S^ Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0^ Utility clearances 

Q^ Property information from Douglas County Assessor's OfiBce 

D 

D ' 

D 
PROPERTY SUMMARY 

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

Property Address: 4710 N 36 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Oflier Relevant Information: NONE 

B2 = 199 PPM @ 6"; LANDSCAPE = 139 PPM (@ SCRAPE 

ATTACHMENTS 

1) Property sketch provided by EPA pxirsuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavation digital video clip/photogr^hs 

4) Post-Excavation digital video cUp/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi). Shall includefinal 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 propertyfile, 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) fomiat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Recx)rd 

Backfill: 

Sample Area: 34936 - 4710 N 36 ST 

Owner: 

n Owner Orrjjpied 

Owner Name: 

(JOHNSON SR JUUAN H 

Owner Addressl: 

Owner Address2: 

)4716 N 36 ST 

City: State: Zip Code: 

JOMAHA )NE |68111 

Owner Phone: Alternate Phone: 

' - - — - j . 

Qean Up Query Lead Remaining Query I

Resident: 

Resident Name: 

[TENANTS 

Property Address: 

|4710N36ST 

Zip Code: 

|68111 

Resident Phone 

 Property Damage Query 

Contract: 

Contractor: 

|PRUDENT2008^S 

Group: 

Assessment: 

Qualifying Group 

|PLAY ZONE 

Assessment XRF Date: 

Assessment Max XRF Value: 

I 701.05 
TECHNOLOGIBS, INC SEM 

EPA Property Close Out 

Property #: 3^'=^3>4. Property Address: ^n/c W3< S TDate/Time: Owner's Name: 

Quads Excavated: B 0- y eft Contractor Group Prudent Technologies 

Excavation General 

Yes /No 

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

2. If necessary, were the correct areas of drip zone excavated and restored? 

L / 

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? c/' 

2. Has sod been laid in all areas that were excavated? 77­ 3.

 Doe

day tim

s th

e

e

 period

 sod appea

) 

r to be generally healthy and growing? (Only evaluate if inspected at a 30 z"­ 4.

 Are sodded areas generally firm and evenly graded? Z 

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? « / 

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) 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) Z ' 

3. Was damage to gates or fences avoided? (If applicable) 17 

Z . 

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

Foundation, Siding and Gutters 

Yes ^ b 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? ^ ' 

3. Was damage to windows avoided? Z^ 

4. Was damage to windows or door screens avoided? ly 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
Ovi^ners comments: 

Inspection notes: 

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

EPA Representativee 0 ^ Ll £ Da.: //^/^'^ 
dERA 

Property Completion Agreement 

This agreement documents the completion of removal activities perfonned on tiie below listed property. 

The property owner's signature indicates &at 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: Li" ! I n M ^C+ ^ ^.v- '^^^ 

Owner: 

Phone: 

Restoration Items in Question: 

Kem: 

Hem: 

Item: 

Item: 

Item: 

Item: 

Required correcfions to complete the property: 

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

O i do not agree restoration i& completed 

XI ^ 

Owner's Signatare Date 
Prudent Technologies, Inc. (Piudent) is under contract with die U. S. Environmental Protection Agency (EPA) to clean up leadcontwjnated soils at animAer of pioperties located in Omaha, Nebraska, including the property located at 

V7/ 0 A/ . 3(r ^ .sy. The EPA requests your permissbn to allow I^en t to perform a soil cleaniq> at this 

property to remove lead-contammated soil. By signing thisform, 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 ihe referenced property. 

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

Omaha Lead Site cleanup. Ms. Deborah Johnson -at (402) 733-1188. Graieral questions about the Omaha Lead Site cleaiup can be 

directed to the EPA Public Information Centers at (402) 731-304S (South Omaha o£Bce) or (402) 991-9583 (North Omaha o£Bce). 

Property Access Granted By: <JL^ \ I Af>J JI}/|A/.^OA / "^ l/i/"ij i \ f j' A 

(Please Print Name) ' 

Property Owner Signature: (Sign^ure) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Oo h M.SO/\) , \Jl(ltjihl l A .• K)wnen Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: h/rh 

OWNER'S MAILING ADDRESS; 

^"TfTi^e r^-s ojp0i/f 

OWNER'S TELEPHONE NUMBER - HOME: (ft>dL) 70 S 'S / 0 V " WORK: 

J 1 

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

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ( 0 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: 1 

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 providedfor in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entryfor "determiningthe needfor response, or choosing or tiking any response action 

under this title, or otherwise enforcing theprovisions of the 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 
AS - BIJttTJDiRAWBfG; 

OMAHA LEAD SUPERFUND SITE /^ OLS#: 34936 

Date Excavated: 11/20/2008 

USEPA Signed'OffDate: 

34936 

Onnaha Exterior Psint Ncfth Arnow Own« Lead Site r Nam*: RAYMOND L CARLISLE • Good Site Sketch Address: <710N 36 ST .._jtx 

Phone: *^- 402-932-6996 W: 402-633-1652 [J^f Not paint 

Sampie Number Lead Sample LAB Samples Collectecf 

Concentration Collected Firm: M£ ^ M ^}i^ ­

RY/iiSCPXA-34936 F l D Date: _3d±QS____-_ •RYBSCPXAr34936 F2 D Time: 3iS& 

RYCSCPXA-34936 Bl LSI. _ ppm 

D Samples Aralyzed RYDSCPXA-34936 B2 —HA i _ppni or a 

RDZSCPXA-34936 DZ •- /(S-^.. w>m I T ' • XRF Unit /i937 Boolt: 13 2 

nOilOOPKA 04006 62 .ppm Date: 

RP2SCPXA-34936 P2 ^ S ppm 

• 

Time: P'/H 

Lab RPZSCPLA-34936 Number of Samples = ' 5 t Staff: J ^ 

ResuH 73,4ppm lA<^^r>M Front Right, B l = Back Left. B2 > Back Right DZ = Drip Zone, GZ >= Garden. PZ = Play 

All quadrania it^f t viewed flwntht ttreei. Iicng prapoly ^ 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^7/ 0 Ncr ^ ^^ ^ S,f- Date: 1//l3^jo% 

Phone; CVOa) ^I^-<ii n or (^02) S22-/(,^^ BVID: 3V934 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

N 0 pli\^h ^ ^^^ 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No /y 

Item NO Description & Location 

On Map 

X 

Property Prudent Employee 

Signature Signature: 

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

Kansas City, MO 64114 Omaha, Nebraslca 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 

Page 1 of 1 

Auaust 2007 - DOUGLAS COUNTY ASSESSO 

^-JIO Kf 3t Sfhttp://douglasne.mapping-onIine.com/assessdoc/Photos/01/R10236900020001.jpg 11/19/2008 
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 

1023690002 

JOHNSON 

SR JULIAN H 

4716 N 36 ST 

OMAHA 

68111 

4716 N 36 ST 

OMAHA 

NE 

68111 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

05-15-13 

EPWORTH 

0 

10 

ALL LOTS 9 & 10 101.6X128 

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

parc=1023690002 

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

accountno=R1023690002 

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 = 93 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Count... 11/18/2008 

-^.v-'Sinj^yf 

. ^ag;^'!l^^ 

^^g# ^ -#^^:«y?^# 
Page 1 of2 

"> 

Create Another Ticket ^. Back to Irth Internet i;: 

> Send Email 

YOUR TICKET NUMBER IS 2176550. 

Original Call Date: 11/17/08 Time: 10:48 am Op: MADHURIMA18967 

Work to Begin Date: 11/19/08 Time: 11:15 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4710 Street: N 36TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 04-NW,05-NE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


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 METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC SPRNTPCS 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

METRO METRO COMM. COLLEGE CHRIS

Day: 4024572307 

 Alt: 4026727033 

Emerg: 4024572313 

MUDOl 

Day: 4025047823 

METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESlJLT... 11/17/2008 
Page 2 of2 

Day: 4067289343 


OPPDGPRS OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNEIC QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 


Day: 4025371800 


SPRNTPCS SPRINT SPECTRUM L P Alt: 4025371810 


Emerg: 8005210579 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?retr=<RESULT... 11/17/2008