TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAn)#: \.^a ^ Date: 

Address: ^1 v .? .T '^ r A ^ 

Remediatioii Contractor: f^^^-ir H^fl^^^J^^. • TXn^ .. Year: ^oS_ _ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0" Video ofproperty (DVD) _^___ _ 

H Executive Summary 

a EPA-provided property sketch 

El Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Cd Restoration Agreement 

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

D Confinnation data 

^ Photographs 

0^ As-built sketch 

0 Satisfactory restoration signed by Property Owner 

l / Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

ffl Utility clearances 

[tf Property information from Douglas County Assessor's Office 

D 

D 

D 

„/9r>^Ay 3l>^l^\ 

SignatUTQA \ ... Date 

40310728 

nmni 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2303 S 32 AVE 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Otiher Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F1 = 106PPM(@6" 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement includmg access ^reements 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 includefinal 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 OAvner 

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. 

TECHNOLOCIES, INC. 
Find Record I Clean Up Query Lead Remaining Quer/ I Property Damage Query 

Backfill: 

Sample Area: 17513 ­ 2303 S 32 AV 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: Contractor: 

Owner Name: |KAZOR JEFFREY J |PRUDENT2008_S 

|KAZOR JEFFREY J 

Owner Addressl: 

Property Address: 

2303 S 32 AV 

Group: r—I- Owner AddressZ: 

Zip Code: 

[68105 Assessment: 

|2303 S 32 AVE Resident Phone Qualifying Group 

City: State: Zip Code: [PLAY ZONE 

jOMAHA )NE [68105 Assessment XRF Date: 

Owner Phone: Alternate Phone: I --_.„. ­ |(402) 344-8141 |(402) 871-7441 /^sessment Max XRF Value: 

I 784.82 
TECHNQLOGIESbINC dEm 

EPA Property Close Out 

Property #: \ 1 ^ \ 5 Property Address: 53o 3 ^ 3 2-AV 

Date/Time: Owner's Name: 

Quads Excavated: P I y G P^ Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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

Grading Sod and Vegetation 

Yes No 

1. Does the grading around die perimeter of die 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 

day time period) / 

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

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

time period) / 

6.

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

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (IfappUcable) / 

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) 

/ 

4. Was damage to retaining walls avoided? (IfappUcable) 

/ 

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? 

/ 

5. Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

/ 

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 ^c ^ J^L^ Date: /Ms'Jay 
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: Xl-^Q- ^ ^ , ?> Z^ ^ fVH>. 

Owner: "J^-l ^c^-2.aC 

Restoration Items in Question: 

Item: 

god O) Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: i 

n 

yH-1 agree restoration is completed, except as noted above. 

 I I do not agree restoration is completed 

IL ^/> ^^ 

Date 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean ap leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including tfae property located at 

. The EPA requests your permissbn to allow Prudent to perform a soil cleanup at this 

property to remow 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 oflead-contaminated soil, and restoration of tfae referenced property. 

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

Omaha Lead Site cleanup. Ms. Madhurima Duru -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 (Soutfa Omaha ofBce) or (402) 991-9583 (Nortfa Omaha office). 

Property Access Granted By: 

Property Owner Signature: 

(Date) 

PROPERTY INFORMATION 

(To 9t completed by resident and/or property owner - please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

^3^3 3- ^1Y \ «j Avf-^ loe Q^\o ^ 

IF RENTAL, PROPERTY OWNED BY: 

OVVNER'S MAILING ADDRESS [\ ^ 

OWNER'S TELEPHONE NUMBER - HOME: < > WORK: 

AGE OF HOME? I ft\o YEARS. HOW LONG HAVE YOU LIVED HERE? ^=> ^ YEARS. 

SrvsjLt v_ji 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? 

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; Tfae 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 providedfor in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "determining tfae need for response, or cfaoosing or taking any response action 

under this title, or otfaerwise enforcing tfaeprovisions of tfae 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 
AS-BUILT DRAWING ~ S 

OMAHA LEAD SUPERFUND SITE 

OLS#: 17S13 

Date Excavated: 10/10/2008 

USEPA SIpwd-OffDate: 

/Tsr/3 

Omaha Ijeai Site S~ST7v^ 46130 

EA = 260 PPM @ SCRAPE 

CONTRACT #: EP - R7-07-06 / 0004 PRUOENT TECHNOLOGIES. INC 
1 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Address: 

Phone: 

Item NO 

On Ma p 

Item NO 

On Map 

Property Status Form 

Date: 

BVID: 

Plants & Pennanent Landscaping To Remain In Place 

Description & Location 

^.^ ^ 

Pre-Existing Condition of Structures 

Doeijyour.Basementhaveahistory of leaking? Yes No 

>M^4A-«!^«^ J^ ^ >^ftr. 

Description & Location 

Property Ownei Prudent Employeey 

Signature:. , Signature: 

V 

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 
46130 
Page 1 of 1 

March 2007 DOUGLAS COUNTY ASSESSO 

330^ S 3<?AYf 

http://douglasne.mapping-online.eom/assessdoc/Photos/21/R09046200000001 .jpg 9/25/2008 
Print Preview Page 1 ot 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

0904620000 

KAZOR 

JEFFREY J 

2303 S 32 

AV 

OMAHA 

68105 

2303 S 32 

AVE 

OMAHA 

NE 

68105 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

28-15-13 

CREIGHTONS 1ST ADD 

6 

17 

47X127.5 

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

parc=0904620000 

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

accountno=R0904620000 

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 = 54 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/24/2008 

Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2145003. 

Original Call Date: 10/01/08 Time: 10:00 am Op: RAMITA18967 


Work to Begin Date: 10/03/08 Time: 10:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2303 Street: S 32ND AVE 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project for soil 


Location of Work: 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: 6ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 


Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

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0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 8887289343 

Emerg: 4067289343 

QLNNE 1F QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

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