TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAn)#: ^^[^^' i Date: l^-flfif^q 

Address: KviL^^ >4y^^ a / W 

Remediation Contractor: YSX/^JID A ^ •. U Tyi C Year: ^j^n<^ 

SOIL REMEDIATION 

PROPERTYFILEFOLDERDOCUMENTS 

!^ Video of property (DVD) 

sf Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

E Restoration i^reement 

IS Setdement documents (i.e., for damage or to replace plants, etc.) 

m Confirmation data 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

d Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleamq? criteria 

/ 

Utilily dearances 

Property information from Douglas County Assessor's Of&ce 

D 

D 

D 

Signature bate 

30054126 

•Uiii 

Superfund 
Rnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 38668 - 3047 STONE AV 

Owner: Resident: Contract: 

D Owner Ocnipled Resident Name: Contractor: 

Owner Name: [RESIDENT |PRUDENT2009_S 

JRAYER WILLIAM J 

Property Address: Contract Option 

Owner Addressl: |3047 STONE AV OPTION 2 

Zip Code: 

Owner AddressZ: |68111 

Assessment: 

|13406POLKST Resident Phone 

City: State: ZipCode: Qualifying Group 

I 

|OMAHA |NE |68132 poo 

Owner Phone: Aitemate Phone: 

Assessment Max XRF Value: '1 r 423.3 
mnmmiHtirar.sHiTWWttMBy 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Montli of: November 

Property Address: 3047 STONE AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 163 PPM @ 4"; DZ = 93 PPM @ 12"; EA = 119 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 include final 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 mdividual 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 m 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. 
TECHNOLOGIES, INC. 

Property*: gft*^?:^ ^gj^g 

Date/Time: 

Quads Excavated: Bi-^ D'2. 

EPA Property Close Out 

Property Address. 

Owner's Name: U)\ l'Ui3LAv\^ ^tA^n 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Ves No 

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

from the house? y 

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) y 

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

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

time period) y

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

y 

7. Was damage to landscaping or plant materials avoided? 

y 

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 

Was damage to gates or fences avoided? (If applicable) 7 

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

/ 

Foundation, Siding and Gutters 

Yes No 

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

2. Was damage to the foundation avoided? c 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? y 

2, Was damage to walkway surfaces avoided? y 
Owners comments: 

Inspection notes: 

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

EPA Representative />L, ^ ^ Date: //^Q/^*? 
^BV< 

Property Completion Agreement 

This agreement docunients the completion of removal activities performed on the below listed property. 

The property ovraer's signature indicates that the property ovmer is satisfied with the restoration ofthe 

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. 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I Required corrections to complete the property: 

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

L J I do not agree restoration is completed 

yy y^/^Ar 

Owner's Signature^ • ' ' Date 
Pnident Technologies, Inc. (Pnident) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permission to allow indent 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 the cleanup including soil sampling, removal of lead-contaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact the Pnident Office for the Omaha Lead Site 

cleanup at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: •A.KVV ­

(Please 

Property Owner Signature: 

Pate) 

PROPERTY INFORMATION 

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

RESIDENT NAME: ^\^ _ ^ ^ />J^- Owner Renter 

£SIDENT ADDRESS: 3 ^ ^ ""l SVT^'^-C - A «->-«-

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; JO ^ G^\1>9 

OVVNER'S T^EPHONE NUMBER - HOME: J L WORK: 

AGE OF HOME?: . O YEARS. HOW LONG HAVE YOU UVED HERE? t t^EARS l . 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? _ AffiS—- NO o-vi'cU^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: t~ ) 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.) 

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'srightofaccess 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." 

C.Hn AtKn 
ECHNOLOGIES, INC. — 

r 

Property Status Form 

Address: ^^e^- , ^ Vorxe. -^^ ^ °^^^= "7 / *? ) 5^ ^ ^ 

Phone: BVID: 

3 o t» - 11 \ y 

T 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

O ^ 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

Property Owner Prudent Emplg, 

Signature: lJ<y^^'^~yC:^'^'^-'i^y_,,^ Signature: 

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

KansasCity, 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 - BUILT DRAWING 

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".>]•'".'•'.';. S': ; -.r.; w'" " ;;(:!:•: OMAHA LEAD SUPERFUND SITE 

Name: Uii'llitt v Q<^i,ty Omaha Lead Site Date: f/G-Q-j North Arrow —i 

Address: T^t^ l SIcJ^ 4t/.^ Site Sketch Time: 9- W i 

Phone: I 

Team BV1D# 3Sr(pQ,S XRF Code 6 ^ ^ I Elik/jrerrnMr i . 

Sample Number l.ead Concentratun Confirmation Sample sample Numoer 

f'Yes ^ No a 

f^Yes n No IST 2 kvC.BC.f'Xfi ' ^BA& \ ii(Yes a No ra^ \ MVDSCFX A - gg^^ g fttYes O No 2/' Aygf^ / PP*" g ^ ~^ ' ppm f»-Yes D No 13^ 

6 ppm Yes • No CD 

ppm Yes • No • "^ - Lab RYASCPLA-38668 — 

Result )9i ppm 

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Omaha Lead Site 46130 

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

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3047 STONE AV 

lidy 1999 - Douglas Comity Assessoi 
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Print Preview Page 1 of2 

.

Douglas County-Omaha, NE 

1 Pamel ID 

Owner 

A/ame 

Pmperty 

Address 

City 

\zip 

Owner 

\ Address 

Owner 

[Address 

\2 

Owner 

\ City 

Owner 

State 

Owner 

\zip 

Sec-Twn­

\Rng 

0916870000 

RAYER 

WILLIAM J 

3047 STONE 

AV 

OMAHA 

68111 

13406 POLK 

ST 

OMAHA 

NE 

68137 

33-16-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

kuvIM ' us'k'k^^^fl 

CURTIS & STONES ADD | 

4 

13 

W49FT 1 

49X140 1 

'"• .*••; - 1 

0.15 

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

parc=0916870000 

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

accountno=R0916870000 ] 

1 ••• •.-, • :- ' •:•,:, : . ' . • 1 

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

"> 

( Create Another Ticket j [ Back to Irth Internet j Send Email 

• YOUR TICKET NUMBER IS 2361704. 

Original Call Date: 

Work to Begin Date: 

9/11/09 

9/15/09 

Time:

Time:

 8:37 am 

 9:15 am 

Op: SIVA18967 

State: NE 

Address: 3047 

County: 

Street: 

DOUGLAS 

STONE AVE 

Place: OMAHA 

Twp: 16N Rng: 13E Sect-Qtr: 33-NE-NW-SE-SW 


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 


CXCATV MAGELLAN METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP DEBORAH

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11 /2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
EN"' 

TECHNOLOGIES, INC. 

Site Safety Hazard AnaSysis 

Address: ^CJ^-? S,^^j^ 

Cre>v: 

Date: ^.y^£?<T 

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 

Condition Hazards 

CfC/^-fi /w/^/^i^/i ^ 

y^jf i<sd 

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Site Safetv

^ ^ ^ 

Corrective 

Action 

/»*-V Joc4~hr 

1 

L^ ^ iot-yf^c^ 

uset ^^yt^c^yt^ 

 Officer 

S080 Ward Parkv/ay. Suits 405 2505 W. 24 Street. Suite SOS hoiicfl! Uriv.:. i>;ii-e : ^;.., 

KansasCity MO 6^114 0(nfli',=t. vebrasKa 68110 S.in aiiroiiio. TX 7S2?S 

Phone: (316) 36:;-; •'0' P;^•.i^!•;: (402) J04-1004 P?:;.:ie: 1^10: ?22-^5S? 

Fax; (816^ 363:;"C:y F\-.x­ .:J02! r,04-i005