TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^^1) ^ Date: \\ |^(:.|o^ 

Addiess: 1>15) I LoxM^oi A^ 

Remediation Contractor: fiyu^g.J 7^p^^ - TvlC y Year: ..^^L . 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

Q Executive Summary 

E EPA-provided property sketch 

Q Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

oi Restoradon Agreement 

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

U Confirmation data 

E Photographs 

il As-built sketch 

H! Satisfectory restoration signed by Property Owner 

li Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

O Utility clearances 

E Property information from Douglas County Assessor's Office 

D 

Q 

D 

(^t ^ »\t*''*' 

Signature Date 

30054167 nil 

Superfund 
Rnd Record 

Remediation Queiy I Lead Remaining Query j Property Damage Query 

Backfill: 

Sample Area: 38118 - 3721 LAUREL AV 

Owner: 

Resident: 

D Owner Occupied Resident Name: 

Owner Name: [ANDERSON JUDmi D 

JBLACKSTONE GARY Propeity Address: 

Owner Addressl: [3721 LAUREL AV 

I 

Zip Code: 

Owne [68111 r AddressZ: 

|3721 LAUREL AVE Resident Phone 

City: State: Zip Code: 

I 

[OMAHA [ NE |6811 1 

Owne Aitemate Phone: r Phone: 

I 

Contract: 

Contractor: 

[PRUDEm7009_S 

Contract Option 

OPTION 2 

Assessment: 

Qualifying Group 

[400 

Assessment l^ax XRF Value: 

r 448.9 
Date; l4/15/2009 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: October 

Property Address: 3721 LAUREL AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 247 PPM @ 8"; B2 = 134 PPM @ 8"; DZ = 85 PPM @ 12''; NO EASEMENT 

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 sketchi) 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. 

fmlHNllUiilUlibCiNC 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: S^^/'Sr Property Address: S'T^) ^^" ^ 

Date/Time: Owner's Name: /4- n ^ | K \\^ay< ^ 

Quads Excavated: 6 ' r *^/ ^ Contractor Group Prudent Technologies 

Excavation General 

Yes 

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 

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) 

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 

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

/ 

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? (If applicable) / 

Foundation, Siding and Gutters Yes 

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / 

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

5. Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) Yes 

1, Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 

^ 

No 

No 

No 

No 

No 
Owners comments: 

Inspection notes: 

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

EPA Representative ^^>SL ^ Date: lofiofo^ 
Property Compietion 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: 3>n:2-i i^,,,^ ^ A^ ^ 

Owner: A AY^ eldU> ^ [VA ^ oA^ ^ ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

[pi I agree restoration is completed. 

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

/Owner's Signature Date 

I
TECHNOLOGIES, INC. 

Prudent Teohnologip, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcjmtammated «oils at a nymbe^f properties located in Omaha, Nebraska, including the property located at 

37^ 1 l^f\jiff^A rf^^K-' • ^ * ^ ^ 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 (he cleaniq> including soil sampling, renioval of lead-containinated soil, cmd restoration of the referenced property. 

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

Oinaha Lead Site cleanup. Ms. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA IPubUc hiformation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha ofiice). 

Property Access Granted By: Xi . (^>yOtU^< fA*^-CaWicc HjtKfltf^J^r^f," 

1 (Please Print Name) 

Property Owner Signature: X >• (V^>.f.rr o M ^ ^JrJij^- (^JLcuUCcil>vt^» c I I « I A c, 

(Signature) ^ ^ (Date) <ill»l® T 

PROPERTY INFORMATION 

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

RESIDENT NAME: MffC;, (XiLJN^tU^i U*^- ^ U « <hfsit'\(d/,^'(^^ Renter 

RESIDENT ADDRESS 1: / / /) 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; SatM-^ 

OWNER'S TELEPHONE NUMBER - HOME: J . to 99l'9Sli WORK: 

( > 

O 

AGE OF HOME?: 'YEARS . HOW LONG HAVE YOU LIVED HERE? 3 YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? ^YES NO I 

NUMBE^ F OCCUPANTS UNDER 7 YEARS OLDy . : e»a C 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: 

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

Of2 ^ - ^Sj ^ 

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

are pursuant to Section 104 of CERCLA, 42 U.S.C. %04. EPA's right of access to the property is provided for in Section 104(e) 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 of the title." 

8080 Ward Parkway, Suite 40S 5600 3 10*^ Street 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

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

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
IRUDE] PECHNOLOGIES, INC. 

Pronerty Status Form 

Address: 37^ / LaOht l Hu€^ Date: <f^/^^09 

Phone 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

d ' of f f^'Ml'^ O-f <^^^' 

Pre-Existing Condition of Stnictures 

DoesyourBasementhaveahistory of leaking? Yes — No y 

Item# Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: •» OjuoafcJtco HS WJVJULJ* Signature: ^A//J^^te^yvO-­

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 
• • 

miKs. i\c . 

AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

Name: :]..J.J^ Mj* r 

Omaha Lead Site Date: U-IS-'C-J North Arrow —i 

Address: .072^_t<iij>/_ifK' 

SNs Sketch Time: •?.<«-

Phone: ef^T-^^Z -

I 

TBamft/f.r/U^.r^t ^ //Ufc-S*) BVID# '^Jll ^ XRF Code ^^^y 

Sample Number 

Lead Concentration Conf nna 

^ 3 

ppm •T Yes a No ^ y 

ppm 4^Yes a No ^sr 

ppm ftt Yes No SO "i-o^ 

• 

ppm »Ye s u No ^ /<^» ^ 

ppm r*Ye8 a No C= 

ppm Yes n No Q 

ppm Yes No n • 

&

^ #= T ^

^ ^ 32 = :3^. ??:^: -a- B" 31 = 2-17 ??:^: 

^.^< ^ 

•pe-^U­

"^ y — f*.":; "^^ •-i­ e ' 2 

Z?^ - /<;^ ^ o i 

^'^ ­ 172 ^ /jfHAtl..h& 

# 

^<^Ci«^5 

P^ 93 Z./ 

* - • 

f 

Uuitl A\jo~ 

y.'c'j.A^^y.y.y.x:. 

Omaha Lead Site 46130 

CONTRAa #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
I 

319^1 Uctu'r&l Ao ^ 

Omaha L«Bd Site 'li&fA A'rub 

mm Sketch T:-ne ^.-^-t 

_V 

eao^^'; . /U.fvty . ^<H^D aVlD»_2f*lI^. - XRF Code_l££5f. •• • • Il l

 I 

Sample Numbo:' 

Lo«c c^nse'tfawn Conff^ation Sen » 

93 - ppn 

N c ^•, . 

- ppir No 3 " 

l4o ^." 

No 3r 

No a " 

- PP"i No n 

pjMn Ma • 

-j— ^ "Hfft 

& 

— i . 

SK^L-ik t rdL Av i^Vj \ : i -rJpi-t-^ ' ^ :< 

Sr 

! IV +• 

o : 

• ' 1 ! f^-1 " •^•"•" : ! I 

%JJdLy^M^\ Lfejg.. ri r- i Li i J I 

i ! i I 

O^aia :./aif SitL" 

-16130 
^rfu 

\ ^ . 

•••^^-••Z^^ ' 

V ; ••-" • 

¥• 

W% 

• ^-7 0 721 LAUREL AVE 

uly 20O4 »Douglas Countv Asses 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

IName 

Property 

Address 

City 

\zip 

Owner 

Address 

Owner 

\ Address 

2 

Owner 

City 

Owner 

State 

Owner 

\Zip 

Sec-Twn 

\-Rng 

1913850000 

BLACKSTONE 

GARY 

3721 LAUREL 

AV 

OMAHA 

68111 

3721 LAUREL 

AVE 

OMAHA 

NE 

68111 

32-16-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

OMAHA HEIGHTS 

10 

9 

50X130

& 1/2 VAC ALLEY AD J

 1 

| 

0.17 

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

parc=1913850000 

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

accountno=R1913850000 ] 

http://vvww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/3/2009 
Page 1 of2 

"> 

[ Create Another Ticket ] [ Back to Irth Internet ] Send Email 

. YOUR TICKET NUMBER IS 2372127. 

Original Call Date: 9/24/09 Time: 3:50 pm Op: SIVA18967 


Work to Begin Date: 9/28/09 Time: 4:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3721 Street: LAUREL AVE 


Twp: 16N Rng: 13E Sect-Qtr: 32-SE 


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 CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

ALT872 WINDSTREAM COMMUNICATION NA

Day: 4067289343 

 Ah: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Ah: 4029340469 

Emerg: 4029329757 

METRO METRO COMM. COLLEGE CHRIS

Day: 4024572307 

 Ah: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Ah: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/24/2009 
Page 2 of2 

OMAHACOF CITYOFOMAHA-TRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/24/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

a 

Site Safety Hazard Analysis 

Address: ^7^2 / LAi>r><f/ 

Crew: 

Date: '^•J23a') 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Eoreman 

[ykf-0 

Condition 

•=;o**^ 

Se^ r»i^ 4 

1 

htyr^» ^ 

AMAM 

-/•»1 A 

^ , ^ 

A . ^ 

•f-^-ltAl.o^ 

•A^.y. 

^^ 

^ ^ 

Ex. ^3^^? 

Bf. (m<^'\ 

Hazards 

McM^/e^^nt i ^'^' ^ 

Corrective 

Action 

Lri<r fJn:/ ^ 

A^ ^ /e,4^^fr 

• 

4* ^ /eu:^i~e 

Ln-e fi/u-'-^ t> 

LTie ^L^^ ^ 

Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive. Suite 7250 

Kansas City. MO 64114 Omaha, Nebraska 68110 San Antonio. TX 78229 

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

Fax: (402) 504-1005 

Fax: (210) 579-6577 

- — ^ ^mmm '^^^H "—•. - . , ^ 

1' 

/ JJ^^^Bl ^^1 

•'* •'^'•."tH' ^ 

' ''li^^^^^^^^^^^H B^^^^^^ H 

B'­ - ••'•' • 

w^KTiw ^t/'^/?^^. H^^^^^ H