TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: -^^^^ r Date: ^ Jldo'^ 

Address: ;2.o(>, <L %.B A / 

Remediation Contractor: pr^-j^^ ^ ^- ^ . Tnc y Year: , 2^0 ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Q^ Video of property (DVD) 

3 ^ Executive Simimary 

Q^ EPA-provided property sketch 

Q^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Q^ Restoration .^reement 

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

B^ Confinnation data 

\ ^ Photographs 

a^ As-built sketch 

0^ Satisfectory restoration signed by Property Owner 

Er i*roperty close-out check list signed by EPA 

D Description of areas not meeting ROD cleanxq) criteria 

w Utility clearances 

Ca^ Property infonnation from Douglas County Assessor's OfBce 

D 

D 

D 

.,, Artfi ^ fM/<^ 

Signature/ Date 

30054230 

PM 

Superfund 
Date; 9/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: August 

Property Address; 1204 S 25 AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

AJ Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 140 PPM @ 15"; GA = 97 PPM @ 15"; B2 = 83 PPM @ 13"; EA = 125 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 sketchi) Shall includefinal lead levels v) Legend 

ii) Contamination left behmd 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 (Wmdows 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. 
Rnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 20925 ­ 1204 S 25 AV 

Owner: Resident: Contract: 

D Ovmer Oocupied Resident Name: Contractor: 

Owner Name: [TORRES EMILIO PRUDENT2009 S I 

|TORRES EMILIO Property Address: Contract Option 

Owner Addressl: J1204 S 25 AV [BASE 

r Zip Code: 

Owner Address2: [68105 Assessment: 

J1204S25AVE Resident Phone 

City: State: Zip Code: I Qualifying Group 

|OMAHA [N E [68105 |800/CHILD 

Owner Phone: Altemate Phone: Assessment hiax XRF Value: 

|(402) 341-5621 I 1096 
TECHNOLOGIBS, INC. SEPA 

EPA Property Close Out 

Property*: %o^i.f Property Address: /^O^ 5 2-S A/ 

Date/Time: ff-l'r-C^ Owner's Name: £>yxri'V^ iorfc> 

Quads Excavated: pl-, Av, ^-j . Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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

i / 

Grading Sod and Vegetation 

Yes No 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? y

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day time period) 

4. Are sodded areas generally firm and evenly graded? J 

5. Are the joints between the sod strips generally tight? (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? y 

7. Was damage to landscaping or plant materials avoided? 

J 

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) y 

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

4. Was damage to retaining walls avoided? (If applicable) y 

Foundation, Siding 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? y 

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? 

y 
\^oi^ S ^ ^ ^^ ^ 

Owners comments: 

Inspection notes: 

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

EPA Representative j9„^yQi^ Date: 8//9/a<^ 
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 fiimre, excluding any 

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

Property ID: 

Property Address: Q o «-t Q^ 2 ^ ^ A^ ^ 

O^"^'-^ ^rvJfUe o ^^rr'^e ^ 

Phone: C,o2_ . '^M \ ­ S'^Z. V 

Restoration Items in Question: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

p A I agree restoration is coinpleted. 

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

Orri'l' g>|13| g ^ ^ \Ofyc. ^ 

Owner's Signature Date 

I
Prudent Teclinologies, Inc. (Pmdent) is under contract with the U. S. Environmental Protection Ageaicy (EPA) to clean iq) leadcontaminated soils at a number ofproperties 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, die property owner grants pennission to Prudent to perform 

activities related to the cleaavap including soil sampling, removal of lead-contaminated soil, and restoratian ofthe referenced property. 

If you have any questions about the soil cleanup plaimed for your propeity, please contact Prudent's Administrative Cleik for the 

Omaha Lead Site cleanup. Ms. Siva S. Jampana-at (402) 733-1188. Oeneral questions about the Oinaha 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: i^yuii^^^^l^ ^ 

(Please Print Name) 

Property Owner Signature: ^yy ^ ..^^ ^ j£/US/ ^ 

(Date) (Signitturc) ^ 7 

PROPERTY INFORMATION • 

(To be compkted by resident and/or property owner — please prfait) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: 

AN^CT C5*^aA^ toe. g>g/o 5 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: ( MflU ^Hl - '^iJl ^ I WORK: 

AOE OF HOME?: _iUD J YEARS. HOW LONO HAVE YOU LIVED HERE? < ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDINO SINCE 1978? YES " "N O 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLO WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: 

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

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

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

CERCLA, 42 U.S. C 960S(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 
ENVBRON.MENTAL 

CONSTRUCnO 

TECHNOLOGIES, INC. SERVICI 

Property Status Form 

Address: 12. ©M 3 2-SH^ A>-^c Date: i^|l3h t 

Phone: ^02 ' H^fc - 3S$2 - BVID: ^.^'Fa. S 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^ V Cl-2 , p . (p .o*, Sc^^*- ^'<*u»J^«uUV.«. U*i u*/-

\ v t 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes "^ \ No r ^ 

Item NO Description & Location 

On Map Q,^ K>a«Hs.&t<i' Xc«0 Cf^JtXtJA -at- t>n»^e u» ^ 

Property Owner Prudent Employe 

Signatiire: Signature: 

8080 Ward Parkway, Suite 405 2505 N. 24"^ street, Suite 308 4242 Medical Drive, Suite 42S0 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX7822S 

Dhnna- /«1«1 IRI-ITflt Phnnn- UO?) .^04-1004 Phona: (210)822-9588 
JIES, INC. 

AS - BUILT PRAWING 

OLS#:20925 

Date Excavated: 07/25/2009 

USEPA Slgned-OffDate: OMAHA LEAP ^in^RFllNP SItE 

20925 

Exterkir Paint in/ithAirow 

QOood 

Omaha Lead Site 

Sits Sketch 

Q^oo r 

Swnpllng Address: 1204S2SAV Q Not paint 

Sample Number Lead 

Conoentratton 

Sample 

Collected LAB 

Firm:

Samples Collected 

 V^ K fP>/D Q 

RYAscRYiA aooae—F4 D Date: <o- Vl - Q5t 

RYBSCPXA-20925 F2 JOQ & Dom D Time: 2' . ^C> p 

RYCSCPXA 3003S

RYDSCPXA-20926

 Bl 

 B2 li, H

PPW 

 ppm 

D 

D Samples Analyzed 

RDJOGPXA-aOOaB BZ .ppm D XRF Unit CkSHO Book: 2o a 

RGZSCPXA-20925 GZ ^7 0 ppm \Sf Date: l-QT-'-Qf t 

RPZSCPXA aooas P Z 

Lab R6Z8CPLA-2002S 

S Result 857 ppm 

ppm 

Number of Samples = |

D 

^ | |

a 

) | 

Time:

Staff:

 P/ 1 

 M^U / 

I IU . I I — I IVt K kOll , I & < Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ ° Garden, PZ <= Play 

All quadrants are as viewed trom the street, facing property 

• '•r*\"1'•••• • ^' ' •••''' 

•it)H?5-208S 

'•v\ ' 

CJftttl :7Z*i B2 = 83PPM'a;13' ' ijj 

/2o/s zs/^i/zr 

•? 

^ ^ 

GZ = 97PPIVI'a, IS" 

^. 1 

R<!>200e..1A Cnau d I3-Mar48 

Hia3^ 

.C«rt<i 

FI 

_vst&kbu 

• ^%l\\i ^ 

F2 = 140 PPM 'a, I.S" 

EA = 125 PPM 'a, SCRAPE (-1") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC 
Omaha Lead Site 

Site Sketch 

Samollna Address: 1204 5 25 AV 

Sflrrdc Number 

ftY;\3i;p.v/> aooas 

RYBSCPXA-2D925 

RYDSCPXA-2Q925 

R02GgpxA-gogaRGZSCPXA.2C925 

L.35 RGZ3CPLA-20925 

'Re^'iii S57ppm Nijnj^C' of Siirnplos = a T] 

Lead Sampio 

Concsnlrarioit Co.U*:tec 

ppiu 

F2 ppm n 

ppn-. D 

S2 ppm :ii± n 

-ez ppm p 

G2 Jkio. ppn^ a' 

-452 ppm D D 

20925 

Ext«ncr »3tnt 

• Gool 

[3^PcDr 

Q Noi paint 

Samples Collected 

c--i:e. U3-tl^OS ^ 

Samples Analyaso 

XRF Unit; G^^ a SooX: 2g>fi 

Dalo-. "?-Q7'-OB 

T^rie P/ i 

L.«.»j&i IU. I I * t w« -. w^)^ , I *. - Front R-sf.T. B1 = Back Left, 82 = Back Right DZ = Dna Zor.e. GZ = Garden. PZ = Play 
I'age 1 ot 1 

1^0^ ? 25 A/ 

http://douglasne.mapping-online.eom/assessdoc/Photos/l 8/R22181500000001 .ing 6/1 ?./700q 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPreview.aspx7PrintOpt.. 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2218150000 

TORRES 

EMILIO 

1204S25AV 

OMAHA 

68105 

1204 S 25 

AVE 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

27-15-13 

SHULLS 2ND ADD 

8 

1 

E 30 N 61.5 FT LT 2 

&N61.5FT 

61.5X90 

fTttp://webapps.dotcomm.org:8080/TreasTax/faces/pages 

/taxinfo.jsp?parc=2218150000 

http://douglasne.mapping-online.coni/DouglasCoNe/static 

/accountinfo.jsp?accountno=R2218150000 

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 = 28 feet 
Page 1 of2 

• ' 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2313600. 

Original Call Date: 7/09/09 Time: 11:19 am Op: SIVA18967 


Work to Begin Date: 7/13/09 Time: 12:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1204 Street: S 25TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: soil lead remediation project 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLE7VRS 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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Nuniber UtUity Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt 4029340469 


Emerg: 4029329757 


Day: 8773668344 


LEVEL3 LEVELS COMMUNICATIONS, LLC NA Alt: 


Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt. 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt 4024445161 

Emerg: 4024445160 

http://www.dhoii.org/irthiiiternet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULTS... 7/9/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: /J^oH S . JLS ^p ^ 

Crew: -^ ^ 

Date: ^ ' /^- o^ 

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 Foreman 

Condition Hazards 

Corrective 

Action 

OfCC ^ 

Aufi ^ 

histtusJ 

/t/ ^ 

/ly4*vJ tc/^^Hv^ 

UM ^ ^•OC^4^Ht 

I^H S loeA+K. 

AJA 

A^A­

"TAtK. 

Pcct c 

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poo/* -

pcgf^ ^

r

 Aiifjf 

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yOA 

J0C4U. 

U/ c 

Site Safety Officer 

^%^. u /^y!=^ 

8080 Ward Parkway, Suite 405 2505 N. 24 Street, Suite 308 4242 Medical Drive, Suite 725C 

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 



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