TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 47716 DATE: 12/15/2010 

ADDRESS: 3615 R ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

a i PRE AND POST VIDEO OF PORPERTY (DVD)

d EXECUTIVESUMMARV

m EPA-PROVIDED PROPERTY SKETCH 

[ ^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

[ ^ RESTORATION AGREEMENT 

 30237535 

 1111111111111111 

Superfund 

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

Bl CONFIRMATION DATA 

a PHOTOGRAPHS 

Q AS-BUILT SKETCH 

ffl SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

• DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

o f UTILITY CLEARANCES 

IZ PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

• 

• 

• 

SIGNATURE DATE 
Find Record Remediation Query i Lead Remaining Query a Property Damage Query 

Backfill: 

Sample Area : 4771 6 ­ 361 5 R ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

JGAROA ALFREDO 0 \ I 

Owner Addressl: Owner Address: Property Address: 

! 3615 R ST 

Owner AddressZ: Zip Code: 

J3609 R ST |68107-

City: State: ZipCode: City: state: Zip aide: Resident Phone 

jOMAHA JNE J68107­ [ 1 1 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

r­ • r 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group [400 

Contract Option lOFTlON 2 Assessment Max XRF Value ! 499.77 
PROPERTY SUMMARY 

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

Property Address: 3615 R ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Otiier Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 76 PPM @ 2"; EA = 51 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 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, if available, or obtained include: 

i) Pre-excavation agreement details (ifany 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. 
•HECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: U'^' ^ Property Address: 3t. \'=• "^ ^ ^ . 

Date/Time: )(/n Owner's Name: A\^-«^* ^ Ciarcacv 

Quads Excavated: ^ ( Contractor Group: Prudent TeSahnologies, Inc., 

Excavation General Yes No 

1, If necessar>', 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 aroimd the perimeter of the house in excavated are.as generally slope away / from the house? 

2, Has sod been laid in all areas tliat 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 y time period) 

6, Was the property graded such tlial water will nol pool on the property? 

y 

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

Gates, Fences and Retaining Walls Yes No 

], Do gates open and close freely? (If applicable) 

2, Were all gates or fences taken do\vn during restoration activities reinstalled? (If applicable) 

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

4. Was dainage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters Yes No 

1, Was damage to the siding or trim avoided? y 

2, Was dainage to the foundation avoided? y 

3, Was damage to windows avoided? ~y 

4 Was damage to windows or door screens avoided? 7' 

5, Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was dainage to driveway surfaces avoided? y 

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

Inspection notes: 

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

EPA Representative Q^ ^^ ^ ^Date:__ ulizhb 
X'llNOIOdlRS. INC. 

AS - BUILT DRAWING 

OLS #47716 

Date Excavated: 10/14/2010 OMAHA LEAD SUPERFUND SITE I SEP.\ Signed-OfT Date: 

y77/g Exterior Paini Noith AFFDW Owner Name: AJfTed o G&tXUS- Onnaha Lead Site • Good 

Addre»:_3G/5 /? ^ : y<3Qanf Ui&^'^^ Sketch • Poor Phone: » 0 ^ Not paint 

Sample Number Lead Sample Samples Collecteci IJ\B Concentratior Collected Fimi: ^AE S K<M., e^A 

nVAOCPXA- -H - ppm a D Date: Ipj-Z-t/olg 

ppm Q D Time; % ^Ctuwv. 

RYCSCPXA-yT'T'/^ Bl ppm D Samples Analyzed RYDSCPXA-Y77-/G B2 , ppm BT D

ppm 03 D XRF Unit f(30 T Book f5 3 

ROgOCPKA- -62 0 D Date: 7-/.=?-Of 2 . ppm nPZSGPXA- -P2 , ppm 0 D Time: A M

Staff Mi'Hf^ Number of Samples = 

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 

.Gr<aAVE,U. 

HI 

Weeo s 

• JSS • • y se e eviD N^. 909 y 7^ 

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CONC A 

^i 

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61 u Bl =76PPM « 2" 

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C6iN<c '• f 

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|5::ST 

EA = 5I PPM a SCRAPKI 1") 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
pRIDEN 

This agteeirici-ii doc-uiiieviis tlie uoijiplction ot removal aciiviiics pertoiHieu on tiie beiow jisicd pcopeiTy 

The DTopei-ry o->viier s .signature tnd icates that the propeity owtier is satisfied witii 'the restoia'fion of the 

subject property', and that no ite:fn'i are in question,, no-w, or at anj' time in the future, excluding any 

remaining -W'arrant^- (30 days totai) except those items listed below., ifany. 

Property HD'. 

Property .'^ddrsss; "P zyyyy^.^ 

2^ 

Phone; ygy^yy^iv?^ 

Restoraltoos-ii litems LTD Quiestioini: 

,1 RequjiDFed co-STecltooFDS to compielte ih® propestj/: 

,[/N- I ?,gfee resTora'iion is completed, except as noted above 

I — I 

I '• \ ao ,not agree restoration is completed 

\ypy± 

Dave 3igii..aifure 
\o/n* 

Piiideiit Technologies, Inc. (Prudent) is under contract with the U. S, Environmenlal Protection Agency fEPA) to clean up leaclgjntaminated si^s at. a. number of properties located in Omaha, Nebraska, includmg the property located at 

Q V?/ ^ J K t)^ ? '^^^ KPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contammated soil. By signing this form, the property owner grants permission to Prudenl to perforni 

activities related to tlie cleanup including soi] sampling, removal of lead-contaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Pmdent soutii office for the Omaha Lead 

Site cleanup-at (402) 733-1188, General questions about tlte Omaha Lead Site cleanup can be directed to the EPA Public Information 

Centers at (402) 731-3045 (South Omaha office) or (402) 991 -9583 (North Omaha ofl'ice). 

Property Access (jraniod Dy 

(PleasePrinl Name) 

Property Owner Signature: ^<^^.^ ^ AAHiAAyyA 

(Signature) (Datel 

PROPERTY INFORMATION 

(To be completed by resident and/oT properly owner -- please print > 

RESIDENT NAME:. ^ iCy^t O Owner Renter 

RESIDENT ADDRESS: 

3(A'^'A .^ s l 

IF RENTAL. PROPERTY OWNED BY: UZ. OWNER'S P/IAILING ADDRESS; 

OWNER'S TELEPHON TELEPHONE NUMBER - HOME: J L WORK; 

Ceu, yti22yMJ^lJko± 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU UVED 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 OF^^ECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) A 


M>vT ^DG ^ CAA CA!^P^k ^d TK^^r-jx^ ^ ^f/Ar ruudy 

,.\LlTHORITY l-OR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreement 

are pui-suanrio 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 O..S C 9603(e), which provides entry for "detennining the need for response, or choosing or taking any response action 

under tliis title, or otherwise enforcing the provisions of tlie title." 

8080 •ifiliil : . ::<; vVarei PdikVva'v, Sairi^ • •:Vi7. fvle/iir.al Drivft, ;jijitft 42SO 

Kansas C-'ru::\\i.. :\iftij^ii;;:^ Ciry.MO (T-ii i * 

Pnone; 1816^ 36-.tj70S I- ;.,,• .!io:; • •::.•:•. ^ax: '816'; ses-.-i'-jr'­
i;,NVl.KOiN!VH?:.i'vr,.'Xi, .*i: 

C(•>NSTRt,lCTfO^ 

TECHNOLOGIES SE,RVlCF,r) , INC. 

Property Status Form 

Address: 3 6 / 6 % ^ ^ x^yf /Jl)C< Date: 

Phone 1 

B/l1i'l>}AL /\AU.A ^ / 

"jAJYlCA \/m£ ^. ^fO p 

(ytyij^ \0 ^ ^JATyZyyA^^'^^^y 

Property Owner Prudent Em 

Signature: Signature; AC Ayyiy^ 

30Ba Ward Par*;w3-v'. -TI. 'p. 40H 5(>(;>i o If; ot V<,7. ivieriical Dfivtv Suite 4-iSO 

riansas City, MO (5411.1 iiaii Anioniu. TX 7«i28 

Phone; (816) n63-:i70.-? fhoMs: (210)822.»68R 
^771G 

Omaha Lead Site Exterior Paint ttorthAmw Owner Name Q Good 

Address: 3Cn z^y<3Qant U^' ^ ^•^^**^*^ D Poor 

Phone: ^• W: g^Not paint i 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 V^t % KM , &lyA 

nVAOCPXA­ -f^- D Date: lg|'2-t/6(o 

nYDOOPXA -Fe­ ppm D Time: %//^fx-N-.. 

RYCSCPXA-y;-//^ Bl 

RYDSCPXA->y77'/c B2 

^rY )

gT Q

 ppm 

 ppm 

D 

D Samples Analyzed 

RDZGOPXA­ B2- ppm 0 D XRF Unit: IQQ l Book ISS 

ROZOOPXA­ -€2 ppm n Date: _ 7-L^-0C2 

RPZOCPXA­ •4 * ppm Time: AM. Number of Samples Staff: M3M. 

Legend; Fl = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 0 

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%^ CIA. Printed: Oct 12.2010 

wwwdcgis.org/dogis 
Page 1 of2 

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Create Another Ticket Back to Irth Internet .Send.Email. 

YOUR TICKET NUMBER IS 2614392. 

Original Call Date: 10/11/10 Time: 4:29 pm Op: SIVA18967 


Work to Begin Date: 10/14/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3615 Street: R ST 


Twp: 14N Rng: 13E Sect-Qtr: 08-NE,09-NW 


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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

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-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/11/2010 
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OPPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemefDHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/11/2010 
l!;iNl^iISl<;ERING AND 

CONSTRUCTKH^ 

SOLUTIONS 

SITE SAFTfcTY HAZARD ANALYSIS 

Address 1(QA ^: 

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 

(L - Excavation Date: 

BackfiU Date: — 

Condition Hazards Corrective Action 

P 

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J • C^ ^ •• /»')vw**-» ~"-^\ J 

t-A<J <=» ^ f-e^i^tf? 

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Site Safety Office 

Date: 

SGWSIOSt 4242 Mtadical Drive, Suito 7250 

Kai»a»Cliy;lia«4114 San^Antenio, TX 78229 

Phone: (>W) SOjnW (402)733-1188 Phone: (2t0) 822^9588 

^x : fStt) 383^^3707 Fax: (402)73»'1883 Fax: (210) 879-6577 
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