TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: c^VV? Date: 1 1 ^ I 5 "" I 0 

Address: ^S^JH . ]mt ^ 9 ^ 

Remediation Contractor: Pb^->ngarM^ T^/^-H N<V.00| i"^<^^ /rsiro Year: LX ) I (,J 

SOIL REMEDL^TION 

PROPERTY FILE FOLDER DOCUMENTS 

[ / 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

/ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaipent property 

y Restoration Agreement 

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

y Confirmation data 

Q/ ' Photographs 

a" As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check Ust signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

[ / Utility clearances 

Property informationfirom Douglas County Assessor's Office 

D 

D 

D 

^ M ^ AV^V 

Signature Date 

30218876 

Superfund 
# 

PROPERTY SUMMARY 

Date: 11/15/2010 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 2570 JONES ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 73 PPM @ 6"; 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 sketch ­

i) 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, ifavailable, 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 

Backfill: 

Sample Area: 22448 - 2570 JONES ST 

Owner: 

• Owner Occupied 

Owner Name: 

I HERMAN BROS INC 

Owner Addressl: 

I 

Owner AddressZ: 

)2565 ST MARYS AVE 

City: State: ZipCode: 

[OMAHA " " [NE |68105 -

Owner Phone Alternate Phone: 

I I 

Contract: 

contractor: |PRUDEr^n010_S 

Contract Option (OPTION 1 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Code: 

1—r 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group pOO 

Assessment Max XRF Value | 526.77 

Resident: 

Resident Name: 

I 

Property Address: 

|2570 JONES ST 

Zip Code: 

)68105-

Resident Phone 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ;2-2-H*\S Property Address: 2^S7 0 IJOY^C^ 5iVDate/Time: (o (l ^ Owner'sName: H<r»v\-C»-*\ "^foi/ln c 

Quads Excavated: 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? / 

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. Arc tlie joinis between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) y 

6. Was the property graded such tliat water will not pool on the property? y 

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) / 

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

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

4. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? / 

Was damage to the foundaiion avoided? 

/ 

Was damage lo windows avoided? y 

4. Was daniage to windows or door screens avoided? A 

Was damage lo downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

 Was damage to drivewav surfaces avoided? 

2. Was damage to walkway surfaces avoided? y

1
Owners comments: 

Inspection notes: 

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

EPA Representative ^«M - ^ ^Date: wjuffio 
^CHNOLOOIES. INC. 

AS - BUILT DRAWING 

OLS # 22448 

Date Excavated: 9/30/2010 EAD SUPERFUND SITE rSEPA Signed-OfT Date: 

22448 

Omah Exterior Paint Owne a Lead Site r Name: HERMAN BROS INC • Good Site Sketch Address: 2570 JONES ST • Poor W: 

Q^Nol paint Phone: ^-

Sampie Number Lead Sample Samples Collected LAB Concentration Collected Firm: Asto l Ra.1 »ir 

RYASCPXA-22448 F1 

ppm D Date: to-to-06 . 

RYBSCPXA-22448 F2 _a_ ppm [T D Time: M-.;^t ^^ ^ 

RYCSCPXA-22448 B1 IfiH ppm \ ^ D 

Samples Analyzed 

RYDSCPXA-22448 B2 ^z- ? ppm 0'

RDZaePXA-gg440 B2 ppm n D XRF Unit too ? Book: 1 1 "^ 

WOgOOPXA-gg440 62 ppm D D Date: /<?-/? - Qje 

npnoorxA 22440—PS ppm D D Time: A m D Staff: JISW : Number of Samples = 

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

All quadrants are as viewed from the street, facing property 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
«ER^ 

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: 

Property Address: QP^'/ Q ^,Wi\il^ 

Owner 

Phone: 

Restoration Items in Question: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

Q l agagren e restoration is completed. 

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

z^ <ZZ/ ^ 

Owner^sSignature Date 

I
-10-10 14:00 FROM-TransWood-^,NE m- T-031 P00l/0g4 F-IIO 

Y^t(^S<JXM 

TransWood Inc, 

2665 Si Mary's Ave. 

P.0, Box 189 

Omaha, NE G8105 

fkoM#40Z>^46>8092 

Kn# 4t^341'2112 

FROM: flJcTfA/^^.. f-

DATE: f//?/7/ o 

^fmnber of Pages: _, iaehidiqg carer sbeet 

TO: 

Notos: 

Qjigent Lf w Your Review [jReplyASAP [jPIeaseOownient 

NOUCE: TUs traiumissioa mi/i u ittMhed docnaents may eontain CONHDENTIAL 

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09-10-10 14:09 FR0l»-Tran8*ood-Q^,NE 

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PROPeRTY INFORMATICm 

CTo bn eoapietet liy rvUttii uri/or piopoty ownr - pkose piM) 

weameMTMAMgi VO l g,CtY\A- I w I- owwr Ranter 

RESIDENT ADDRESS: , / , ^ 

F RENTAL* PR0P6RTY OWNED BY: 

OWNER'S MAUNQADORBSfi; / y ^ , 

Po H.^ /S'f ^yh4^^ yyy^ ^//^ z 

OWNER'S TELEPHONE NUMBER • HOMB: < S WORK: 

M E OF HOME?: _!:: YEARS. HOW LONQ HAVE YOU UVBD HERE? ._^.__ _ YEARS. 

HAB THE EXTERIOR RBEN PAINTED OR COVERED WFTH SIOINO SINCE 1978? YES NO 

NUMBER OP OCCUPANTS UNDER T YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLO ANO OLDER 

••I I . . N 

NUMBER OP CHILDREN UNDER ? YEARS OLD WHO PLAY IN THB YARD FOR 6 HOURS QR MORE PER WEEK: 

COMMENTS OR SPBCML INSTRUCTIONS: (LE. DOCS, ENTRY GATES, ETO) 

At^1IORITyPOR£^(VIR0^IME^n'ALR£SPalNSBACTK>NSi Th6«(ivftlMiebeiiBplqnntedVyBPAundar<iisaBtMiunt an poiNuato 8«eli«t 104 ofCSSCLA, 42 i;.S.C. 9604. BPA*BriBtt ofaecesatstboptapa^ il piDVitfedftr la Sedioik 104(e) af 

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aniktrfilatitles er ailierwita gafincing tbo pra«islaat ofib> lh!*." 

BOM Wara PVKWay, suite 405 S8M S TO St 4242 Msdleal Oriw. suite 4250 

K«nsu City, ^ 0 64114 Omaha. Nabfasti8B8107 San Antonle, TX 7822S 

Phana:(li6)3SX^r03 Phona: (402^733-1188 PhonK (Zia)822'ft58B 

Pax: (BIS) 3B3.370r Fok: (aOZ) 733-1883 Pax: (210) 679-6677 

' ^"• ' ' A M A li^n oLozrat/60 
09-10-10 14:08 FROM-TransWood 


T-039 P.003/004 F-


GNVtRONMeNTAL^ 

COrfSTHUCTJON 

TECHN0L06XES, INC. SERVICES 

Property Status Form 

Addles: Date: 

Phone: BVID: 

\Jxu^y L^i: 

Propeity Owner 

9/7er//(y 

8B80 Ward Pailnvay; Suite 40fi 6600 SIO SI 

Kansas Ctty, MO 64114 Omaha, Mabraalta 68107 San'flnlonlD, 77 76228 

Phone: («16) 383-3703 Phone: (403)7^^^160 Phona: (Slfl) 827.^86 

Cum' nifli «Ta.^c7T 

»00/£0(rd 00f:0 LZVL OLOZ/OL/60 
• • 

09-10-10 ^ 14:09 FROI*-TransWood-^a,NE 

T-039 P.004/004 FExiefior Paim NorihAnaw Omaha Lead 6itd Owner Name: H6RMA» BROS INC • Good Site Sketch 

Address; ?6TO JON^fi l • poor 

Phone;": ' ^ W: 

1 

Leed Sample 

Samples Collected Sample Number 

1 AR 

Concentration CoUected LnD Fimi: /kS»H (>A1 ft?-

RYASCP9WrfJ2448 •'F1 ppm ^ D Pete: tQ-iO"Q4^ 

RY8SCPXA.2244S F2 8LJ _ ppm [T D Time; M'.la r,uv> 

RYCSCPXA-2244a Bl .•i<6'f . ppm 

a" • Samples Analyzed RYDSCPXA-2244B B2 

ppm Ef D 

i^£jaaapKA«zs^40 ppm • D XRF Unit /Qo 7 Book: Z*?^ 

nGgocrxAi2!H4o o a ppm D D Oate: r a -1 9 - rJo 

ppm a Q 

Time: .A m . . , 

staff: jy.Sw: Number of Samples « [ A;-_ 

l^endt F1 ^ Front Left. F2 » Fnsnt RIglit. Bl = BacK Left, B2 = Back Right DZ = Drip Zone, GZ = Ganden, PZ « Play 

AD quadRsnIs an: aa viewed ftom (ha sireet, ftielnd property •!.--• . . . • • i f 

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A Printed

: Nov 16,2010 

tt-H.'w. dcgis org/dogis 
Page 1 of2 

" > 

Create Another Ticket Bgck Jp Ji;t|:i^l.ijjte.r,n.et •Send Email „. 

YOUR TICKET NUMBER IS 2594330. 

Original Call Date: 9/16/10 Time: 3:17 pm Op: SIVA18967 


Work to Begin Date: 9/20/10 Time: 3:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2570 Street: JONES ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-SE 


Twp: Rng: Sect-Qtr: 


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 

CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 PAETEC QLNNEIC 

utility Service Area Contact Phone Nuniber Type 

Day: 4029340469 

r^vr-A'^^/ COX COMMUNICATIONS, TM„ , Alt: 4029340469 CXCATV „, „ HEIDI 

INC Emerg: 4029329757 

Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 

CITY OF OMAHA- OMAHACOF RICH/TRAFFIC Alt: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
Page 2 of2 

OMAHA PUBLIC POWER OPPDGPR5 ELM LOCATING DISTRICT 

NO NEED TO CALL OUT PAETEC PAETEC COMMUNICATIONS EMERGENCY 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING 

Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TEOHNoiAnEs, mc. SOLUTIONS 

SITE SAlfifcTY HAZARD ANALYSIS 

Address: —^•^ ^^

Crew: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

 ^^t? S 

Excavation Date: 

Backfill Date: — 

Condition Hazards Corrective Action 

j ^ 

Lrr-e- iPrc/y y 

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Site Safety Office 

Date: 

80601MMF«ariany. 5uito4IK 

Kannsei^,liOe4114 

SSOOSIOSt 

Omaha, Mebraifca eotOT 

4242 Bdedical Drive, Suite 7260 

San Antonio, TX 78229 

Phone: (QIQ 36^3703 

ftc (8ie) 363^707 

Itwm : (400) 733-1188 

Faoc (402)7334883 

Phone: (2t0) 822-«588 

Fax: (210) 679-8S77 
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H/llo/ZOJp '"fA. , t -, 

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