TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SATOfr. im^ Date; ^ 1^ 7 

Address: [ bZ \ LrO[l<u{ ^ V 

Remediation Contractor: ?rli4jUV^' T^l U \ ftt Year: _^£iUL 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

2f Video of property (DVD) 

Executive Summary 

if EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

d Restoration Agreement 

D 

Settlemeat documeats (i.e., for damage or to replace plants, etc.) 

Confiimation data 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

Qf Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property informationfirom Douglas County Assessor's Of&ce 

D 

D 

D 

Signature 

Date 

30260771 iliii 

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

Backfill: 

Sample Area: 29942 -162 1 LOCUST ST 

Owner: Resident: Contract: 

t n Owner Occupied Resident Name: Contractor: 

Owner Name: |PRUDEr^T2009_S r 

jCITY OF OMAHA Property Address: Contract Option 

Owner Addressi: 11621 LOCUST ST [BASE 

Zip Code: 

Owner AddressZ: |68110 

Assessment: 

)1819 FARNAM ST Resident Phone 

City: State: Zip Code: Qualifying Group I 

|OMAHA |NE |68183 poo 

Owner Phone: Alternate Phone: Assessment Max XRF Value: "1 

t 

500 
• • • • 

PROPERTY SUMMARV 

Date: /15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: Qf f 

Property Address: 1621 LOCUST 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 

Fl = 86 PPM % 6"; F2 = 99 PPM @ 6"; Bl = 102 PPM @ 6"; B2 = 86 PPM @ 6"; NO EASEMENT 

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 number 

7) Other items to be included in the individual property file, if available, or obtained include: 

i) Pre-excavation agreement details (ifany are made with the property owner) 

ii) Property Status Fomi 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. 

Property #: ^'^'t' ^ 

Date/Time: 

Quads Excavated: R-'/ P2-,R)/&vEPA Property Close Out 

Property •\ddrcss: /^T J iouy h ol'~ 

Owner's Name: ^-V-^ ctS C>^vx3ik<^ 

Contmctor Group: Pniidcnl TccliiioJogies, 

F.veavation General Yes No 

1. ir iioccssMiv. were lhe correcl quridrant(s) excavated aid restored? / 

2 if necessary, were llie conecl areas ofdrip zone excavated and reslored? / 

Grading Sod and Vegetation Yes No 

1 Docs lhe grading around the pennieter ofthe house in excavaled areas generally slope away / IVoni lhc house':' 

2. Has sod been laid ni all areas Ihal were excavaled? y 

3. Does lhc sod appear lo be generaJly healUiy and growing? (Only evaluate if inspected at a .30 

day lime period) y 

4 Arc sodded areas generalh' llrm and evenly graded'.' d 

5. Arc lhc joiiiis belween Lhe sod smps generally lighi? (Only evaluate if inspected at a .30 day 

lime period) y 

6. Was lhe propeily graded such tliat waler will nol pool on lhe property? / 

7. Was damage lo landscaping or plant materials avoided? A 

Gates, Fences aiui Retaining Walls Yes No 

1. Do gales open and close freely? i If applicable) / 

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

3. Was d;imagc to gates or fences avoided? (Ifapplicable) / 

4 W.as damage to retaining w;ills axoided? (Ifapplicable) / 

FouBuliition, Siding and Gutters Yes No 

I Was damage to the siding or Uini avoided? / 

2. W;is damage lo lhe foundation avoided'/' / 

3. Was d;imagc lo windows avoided? / 

4 Was damage to \vindows or door screens avoided? / 

.> Was daniage to downspouts or downspout extensions avoided? / 

Sidewalks ;iiui DriAOways (Coiierete) Yes No 

i Was daiiLigc lo driveway surfaces avoided'.' / 

2. Was d;imat;e to ^^•alk\\a^' suifaces .avoided? 

A 
0^ 1 ^CxJ^ ^t-

Owners comments: 

Inspection notes: 

nutonllBlO 

d.A:p SP/fs ckscyy*" 

/ieati^* ^ 

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

EPA Representative *-^^^ Date: ddM­ ija»> 
)3/0003 

ii^Nov.30 . 2009411:00A M OMAM PLANNING OEPT, 402-444-614 0 7168 'P. 3

m\ 

h mH. I ;i ^ r 

Propetty Completion Agreement 

This agreement documents tlie completion of removal activities performed on the below listed properly. 

The propeity owner's signature indicates tliai the property owner is satisfied with the restoration of the 

subject property, <ind that i^o items arc in question, now, or m any time in the fiuurc, excluding any 

remaining warranty OO days total) except tiiose items listed belov^', ifany. 

srjfi'vrx^r 

i property ID: 

Property Addrcs.s: / ^ Q / LoCW/iri- Sji Owner: 

\!AfA7dA^.-Jd£2zdAdfAf.izJl27.^A.^.^ 

Restoration Items in Question: 

Item: 

Item: 

I

\ Item: 

! Item: 

i 

! Item: 

•^»^^-*•'^'*^•."••Jc-"':i•^'r'n •im,n;'i"^'-f>*'--'-

Required corrections to complete the propisrty: 

i 

agree restoration is completed. % 

I—1 I do not agree restoration is completed at (noted deficiencios above) 

ffdf^cd^ 

Owner's Si.i;»fMut Date 
No, 4421 P. 4"'' — PLANNING DEPT. 402-444-614 0 

^^Oct, 9. 2009= 10:13AM 0M| | 

••r:j;^;?;t*5:' ••; 

V'^vrtciv; VttcUiKil«ii!,i<s. loc (PriKicnr/ i5 u/idttr colilrstl wiU) Uic U. 5. Environmenial l^foicclion Agoncy (lil'A) io clean up Icadmanamipiiicii 5pil.« III n aumljcr of prapcrties located ia Oinnha, r-iebrafkf. includiog ijii: prcpeny loculcd nt 

jh73iJ...-IyACLPJi^(Z. _S^t.J - ri'* '^''A rcquEBls your pfcmjissipji ii> ailow Prudem lo perfprm ? .loil cicair.ip at Ulis 

pr^eily ui n;!!^^^lajd-comamimited soil 6y .Mgning\hjs form, (ht pIOpoT^>- owner aretils ptiivusiwn \o I'riitlisiH lo pcil'oi-m 

/ti:iniiiiV- ;cl;ii,!d Ul Illi; clciump mcluJiiiti soil sampling, rejnovsl oClcad-winiaoiiniilcti soil, and resiijrdiiiMi of llic rcl'cromwl projWly. 

U'yDiilinvc any qiieslioiwnbiiul lhc soil cloanup plmincd for your property, pteiiSc conliicl ['rwUwu's Icrlhc 

Om.lhft 1 «ici .Silc clcjimip at (W2) ~ •• •, OciKsral qucsuow aboui llic OnsKo Lead .Siic clcamiii w r he 

(liitiilud 10 lhc TiPA Public lAromilion Centers al (402) 7:il-30AS (SouUi 0>«;iJw o(r.c.i> oi i.*02) V'yl-'J.'iR.'V CNorih (.)rH,ih^ offioc). 

Ih-opcriy .'\tt-.c5S Gronvodft>,•. y AAA' ^ y^^CJ>t 

I'ropcny C)win;r Slgi 

A S (Signnturc^ (VJ^w) 

i : PROPERTY INFORMATION 

(To bi; complctcU h)' rCTidoit and/or proper^- ovjner — p)«3is« print) 

RESIDENT NAME: 7 /y ^ , Owner Renter 

RESIDENT ADDRESS. . 

tF RENTAL,PROPSR PROPERTV ' OWNED BY: 

OWNER'S MAILING AOORESS 

< Sr. <CAL^/A/^^. /U ^ ^ (t/^- ^ pr/f 

OWNER'S TEl.EPHONfe NUMBER • HOME-. (7^-V', 7/ V ~ -^ ^- J / WORK: 

J )-_ _ „ „ 

A//f ^' AGE QF HOME?; YKARS. MOW LONG HAVE YOU LIVED HERS? YEARS. 

/l/d p "AP^^ TME EXTERIOR BEEN PAfNTEO OR COVEReO WITH SIDING SINCE 1978? ___,_YES __ „ NO 

/1^\£NUWIBE R O F OCCUPANTS UNDER 7 YEARS OLD: NUMBER QF OCCUPANTS 7 YEARS OLD AND OLDER 

/^^fY^NUMSE R QF CHILDREN UNDER 7 YEARS OLD W»0 PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

COMMENTS OR SPECfAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

l"i iVi^-'.'jir.iV: r.irivi;!. StjiV'.; 42Sr, •'^."'i'l'.-.A-s Ci;v . fiiO '.!'•";.; 

Ss?i .ih-,^ioiv<,vTX7a2t<> 
Oo/OOOT 4421 P. 5 PLANNING OEPT, 402-444-614 0 i U Oct. 9, 2009' ' 

i 

TECHNOLOGIE.S, ]i.NC, Js. 

I Property Status Form 

'\y^m^ ^07-H^H-ycyi , ^........lyj?^,,<?.t.t•^:? 

I Item NO j Pktits & Pet utanent Landscaping To Remam In Piace 

I Oa Map I Deseriptiotii & .LocatWH 

\ ^ 

N^' 

Pre-Existing Cqadition of Stfuctnres 

Does your Baseraeot" have a fetstory.of Jeakjag? Yes .iVo 

Item NO Ei'escriptiofit & Locjitioci 

Ort. M.ap ! 

fs p PtoAps /A fu//>7io siS&u/c^Jk pPna/^yA) 

Pr^ifcnt Etnptoyee S-^Pi/tey*.f..s . . 

Sfgt5;aty.re'.: ^ J /J^A^y^^yy­
ECiTN(M.O(itr,S, INC. 

AS - BUILT DRAWING 

01,S#:29'J42 

Diifc I'Ai-iivatid: l(>/2K/2()(»9 OMAHA LEAD SUPERFUND SITE i:SKl',\Slj>nci\-01Tl)atc; 

ili l Hlllil l 29942 

Omah Exiarior Paint Morth Arrow a Lead Site 

Sit • Good e Sketch 

npoo r 

Sampline Address: 1621 LOCUST ST I^No l paint 

Sample Number Lead Sample Samples Colleaed LiVB Concentration CoUected F-rm: TOg) Fft Oft 

RYASCPXA-29942 Fl 5 0 0 ppm a Date: ^)?. ^ \f7l 

RYBSCPXA-29942 F2 1-l-Z.Z. ppm n Time: |27 P 

RYCSCPXA-29942 Bl HS l ppm Samples Analyzed RYDSCPXA-29942 B2 3 1 7 ppm Id D 

RDZeorXA-2&042 -B2- ppm n u XRF Unit: Lj^HT . Book: V\ h 

nG2CCPXA-20Q4g 62- — ppm 

- • n Date 7 6 - /O -O l 

Lab RYDSCPLA-29942 ppm D Time A M 

-Result 406 ppm Staff: ^^^ ^ Number of Samples = 14 ' / 

Legend: Fl = From Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ - Drip Zone, GZ = Garden, P2 = Play 

All quadrarMs are as viewed from Ihe street, facing property 

ENTERED 

-opt- r: -1- •y^'--f - ­

.H5.1 • 3T\ 

»2 = 86 I'I'M .; ; 6 " HI = 102 Pl'M lyi! 6" P$.1. .SZ A 

1 

k 

..Soo. .\yM.1. 

Fl = 86 PPM {ib 6" F2 = 99 PPM («> 6" \='.f.\ -.\ n 

-HiOtliL 

./-.QAUit f/ 

NO P.ASr.MKM 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
29942 

Omah Exterior Paint North Arrow a Lead Site 

Sit • GooC e Sketch • Poor 

Sampling Address: 1621 LOCUST ST r I^Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm 

Sampies Collected 

RYASCPXA-29942

RYBSCPXA-29942

RYCSCPXA-29942

RYDSCPXA-29942

 F1 

 F2 

 Bl 

 B2 

mLZ. '^5 1 

3 1 7 

ppm 

ppm 

ppm 

ppm 

ra' 

n 

n 

r:i 

Date 

Time 

_a.lza.K2 

_J2:iP 

Samples Analyzed 

r?Dg6GPXA-29942 &gr ppm n n XRP Unit: Cff^HV Book: 1<^5 

RCZSGPXA 20042 G ^ _ pprn n D Date: 7 6 • /£> ­ O l 

Lab RYDSCPLA-29942 - ppm D a Time Ai± 

SResult 406 ppm Number of Samples = | M / Staff; ns> ^ 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Lefl, B2 - Bar.k Right DZ = Drip Zone, GZ • Garden, PZ = Play 

All quadrants are as viewed from the strf-et, facirig property 

ENTERED •V. -<;. XV '•"•• ? 

' , i 

^57. .3.1 

^ 1 .SZ 

[ 

/^2/ 7o(i/f/: 

7y...:.'.*. i5c>o....\/^lsi, 

^ \ - \ ^ ^ 

W V III .l l V - - ^ 

LoctyfiP rp 

Ki' v 5 I'l l .'i-.-i -I'lJ.yX)-! 11:1.', I.' 
Print Preview Page 1 of2 

# • 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

\zip 

Sec-Twn 

-Rng 

2344490000 

CITY OF 

OMAHA 

1621 LOCUST 

ST 

OMAHA 

68110 

C/O PLANNING 

DEPARTMENT 

1819 FARNAM 

ST #1111 

OMAHA 

NE 

68183 

10-15-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

URES SUB DIV 

0 

2 

36 X 78 5/8 

0.06 

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

parc-2344490000 

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

accountno=R2344490000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Count... 10/14/2009 
Page 1 of 2 

"> 

[ Create Another ticket f | Back lo Irth Internet ~ ] Send Email 

YOUR TICKET NUMBE.H IS 23S3464. 

Origiric-i. Cal l Dd-^e: 10/09..n9 '.'"ifie: lU:-;:3 an Op: SIVA18g6'/ 

Work r..-^ riegin r.Jav.e: 10/1';,''09 'y::ae-. .L;!.:0() am 

State: HI: County: DOUGLAS Place: OMAH. 


Addres:s : 1621 Sti-Gol; : LOCU.ST ST 


Twp: ' ^,)?j Se:;-.-Qtr: IC-NE-NW-SE-SW 


Twp: Rng: Sect-Qtr: 


Legal Giiven: C 


Type of Work: SOIL LEAD P.Li'IEDIATION PROJECT 


Location of Work: LOCATE ENTIRE ?RC?ERT'i' 


Remark:;: FAX ALL Ck.RARS 'VO: (402)731-1833 


: FAX ALL CLL.ARS TO (402) 733 1^)83 


: UNSURE CORNF'.RS 


Compai-y : PR.[iDFNT TECHNOLCGT ^y: 


Contact Name: Sl v'A JAHPA.M/V Pho;ie: (402) 733-1,; 


Work L..:-. nc Doiie For: EPA 


Depth ..:'! Exc-^v at .L-r,; 6 F'i Corner Lot: I Front: Y R^ar: 


Invol ^'e.s Tunric 1. j r-.."j c^r HOJ .i.cental Loring : I' E.xplosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF OPPDGPR.S QLNNEIC 


Service A sea Contact Phone Number JUtility Type 

Day: 4029340469 


cxcA i V COX C(.)MMUNIC:ATIONS. INC HEIDI Alt: 4029340469 

Emern: 4029329757 


Day: 9185747098 


MAGl:l,LAN MAGF.LLAN MIDSTREAM PARTNERS LP DEBORAH Alt; 

Ernerg: 9185747098 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 'Alt: 

. . •'' Emerg: 4025047970 

Day: 4024447197 

OMAIIACOI- CiTY OF OMAHA-TRAFFICSEWER /'ROM Alt: 4024445161 

Emerg: 4024445160 

http:.Vv\a\\v.dhon.org/ii1hintcniei/DHO'NN^blice.C.'-eation/MessageText.asp?ret-=<RESl.lLTS... 10/9/2009 
Page 2 of 2 

Day: 4067289343 


0PPDGPR5 OMAHA PUBLIC POWER DISLRICT NA Alt: 4062071494 

Einerg: 8887289343 

QLNNEIC QV/ESr LOCAL NETWORK NA

Day: 4067289343 

 y\lt: 4062071494 

Emerg: 8887289343 

http://\v\Avv.dhori.org/irthinteract.'DHO.N!NoliceCreatiori/]Vlessag«ext.asp?ret=<RESULTS... 10/9/2009 
ENViRONMEivTAL & 

CO!VSTRUCi'IO!\i 

TECHNOLOGIES, INC. SOi.uTIOMS 

SliB Sgit©tv Kaiard Ama I; vs lis 

.Address /^^y /^r.u^r E../o-^-d9 

C revv: ^ -

m.iP:y-Q yD? 

Date: PAS- //p - (S)^^ 

Cf^ -PiefA/l^t 

.i_:„u—Lj.y. ,-r.-».c7i- aatJi—.s-.,u. ••i3ra^i;ij:js:=:.ig=:p 

• Corrective 

it&m Condric^on Hazards Act j on 

Overhead IJnes y^/r 

Ga.s Line i 

Water Line i 

Sewer Line 

Septic / Leech I 

field 

Propane/Biitane I 

SidewaJk 

Foundation 1 i 

1 

{1 • • I 

Retaining WaUs 

Fences 

Trees/ Bushes 

Structures 

Dnvevvav I

1

( 

1

. 

_ .. 1 

Sprinkler System

Other 

i 

M 

Cre>V\Forf!r!aR Site Safet\ Officer 

y y 

S03S \^ard Parkvisy. 3u:r& • 

t\a;-.sas Ciiy, MO 3411^ 

Phone: (8135 3Q"-:?70-i 

h'a:-:: (SIC! r;6j-':: C-T 

••-­. \i. 2v' Siveat, Suks ::CB 

;•?^;^ A[Uonio. • X VflxS 

;-hoi-:t: 1210) a:;;'-?;;s;