TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 17658 DATE: 12/15/2010 

ADDRESS: 2321 S 21 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

[^ EXECUTIVE SUMMARY 

Ql EPA-PROVIDED PROPERTY SKETCH 

0 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

D SETTLEMENT DOCUMENTS (I.E., FOR DAMAGE OR TO REPLACE PLANTS, ETC.) 

m CONFIRMATION DATA 

0 / PHOTOGRAPHS 

ca AS-BUILT SKETCH 

d SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

a PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

d UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

f^ V w *'^'' 

SIGNATURE DATE 

30260813 

Superfund 
Find Record Remediation Query Lead Remaining Query ' Property Damage Query 

Backfill: 

Sample Area: 17658 - 2321 S 21 ST 

Owner: 

D Owner Occupied 

Owner Name: 

JMANDOLFO KIMBERLY J 

Owner Addressl: 

Owner Address2: 

|1006 SKYLINE DR 

City: 

JELKHORN 

Owner Phone 

State: Zip Code: 

:|NE |68022-

Alternate Phone: 

^ '

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option OPTION 1 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: 

Owner Phone: 

State: Zip Code: 

'1— ! 

Alternate Phone: 

Assessment: 

Qualifying Group l|400 

Assessment Max XRF Value ij 513.58 

Resident: 

Resident Name: 

Property Address: 

|2321 S 21 ST 

Zip Code: 

[68108-

Resident Phone 

J — 
PROPERTY SUMMARY 

Date: 12/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Montli of: December 

Property Address; 2321 S 21 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Otlier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 205 PPM @ 6"; Bl = 160 PPM @ 6"; B2 = 163 PPM @ 6"; EA = 123 PPM @ 2" 

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 sketch -

i) Shall include fmal 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. 
TECHNOLOGIES, INC. 

Property #: nC?*?*^ 

Date/Time: 

Quads ExcaviUed: f Z, ^< ,^* 

EPA Property Close Out 

Property Address: 2 ^2.1 >-2 i ^TOwner's Name: \C<rrxWl(j^ M,a^c/oi(c' 

Contractor Group: Prudent Technologies, Inc.. 

Excavation General Yes No 

I. if necessan'. were tlie correci quadrant(s) excavated and restored? / 

2. If necessarv'. were the correct areas of drip zone e.xcavated and restored? / 

Grading Sod and Vegetation 

1. Does tlie grading around tlie perimeter of the house in excavated areas generally slope away 

from the house? 

2. Has sod been laid in all areas that were excavated? 

Tl. Does the sod appear to be generally healthy and growing? (Only evaluale if inspected at a 30 

day lime period) 

4. Are sodded areas generally fimi and evenly graded? 

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

time period) 

6. Was the property graded such lliat water will not pool on tlie property'? 

7. Was danuige lo landscaping or plant materials avoided? 

Yes 

/ 

/ 

/ 

/ 

y 

y 

y 

No 

Gates, Fences and Retaining Walts Ves No 

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

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

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

4. Was damage 10 retaining walls avoided? (If applicable) 

/ 

/ 

/ 

/ 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage lo the foundaiion avoided? 

3. Was damage to windows avoided? 

4. Was daniage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Yes 

/ ^ 

/ 

/ 

y 

y 

No 

Sidewalks and Driveways (Concrete) 

Was damage to drivcwfiv surfaces avoided? 

Ye.s No 

~7^ 

2. Was damage to walkway surfaces avoided'!" 
Owners connments: 

Inspection notes: 

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

EPA Representative S<^ ^^^ ^Date: ///iy/.-^ 
tCHNOLOGIES. INC. 

OLS #17658 

Date Excavated: 09/22/2010 

I SEP.A Signed-OfT Date: 

AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

17658 

Owner Name: JOHN COMSTOCK Omaha Lead Site 

Address:232iS2iST _ Site Sketch 

Phone: » •402-933-6779 W 402-250-2300 

Exterior Paint 

• Good 

n Poor 

13 Not paint 

North Arrow 

Sarr.ple Number 

RYASCPXA-17658 Fl 

RYBSCPX/^-17658 F2 

RYCSCPXA-17658 Bl 

RYDSCPXA-17658 B2 

-Re-zseP)tA-w66e—9Z 

nCZSCPXA 17668 G2 

RPgOCrXA-1705Q FCLead 

Concentration 

2 T Z, 

w?-^ 

HO(jHoq 

— 

— 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

D 

D 

D 

a 

D 

D 

n 

D 

D 

D 

Number of Samples = M 

Firm: 

Oate: 

Time: 

Samples Collected 

J^Ct^. f ^ rc 

/ o • ^-ci c 

Samples Analyzed 

XRF Unit tao l Bock: J7-^ 

Date- /C>-/ 9 -jgg 

Time: P m 

Staff: Al<i>,/ 

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

All quadrants are as viewed from the street, facing property 

i.<y.b. 

Bl = 160 PPM (2! 6 yr 

• / > 

^-<i( 

r\ 

• • • fr 

OCT 

<m 

.;. cii'iS^^ 

82 = 163 PPM® 6" 

•isZ'/syi 5c 

\ 

1/ 

'-izy. F2 = 205 PPM @ 6" 

i 

F2 

.i&ZQli*w...' 

5^1 Sh 

EA = 123PPM(2>2-

1 

^ ' 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Propert}/ ComplBtmn Agr®em©ot 

Ti!i5 S.gfCefhcjTt doCiiiiicritS il'ic COliipietiOii ot i'ciiioval acuviiics pcrioiTricd OiJ t.hfc btJiO'w jiStcd pi'OpcjT/. 

The p.ropei-t>' owner's signature indicates that the- property ov\'ner is sarisfied vvith the restoration ofthe 

.subject; properijy-. and that no items are in question, now., or al any time in the future, excluding any 

remaining warrants' (30 days tota)) except those items li.sted beiow, if any. 

j Property 

Property 

Ownsr;: 

Ptione; 

ID; 

,4ddrass; 

\ /C/ 'M. 

' fOXi 

^23yyii 

^GT/liif 

IbS l 

J > ^ •• ry/ Sr-

^/l/yj c Lf^ 6 

^6?-^ ? 9 9'i^' 1 

• 1 

Restcraiiiiiorni litems 5^ QtiestLJort 

Reqwiiredi correctoonis to complete th® propeBty:. 

j/v ' i agree restoration Is compieied, except as noted above. 

.1 ^- i ao not agree restoration is complgted 

^ ' /AC - I 

/7'//V^ 

.Daiie 
!f\:l!^;:5> l\] . 

Prudenl -rcchnologies, Inc. (Prudent) is under contract with the U. S. Environmemal Protection Agency (£PA) to clean up leadcontaminated soils al a nusher ol" Djflperties located in Omaha, Nebraska, including the property locaied at 

The EPA requests your permission to allow Prudent to perform a soil cleanup at Ihis 

profWns''t5>eVnove1ead-coWtaminated'soil By signing this form, the property owner grants permission lo Paidenl to pcrforni 

activilies related to the cleanup including soil samplmg, removal of lead-contaminated soil, and restoration of .he referenced property. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent . • '•.!•-, --.-.: )i.-:.- for the Omaha 

Lead Site cleanup, at (402) 733-1 188; 733-1455. General questions about the Omaha Lead Sile cleanup can b; directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaiia office). 

Property Access Granted By 

Property Owner Signature: 

^ <f m^tjJo Lfo 

(Please Print Name) 

f'^ 

(Dale) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner - ple.ise print) 

RESIDENT NAME 

RESIDENT ADDRESS 

Renter 

^unESS: . _ ^ ^ _ „ g 

CENTAL, PROPERTY OWNED BY: ^ 

OWNER'S MAILING ADDRESS; 

/an^ S/ri//-/ju€ •7)/e- ei/cyihicjo, Ale, c%o7'^ 

OWNER'S TELEPHONE NUMBER - HOME: ^Or2 \ Bl^^-^/i O / / WORK: 

AGE OF HOME?: 

T ^ 

YEARS. HOW LONG HAVE YOU LIVED HERE? O YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YES NO f ^ ^ ; 

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.) 

AUTHORITY 1-OR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemenled by EPA .uider this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C 9604. EPA's right of access to the property is provided fo" in Section I04le) 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 tale, or otherwise enforcing the provisions ofthe title." 

30S0V-VO:L- P-:y,-; 

Asnsas C.i> V.C 
iRUDRNI 

TECHNOLOGIES, INC. 

E^VlRO^ME^TALX• 

CONSTRUCTION 

SERVICE.S 

Property Status Form , 

Address: ^ 3 j2.( <£ J 2 ) S ^ ^T ^ ^^*^- 7 /^/^ ^ / ^ 

Phone: BVID: 

.j.^f A/^^--=- AtJt. E/ . /3 2 , /^ / 

A A ^ T Z ^ ^ r ^ ^ c 

/ ^ ^/g^ r/^(Pt^^ B r 

P operty Owner 

ignature 

Prudent Emp^yee 

Signature: 

Mnptoyee ^ 

8080 Ward Parkvi/ay. Suite 4 

Kansas City, MO 64114 

Phone: (316) 353-3703 

5600 S 10 SI 

Omaha, Nebraska 68107 

Phone: (402) 733-118S 

4242 Medical Drive. Suite 4250 

San Antonio, TX7822S 

Phone: (210) 822-95S8 
17658 

Owner Name:JUMN<;ows-ocK 

Ad*«»:aaiiS2ia r 

Phone: " 4Di93a.C7T9 tv >iQ2.2»,3.-)no 

Omaha Lead Site 

Site $kotch 

Eite-kp Painl 

• f'fiOf 

•_h«t^>'': 

SarrplB Number L«ad 

Concenlralion 

Sampie 

Colecied 

RYASCPXA-17e58 

RVBSCPXA-1T658 

RYCSCPXA-176Sa 

RYDSCPXA-17658 

-R«2'S6PXA^?e6a <MI 

-ftpzaePK 

n 

F2 

01 

02 

ppm 

np-n 

nfprri 

oprr. 

spm 

ppm 

r<uin(ief ol Saitipvss • 

2 T i . 

<^? ^ 

HOiP 

4 c q 

_ 

— 

D 

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LAB 

a 

a 

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a 

SanipV:! CcllSCtM 

Firm, t" ^ F}?> T.c 

Dale, /i-i </-C(, 

T4X\6. ^/-y p ?•"} 

XRF Unn. JO07 DOCUL j 7 ^ 

Date JO - /<i -Dt) 

Time Prt-j 

Staff-asi/:^ 

leiiend: Ft >• FroMlell. F2 - Fri>;il.«?iijhl, B; = Back Left, Q3 ^ &ir>; fiigtitO? = ni(p iono. G i = Gsrdon, Pi - Pl3y 

Al t;M(ii»il> »v as *K*ed i'vn ijit atvcl, ra:4ig pro;«ftf 

SNT.I5.EED 
A 

2321 S21 ST: 47X55.7 

Printed: Dec 03. 2010 

www. dcgis. org/dogis 
"> 

Page 1 of2 

Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2590959. 

Original Call Date: 9/13/10 Time: 4:18 pm 

Work to Begin Date: 9/15/10 Time: 4:45 pm 

State: NE 

Address: 2321 

County: DOUGLAS 

Street: S 21ST ST 

Op: SIVA18967 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 27-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

Type of Work: lead soil 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 MUD02 OMAHACOF 0PPDGPR6 

PAETEC QLNNEIF 

Service Area 

ALT872 WINDSTREAM 

COMMUNICATION 

ATTNEBRl ATT/T 

Contact 

ELM LOCATING 

CXCATV 

LEVELS 

COX COMMUNICATIONS, 

INC 

LEVELS COMMUNICATIONS, 

LLC 

HEIDI 

NA 

Phone Number 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 80024136249 

/yt: 

Emerg: 80024136249 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Utility 

Type 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/13/2010 
Page 2 of 2 

MUD02 

OMAHACOF 

0PPDGPR6 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

SANDY 

RICH/TRAFFIC 

PAETEC PAETEC COMMUNICATIONS 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.orR/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/13/2010 
TEeHNimasss, mc. 

ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: 

Crew: 

Excavation Date: 

Backfill Date: 

• V^///o 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane^ntane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Condition 

\tljiljj'^"Sf*^ ^ryt^-^^ 

.y^^i i %\j<-\ji.d 

Bw^^«-c^ 

w/4 

^iiA-

^-O-s./vr 

4x4. trv^ 

VVJ j A 

Asj-«.rC>^^"€. 

kVJl ^ 

rv/ laAJl n 

Hazards 

TNJTTP 

Corrective Action 

Crew Foreman Site Safety Office 

Date: 

8080 Waitf Paftaray. Sute 405 

Kansas Gily, ••0«4114 

PfMne: ^6 ) 363'3703 

Fac (8ffi) 363-3707 

5600 SIO St 

Omaha, NdMaska 68107 

Phone: (402)733-11S8 

Fax: (402)733^1883 

4242 Medical Drive, Suite 7250 

San Antonio, TX 78229 

Phone: (2t0) 822.-.S588 

Fax: (210) 579-6577 
\/l8/^o/o