TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: )^3fe7 Date: )ojilln& 

Address: }n 9 Sf<au.i^;3 CJ^CU 

Remediation Contractor: &.2P^4 71 CL^ J^cpe... ,^'^'^y ^^^'- '^'^"'^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

a' Video of property (DVD) 

l?f Executive Summary 

[ET EPA-provided property sketch 

[? Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

0' Confirmation data 

0^ Photographs 

y As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

0 Property information from Douglas County Assessor's Office 

D 

D • 

D 

Signatur^^ Date 

40311313 I ;:iiii iijii IIIII mil mil IIIII IIII III 

iiiiini 

Superfund 
PROPERTY SUMMARY 

Date: 10/17/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Sept/Oct 

Property Address: 109 STANFORD CR 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A 3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl=88 PPM @ 7"; DZ=144 PPM @ 11"; 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 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 verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record Clean Up Query Lead Remaining Query 1 Property Damage Query Close 

Backfill: 

Sample Area: 16367 - 109 STANFORD CR 

Owner: Resident: 

• Owner Occupied Resident Name: 

Owner Name: FERRAGUn DONNA 

|FERRAGLrnDONNAJ Property Address: 

Owner Addressl: 1109 STANFORD CR 

Zip Code: 

Owner AddressZ: | j68108 

1109 STANFORD CIR Resident Phone 

City: State: Zip Code: 

1 OMAHA JNE |68108 

Owner Phone: Alternate Phone: 

1 

Contract: 

Contractor: 

Group: 

Assessment: 

Qualifying Group 

I PRIORITY 

Assessment XRF Date: 

Assessment Max XRF Value: 

I 700.88 
SERV 

EPA Property Close Out 

Property #: 163&

Date/Time: 

Quads Excavated:

 1 

 F- )j •^•^ 

Property Address: / ^ ^ ^t ^ ^-^^^^'^L G 

Owner's Name: JC-^rtP, fTLR£firqK)t\ 

Contractor Group Prudent Technologies 

Excavation General Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? y 

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

\y 

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? 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) y 

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

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? (If applicable) y 

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? 4 y 

4. Was damage to windows or door screens avoided? t y 

5. Was damage to downspouts or downspout extensions avoided? 

t y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? 

y 

2. Was damage to walkway surfaces avoided? 

y 
Ovrners comments: 

Inspection notes: 

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

EPA Representative A Date: 9/js/o» 

aa. 

" ^ 
oEFVV 

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. 

1 Property ID: 

1 Property Address: \^[) (A ^Uw^^rc ^ C7 ' 

Owner: TN- ^ ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I I I agree restoration is completed, except as noted above. 

I I I do not agree restoration is completed 

ly-t ^ 

Owner's Date 

^ 
^^^' '

•flR!lDF.NT 

Piud»nl T»clinolo^»s, Inc. (PiudaiQ isundsr contract wife th* U. S. EnTiiommsntjl Prot»etion Agaocy (EPA) to clisni^ UsdcontiiBuul»dEoilE it a nuaib»i of ptoptitifts located in Omaha, N »biadca, indudizig th« piopttty locstsd at 

\0 ^ S-fcL-A/Ac^ f^ Q>prThtEPAnqutstcyourpHsiaiottto alloirPmd*nttopctfom a»i l cUaai^atftii 

piop»ilytoi»»i--^ -:i V .: -^toU. By BgangftiEfon&, th«prop»%ownwgrantspenniaaontoPiud*nttcpMfom 

acti^«Eielat»d to th« cUmap mcIudiiQ soil sampling, rsmotrai of l«ad-contamindL»d soil, and itstoiation of th» r»f*renc»dpiop«ity. 

If youha7» any iju«sIious about th» soil cltan^plamwd for your pTop«ty,pl»a» contactPrudMit'sAdnunittntt'T»Cltdc forth* 

OiBahaL»adSit« cUanup. ME.ShatmonHolt-atf40Z)304-lOC4. G»n«al qutstiom about&» OmahaL»BdSit« dtao ^ caub* 

dir»ct»dto &» EPA Public InfonaaiiouCtntut at(40^731-304j l^ouihOmaha offic») oi(402)991-9383 (^oithOmaha offic»). 

Propeitr AecossGrantsdBy: 'pO ^ ^ ' ^ ^^^^^^7 ^ ' 7 T ' / 

^ s I?' vi;v Pnrit""' »:->i«) 

Prop»itj O wnsr Si^ulurt: Joj-O^oS­

(Pal*) 

PROPERTY MFORMATION 

^ a Ve ron^btoj t r rcnlcnl asi/vrpnf eitf nrwr - pbaat l(jiat) 

RESIDENTHAME: t\nrvrv ^ f^ ^C^(2F\{l^TI Renter 

RESIDENT ADDRESS: 

^^3. Szt o^*>d-Ag' oA a r 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S HAILMG ADDRESS; 

i^f^ Sjq^^nJI ClL O^wa^siv k3=£ -C-Slt> 5 

OWNER-STELEPHONE NUMBER-HOME: (Hti l "lofc, ' *7^g 7 WORK: 

J 1 

AGE OF HOME?: | Ot> f YEARS. HOW LONG HAVE YOU LIVED HERE? \ c2 - YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTIH SIDiNG SINCE 1378? ^y§«— NC Aslyto^J^ ^ "SrUjte^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: *] NUMBER OF 0CCUPANTS7 YEARS OLO AND OLDER 

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

COMMENTS o n SPECIAL IMSmUCTIONS: (I.E. DOGS. ENTRY GATES. ETC.) 

AUTHORITY F0REN7IRDNMEHIALRSSP0HSEACTI0WS; Tii*activiti»stob»impl»m9Ht«dbyEPAuiii*rlbdsaHr**m«nt 

are pursuant to Ssction 104 of CERCLA, 42 U S.C. 9604. EPA's n ^ of access to th* piop*rtyispTo^dedfoiinS*clion i04(e) of 

CERCLA, 42 U .S. C 9£03(*), vriiiAi piovidts entry fox "dettrmising the need for lei^onse, or chooang ox taking siy req)onse action 

under thislitl*, or othenrise enforcing the piomoons of the title." 

8080 Ward Pamw^ . Suits 405 2S0S N. 24** Street Suite308 4242 Medical Drlva. Suite 42S0 

Kansa Omdin MflbraskaesilO San Antonio. TX 78223 s Clfy. MO 64114 

Phons: (4(S)S04-1004 Pllon«: (210)822-8688 Phone: (816) 363-3703 FB)C (210)679-e677 Fax: ^16) 363-3707 FBJC (402)604-1006 
AS - BUILT DRAWING fi 

OMAHA LEAD SUPERFUND SITE 

OLS#: 16367 

Date Excavated: 7/12/2008 

Date USEPA Signed-Off: 

Owner Hams: DOno a SetlTBCKj h Oi^aha Lead Site 

Address: 103 iSfan&ird lllrde ^"® ^^^^"^ 

Phone: H 7Qc^Z2aS-^:! .JViT- 4SHZ 

Sample Number 

RYASCPXA-It? ^<« 7 F1 

, nvDOOPXA FaRYCSCPXA /i34. 7 Bl 

RYDSCPXA-»«»5i»7 B2 

RDZSCPXA fii^fe 7 D2 

RGZSCPXA- (i ? <• 7 GZ 

RPgOCPXA P*-

Lead Sample LAB Concentratior Collecta6 

7 0 / ppm D 

ppm D ^ 0 ^ 

ppm D 2H?> 

ppm D 

7 5 1 

IC 3(2 7 Extenof Paint NoitltAfrow 

• Good 

Ds^ • Poor 

Of Not paint 

Samples Collected 

Date 

Time \^M ^ 

ppm D XRF Unit:

^k ^ 

ppm D Date: 

ppm D D 

Time: 

Staff: Number of Samples = ^ 

Samples Analyzed 

 fP'^ l Book: //*? 

g-^-gS T 

/yy ? 

AA. 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

^^ll quadrants VK ^ vneoed fromthe str«f. facing property 

.d<sa\. 

I •^2 1 ••: aa 

FI=88PP M o 7" 

i: 9 

->T ^ X X 

isa 

iflR.3UrfwtiC-ir:. 

<J b i 

.font, 

NO EASEMENT />)}/4l/ 

mmBMB­ 40G S 3 5fl(^5 

DZ=144PPM «; 11' 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
IRUDEK rECHNOLOGIES, INC. 

Property Status Form 

Address: lo^l S-l-o^vgLj^r^ O r a °^^^' ^^ ^ ^ ^ Oprtr^ 

Phone: BVID: iG 3 C="\ ^^i ' l b t,- -19^1 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

Pre-Existing Condition of Structures 

4' 

Does your Basement have a history of leaking? Yes- ^ No — 

P 4*-

Af r dtlA r^j^A g^.^i- Ot- CW>j^f g ^ ^ ^ 

Item# Description & Location ^ 

On Map 

Uou/SK, oJLo/\^ VW Cc^^c Oo C^<\cjc av P °l u.3)<3 

9(J- s 

f6-e 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 IVIedical 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 
1Q5Q7 

Exterior Paint North Arrow 

r Owner Name: DO/ina^EeCT^C^ h °"l^.^^ ^l^' ^ f *® • Good Address: JO^^aii^bcdJlIrde ^'^^ ^^^^""^ — D ^ n Poor 

Phone: »:lQ<is.ISd^y^.LjifS-.*fSM2 j ^ Not paint 

Sampl Lead Sample Samples Collected e Number 

Concentration Coltects(6 

LAB Firm: /YES. "9\CJ F 

RYASCPXA-16 5^ 7 Fl 70 1 ppm a Date: M ^/^ 3 

RYDGCPXA F&~ "" ppm n Time: |(>:^5' 

RYCSCPXA-/(&347 Bl 'b o ^ ppm D Samples Analyzed RYDSCPXA-/t!»3f^7B2 g^ 3 ppm n 

RDZSCPXA-lis 36 7 DZ 7^7 ppm D XRF Unit: ID?>'7 Book: // ? 

RGZSCPXA-1 &•? i* 7 G2 Ml_PPm v D Date; ^'^'O ^ 

RPZSCPXA PS- •" ppm D Time: yyy i D 

Staff: Number of Samples = | , ^ AA. Legend: Fl = Front Left, F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

s^ll quadrants are.a^ viewed frorn the street, facing property 

Rev"t' W6t4L0123 
IC 3(2 7 

Exterior Paint North Arrow 

r Owner Name: niOna^EeJOC^C^ h ^"l^.^ ^ ^^^"^ 5'*® •

 Good 

D —Di ^ Poor 

9hox^e: ^ZQ<^J33^y^j:_MS:yi-SH2 (5^ Not paint 

Sampl Lead 

Sample Samples Collected e Number 1 AC 

Concentratior Collected 

Firm: PPfS. IfJ^^ F 

RYASCPXA-16 5 (r 7 Fl 70 / ppm D Date: m^fl^ b 

RYDGCPXA- HFB- •— ppm D Time: |(^'^< r 

RYCSCPXA-/<S»347 Bl 30 ^ ppm D Samples Analyzed RYDSCPXA-<to367B2 2H2? ppm m/ D 

RDZSCPXA-»ii •5^ 7 DZ 

751 ppm D XRF Unit: fP^ l Book; // ? 

RGZSCPXA-1 &•?<'7 GZ ^ 6 ^ ppm a Date; g-?-«?S " 

RPZSCPXA P*- — ppm D D 

Time: /'nn 

Staff: 4:A Numljer of Samples = ; , ^ 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

sAII quadrants are.^ viewed from the street, facing property 

Rev 4' 

046141.0123 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPreview.aspx7PrintOpt.. 

Douglas County-Omaha, NE 

Parcel 

ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1905920000 Sec-Twn-Rng 

FERRAGUTI Additton DONNA J 

109 

STANFORD Block 

CR 

OMAHA Lot 

68108 Legall 

Legal 2 

109 

STANFORD Legal 3 

CIR 

OMAHA Legal 4 

Treasurer NE Website Unk 

Assessor 68108 Website Unk 

27-15-13 

OKAHOMA-S E ROGERS0 

26 

N 33 S 89 1/2 E 

89 1/2 W 179 FT 

33X89 1/2 

http://webapps.dotcomm.org:B080/TreasTax/faces/pages/taxinfo.jsp?parc=1905920000 

http;//douglasne.mapping-online.com/DouglasCoNe/slatic/accountinfo.jsp?accountno=R1905920000 

Disclaimer: Map and parcel data are t)elieved 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 verificatwn. 

io-i ^y^y^pr> ^1^^ ^ 

Map Scale 

1 inch = 55 feet 

ofl 6/6/2008 12:22 PM 
IQ^ y^> '^J O'J^ 



file:///C:/Users/lord%2Q^o20my%20shepherd/Desktop/STREETS/2.htm 

Create Another Ticket Back to Irth internet 

fcSend Emai...i 

YOUR TICKET NUMBER IS  2077830. 

Original Call Date: 7/09/08 Time: 1:09 pm Op: RAMITA18967 


Work to Begin Date: 7/11/08 Time: 1:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 109 Street: STANFORD CIR 


Twp: 15N Rng: 13E Sect-Qtr: 27-SE,34-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD 


Location of Work: ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)504-1005 


: UNSURE CORNER 


Company : PRUDENT TECHNOLOGIES 


Contact Name: RAMITA Phone: (402)504-1004 


Alt. Contact: Phone: (4 02)452-9806 


Work Being Done For: EPA 


Depth of Excavation: 6FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


ATTNEBRl CXCATV LEVEL3 MCINEB MCLEODNE MUD02 OMAHACOF 


0PPDGPR6 QLNNEIF QWEST2 


Utility Service Area Contact 

Phone Number Type 

Day: 80024136249 


ATTNEBRl ATT/T 

Alt: 


Emerg: 80024136249 

Day: 4029340469 


COX CXCATV HEIDI 	 Alt: 4029340469 COMMUNICATIONS, INC 

Emerg: 4029329757 


LEVEL Day: 8773668344 
 S 

LEVEL3 COMMUNICATIONS, NA Alt: 


LLC Emerg: 8773668344 

Day: 8002893427 


NO CALL PER MCINEB MCI 

Alt: MEMO 

Emerg: 8002893427 

of 2 

7/9/2008 
file:///C:/Users/lord%2iik%20my%20shepherd/Desktop/STREETS/2.htm 'o^^ o 

MCLEODNE

MUD02 

OMAHACOF 

r^DOT^r-oo/; 0PPDGPR6

QLNNEIF 

QWEST2 

 MCLEODUSA 

METROPOLITAN 

UTILITIES DISTRICT 

CITY OF OMAHATRAFFICSEWER 

 OMAHA PUBLIC POWER

 Djs^c T

QWEST LOC/U. 

NETWORK 

QWEST LONG 

DISTANCE 

NO NEED TO CALL 

OUT EMERGENCY 

EDWINA 

RON 

 ..^ 

 ^ ^ 

NA 

SARA 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

Day: 8002834237 

Alt: 3039921926 

Emerg: 8002834237 

2 of 2 7/9/2008 1:15