TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: y)^^ ^ Date: 11-15^1 0 

Address: 3^B 1 Oc.fb u S f 

Remediation Contractor: Ppfirypr^-f 7»^-H'^o<^C|<g'V/^'^7 Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[?( Video of property (DVD) 

ffl Executive Summary 

a EPA-provided property sketch 

H Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

d Restoration Agreement 

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

Sl Confirmation data 

d Photographs 

d As-built sketch 

i Satisfectory restoration signed by Property Owner 

d Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

i Utility clearances 

Property informationfirom Douglas County Assessor's Of&ce 

D 

D 

D 

^. ^vv '^W 

Sipature^ Date 

30218928 inninin 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2857 CORBY ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 336 PPM @ 8"; EA = 57 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 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, 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: 29342 - 2857 CORBY ST 

Owner: 

D Owner Occupied 

Owner Name: 

IPOLSLEY GREGORY S 

Owner Addressl: 

Owner AddressZ: 

|6996 COUNTY ROAD #32 

City: State: Zip Code: 

I F=ORT CALHOUN |NE |68023-

Owner Phone Alternate Phone: 

|f402) 468-5119 |f402) 658-2380 

Contract: 

Contractor: |PRUDENT2010_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: 

I — r 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group J406 

Assessment Max XRF Value | 518.57 

Resident: 

Resident Name: 

IBRUMFIELD HATTIE 

Property Address: 

|2857 CORBY ST 

Zip Code: 

|68111-

Resident Phone 

I 
INOLOGIES, INC. 

EPA Property Close Out 

Property #; 2.13^12- Property Address: 2-SS T CcRBM ^ T 

Date/Time: t o f\\ Owner's Name: MR£"6 PoS6.tW 

Quads Excavated: rt^o__ Contractor Group: Prmlent Technologies, Inc, 

Excavation General Yes No 

1. If necessar>', were tlie correct quadrant(s) excavated and restored? / 

2. If necessar>', 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 y day time period) 

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

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

time period) y 

6. Was the property graded such tlial 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 

I. Do gates open and closefireely ? (If applicable) / 

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) / 

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

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

y y 

Sidewalks and Driveways (Concrete) Yes No 

 Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? ^ 

1
Owners com meats: 

Inspection notes: 

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

i 

EPA Representative ^ /Q^^ y ^ ^Date; lolnlia 
mi 

:CHNUL(XiIES, INC. 

AS - BUILT DRAWING 

OLS # 29342 

Date Excavated: 09/22/2010 

ISEPA Signed-OrrDate: OMAHA LEAD SUPERFUND SITE 

r 0 tr-afe-o3 Name: Un^ g t>^w,vU!-\ A Omaha Lead Site Oate: h4oith Arrow 

Address: 7^5' ? OAv > 'S.l Site Sketch Time: 10 -.2 <f 

Phone: i^t^i.- (Z'=.1t-^i \ ^ i 

fi a. D 

Team Ot e o \ A ^ SVsre. ^ Kyji, BVID# y,^'h'-K'2 - XRF Code 55oV 

Sample Number Lead Concentration Confimiation Sample 

l'5 / ^ ; U> ^»Yes n No K: 

ppm 

ppm Cifes n No » 

ppm %(Yes a No 53 

ppm %i^es a No ra^ 

ppm Difes M 

ppm Yes • No cn 

Lab RDZSCPLA-29342 ppm Yes • No • 

132 ppm 

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Omaha Lead Site EA = 57PPM a SCRAPE 46130 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
I

This agreement documents the completion of removal activities performed on the below listed properry 

The property owner's signature indicates that the property owner is satisfied v/ith 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 totai) except those items listed below, if any. 

Restoratsom litems iin Questiomi: 

 1 1 agree restoration is completed, except as noted above 

LJ i do not agree restoration is completed 

L^z^^yA. s SigjMture ^ 
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Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soilsji soil ^ fa number ol f properties located in Omaha, Nebraska, including the property located at

Tlie EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contimninate u 

d soil. By signing this form, the property owner grants permission to Prudent to perform

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

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent south office .for the Omaha Lead 

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

Centers al (402) 731-3045 (South Omalia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By / ^ f^^/j^f^ "^/ 2 iblM^ r ^L A 

(Please Print Name) 

Property Owner Signature: rj^j(j^|gf ^ ^ ^/iJ-^O l ^ 

"— (Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: ^Pttti'^Z ^ X> ^^- ^ ^ I^TQ^IC L Owner ^ntej ) 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

(^r^^ ^(s\fh\^c^^^o^-^'r^-ii^') 

OWNER'S MAILING ADDRESS 

(IP^O'IVATO/ ^ ^ 

OWNER'S TELEPHONE NUMBER - HOME: t/o-0JS ^'/^f-f l 3^ C / WORK: 

AGE OF HOME?: ICfO - K YEARS. HOW LONG HAVE YOU LIVED HERE? ^- ^ YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: U 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 FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to 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 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 40& 5600 S 10 St 4242 Medical Drive, Suite 4260 

Kansas City. MO 64114 Onnaha. Nebraska 68107 San Antonio. TX 78229 

Phone:(816)363-3703 Phone:(402)733-1188 Phone:(210)822-9688 

Fan: (816) 363-3707 Fa*. (402W33-1883 Fax:(210)679-8677 
E^VrRO^\MENTAL& 

CONSTRLCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^S*^' ^ CX>^^ Y Date: ^//^[^jC>\d 

Phone: If^^^ q^2. ^ jS^^ Q BVID: ^ q 5^- 3 

\^£~< . g-^ 

yOon-4-rA^c^ 'Wssm-ucyniyC f^^ uy/^ ^ 

i£^o./H/-<-'rg: ^ K-^^/ac ^ U^LT\-I ^ ^ >N 

Property Owner Prudent Emglgxee 

Signature Signature: 

8080 Ward P^kkwo^. St ^ 5600 S 10 St "^242 Medical Orive, Suite 4250 

kansascity, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9688 C-.W. tO^C \ te t '•TA T 
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Name: U o Vi f 'Druv.v^ V 6 Oiraha Lead Site D ^ : 6Cr3fc~Q ^ No(th AnriMi 

Address: 7^ 5 -^ C*r\K« "STf Site Slcetch Time: 10 :.?«> 

Phone: ^Jl-/,^«-«^' A i^ i 

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Team OPo V A \ SV\r«/ \ K ^ BVID# 7 ^?>^2 - XRF Code S5C ^ 

Sample Number Lead Concentration Confwmation Sannple 

1 ^ / -i^lt P No » ppm • Z O ^ (Sf PiTes n No 81 •2.C? i j _ ± ppm 

^Yes a No 53 ppm 

ppm ^"^es Q

t^es )sr NoJSa'*^ ppm 

Yes n No CD ppm 

Yes • No • ppm RDZSCPLA-29342 Lab 

132ppm 

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Omaha Lead Site 46130 
Page 1 of 1 

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Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2592061. 

Original Call Date: 9/14/10 Time: 5:12 pm Op: SIVA18967 

Work to Begin Date: 9/16/10 Time: 5:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2857 Street:- CORBY ST 

Twp: 15N Rng: 13E Sect-Qtr: 09-SE-SW 

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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

TEOHNOUkmBi, HtC 

SITE SAF&TY HAZARD ANALYSIS 

Address: - ^.f.f ?

Crew: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining WaUs 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

 CgtfJiy. 

Excavation Date: 

Backfill Date: — 

Condition Hazards Corrective Action 

CP ^ 

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A 

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CJi-f ya^xjBPe* ^ • ^^K^ r • ^ 

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Site Safety Office 

Date: 

aOMUMmflRaftany. SiMtMIS iSSOOSIOSt 4242 Medical Drive, Suite 7260 

Kansas Oly;, IIO«4114 OmAta, NdMaMia tttOT San Afltento, TX 78229 

PtMne: |»1<)36M703 Ptane: (402)733-1ia8 

Tte: (402)733'<1«83 

Phone: (2t0) 822-4S88 

Fax: (210)679-6577