TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAK)#: ]\^/| j Date: 

Address: U\'^'\ S> 2.1-Sh 

Remediation Contractor: •r^iruJju^ H'^i^xL^' . X^^o ^®^" - ^ • 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Ef Video ofproperty (DVD) 

^ Executive Summary 

0^ EPA-provided property sketch 

y Signed Access Agreement for subject property 

l3 Signed Access Agreement(s) for adja(?ent property 

^ Restoration Agreement 

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

0^ Confirmation data 

y Photographs 

y As-built sketch 

IF Satisfiactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

^ Utility clearances 

W Property information from Douglas County Assessor's Office 

D 

D 

D 

Signatur^ Usto 

40310736 

IMiNilHHi 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 4123 S 22 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Fmdmgs: NONE 

A.4 Other Relevant Infonnation: AREA NOT EXCAVATED Bl LANDSCAPE 12'X50' @ 390 PPM; 

AREA NOT EXCAVATED Fl LANDSCAPE, BUSH 6'X7' @ 150 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 213 PPM @ 10"; Fl = 148 PPM @ 12"; DZ = 154 PPM @ 12"; EA = 39 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) Pbst-ExcaVatioB digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi) 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 

photographs 

iv) Signed form verii^ong satisfactoiy restoration 

v) Description of areas not meeting Interim ROD cleanup criteria 

TECHNOLOCIES, INC. 
Find Record 

Backfill: 

Sample Area: 11941 - 4123 S 22 ST 

Owner: 

Qean Up Query 

D Owner Occupied 

Owner Name: 

[STEINHOFF CHARLIE A 

Owner Addressl: 

Owner Address2: 

|4123 S 22 ST 

City: 

[OMAHA 

Owner Phone: 

1 

State: Zip Code: 

|NE ' J68107 

Alternate Phone: 

1 

Resident: 

Resident Name: 

[HANSON RICHARD C 

Property Address: 

(4123 S 22 ST 

Zip Code: 

68107 

Resident Phone 

Lead Remaining Query I Property Damage Query 

Contract: 

Contractor: 

|PRUDENT2008_S 

Group: 

Assessment: 

Qualifying Group 

I PLAY ZONE 

Assessment XRF Date: 

I -

Assessment Max XRF Value: 

I 609.33 
TECHNOLOGIES. INC 

Property #: )\'?4l 

Date/Time: 

Quads Excavated: &/, Fl D^^ 

EPA Property Close Out 

Property Address: l^\2-^ 5ZZ- ^ 

Owner's Name: 

Contractor Group Prudent Technologies 

Excavation General 

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 

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? 

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 pioperty? 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

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

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

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

4. Was damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to vrindows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage io walkway surfaces avoided? 

Yes 

/ 

/ 

No 

Yes No 

/ 

/ 

/ 

/ 

/ 

/ 

y 

Yes No 

/ 

/ 

/ 

i / 

V« No 

/ 

/ 

/ 

/ 

/ 

Yes No 

/ 

/ 
Owners comments: 

Inspection notes: 

^'^"'^^ CoNomo^j prteoDic^ ouni^ EPR cjcscouh 

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

EPA Representative Q^^ jgL-. Date: //??/o^ 
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 fiiture, excluding any 

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

Property ID: 

Property Address: ^/Z 3 J J2.3-^ ^ i5/ . 

Phone: 

Restoration Kerns in Question 

Item 

agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

'wner's Signature 

\^biior 

Date 
DMBEMX 

Prudent Technologies, Inc. (Pnident) is under cantract witli the U. S. Envinminental Protecticn Agency (EPA) lo clean up leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

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

property to remove lead-contaminated soil. By signing tfais form, tfae property owner grants pennission to Prudent to perfonn 

activities related to the cleanup including soil sampling, removal of lead«ontaminated soil, and restoration of tfae refiaenced 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. Madurima Duni -at (402) 733-14SS. Goieral questions about tfae Omafaa Lead Site cleanup can be 

directed to tfae EPA Public Infonnatio>qeirkrs at (402) 731-3045 (Soutfa Omaha ofGce) or (402) 991-9583 (North Omafaa office). 

Propeity Access Granted 

Property Owner Signature: 

RESIDENT NAME: 

Cjn^fW^ SvelvrNVX^^ 

lease Print Name) 

(Signature) 

^MQ^ 

(Date) 

PROPERTY INFORMATION 

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

Owner Renter 

RESIDENT ADDRESS: 

(^....^.oJU^ F3Q Q<3lo '^ 

IF RENTAL, PROPERTY OWNED BY:;, I 

f ^ 

g WNER'S MAILING ADDRESS; 

f^|v>wi. iU^ Ll-i_ &?(o7 

OyyNER'S TELEPHONE NUMBER-HOME: _ L 

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

WORK: 

^ YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ' ^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

^sTclJi 

NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

3 

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 providedfor in Section 104(e) of 

CERCLA, 42 U.S. C 960S(e), wfaich provides entry for "determiningthe need for response, or choosing or tiking any response action 

under tfais title, or otherwise enforcing theprovisions of tfae title." 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

2505 N. 24*^ Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

4242 IMedical Drive, Suite 4250 

San Antonio. TX 78229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
OLS#: 11941 

Date Excavated: 10/04/2008 

USEPA Sl^ied-OITDate: 

AS - BUitT DRAWING 

OMAHA LEAD SIIPEMtiND SITE. 

Owner Nanrw; CHARU e ^s-rAf-gy 

Addreas: <4i-g:i& S. 1 ^ ^4 , 

Phono: Ht W: 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

Q-Good 

• Poor 

(g^Not paint 

n± 

North AmtH 

Sample Number 

RYASCPXA- IW m Fl 

RYBSCPXA-ttWt F2 

RYCSCPXA-n#in Bl 

RYDSCPXA-M»tn B2 

RDZSCPXA-ll»*H DZ 

nozcopKAtwn—ez 

RPZSCPXA-H»«H P2 

Lead 

Concentration 

5it.1 

3l3 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

iT 

n 

S3^ 

U\B 

• 

n 

D 

n 

D 

D 

Samples Collected 

Firm: (VVES KM^e M 

Dale: to|ai/Oto 

Ttfne: t \ OOofii^^ 

,Lab RYBSCPLAr11941 Number Of Samples = • L 

Sa^.i 2 M .104 1 LJSL-l Result 

Samples Analyzed 

XRF Unit: iOC n Book: JjS ^ 

Date: 1 -O ^ -g)< j 

Time: 

StafF: 

1 -ot^ 

. J.'.^Pf!!'. _ = Front Right, B1 = Back Left, B2 = Back Righl DZ = Drip Zone, GZ = Garden, PZ = Play 

Air quadrants »ie j » viewed fw n tne ttrsMJicinsproperty... 

04tHlj»l23 

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

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: ^^^ ^ S 2.2r>*J S K 

Phone: 

Item NO 

On Map 

Hoji- ^\ o - CSS2 > 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

" ^ ' S /? I^.aqr ^ U l 0 

Does your Basement have a history of leaking? 

x" 

Description & Location ^ 

Pre-Existing Condition of Structures 

Yes '^- ^ No 

Property Owner 

Signal 

Prudent Employei 

Signature: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

2505 N. 24*^ Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

4242 Medical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
Owner Name; CkARLi e ^^TA^^gy 

fi 

Address: UH. ^ S. -O. ^ . 

Phone: H: w 

Omaha Lead Site 

Site SIcetch 

Exterior Paint 

• Poor 

Q3''Not paint 

laii 

North Anow 

Sample Number 

RYASCPXA-11 <lm 

RYBSCPXA-ll^m 

RYCSCPXA-lim.| 

RYDSCPXA-U>ifC 

RDZSCPXA-ull 

nOZOOPXARPZSCPXA-U>*VI PZ 

„Lab RYBSCPLV 

SResult 11)1 

Fl 

F2 

B1 

82 

DZ 

-ez 

Lead 

Concentrajtion 

m 

±Lil 

2 ^ 

.^ift l 

313 

r11941 

ppm 

- = Front Right, B1 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

Ef 

D 

lAB 

Number < >f Samples = (p 

Firm: 

Samples 

Date: ia.\3L\ /cxa 

Collected 

Time: W 00<x w 

Samples \naiyzed 

/pen Book: l^<^ 

= Back Left, B2 = Back Riiht DZ = Drip Zone, GZ = Ciarden, PZ = Play 

All quadrant i are as viewed from the street, i icing property EN^EilED 
Page 1 of 1 

.UGUST 2003 - DOUGLAS COUNTY ASSESSOR 

lfli^5S^J?ST 

http://douglasne.mappmg-online.com/assessdoc/Photos/33/R22427500000001.jpg 9/25/2008 
Print Preview " 6 ^ J. V^J . J. 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

\Zip 

Owner 

Address 

Owner 

\ Address 2 

Owner 

\City 

Owner 

State 

Owner 

Zip 

2242750000 

STEINHOFF 

CHARLIE A 

4123 8 22 ST 

OMAHA 

68107 

4123 S 22 ST 

OMAHA 

NE 

68107 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

34-15-13 

SPRING LAKE PARK ADD 

8 

15 

S 40 FT 

40X130 

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

parc=2242750000 

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

accountno=R2242750000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not 

guaranteed. This is not a legal document and should not be substituted for a title search, 

appraisal, survey, or for zoning verification. 

Map Scale 

1 inch = 35 feet 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/25/2008 
"> 

Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2144792. 

original Call Date: 10/01/08 

Work to Begin Date: 10/03/08 

State: NE 

Address: 

Time: 

Time: 

UGLAS 

8:42 am 

9:15 am 

Op: RAMITA18967 

Place: OMAHA 

4123 

Twp: 14N Rng: 13E 

Twp: 15N Rng: 13E 

Legal Given: C 

Sect-Qtr: 03-NW 

Sect-Qtr: 34-SW 

Type of Work: lead remediation work for soil 

Location of Work: LOCATE ENTIRE PROPERTY 

Remarks: FAX ALL CLEARS TO: 

: UNSURE CORNERS 

(402)733-1883 

Company 

Contact Name 

Alt. Contact 

PRUDENT TECHNOLOGIES 

RAMITA Phone: (402)733-1455 

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 MCLEODNE MUD02 OMAHACOF 0PPDGPR6 

QLNNEIF QWEST2 

Service Area 

ATTNEBRl ATT/T 

Contact Phone Number 

Day: 80024136249 

Ah: 

Emerg: 80024136249 

Utility 

Type 

CXCATV COX COMMUNICATIONS, ^^jj^j 

INC 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, .^^ 

Day: 8773668344 

Ah: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT Qay: 8002891901 

EMERGENCY 

Ah: 

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Page 2 of2 

MUD02 

OMAHACOF 

0PPDGPR6 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

SANDY 

RON 

NA 

QLNNEIF QWEST LOCAL NETWORK NA 

QWEST2 QWEST LONG DISTANCE SARA 

Emerg: 8002891901 

Day: 4025047823 

Ah: 

Emerg: 4025047946 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

Ah: 

Emerg: 8887289343 

Day: 8002834237 

Ah: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2008