TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SATO #: 7.7 llP^ Date: /iJi 

Address: ^ ZD U . 7 ^T 5^^ 

Reinediation Contractor: V^^MM T ^J^(lir< \i\C • Yean ^O l 0 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

IZf Video of property (DVD) 

af Executive Summary 

/ EPA-provided property sketch 

^ Signed Access Agreement for subject property 

• Signed Access Agreement(s) for adia^ent property 

/ Restoration Agreement 

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

a Confirmation data 

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 

Utility clearances 

Property informationfirom Douglas County Assessor's Of&ce 

D 

D 

D 

isignature "•• Date 

30260732 iiiii 

Superfund 
Find Record 

Backfill: 

Sample Area: 27163 - 1920 N 25 ST 

Owner: 

n Owner Occupied 

Owner Name: 

• 

(SUNBURST PROPERTIES INC 

Owner Addressi: 

Owner AddressZ: 

|7519 S 137 AVE 

City: State: Zip Code: 

[OMAHA |NE |68138 

Owner Phone: Alternate Phone: 

1 

% 

Remediation Query i Lead Remaining Query I Property Damage Query 

Resident: 

Resident Name: 

I 

Property Address: 

)1920N25ST 

Zip Code: 

|68111 

Resident Phone 

I 

Contract: 

Contractor: 

|PRUDENT2009_S 

Contract Option 

|OPnON 2 

Assessment: 

Qualifying Group 

poo 

Assessment Max XRF Value: 

I 591.07 
PROPERTY SUMMARY 

Date: /15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 Month of: 

Property Address: 1920 N 25 ST 

A EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.S Unique Findings: NONE 

A.4 Other Relevant Information: 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 58 PPM @ 13"; DZ = 301 PPM @ 12"; Bl = 173 PPM @ 16"; EA = 244 PPM @ SCRAPE (~1") 

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) Propertv' address vii) Date 

iv) BVIDiiumber 

7) Other items to be included in the individual property' file, if available, or obtained include: 

i) Pre-excavation agreement details (ifany 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, iNC. 
TECHNOLCXJIES. INC. 

Property #: TSI I ttf''^ 

Date/Time: 

Quads Excavated: p ) , ^2 - 9 i 

EPA Property Close Out 

Property Address: X'^T/b /O- Z S ff . 

Owner'sName: \cLir\a, H<2.vv^t/\ 

Contractor Group: Prudent Technologies, Inc, 

Excavation General Yes No 

I. If necessary, were llie 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 of the house in excavated areas generally slope away 

from Hie house? / 

2. Has sod been laid in all areas tliat were excavated? / 

3. Does tlie 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? 7 

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

time period) J 

6. Was tlie property graded such that water will not pool on the property? y 

7. Was damage lo landscaping or plant materials avoided? y 

Gates, Fences and Retaining Wails Yes No 

1. Do gates open and close freely? (If applicable) 7 

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

3. Was damage to gates or fences avoided? (Ifapplicable) y 

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

y 

Foundation, Siding and Gutters 

Yes No 

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

2. Was damage to tlie foundation avoided? 

y 

3. Was diunage lo 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 f 

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided'.? y 
m ^ M c^r s^ 

Owners comments: 

Inspection notes: 

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

EPA Representative 9 ^ - ^ Date: z\n |(P 
.;jKiiW».c?iiria(rt'r;SvJ'-'.' M 

03r­ ^1? 

Property Completion Agreement 

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

The property owner's signature indicates that the property owner is satisfied with tlie restoration of the 

subject property, and that no items are in question, now, or at any time in the tliturc, excluding any 

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

Property ID: Si^\C3 

Property Add '"'''-• 1^^9.0 U ^ ^ .<:t 

Owner: 

nlajyxA. f4ai.vAjcr> 

Phope: 

Restoration Items in QuestDon: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I I I agree restoration is completed. 

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

y/i ^ 

Date 
10/28/200 9 12:5 5 FAI 4023937660 CREDIT ADVISORS 1)003 

O c t 2 8 200 9 12!17P M NT TECHNOLOGIES 4 0 0 0 5 p.:2 

TECHNOLOGIES, INC. 

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(Pate) 

tntOPgRrV INFORMATK)N 

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J^^OWNER'S MAIUNG ADO 

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^JHAS THE EXTERIOR BEEN PAIMTEQ OR COVEREDIVyrfHSlDIttf W^H WC ^ lSRUCE 107B7

^MUMBEft OP OCCUPANTS UNDER 7 YEARS OLD: . NUMBER OF OCCUPANTS 7 YEARS OLO AND OLDER 

%^ DUMBER OI« CHILDREN UNDER r YEARS OLD WHO PLAY IN THE YMID FOR £ »40URS OR MORE PER WEEK: 

J UN^^A^W- YlcOMMEAfTS O R SPECIAL.MSTRUCTIONS fftl^fnUJCnONS:: (I.E I.E . DOGS, ENTRY GATES, ETC^ 

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iii i NkMiical Drlyc, Suite 4250 

Kari&as cilty, MO 641-iJ 

PhoriE; ($1«) 3B3'37C3 Pio'i'^-. 14P..>,'?;',.•» i!» * ilnii Antonio. TX 79^23 

Fax: tSl63 363-S70" 

|:.is- [B10I 573-S57T 

 I 
X 

CREDIT ADVISORS 10/28/2009 12:54 FAX 4023937660 

NT TECHNOLOGIES 40 0 0 5 P-3 O c t 2B 200 3 12217PN 

,CONSTla.if.TJO^ 

TECHNOLOGIES, INC. 

Property Status Form 

Address: ^ /? ^ f / 2 ^ ^^^ - Date:

3 r/^5* 

Address: • i * *M-^ ' " ^ ^ ^ ' - Date: /o/^k//>f 

Item Pl 

On Map l>escription & Location , j 

teiuNO Plants & Permapoi Permapoit Landscapin Landscaping To Remain In Place 

,. (i^^r^ ^f^./iJ moy^^ /res- /^ ^ ' ^^'^^­

Pre-TC»i.«itinff Condition of Stmctnres 

y Does your JSasement have a faistory of leaking? Yes No X 

Item NO Description & Location | | 

On Map 

f^5 - CrccJ^ y^ J7^<'^^ ^^^^ Cea^,r^^f^^<^^^^'^^ 

Property Owner Prudent Emplftyee 

Signature; Sigziatare: ^4^U^ pbn&y^*.^— 

J S5 WfafS '*'Srlf.v*v.jSi.'i|? iO£ 

^•••^ ! 'VOll ; ••;:' • :";^ v 3li(.v-*; <i13l e2?-9r»5 
PCH\(M,<K)IF.S. TNC. 

AS - BUILT DRAWING 

01,.S#:27163 

Date Kvi-avaUd: 11/10/2009 

LSKP.^Sijimd-OlTnato: OMAHA LEAD SUPERFUND SITE 

27163 

Omaha Lead Site Exlsfior Paim North Arrow Owner Name; INNER CITY RESOURCES D 

Address: 1920_N_25 ST Site Sketch [ y Good 

• Poor 

Phone: H: W: • Not paint 

Sample Number 

RYASCPXA-27163 Fl 

Lead 

Concentration 

. ppm 

Sample 

Collected LAB 

D 

Firm:

Date:

Samples Collected 

 fb k Ocfjh/^ J 

 'H' " l-Q' l 

RVBSgP.YA^37163 ^2 - ppm n Time; /V.-2(D 

RYCSCPXA-27163

RYDSCPXA-27163

 Bl 

 82 {P7 

ppm 

ppm 

n 

D Samples Analyzed 

RDZSCPXA-27163 DZ , ppm D XRF Unit: 3/" ^ Book; ^/ ^ 

raOgOePXA-27163

WZSCPiXAa71G3

 02 -

 P2­

ppm 

. ppm 

D 

n 

n Date:

Time: 

 (^-7-^1 7 

p'^->r7 

Number of Samples = Staff: pycyy^n 

Omaha Lead Sile 46 no 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
273f)3 

Omah a Lea d Sit » i;.xtgfcir Pairrt i Kri-t*i Arrow Owner Nsrm©; INNE^ Ciry^ESOURCES D 

Sit J23 Gcad e Sketc h Adearcis: n)m \ ;^.nSi Q f»-A-*r -~,> Phone- H '.'I • Nat pkiinl 

Lead Samples CollBcled Sfif-io'e Numi>ef 

Concentration 

Firm: ...LClh J^fjlf/J^/ J 

RYASCPXA-i!i'163 ^¥9 . Date. ^' ' i-Oi ' 

.£2- Jime: /¥.-^<D / 

RYCSCPX.^-^71fi3 B1 

Sampies Analvzed 

RYDSCPXA-271G3 B2 

ROZSCPXA ?T1©5 DZ XRFUnit: B/'^ - BccH: f ^ 

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Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

1944890000 

SUNBURST 

PROPERTIES 

INC 

1920 N 25 ST 

OMAHA 

68111 

7519S137 

AVE 

OMAHA 

NE 

68138 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Unk 

PARKERS ADD 

5 

1 

8 32 FT 

32X120 

0.09 

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

parc=1944890000 

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

accountno=R1944890000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/2/2009 

2 
Pagel of2 

"> 

i ae ilM 

• YOUR TICKET NUMBER IS 2398003. 

Original Call Date: 11/02/09 Time: 11:09 am Op:. SIVA18967 

Work to Begin Date: 11/04/09 Time: 11:45 am 

State: NE County: DOUGLAS Place: OMAHA. 

Address: 1920 Street: N 25TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 09-SE,16-NE 

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 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth bf Excavation: 6 FT Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CiXCATV LEVELS MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber UtUity Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 
Page 2 of 2 

Day: 4067289343 


OPPDGPRS OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 


Emerg: 8887289343 


Day: 4067289343 

QLNNElC QWEST LOCAL NETWORK NA Alt: 406207 1494 

Emerg: 8887289343 
E.'VViRONJViENTAL & 

COr-^!STRUCTiO.\' 

TECHNOLOGIES. INC. SOLUTiONS 

^ 

te baf-9ty Hazard Analysss 

.\ddress: 7^y.O /J , ^

Crew: 

Date: y y S -c^^ 

S /• 

Item Condition Hazards 

Corrective 

Action 

Overhead Lines ^ c. ^ [Mtjf/y/^^ /cUi kgn^i...^ '\t^,^tz y>*^/3 

Gas Line TycJirt e- J heryuJ 4P^<</ ^ 

Water Line 4- XSewer Line <SKJV-> C / a»»-i- /oCj<r-/ts 

Septic / Leech 

field yj^y -

Propane/Butane Ayy t 

Sidewalk Jc:>s^^ O^tf^ ^/yuje-ts-J ^ 

Foundation J ^ 

Retaining Walls •ct ^ 

Fences - ^ '^=g>^ 

Trees/ Bushes j±h. iiS_ 

Structures /t^TAt 

Drivewav yj­ ^ 

Sprinkter System i yt^.^ 

Crew^oreman Site Safetv Officer 

80S0 Ward Parkway, Suite 405 250£ i\. 24" Strest, Suits 3C-2 AZ'Yi Medicai Drive, Suite 72£i: 

:<ap.sas City, MO 64114 Omatia. Nebras!<a 68110 San Antunio, TX 7822S 

Phone: (816) 3S3-3703 Phone: i402i .504-100^ Pfione: (210).Si'2-S5Se 

Pav (in?.! SO^r-1005 ?.,>:: (210) 573-€577