TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ;?; S(^^ Date: 

Address: /O. ^ l j ^ r XfRemediation Contractor: A^.^i^h H^rli^Acj^^ .T^r. Year: ^2i»og 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

El Video of property (DVD) 

l?f Executive Summary 

• EPA-provided property sketch 

a Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

3 Confirmation data 

^ Photographs 

^ As-built sketch 

/ Satisfactory restoration signed by Property Owner 

El Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

la Utility clearances 

M Property mformation firom Douglas County Assessor's Office 

D 

D 

D 

Signature/^ , ~ ~ ~ [ Diite 

40310716 

Superfund 
PROPERTY SUMMARY 

Date: 01/23/2009 Omaha Lead Site Remedial Action Contract # EP-R7-<)7-06/0004 Month of: Dec/Jan 

Property Address; 1508 N 4S ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Oflier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 185 PPM @ 6"; EA = 251 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) Post-Excavation digital video cUp/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: 81868 ­ 1508 N 45 ST 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: Contractor: 

Owner Name: [PRUDENT2008_S 

[GREEN LEO C Property Address: Group: 

Owner Addressl: [1508 N 45 ST 

Owner Address2: 

Zip Code: 

68104 Assessment: 

[4519 S 148 ST Resident Phone Qualifying Group 

City: State: Zip Code: [800 

[OMAHA [NE [68137 Assessment XRF Date: 

Owner Phone: Alternate Phone: 

[(402) 991-3396 [(402) 290-8633 /Assessment Max XRF Value: 

832 
TECHNOLOGIES, INC dER(V 

EPA Property Close Out 

Property#: Bl 8 6 8 Property Address: I'^o^H'^SS T 

Date/Time: Owner's Name: 

Quads Excavated: ^^ j ^ ^ 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 of the house in excavated areas generally slope away 

y ^ 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) 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 IX 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? 

1 ^ 

Gates, Fences and Retaining WaUs /Yes No 

1 

1. Do gates open and close freely? (IfappUcable) 

l / 

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

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

«/ 

4. Was damage to retainmg walls avoided? (IfappUcable) 

y 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

y 

2. Was damage toflie foundation avoided? 

y 

3. Was damage to wmdows avoided? 

y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? (/ 
Owners comments: 

Inspection notes: 

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

EPA Representative ^c^^^ ^ Date: tlz»/oj 
« « EFA 

Property Completion Agreement 

This agreement documents the 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 future, excluding any 

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

Property ID: -

Property Address: ^jr^,^ ^ ISOf?: N • .'.^• .

J M<: ^ A. ^ 

o^"'='-= [^c . rs^r^. ^ 

Pbone: 

Restoration lt«ns in Question: 

Item: 

Rem: 

Item: 

Item: 

Kem: 

Item: 

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

L H I do not agree restoration Is completed 

/^ a7-<^>? 

Date 
Prudent Technologies, Inc. (Prudent) is under ccntract with the U. S. Environmental Protection Agency (EPA) to clean vp leadcontaminated soils at a numlser ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permissbn to allow Prudent to perfoim a soil cleaniq) at this 

property to remove lead-contaminated soil. By signing this form, the property owner grants permission to Prudent to perfonn 

activities related to tfae cleanup including soil sampling, removal oflead-contaminated soil, and restoration of tiie re^enced propeity. 

If you have any questions about tfae soil cleanup planned for your property, please contact Prudent Administrative Clerk for the 

OmahaLead Site cleanup. Ms. Deboiah Johnson -at (402) 733-1188. General questions about tfae OmahaLead Site cleaiup can be 

directed to the EPA Public Information Centeis at (402) 731-3045 (South Omafaa ofQce) or (402) 991-9583 (Nortfa Omaha office). 

Property Access Granted By:. Ze.^ ^yf^e^i^j 

'lease Print Name) 

Property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: \ / CK- r^A^W-A~ Owner Renter 

RESIDENT ADDRESS: 

g > ^ C^^U^^.r. k>f d>^Vt) ^ 

IF RENTAL, PROPERTY OWNED BY: 

ypfi ^ 

OWNER'S MAIUNG ADDRESS; 

<kw c^^u^sA^ M-g, ^S'l' ^ 7 

OWNER'S TELEPHONE NUMBER-HOME: ( \ ^'^ ^ " «^4^'>WORK: 

AGE OF HOME?: \(JlP ' YEARS. HOW LONG HAVE YOU blVEB HERE? ' YEARS. 

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

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 5 HOURS OR MORE PER WEEK: 


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


AUTHORrrY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by BPA under tfais 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 9605(e), which provides entry for "determiningthe need for response, or choosing ortaking any response action 

under tfais title, or otfaerwise enforcing tfaeprovisions of Ifae 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-«577 
•AS ^ BUILX I>RAWEVG 

<:• 0]VL^}tEAli!"Stl'EKiptJNi>. SlTE^fi^ OLSH: 81868 

Date Excavated: 12/06/2008 

USEPA Signcd-Off Date: 

^ sid ^ 

Omah Exterior Paint NHSIAIIOV a LMd Sif» 

QGood SMtSMtch 

Q Poor 

a-ypAddiMK iso a M Jig fi^- Q Notpalnt 

SomiileNuiiiiie SampiesCoaeGlect r 

I LAB Conoenhattoa Cotteded ram: fhf l l^B . AT 

RYASCPXA-aiaea F I a o 7 com n Die: Q - ft. - of l 

RYB8CPXArflM«« F2 D Time: liOft p-rfl. 

RYCSCPXA-aiMe Bl gag - Mm a &ainptos Analyzad RYDSCf>)(A-Sl8<S BZ 3Cfe opm D 

RDZSCPX^«IMe DZ ___*0___ppin D XRFU * 6&U > Book. yZ O 

D D t>le: lQ-(T-O a 

D •nme: p|Q a SJafft. Number or Samples gfg" } J Q ) MSW 

ugaml: PI > Front Len, F2 « FraMreght. 81B Back LB4L 82 « BM * RigN OZ >'Oiip Zone. GZ » Ganteh. PZ=Play 

Al QHiiAwSw# Si 4MMBtan Vw AN ^ iKlnQ |MpMtf 

...MT.1.5.2MI:. 

JL: ^ 

z9^ 

M M^':St 

EA = 251 PPM @ SCRAPE 

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

CONSTRUCTION TECEEN^ttpGIES, INC. SERVICES 

Property Status Form 

Address: Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^ O^v.^^ ojil ^ pUvJ^ 

Pre-Eiisting Condition of Stmctures 

Does your Basement have a history of leaking? Yes No 

Item NO 

On Map 

Description & Location 

/Z \ 

Property Owner Prudent Employei 

Signature> Signature: 

2505 N. 24*^' Street, Suite 308 4242 Medical Drive, Suite 4250 8080 Ward Parkway, Suite 405 

Omaha, Nebraska 68110 San Antonio, TX 78229 Kansas City, MO 64114 

Phone: (402)504-1004 Phone: (210)822-9588 Phone: (816) 363-3703 

Fax: (402)504-1005 Fax: (210) 579-8577 Fax: f816) 363-3707 
815<b8 

Omaha 1

Biterior Paint North Anw Lead Site 

QGood Site Sketch 

n Poor 

Sampling Address: I50 a H H S SJ - • Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Finn: f^DA DB ; ffT 

RYASCPXA-51868 Fl "ZCTt ppm D 

Date: Q-/fao « 

RYBSCPXA-8IB6ft F2 ZS 4 ppm D 

Time: iV3f> p-nr^. 

RYCSCPXAr8l8«e B1 S32 . ppm D 

Samples Analyzed RYDSCPXA-0IMB B2 366> ppm D 

RDZSCPXA-ai8«e 60 ppm  i^z D XRF Unit: ^&^ 0 Book: 22. 0 

RQZ0CPXA"ft»*6 OZ PP*n D D Date lO-IT-Od 

ppm n pm RPZSCPXA' D Time: 

Numbe Staff: M€>W f of Samples = [ 5 

Legend: Fl = Front Left, F2 = Front Right, Bl = Bade Left. B2 = Back Right DZ = Drip Zone, GZ = Ganteh. PZ = Play 

Al qiMdianls aie as viewed tram the straet. fadng proparty 

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Rcv2aa».BL CicAsd: 16-Kiiy ^ 046141.01231 

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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

2152480000 

GREEN 

LEOC 

1508N45 

ST 

OMAHA 

68104 

4519S148 

ST 

OMAHA 

NE 

68137 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

17-15-13 

SAUNDERS & HIMEBAUGH TO WALNUT HILL 

4 

31 

N 70 FT LTS 32 & 

81.5X70 

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

parc=2152480000 

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

accountno=R2152480000 

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 = 59 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 12/2/2008 


Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2185585. 

Original Call Date: 12/03/08 Time: 2:58 pm Op: MADHURIMA18967 


Work to Begin Date: 12/05/08 Time: 3:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1508 Street: N 45TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation work for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)733-1188 


Alt. Contact: Phone: (618)401-2223 


Work Being Done For: epa 


Depth of Excavation: 6 ft Corner Lot: N Front: N Rear: N 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day:

Alt: 

 8002891901 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day:

Alt: 

 4025047823 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA- TRAFFIC.SEWER RON 

Day:

Alt:

 4024447197 

 4024445161 

Emerg: 4024445160 

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Day: 4067289343 

OMAHA PUBLIC POWER 0PPDGPR5 NA Alt: 4062071494 

DISTRICT 

Emerg: 4065237717 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 4065237717 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/3/2008