TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: I^H v Date: /2-/^J- Jl^o i 

Address: 17 2.o j l S /3 sf 

Remediation Contractor: /vo^.'/~'7^.i.u.<^j.y . ^intL. Year: 2L£>OS 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

M Executive Summary 

a EPA-provided property sketch 

a Signed Access Agreement for subject property 

D Signed Access Agreement(s) for.adjacent property 

^ Restoration Agreement 

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

m Confirmation data 

sf Photographs 

0^ As-built sketch 

a Satisfactory restoration signed by Property Owner 

H Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0' Utility clearances 

0^ Property infonnation from Douglas County Assessor's Ofifice 

D 

D 

nil 

40309536 i • Superfund 

Siignatur m ^ Date 
PROPERTY SUMMARY 

Date: 12/20/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Monft of: Nov/Dec, 

Property Address; 1720 % S 13 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encouitered: NONE 

A.2 Issues Resolved: NONE 

A-3 Unique Findmgs: NONE 

A.4 Olher Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS; 

DZ = 807 PPM @ 13"; Bl = 30 PPM @ 12"; B2 = 129 PPM @ 12"; 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 sketchi) 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 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. 

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

Backfill: 

Sample Area: 19190 ­ 1720 1/2 S 13 ST 

Owner: Resident: Contract: 

n Owner Occupied 

Owner Name: 

|HOLOCH JENNIFER L 

Owner Addressl: 

Owner Address2: 

|1716 S 13 ST 

City: 

[OMAHA 

Owner Phone: 

State: Zip Code: 

|NE |68108 

Alternate Phone: 

1 1 

Resident Name: 

r 

Property Address: 

11720 1/2 S 13 ST 

Zip Code: 

[68108 

Resident Phone 

|(402) 490-3008 

Contractor: 

|PRUDErJT2008_S 

Group: 

Assessment: 

Qualifying Group 

|800 

Assessment XRF Date: r"­ "~ 

Assessment Max XRF Value: 

I 1110 
TECHNOLOGIES^ INC dEFVV 

EPA Property Close Out 

Property #: I'jI'io Property Address: H^* /i- 5 2J> ^^ 

Date/Time: Owner's Name: 

Quads Excavated: F ^^ li'j B'^,D2- Contractor Group Prudent Technologies 

Excavation General Yes No 

1. If necessary, were the correct quadrant(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 the perimeter ofthe 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) / 

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? 

y 

Gates, Fences and Retaining Walls 

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) y 

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

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? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? / 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfeces 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 Qr,^ Mr^ Date: ///v/^f> 
&EFA 

Property Completion Agreement 

This agreement documents tiie completion of removal activities perfonned 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 fiiture, excluding any 

remaining warranty (30 days total) except those items listed below, ifany. 

Property ID: 

Proper^ Address: /v^. ^ A, 5 a^* ^ .5 ^ 

Owner: ^^ ^ iXr>[oc)c^ " • . 

[Phone; ^O'X.^ul'^ o ­ 2 Q-Q B 

Riestoratioh Items in Question 

Item: 

Item:. 

Kem: 

Item: 

Itenri: 

Item: 

S^ l agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

I M OCK^J> / Q /^d/tTX > /Of/\/V­ Owner's Signature Date 
Prudent 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 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 ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Administrative Clerk fbr 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 A=^Hkh AWx=>c-H , 1 ^i'lease fnm Name; 

Property Owner Sigi U^: ^ 

( \ '(Signature) (Date) 

PROPERTY INFORMATION 

(To brtomplete impletedd Iby resident and/or property owner ~ plea§e print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

11PD ^' S ITS^ S t d^t^^A^ i3^_Q%^^ ^ 

IF RENTAL, PROPERTY OWNED BY: 

LJtLjT 

OWNER'S MAILING ADDRESS; 

Au^ c : o fr^^aJL^v Me_ ^ / 3 

OWNER'S TELEPHONE NUMBER-HOME: r ) WORK: 

AGE OF HOME?: I tT V ' YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

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

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 S 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's nght 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: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
OLS#: 19190 

Date Excavated: 9/18/2008 

Date USEPA SigMd-Off: 

19190 

Omaha Lead SIta Extonor P*mt Norti AmMr 

Site Sketch • Good 

• Poor 

Sampling Addrasi: l720_i/2 S 13 ST Q Not peint 

Sample Number 

RYASCPXA-18190 F1 

RYa8CPXA-19180 F2 

RYCSCPXA.19190 Bl 

RYDSCPXArlflIM B2 

RDZSCPXA-19ieO DZ 

RoggepxA-iBiM—e e 

^Lab RYBSCPLA-19190 

"Result 552ppm . 

Lead Sample 

Concenlration Collected 

3G> C onm 

&67 . .pp f 

2/^ / com 

• 

Number of Samples = [ g " 

LAB 

D 

tr 

D 

n 

a 

D

• 

CD 

Samples Collected 

Firm- FPft F^.Oji 

Dale. SU»loft' 

Tune. U'.<» ptft 

Samples Analyzed 

XRFUn«: G6H O Book: 20 1 

Dale: C-/2-O Q 

Time: P/ ^ 

Staff: AISK" 

Legend' h i = Front Lett, F2 = Front Right, Bl ' Back Left, B2 •> Back Rioht DZ = Dnp Zone, GZ = Ganlen, PZ =Play 

All qua I tbtet, hcti J pvperty 

kev ! .TiMid 3I4*C«7 

NO EASEMENT 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC 
ECHNOLOGEES, INC. 

n 

Property Status Form 

Address: V/.*> '/^^ S |^VV %\ ^ Date: 

Phone: BVID: 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

A l l fU _ 4Y«_C _ Ltv^UrS Kee ^ h> "tuu re>-*v^<z|, 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Y^T-— No" 

Item# 

On Map 

Description & Location 

Property Owner Prudent Empl 

Signature: ignature^^^^^^^^ WDVQCV^ J ^ \ A 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4*250 

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 
19190 

Omaha Exterior Paint North Arrow Lead Site 

Site • Good Sketch • Poor 

Sampling Address: 1720 1/2 S 13 ST [ 2 Not paint 

Sample Number Lead 

Concentration Firm:

Samples Collected 

 FPf t Ffe.OR 

RYASCPXA-19190 Fl Date: 5\2> \C)^ 

RYBSCPXA-19190 F2 Time: U'-dO ptA 

RYCSCPXA-19190 B1 

RYDSCPXA-19190 B2 Samples Analyzed 

RD2SCPXA-19190 D2 XRF Unit: 6i6H O Book: 20"? 

RQ2SCPXA-19190 -«2 Date: g-/2-Q 9 

Time: P n 

Lab RYBSCPLA-19190 

_s Result 552 ppm Number of Samples 

Staff: h^ W 

Legena: hi = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Play 

All quadracfeMire a< wieiofrt frnm tt y street, facing property 

^ : ENTERED 

i \ CO , ^ 

JUN B 6 ZiSS : 5 i3:5*­

iO" 

bl 

: • "er 

mi: 

n.l..F-z;­

•t 

s 13 5t; 

Rev 5 Cre»icd: 3l-Dec4)7 046141.0123 
Rl 5198000000001 j pg (JPEG linage, 640x480 pixels) http://douglasne.mapping-online.cotn/assessdoc/Photos/24/Rl 5198000.. 

A . ^4 

lav 2603 — Donelas Countv Ajisesso 

yco

/7.?o

 C^r. -TmJ

 S ISSf, 

 In^c'U ^ IZS t 

lof l 9/9/2008 11:22 AlV 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

\ Address 

City 

IZlp 

Owner 

[Address 

Owner 

\ Address 2 

Owner 

\City 

Owner 

State 

Owner 

Zip 

1519800000 

HOLOCH 

JENNIFER L 

1720 S 13 ST 

OMAHA 

68108 

1716 S 13 ST 

OMAHA 

NE 

68108 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Unk 

Assessor 

Website 

Link 

(S^I^^^HIH^ 

27-15-13 

KOUNTZE 3RD ADD 

12 

5 

N1/2 

25X140 

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

parc=1519800000 

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

accountno=R1519800000 

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 = 42 feet appraisal, survey, or for zoning verification. 

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

^'^w ^;5?ii»«,fj; 

04/2008 
l^ii : ,«' • 

Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2132385. 

Original Call Date: 9/16/08 Time: 10:58 am Op: RAMITA18967 


Work to Begin Date: 9/18/08 Time: 11:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1720 Street: S 13TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 27-NE-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION PROJECT FOR SOIL 


Location of Work: , ACTUAL PROPERTY TO BE EXCAVATED IS 1720 1/2 S 13TH ST 


: 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 


ATTNEBRl CXCATV LEVELS MCINEB MCLEODNE MUD02 OMAHACOF 


0PPDGPR6 QLNNEIF QWEST2 


Utility Service Area Contact Phone Nuniber Type 

Day: 80024136249 

ATTNEBRl ATT/T Ah: 

Emerg: 80024136249 

Day: 4029340469 


COX COMMUNICATIONS, CXCATV HEIDI Ah: 4029340469 INC 

Emerg: 4029329757 


Day:^ 8773668344 

LEVELS COMMUNICATIONS, LEVEL3 NA Alt: LLC 

Emerg: 8773668344 

Day: 8002893427 


http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.aSp?ret=<RESULTS.. W?i . 9/16/2008 
Page 2 of2 

MCINEB MCI 

MCLEODNE MCLEODUSA 

MUD02 METROPOLITAN UTILITIES 

DISTRICT 

OMAHACOF CITY OF OMAHATRAFFICSEWER 

OPPDGPR6 OMAHA PUBLIC POWER 

DISTRICT 

QLNNEIF QWEST LOCAL NETWORK

QWEST2 QWEST LONG DISTANCE

NO CALL PER MEMO 

NO NEED TO CALL OUT 

EMERGENCY 

SANDY 

RON 

NA 

 NA 

 SARA 

Ah: 

Emerg: 8002893427 

Day: 8002891901 


Ah: 


Emerg: 8002891901 

Day: 4025047823 


Ah: 


Emerg: 4025047946 


Day: 4024447197 


Ah: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Ah: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Ah: 


Emerg: 8887289343 


Day: 8002834237 


Ah: 3039921926 


Emerg: 8002834237 


http://www.dhon.org/irthinternel/DHONNoticeCreation/MessageText.a2p?ret=<RESULTS.. T S ] 5?r . 9/16/2008