TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 2>.^9.^o. Date: ij^.^jrQCiO^ 

Address: ^/ i B /y ^.' T A S 

Remediation Contractor: Pi?,-, (^9-n-f h^4i-Nnir>qt^.lr,ti.^. Year: fPflflS-Afl*? 

SOIL REMEDIATIO N 

PROPERT Y FILE FOLDER DOCUMENT S 

[Ef' Video of property (DVD) 40310283 

^ Executive sTMTM ^ {|||||||Hg | 

B^ EPA-provided property sketch Superfund 

B^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja(?ent property 

Ef Restoration Agreement 

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

B' Confirmation data 

0^ Photographs 

H^ As-built sketch 

0^ Satisfectory restoration signed by Property Owner 

S^ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

B ' Utility clearances 

0^ Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

Sigoati^ ^ ' "^ifate 
PROPERTY SUMMARY 

1 Date: 01/23/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Mondi of: Dec/Jan 

Property Address: 4118 N 25 AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Otfier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 112 PPM @ 6"; Fl = 93 PPM @ 6"; EA = 126 PPM @ SCRAPE 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements reqiured for crossing other properties 

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation ^gital 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) 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 

photogr^hs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record Clean Up Query I Lead Remaining Query I Property Damage Query I 

Backnil: 

Sample Area: 33833 - 4118 N 25 AV 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: |PRUDErrr2008_s 

r 

|CLARKE BERTRAM L _ Property Address: . Group: 

Owner Addressl: |4118 N 25 AV 

r Zip Code: 

Assessment: Owner Address2: |68111 

1156 ESTATE DR 

Resident Phone Qualifying Group 

City: State: Zip Code: L |PLAYZONE 

|CHICO ~ ICA ; 195928 

Assessment XRF Date: 

Owner Phone: Alternate Phone: ! . _ ._ , )(530) 988 5217 • |(530) 321-8649 Assessment Max XRF Value: 

I 7l7 
x 

TECHNOLOGIES. INC &BV< 

EPA Property Close Out 

Property #: 3 3 8 3 2> Property Address: 4l I fi N V5 AV 

Date/Time: Owner's Name: 

Quads Excavated: SO -f^l-J EA Contractor Group Prudent Technologies 

Excavation General Yes po 

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

L^ 

^ 

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

Grading Sod and Vegetation Yes No 

I. Does the grading around the perimeter ofthe house in excavated areas generaUy slope away iyr~ 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 generallyfirm and evenly graded? P ^ 

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

time period) 

Z­ 6.

 Was the property graded such that water will not pool on the property? Z ' 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining WaUs 

Yes No 

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

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 1 / 

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

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? 

1 / 

3. Was damage to windows avoided? P/ 

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

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes y p 

1. Was damage to driveway surfaces avoided? 1/ 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoratioii_activates compl^i;b including the 30-day sod warrpty: 

EPA Representative MTK l{/Al<y Date: U 6 O f 
^ P 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 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. 

Property ID: 

Property Address: Mi'l^ j S asv f(\ ^ ' --<:J: 

Owner: 

Phone: 

Restoration Hems in Question: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: , , . ^ 

yi/^ed -h^ iy^ ^ ^^< ^ <^^> ^ ^ .p""^ ^/ooj- . 

M I agree restoration Is completed, except as noted at}ove. 

l l I do not agree restoration is completed 

/:>-p.i(, - a 3 

wher's Signature Date 

\ ^ 
Pnident Technologies, Inc. (Pnident) is under contract with the V. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of properties 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, the property owner grants permission to Prudent to perform 

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

If you have any questions about the soil cleanup planned for your property, please contact Prudent Administradvc Clerk for the 

Omaha Lead Site cleanup. Ms. Deborah Johnson -at (402) 733-1188. General quesdons about the Omaha Lead Site cleanup can be 

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

Property Access Granted By: /? LJ/J^ ^ - ^ 

(Please Print Name) 

Property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME A/OLCXJI ^ fol— Owner Renter 

RESIDENT ADDRESS: 

9.,S^^- Ay^ ^ 6-V^^^JUA. k3 ^ 4SH O 

IF RENTAL, PROPERTY OWNED BY:v , . \ 

/ 

OWNER'S MAILING ADDRESS; y^ /w^ sc.,..JU M^ esM D 

OWNER'S TELEPHONE NUMBER-HOME: X WORK: 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? _YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: 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 104of CERCLA, 42 U.S.C. 9604. EPA's tight ofaccess to the propeity is provided for in Section 104(e)of 

CERCLA, 42 U.S. C 9605(e), which provides entiy for "determining die 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 405 2S05 N. 24*^ Street, Suite 308 4242 Metiical 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 

\ . 
J^"^ 

f . ' 

.•.iOMAHALEADSlJEERFIlSn)SITE >: OLS#: 33833 

Date Excavated: 11/24/2008 

USEPA Sii^-Off Date: 

33833 

Omaha Lead Site Exterior Paint North Arrow

• Good Site Sketch • Poor 

Sampling Addrast: 411BN2SAV [3f Not paint 

Sampla Number Lead Sample Samples Collected U B Concentration CollecteledfidFirm: PF g.C . e.l^ . 

RYASCPXA-33833 F1 CBI. S ppm a' Date: ^-Z^-S -

RYBSCPXA-33B33 F2 I «t 6) ppm D Time, 2'l^i>'f«' 

RYCSCPXA-33e33 Bl 5 5 6> ppm a 

Samples Analyzed

RYDSCPXA-33833 B2 20 2 oom n •negoopx/^Doeaa S i - " PP"' D XRFUnB: CoS'-l n Book: 20 1 

-RczsopxA-saew- -ez ^ ppm D Date: ^•28-o e 

RPZSCPXA-33833 PZ IH S ppm Time: Nf ^

Lab RYASCPLA-33333 

•

Staff: MS W Number of Samples = [ 3 1 | j | i^Result 717 ppm From Right. B1 = Back Lett, B2 = Beck Right OZ - Drip Zone, GZ = Garden, PZ = Pley 

All quadrancs an as rfnnd Iran tha itnat. racing propMy 

t ' • : " ' 

EA = 126 PPM @ SCRAPE 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
>RUDEN ENVIRONMENTAL & ' CONSTRUCTION 

TECHNOLOGIES, MC. SERVICES 

Property Status Form 

Address: Hi\ ^ ^ 2,^t V A^e^ ^ »«*«= ^M^'^*^ 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

OnMap Description & Location 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes No 

Item NO Description & Location 

OnMap 

Property Owner Prudent Employee \ 

Signature: Signature: 

8080 Ward Parkway, Suite 405 250S N. 24*^ Street Suite 308 4242 Medical Drive, Suite 4260 

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

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9688 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
i'rint Preview http://www.dogis.org/dogis_alias/dogis/prmtPreview.aspx7PrintOpt. 

Douglas County-Omaha, NE 

Parcel ID 1433690000 Sec-Twn-Rng 04-15-13 

Owner 

Name 

CLARKE 

BERTRAM L Addition KENDALLS ADD 

Property 

Address 

4118N25AV Block 6 

City OMAHA Lot 2 

Zip 68111 Legal 1 8 5 FT LT 1 & N 40 FT 

Owner 

Address Legal 2 45X132 

Owner 

Address 2 

156 ESTATE 

DR Legal 3 

Owner City CHICO Legal 4 

Owner 

State 

CA Treasurer 

Website Link 

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

/taxinfo. jsp?parc= 1433690000 

Owner Zip 95928 Assessor 

Website Link 

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

/accountinfo.jsp?accountno=R1433690000 

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 = 27 feet appraisal, survey, or for zoning verification. 

lofl 11/5/2008 8:53 AM 



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YOUR TICKET NUMBER IS 2178656. 

Original Call Date: 11/19/08 Time: 2:22 pm Op: MADHURIMA18967 


Work to Begin Date: 11/21/08 Time: 2:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4118 Street: N 25TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 04-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation work for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)733-1188 


Alt. Contact: Phone: (618)401-2223 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 


Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

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