TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: , 7.U^ Date: 3 J J j^T 

AH^re... idl.y^ Ai,^ ^ C-h 

Remediation Contractor: fvUfUM ^ T^C K [\\t . Year: P&l O 

SOIL REMEDIATIO N 

PROPERT Y FIL E FOLDER DOCUMENT S 

Zl Video of property (DVD) 

ffl Execvrtive Summary 

0 EPA-provided property sketch 

H Signed Access Agreement for subject property 

D Signed Access Agreem.ent(s) for adjacent property 

15 Restoration Agreement 

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

G Confirmation data 

ffl Photographs 

As-built sketch 

d Satisfactory restoration signed by Property Owner 

/ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

a Utility clearances 

ffl Property informaJion from Douglas County Assessor's Ofl5ce 

D 

D 

D 

^ ^ «l»t^" 

Signature' Date 

30260777 

illlll 

Superfund 
I 

Find Recotxl Remediation Query I Lead Remaining Query I Propetty Damage Query 

Backfill: 

Sample Area: 2119 - 4624 N 39 ST 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: [COLBERT BERNELL [PRUDENT2009_S 

jCOLBERT BERNELL Property Address: Contract Option 

Owner Addressi: [4624 N 39 ST OPTION 1 

1 Zip Code: 

Owner AddressZ: [68111 Assessment: 

J4624 N 39 ST Resident Phone 

City: State: ZipCode: Qualifying Group I 

[OMAHA [NE [68111 400 

Owner Phone: Alternate Phone: Assessment Max XRF Value: 

|(402) 457-5937 [(402) 598-3495 I 4Tr 

% 
PROPERTY SUMMARY 

Date:'Vl5/2010 | Omaha Lead Site Reniedial Action Contract # EP-R7-07-06 T0#1 | Month of: .^ (J 6^ 

Property Address; 4624 N 39 ST 

A EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

BI = 169 PPM @ 20"; DZ = 190 PPM @ 15"; EA = 117 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 fmal lead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID nuniber 

7) Other items to be included in the mdividual 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. 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Properly #:ZU ^ Property Address: LJ k>7J4 /Vj • 3 9 S"^ 

Date/Time: Owner'sName: 5o'->.rc\^ CoV\)<?<i'^< 

Quads Excavated: Coniractor Groii|): Pnulcnt Technologies, Inc. 

Excavation General Yes 

I. ir necessary, were the correcl quadrant(s) excavated and reslored? / 

2. if iiecessar>-, were lhe correct areas ofdrip zone e.xcavated and restored? / 

Grading Sod and Vcoetation Yes 

I. Does tlie grading aroiuid Oie perimeter oftiie liouse in excavated areas generally slope away J from the house'.'' 

2. Has sod been laid in all areas tlial were excavaled? y 

?-<. Does the sod appear lo be generally healtliy and growing? (Only evaluate if inspecied at a .^0 

day lime period) / 

4. Are sodded areas generally fimi ;md evenly graded? / 

5. Are tlie jomts belween the sod strips generally tight? (Only evaluate if inspected at a ?^0 day / lime period) 

6. Was llie property graded such tiiat water will not pool on the property? / 

7. Was damage to landscaping or phuit materials avoided? / 

Gates, Fences and Retaining Walls Yes 

1. Do gates open tmd close freely? (Ifapplicable) / 

2. Were all gates or fences taken down during restoration activiiies reinstalled? (Ifapplicable) y 

•?•>. Was damage to gales or fences avoided? (Ifapplicable) y 

4. Was damage lo retaining walls avoided'!' (Ifapplicable) y 

Foundation, Siding and Gutters Yes

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

2. W;is damage to the foundation avoided? y 

."i. Was damage lo windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? / — 

Sidewalks and Orivcways (Concrete) Yes

1. W.is (.i.iiuagc iu driveway snrfaces avoided':' / 

2. Was daniage lo walkway surl'aces avoided? T 

No 

No 

No 

 No 

 No 
^b^ ^ N j>^ S t 

Owners comments: 

Inspection notes: 

.-^^ " ^fP^ 

^-°' ^ ...^^ 

0^ 

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

EPA Representative 9"^ J ^ Date: il^l'^ 
(fcjctw.ijrTt 

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, ifany. 

Property ID: 

Property Address: ^ ^ <7 i^ :fi N^ * 3 *^ SV 

Owner: g o VM >^ C i9,\\^ ^ ^ 

Phone: 

Restoration items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

 I I agree restoration Is completed. 

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

Owner' '»•'« Sionafiirp TJafp I s Signature Date 

I
# • 

TECHNOLOGIES, INC. 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontamiiuited soijsiat a nujnljer of properties located in Omaha, Nebraslca, including the property located at 

^7(f p/j f / U r/ y J TT * The EPA requests yovir permission to allow Prudent to perform a soil cleanup at tiiis 

p^peT^pto remove lead-contaminated soil. By signing this form, tlie property owner grants permission to Prudent to perfomi 

activities related to the cleanup including soil sampling, reraoval of lead-contaminated soil, and restoration ofthe referenced property. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent's Administralive Clerk for the 

Omaha Lead Site cleanup. Ms. Siva S Jampana-at (402) 73.'^-l 188. General questions about the Omaha Lead Site cleanup can be 

duected to the EPA Public Information Centers at (402) '731 -3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted By: 5^^fvx ClaLK^o 

(Please Print Name) 

Property Owner Signature: 4irv^j^V.. C^ ^ jdAyAddhd^l -fH­ (Signature) (Date) 

PROPERTY INFORIVIATION 

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

RESIDENT NAME: ^/^r^icf floJ^^.yj - Renter 

RESIDENT ADORESS: ^^V f\A 3 t ^^ ' 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; Sc '<X7h^ 

OWNER'S TELEPHONE NUMBER - HOME : ffoh i^i'^'^O ^ WORK: 

J 1 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? •^ ^ ^ ^^^ YEARS. 

y7„ HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O

NUMBER OF OCCUPANTS 7 YEARS OLD ANO OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTKJNS: (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 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 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 5600 S 10"" Street 4242 Medical Drive, Suite 4250 

KansasCity, 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 
ENVIROiNMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, ESC. SERVICES 

Property Status Form 

Address: iff^ i A^ ^" l ^^ ^ Date: 

Phone: ^7?^ ^^f^d^ ^3.6 ^ BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

X ((^it-aoit cell i,econcf^/y H ^'"'P ^-^n ^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No y

Item NO Description & Location 

On Map 'bJt O u)CL^/ ^ 

^J7a. ^ CrctoK d /v> 

upood f'r^/zyf /^r a </^^ ^ 

Property Owner Prudent Employee 

Signature: /M ^ fhstAiAd^ Signature: / ^ 

8080 Ward Parkway, Suite 405 5600 S 10'" Street 4242 Medical Drive, Suite 4250 

KansasCity, 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 
# 

PCHNOl.OGIF.S. INC 

AS - BUILT DRAWING 

01,.S#:2tl9 

Date KNtavattd: »S/lH/20«9 OMAHA LEAD SUPERFUND SITE i:sr<:i'A Signcd-OtTnatt: 

Name: "So^Jft COil>elI-|- Oinaha Lead Site 

Address: tj(^7.c; N 'i' ^ l-J Site Skatch 

Phone: qtf-^^<,C^'x-J 

t 1 ) Jr l>x 

Date Team BVID# XRF Code 

'ii?.^l&" ^ r-&<n,,,u j r ^)4r;,;ft)<: 311^ S.5~" f 

"t/- ^ f^'^ 

Sample Number Lead Concentrabon Confirmation Sample FTTtUstPvLA - ^if ^ ?.2t. t ^ 5 - ppm Ye..s .• No- e •2 H '5 t l U i?.Vft<.i: t>A.A - X T. ppm ^ 2 Yes ^ No •

p^ c sc Pi^d- - 7 i \ ^ M n ^ 3 2. ppm ^ / Yes _D No ^ 

f.-it,i,C^f.f^ -' -ZM ' j ts £ rr ppm ^ Z - Yes • No a i2h?S.<:pxA -_ ? 1 I <^ S-i/ f ^ ' 1 ppm 17Z Yes Q No S 

)?f>-2icT>>( A - "JI M 

/V ?^ ^-^ 

Omaha Lead Site 46904.783-01 E.\ = 117 PPM VJ Sf K.VPi: (1" ) 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
• • • • 

Name: ^Ji^ , ki,P^i^f Omatka bead Site 

j Phone- _ ^ „,^^^i=^S5a:i_ 

DciU Team er^iD # ^ i XRF Cwe MllL r-BffY.!^ i r s4i*;'i i 1 

r?f'i ^^A 

SE3sm?!le Number Canfifmasiori Sample f—' 

r 1­ Si^-y.t-i. A - .r'.i.f 't ^ • ' Yes • No -Eli i i 

t:>f k c c v^K [i , ^ti ^ ^ f Yes JSD NO Q 

j'j Jt : 5 c p y A- - ? H V ^ ' Yes a NO ^ 

p.Vr^i^4...?^.v --.... •^...'•t H ... . v'.^7_. Yes • . No £ j 

K^gg . i ^-•>' .ft — i 11 •?? ' i-".^- Yes D No ca 

^,A/^d ^ fb 

^ y 39 / / 

Osioivs Lc5>j Site i(i,fjri4.?g.--G'l 

V 

# • 

Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 1603770000 Addition LAKE VIEW ADD 

Owner

Name

 COLBERT 

 BERNELL Block 

Property 4624 N 39 , . 

Address ST 

City OMAHA Legal 1 LTS 1 & 

Zip [68111 Legal 2 

Owner 

Address ' Legal 3 

Owner 

Address 

2 

4624 N 39 

ST Legal 4 

Owner 

City OMAHA Acres 0.14 

TVpa c urGr Owner NE 1^ , ., http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? State parc=1603770000 Link 

Assessor http://douglasne.nnapping- Owner 68111 Website online.com/DouglasCoNe/static/accountinfo.jsp? Zip iUnk accountno=R1603770000 

Sec-TwnRng 
X \ACm,y^ 1. V/.1 . ^tf 

^ 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2338413. 

Original Call Date: 

Work to Begin Date: 

8/11/09 

8/13/09 

Time: 

Time: 

1:20 pm 

1:45 pm 

Op: SIVA18967 

State: NE 

Address: 4 624 

County: 

Street: 

DOUGLAS 

N 3 9TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: 16N Rng: 13E

Legal Given: C 

 Sect-Qtr: 05-NE-SE 

 Sect-Qtr: 32-SE 

Type of Work: SOIL LEAD REMEDIATION PROJECT 

Location of Work: LOCATE ENTIRE PROPERTY 

Remarks: FAX ALL CLEARS TO: (4 02)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

Involves Tunneling or Horizontal Boring : N

 Front: Y

 Explosives: N 

 Rear: Y 

ALT872 CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

Day: 4067289343 

ALT872 WINDSTREAM COMMUNICATION NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

httn://www dhon ore/irthinternet/DHONNntir.pr.rP'.atinri/MesRaapTpvt {»<!n9rf>:t=<I?FS:T n T« 8/11 OOOO 
ir'age / or z 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://wwfW.dhon.org/irthintemet'DHONNoticeCreatinn/MessnapTpYt ncr.7rp<=<'T?T7<;Tn TC B/I I nnnn 
• • 

ENVIRONIVIENTAL & 

CONSTRUaiON 

TECHNOLOGIES, INC. SOLUTION.S 

Site Safety Hazard Analysis 

Address: ^/oSH .<y, 2>^ Ex. 

Crew: Bf. 

Date: 1 • S/S • c^^ 

Item 

j Overhead Lines 

Gas Line 

VVater Line 

Sewer Line 

1 Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Drivewav 

Sprinkler System 

Other 

C rew For 

Corrective 

Condition Hazards Action 

^jtj y /^/»>^ y d ^ US£ prcAp j —t 

TpofiriP 

I )

1 - 1 

Piijriy^ d 

y y ^ 

A y ^ 

py 

-i-c^i y. os-^ y>L/^^ocy 1 

P 

p^:k: ^ , rZcc-Jc /ik?_s-_^/^«? yyy-^.Sj:3 U^t ^ /C^^iCyi ^ 1 

A ' 

So^fAC 

/ } /ty- ^ 

At^A 

/^^^l ^ 

yiy / 

Site SafetA' Officer 

yA'S^ pS•^ ^.oc 

8080 Ward Parkway, Suite 405 2505 W. 24'" Street. Suite 30B 4242 Medical Drive. Suite 7250 

KdiisasCJty. MO 64114 Omaha. Nebraska 68110 San Antonio. TX 78229 

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

Fax: (81G) 363-3707 F^x: (4021 504-1006 


A] 31')^ 

^^yy^ ' Sami^ifikWiSi^fj^y r.:'.-S:.7^-.-'77k^'Jimm»SL''miiS^k^^f.ir^