TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: r5\ <=\6^ Date: /i//^/ao«^^ 

Address: 8^5 " S .Qfi 3 f 

Remediation Contractor: f^ur/p-n-T l^/Lii-f^y^r^r? ig g, ifHCy Year; f^)QD9i 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

a Executive Sunmiary 

sf EP A-pTOvided property sketch 

H Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

a Restoration Agreement 

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

d Confirmation data 

H Photographs 

of As-built sketch 

0 Satisfectory restoration signed by Property Owner 

a Property close-out check list signed by EPA 

a Description of areas not meeting ROD cleanup criteria 

a Utility clearances 

[^ Property information from Douglas County Assessor's Ofi&ce 

D 

D 

D 

Signature " ^ .. Dare 

40312929 llllllli 

Superfund 
PROPERTY SUMMARY 

Date: 11/19/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Oct/Nov. 

Property Address: 825 S 36 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A 3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED, B2 BUSHES, S'XIS' @ 265 PPM; 

CONTAMINATION LEFT BEHIND, B2 BUSHES, rX3 ' @ 810 PPM. 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 189 PPM @ 10", Fl = 26 PPM @ 6", DZ = 381 PPM @ 12", EA = 251 PPM @ SCRAPE. 

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 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 v^'ith 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. 

TECHNOLOGIES, INC. 
Find Rec»rd I Clean Up Query Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 21969

Owner: 

­ 825 S 36 ST 

n Owner Occupied 

Owner Name:

[SHOCKLEY CANDICE D 

Owner Addressl:

 | 

| 

Owner Address2:

|825S36ST 

City: 

)OMAHA 

Owner Phone: 

1(420)296-1810 

State: Zip Code: 

JNE J68105 

Alternate Phone:

|(402) 598-1153 

| 

| 

Resident: 

Resident Name: 

SHOCKLEY CANDICE D 

Property Address: 

(825 S 36 ST 

Zip Code: 

[68105 

Resident Phone 

Contract: 

Contractor: 

Group: 

Assessment: 

Qualifying Group 

[800 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

I 8S3 
•ITCHNOLOGIES,INC 

Property #: 2.)'?fe'J 

Date/Time: 

Quads Excavated: F», g% D^ -

SEBV 

EPA Property Close Out 

Property Address: Sx 5 S 34 ^ 

Owner's Name: 

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 of drip zone excavated and restored? y 

Grading Sod and Vegetation 

Yes No 

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? y ^ 

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

day time period) cy ^ 

4. Are sodded areas generally firm and evenly graded? 

i ^ 

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? i ^ 

7. Was damage to landscaping or plant materials avoided? t / 

Gates, Fences and Retaining Wails 

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) i ^ 

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

2. Was damage to the foundation avoided? Ly^ 

3. Was damage to windows avoided? 1 ^ 

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

iy ^ 

5. Was damage to downspouts or downspout extensions avoided? 

- Ly^ 

Sidewallu and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? ^ 

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

Inspection notes: 

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

EPA Representative /?r.^ ^ . Date: /^ygy/^:.'j> 
&ERIV 

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, if any. 

Property ID: 

Property Address: Z> Z S 

Owner: CLay^..^U ^ 

Phone: 

^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

\F\ I agree restoration is completed, except as noted above. 

 I I do not agree restoration is completed 

h,Krlji.i_/yiMM %J ^ 

^ 

Owffer's Signature DateV 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. 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, tlie 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 Prudent's Administrative Clerk for the 

Omaha Lead Site cleanup. Ms. Madhurima Duru -at (402) 733-1188, 733-1455. 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: _ KJ/^ ' I f (f'lease PrintNaraeV 

Property Owner Signadire: _ hdjuAmFM^ (Date) 

PROPERTY INFORMATIO FOfti N 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

^2S 2 3^ ^ .^4 r:)w.^.JU^ M^ Gsio c 

IF RENTAL, PROPERTY OWNED BY: Ccxti.(\:ce su^c^-^cl 

^ 

OWNER'S MAILING ADDRESS; 

v^ f>e Q aio y - OF 

OWNER'S TELEPHONE NUMBER - HOME: J _ WORK: 

AGE OF HOME?: fcrp 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 104 of CERCLA, 42 U.S.C. 9604. 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 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: (SIB) 363-3707 =3x: (402)504-1005 Fax: (210) 579-6577 
AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE OLS* 21969 

Date Excavated: 9/1S/2008 

Date USEPA Signed-Off: 

21969 

Extatioi Paint 

( 3 Good 

Omah a Lea d Site 

Site Sketc h • Poor 

Sampling Address: 825 s 36 ST f~| Not paint 

Sample Numtier 

RYASCPXA-21fl69 

RYBSCPXA-21969 

RYCSCPXA-21969 

RyDSCPXA-219B9 

RDZSCPXA-Z1969 

Fl 

F2 

B1 

B2 

DZ 

Lead 

Concentration 

fl^3 1 1 2 

.7 ir n 

Mq c 

31 (-? 

ppm 

ppm 

ppm 

ppm 

ppm 

Sannple 

Collected 

i

i 

LAB 

n 

D 

D 

D 

D 

Samples Collected 

Finn: fo A !>&/.Jt> 

Date: ji/PO/Cg, 

Time: .? : L"^ f>n^ 

Samples Analyzed 

XRF Unit: CaSH D Book: 

WaZ3GPXA-g1969 -e s ppm D D Date: ~\ ­ IC>-OS> 

RPZaePXA-g19C9 PZ - — ppm n D Time: Atl 

Staff: M<U / Number of Samples = i S o. Legend: Fl = From Left, F2 = Front RigW. BI = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AN quadrwits «r« as vw««d frrvn th« strqet, facing property 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
>RUDEN' rECHNOLOGIES, MC. 

Property Status Form 

Address: g'2' S S?)G^<1V - Date: ^ 1 o (, | b 9^ 

Phone: q ^ ^ _ q^ ^ ^ ^^^^^ BVID: ;z I q ^ ^ 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

AH ACL6 U U 

_ C a*"—•^ ' 

Pre-Existing Condition of Structures 

Doesyour Basement have a history of leaking? Yes TM- No — 

Item# Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: Signature: // 

3080 Ward Parkway, Suite 40s 2505 N. 24'-' Strsst, stite 306 4,242 Medical Dnv©-&«itg4250 

Kansas City, MO 64114 Omaha. Nabraska 98110 San Anionic, TX7te29 

Phone:(B16)3B3-370.? Phons: (402)504-100.4 Phons; (210).822-9S88 — _. .. ir>A C;\ *> !?>» i^-^AT ;4n'»3S cn.i.HAAjr Co,»- t'5-jn> K-ro..R«-?-7 
^ 21969 

Omaha Lead Site Extertor Paint 

Site Sketch Q Good 

• Poor 

Sampling Address: 825 S 36 ST • Not paint 

Sample Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm: fo A £>5/J7> 

RYASCPXA-21969 Fl QS 3 ppm D 

Date: h/?D/oe> 

RYBSCPXA-21969 F2 

1 1 Z ppm D Time: ^'.L<=;f>M 

RYCSCPXA-21969 BI _3_jL6_PP m 

D Samples Analyzed RYDSCPXA-21969 B2 H q G ppm D 

RD2SCPXA-21969 DZ 3 I I "7 ppm D XRF Unit: CaS^iO Book: 2o6 > 

RQZ9GPXA-2190Q 9 * " ppm D D Date: -]-/& - Ofi> 

r^PZOCPXA-21900 PZ- ~ ppm D Time: ^ n Staff: M<U / Number of Samples = j 5" j ^ | 

Legend: Fl = Front Lett, F2 = Front Right, BI = Bade Lett, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, lactng property 

: : f 

ijUL 8 2 23^3 

.51. .62..: 

3"?^; HOil, 

SOBJJ . ; ;c 

, 

8^5^-3C»Srf, ^ .; 

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Dz.'=3!n; 

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853 

WTT 

$•.3 47 5-h 

RwKiOS:-.' Crealal 07-/«n4)8 mei^i.oiij 
Page 1 of 1 

March 2007 DOUGLAS COUNTY ASSESSOR 

S^SS 56iT 

http://douglasne.mapping-online.com/assessdoc/Photos/19/R10383200000001.jpg 8/8/2008 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1038320000 

SHOCKLEY 

CANDICE D 

825 S 36 ST 

OMAHA 

68105 

825 S 36 ST 

OMAHA 

NE 

68105 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

21-15-13 

FEARON PLACE 

0 

25 

32X125 

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

parc=1038320000 

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

accountno=R1038320000 

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 = 40 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/7/2008 

ly^-^- S\l 



Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2126635. 

Origina l Call Date; 9/09/08 Time: 9:25 am Op: R7\MITA18967 

Work to Begin Date: 9/11/OS Time: 10:00 am 

State: NE County: DOUGLAS Place: Ol^lAHA 

Address: 825 Street: S 36TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 20-SE,21-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remediation project 


Location of Work: LOCATE ENTRIE PROPERTY LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: RAMITA Phone: (402)733-1455 


Alt. Contact: 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 


BSHPCLKS CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

rYnAx^/

CAC A 1 V

 COX COMMUNICATIONS, „„„i 

 HEIDI 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Day: 8002891901 NO NEED TO CALL OUT MCLEODNE MCLEODUSA EMERGENCY Alt: 

http://www.dhon.org/irthuitemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2008 
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MUDOl 

OMAHACOF 

OPPDGPR5 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC,SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

SANDY 

RON 

NA 

 NA 

Emerg 


Day: 


Ah: 


Emerg 


Day: 


Alt: 


Emerg 


Day: 


Alt: 


Emerg 


Day: 


Ah: 


Emerg 


8002891901 


4025047823 


4025047946 


4024447197 


4024445161 


4024445160 


4067289343 


8887289343 


4067289343 


4067289343 


8887289343 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2008