mm • • 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: /'^lo ? Date: nJjKin ^ 

Address: L^n % fl 0_c r AfRemlediationCoimactor: e i^^Jj ^ h-^^ui , S^ o Year: ^^ 9 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

1^

ffl

 Video of property (DVD) 

 Execirtive Suimnary 

Q

til

D

H

 EPA-provided property sketch 

 Signed Access Agreement for subject property 

 Signed Access A€reement(s) for adja^sent property 

 Restoration Agreement 

Q Settlement docurne3Qts(i.e., for damage or to replace pUmts, etc.) 

Confirmation data 

Photographs 

As-built sketch 

i 

d 

d 

D 

D

Satisfiactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

 Description of areas not meeting ROD cleanup criteria 

Utility dearances 

Property infonnationfrom Douglas County Assessor's Of&ce 

D 

D 

Signature 13Sr 

300541 07 I 

Superfund 
Find RecxMxJ Remediation Query j Lead Remaining Query j Property Damage Query 

Backfill: 

Sample Area: 12307 - 4003 S 25 ST 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: [RESIDENT |PRUDENT2009_S 

|SEMIN DELORES M Property Address: Contract Option 

Owner Addressl: [4003 S 25 s r OPnONB 

I Zip Code: 

Owner Address2: [68107 Assessment: 

|2317 DEERPARK BLVD Resident Phone 

aty: ^ State: Zip Code: I Qualifying Group 

[OMAHA |NE |68108 |400/CHILD 

Owner Phone: Aitemate Phone: Assessment Max XRF Value: 

r 569.45 
imWiWilWIYaiHMPffiMBSy 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address: 4003 S 25 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 73 PPM @ 13"; F2 = 212 PPM @ 13"; DZ = 190 PPM @ 13"; EA = 96 PPM @ SCRAPE (~1) 

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. 

THCHNQiamEG^jlN!:. 
TECHNOLOGIES. INC. ^S®^j 

EPA Property Close Out 

Property #: 12-3^7 Property Address: ^' S S 2 S ^ 

Date/Time: Owner's Name: Q^Offc , S<:wOi«^ 

Quads Excavated: p ) p. i prz^ Contractor Group: Prudent Technologies, Inc., 

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 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 tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) y 

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

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

time period) y 

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 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) y 

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

5. Was damage lo downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

i/ 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod v^arranty: 

EPA Representative ><9^.3^ ^Date: njasjo') 
-.^-7=^^- . -r -.^. 

'•••••I I'-ik I Hi /?!f '- ; !t 

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: 

1 Property Address: ^'^^J S^ y^s

 -sr 

1 Owner: 

1 Phone: 

Restoration items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

agree restoration is completed. 

 I I do not agree restoration is completed at (noted deficiencies above) 

br^yuj^ - Lli4 H 

Owner's Signature Date 

I
TECHNOLOGIES, T^C. 

ProdtaaTetikmoVo^es, toe. (jTOdenQ is unAci con!aaawfe\to\J. S.tovnioifltvectoAProtection Agency (EPA) to clean up leadcontanniial^ soWs^l a t]wtibe>' ofpsoperties located in Omaha, Hebraslui, including the property located at 

^QQ Q S O*- ^ S y . The EPA requeste your pennission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contanrinated soil. By signing this form, the property owner grants pennission to Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration of the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Adminjs(r2tiveiilcrk,for the 

Omaha Lead Site cleanup. Ms. Siva S Jampana-at (402) 73-VllSii. Geiieral questions about the Omaha Lead Site cleanup can be 

[^^Tc^rters at (402) 731-3045 (South omana ou.«,. . v^-. directed to the EPA PubUc Information Centers at (402) 731 -3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By 

Property Owner Signatore (Signature) 

PROPERTY INFORMATION 

Cr (To bbee complete completedd bbyy resldeji^o .^.Idea^orr prop propert . y owner - please prm.)

y y y 7a ^JJO I Owner Qenter ^ ^ 

RESIDENT NAME 

RESIDENT ADDRESS:

'^dfoz S c^r^e^-^c^ 

OWNER'S MAILING ADDRESS; ^ ^ ^ ^ </]UL ^ P^L U £1 ^ 

OWNER'S TELEPHONE NUMBER - HOME: {'M'ir ^ f^3-^3^ ^ WORK: 

AOE OF HOME?: / / 3 ^ YEARS. HOW LONG HAVE YOU LIVED HERE? >S ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WPfH SIDING SINCE 1978? _YES NO 

A/c^yf//^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: I J w" NUMBE IMBBRP n OF OCCUPANTS 7 YEARS OLD AND OLDER


NUM

Tm:>4iLDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (l,E. DOGS, ENTRY GATES. ETC.) 

jy^ & r.Ays/D^ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities Vo be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 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 "detennining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Surte 405 5600 S 10* street 4242 Medical Drive, Suite 4250 Kansas Cfty, MO 64114 Omaha, Nebraska 68107 

Phone:(316)363-370 San Antonio, TX 78229 3 Phone: {402)733-1188 

Fax: (816) 383-3707 Phone: (210)822-9588 Fax: (402)733-1883 Fav- !'>"•' — 
TECHNOLOGIES, INC, 

Property Status Form 

Address: ^^0 3 ^ . ^ 6 ^ Date:/^-/7"^/ 

Phone :^5J- 3:i^i m 6r/l ^^A fg// BVID: /^^^y 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Structures 

y Does your Basement have a history of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owner Prudent E 

Signature:^^»(^jd/.,^/Y/<*/?>^^^ Signature: 

L_ 

8030 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) 504-100^ Phone: (210)822-9588 

Fax: (816) 363-370" Pax: l'402) 504-1005 -ax: (210) 5'9-65?T 
"c;n\()i ;u!ifs . IXC. 

AS - BUILT DRAWING 

• sy-^.'.S'n : r;; •::-'• ;,!;•: OMAHA LEAD SUPERFUND SITE 

Name: Omaha Lead SIta Date: : 9/04/g^ North Arrow —1 

Address H^i H 1C5 ^ Site Sketch Time: : . 

Phone < -

Team N\-\Vfc\l^ft<VN ts\^ \ 0. ^?. BVID # 1 7 3 o 1 XRF Code ^t^^V 

Sample Number Lead Concentration Confimiation Sample 

mm ppm F|Yes a No Q ­

ppm (Jjyes a No a< : 

glYes a No H ^ 

No O' , 

ppm (JCfes a No B ^ 

ppm Yes • No CD 

ppm Yes a No • 

>. l ^ ^ 

Omaha Lead Site 46130 

= •;(-:•• ) 

CONTRACT #: EP - R7-07-06 T0# 1 PRUDENT TECHNOLOGIES, INC. 
|>fJav^.SuYim TyV^ 

Name Omaha Lead Sits Date: North Arrow : . 

Addres Site Slcetch Times: : l\'.o!u A..*^ s 

Phone: . ^

^ Ooi^tild ^A L M--s m m66i,t/et:6Jl 

>. ^ f 5r 

Omaha Lead Site 46130 
PRIL 2005 ' DOUGLAS COUNTY ASSESSO 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

I i 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

\zip 

Sec-TwnRng 

0404710002 

SEMIN 

DELORES M 

4003 S 25 ST 

OMAHA 

68107 

2317 

DEERPARK 

BLVD 

OMAHA 

NE 

68108 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

SOUTH OMAHA CITY LOTS 

36 

11 

S 42 W 50 FT LT 11 

42 X 50 

0.05 

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

parc=0404710002 

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

accountno=R0404710002 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/17/2009 
Page 1 of2 

"> 

[ Create Another Ticket ] [ Bacl< to Irth Intemet ] Send Email 

YOUR TICKET NUMBER IS 2396438. 

Original Call Date: 10/29/09 Time: 1:35 pm Op: SIVA18967 


Work to Begin Date: 11/02/09 Time: 2:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4003 Street: S 25TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 04-NE 


Twp: 15N Rng: 13E Sect-Qtr: 33-SE 


Legal Given: C 


Type of Work: SOIL LEAD REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA 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 


ALT872 ATTNEBRl CXCATV LEVEL3 METRO MUD02 OMAHACOF 


0PPDGPR6 QLNNEIF 


Service Area Contact Piione Number Utility Type 

Day: 4067289343 

ALT872 WINDSTREAM COMMUNICATION NA Alt: 4062071494 

Emerg: 8887289343 

Day: 80024136249 

ATTNEBRl ATT/T Alt: 

Emerg: 80024136249 


Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 


Emerg: 8773668344 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/29/2009 
Page 2 of2 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://wvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/29/2009 
ENViRONMENTAL & 

CONSTRUCTiON 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: Vg^^ S- 2S^ ^ E\ .^/'7-^ 

Crew: ^^•itS- 7 

Date: yt>-:si<:>G*i 

Corrective 

Item Condition Hazards Action 

Overhead Lines 3<-rftfi HnuHi^^^/nui l h»nfii ^ ^se yae«v^ 

Gas Line 1 ^ A/»rJ /C'0^<> 'Ufli^ t 

Water Line -fSewer Line AunjsL l^a^J /^t^*Ae 

Septic / Leech 

field JU± . 

Propane/Butane .js^yL 

Sidewalk Z^^eetiz- • ^« ' ^^i<(Arr f y 

Foundation •hC'K. 

Retaining Walls /^g«^ ^ 

Fences Tf't" ' 

Trees/ Bushes Af,, 

Structures .A/ ^ 

Driveway /L.. t/f<9^/^^/C ^ 

Sprinkler System juyL 

Other 

Crew Foreman Site Safet\ Offfcer 

^V^- ^ '^--^9!^-^ ^^^ ^ 

aoso Ward Parkv.'ay. Suite 'aS iSO^ h;. l-i ' Scr&si. jH^ts JO 

KansasCity . MO 64-i14 OrriiJ-!;:, i^!sbiask£: SS110 S.-ir: A;ilcniO. T.X 

Phone: iSlfi i 363-3703 Phone: I'+Oa; 5Gi-lnu4 :"^hOi!e: (210: 3 :-S58S 

.'0^i:;i TC:­ F;-ix: /'JOci S04-''00^ 



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