TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#; 24885 DATE; 1/15 

ADDRESS: 2817 NICHOLfliS ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC YEAR : 201(^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS .^^^^^ 

di PRE AND POST VIDEO OF PORPERTY (DVD) AAVS^iwq fle€-Nxo*o ]»-»­

m EXECUTIVE SUMMARY 

Ql EPA-PROVIDED PROPERTY SKETCH 

Q SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

m RESTORATION AGREEMENT 

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

d6 CONFIRMATION DATA 

CD PHOTOGRAPH S 

AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNE R 

Q PROPERTY CLOSE-OU T CHECK LIST SIGNED BY EPA 

D DESCRIPTION O F AREAS NO T MEETIN G ROD CLEANU P CRITERIA 

[fl UTILITY CLEARANCES 

b PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

9y^ VN ( ^NlA^^ 

SIGNATURE DATE 

30218576 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2817 NICHOLAS ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 335 PPM @ 4"; F2 = 350 PPM @ 4"; Bl = 249 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, 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. 

TECHNOLOGIES, INC. 
Find Record 

Remediation Query 1 Ijead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 24885 - 2817 NICHOLAS ST 

Owner: 

D Owner Occupied 

Owner Name: 

fMOBECO INDUSTRIES 

Owner Addressl: 

Owner Address2: 

j 11413 HICKORY RD 

City; State: Zip Code: 

OMAHA JNE i68144-

Owner Phone Alternate Phone: 

[(402) 342-2820 f 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option |0Fn0N 1 

User Provided Owner Information 

Resident: 

Owner Name: 

Resident Name: 

Owner Address: 

Property Address: 

12817 NICHOLAS ST 1 

Zip Code: 

j|68131-

State: Zip Code: Resident Phone City: 

j r ^' r

Owne ^ r Phone: Alternate Phone: 

r 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value f 516 
4

' TECHNOLOGIfiS, INC. 

EPA Property Close Out 

Property #:ZH^' 7 Property Address: •2-<?-/7 MJOVJVL^ >-f-^ 

Date/Time: Owner's Name: ^iSo€co "X*vA.~ 

Quads Excavated: ^ \ f^Z| ^ ^ Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas ofdrip 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 lhe house? y

2. Has sod been laid in all areas that were excavated? y 3.

 Does tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day lime period) y 

 Are sodded areas generalh' firm and evenly graded? 

/

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

lime penod) / 

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

7. Was damage lo landscaping or plant materials avoided? . / 

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and close freely? (Ifapplicable) y 

2. Were all gales 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? (If applicable) / 

Foundation, Siding and Gutters Yes No 

1 Was damage to tlie siding or trim avoided? / 

2. Was damage lo the foundation avoided? / 

3. Was damage to windows avoided? / 

4. Was damage to windows or door screens avoided? / 

5. Was damage lo downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? 

y 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative Qcor, /^A^ Date: f^-lifif 
Kt'llNOLOUlES. INC. 

AS - BUILT DRAWING 

OLS tf 24885 

Date Excavated: 10/05/2010 

ISEPASigned-OITDatc: OMAHA LEAD SUPERFUND SITE 

2^88 5 

Name: lYlebeco X^ndvsine s Omalia Lead Site Date: North Arrow 

Address: ^S/ ? A^rc/jcxtts t i Site Sketch Time: 

Phone: 

^\-a.PF!t.Pi D<KH' . ID-S'-oe^ Timeip m 

Team c&/^<yi ASi ^ BVID# ^^ggg XRF Code 1051 Bool^ •• I5Z 

Sample Number Lead Concentration Confinmatlon Sample 

jyi5. ppm F' Yes n no ^ 

ppm F3 Yes O No C3^ 

ppm 6/ Yes Q No Q^ |g-^PS^/>Xy\-Z4gfl5 2'?q ppm f>2 Yes CD No '2 ' 

ppm -¥w s D NO D ' 

ppm -Ye a P Nu P 

ppm •¥SA • Nu O ­

a [57 

Omaha Lead Site 46130 

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

Property Compietion 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: ^ ^ <3 \ "^ lOiC^vjctaVS ^ -h-

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I M I agree restoration is completed. 

L J I do not agree restoration Is completed at (noted deficiencies above) 

Vh^co XJ^d.'^^ {/ /^^//o 

O^u^er's Signatun Date 

a u ^ 
• ' X 

V\ 

- - . . • ^ . ^ - . ^ 

Pnident Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadnunated soils ^t a number of proaprties located in Omaha, Nebraska, including the property located at 

^' ' MICVVPIOL. ^ ^'^Th c EPA requests your permission to allow Prudent to perform a soil cleanup at this 

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

activities related to the cleanup including soil sampUng, 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 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 at (402) 731 -3045 (South Oitialia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: /3^rz f^A/^^ r^ot^^^LLy^ •Co '^,^L</xX^ 

(Please Print Name) j ^ /Ko(ff^ -

Property Owner Signatun 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: V^C-O-rv \~ Lo V' C^^Ownet/ Renter 

RESIDENT ADDRESS: 

^4^' cl\n\a^ iJL 

IF RENTAL, PROPERTY OWNED BY 

g>'€^rvo.,-^i Y UorQ^Lt o 

OWNER'S MAILING ADDRESS; 

SLSx. Q^AQty ^ Jsl-^ 6g) M M

^ 

OWNER'S TELEPHONE NUMBER - HOME: r^cX. -^"IZ-XS^^^ WORK: 

J J : 

/O/A AGE OF HOME? -.iTlA. 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: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER h)/Ar 

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.) /^/AAUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreemenl 

are pursuant to Section 104 of CERCLA, 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 "detennining the need for response, or choosing or taking any response action 

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

S080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4260 

Kansas City, MO 64114 Onrtaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Pbone: (402) 733-1188 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402) 733-1883 Fax:(210)579-6677 
ENVfRONMEP^TALA 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: ;^ *5? 1 1 N^ • d U (, o_A ^ Date: ^[z^ff O 

Phone: 4^;^^ 3^^ ^ ^^^ ^ BVID: 

C>pP^ ^Ca,, ^ Lt_ 

_ 

Property Owner Prudent Employee 

Signature: MHi Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 6S107 San Antonio, TX 78229 

Phone: (816) 363-3703 ^/2# Phone: (402)733-1188 Phone: (210)822-9588 

C-.V- l'^^f)^ STOJS^T? i J 
w ^ 

2¥e8S 

Name: MakeCQ XA^VfiriA S Omaha Lead Site Date: fAUs- NorthAnow 

Address: d- 8/"? ^^reMoots * t Site Sicetch Time: //.'5-3 

Phone: 

Si^fFfi-fi i^^teuo'Sr'tis^ m/neifim 

Team ^sU*y i ASt^J BVID# >4X/ggg XRFCode 7^37 BooICi 132 

Sample Numt)er 

Lead Concentration Confirmation Sample 

KiASCPXA - ^vgg g m: 

Yes a No 2^ SM 

ppm 

Yes a No C3^ 

^'> g ppm 6/ Yes n No Q ' lg-fPS<:/>XA-2.tJ^fl5 ^ 1 ^ 

ppm ^2 Yes tn No J3' 

ppm No a 

ppm - Y M a Nu P • 

ppm •Yej D Nu D ­

13 W 

\.. 

—^—. 

n 

u { Mi :NT!JSBB 

-i5€M lUQili. 2 ^ 

6/ I — 

-4 

A 

f/ 

/<"^ 

^;9 

5IZ 

V 

..1 

^ 

KyXc/f0iCi4s 4 7" 

Omaha Lead Site 

46130 
281

7 Nicholas St 51 x 125 

A Printed

: Nov 30, 2010 

www.dcgis.org/dogis 
http://www.(lhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU., 

Create Another Ticket Back to Irth Internet Seind Erfiail 

• YOUR TICKET NUMBER IS  2605475. 

Original Call Date: 9/30/10 Time: 12:33 pm Op: SIVA18967 


Work to Begin Date: 10/04/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2817 Street: NICHOLAS ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

lof 2 9/30/2010 12:33 PM 
http://www.(ihon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNElC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:33 PM 
TEDHNt MC. CONSTRUCTION 

SOLUTIONS 

SITE SA^TY HAZARD ANALYSIS 

Address :ZLLXJ^LsiA:,.^^i:l. : Excavation Date: 

Crew: Backfill Date: 

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 

Condition Ha/^rds Corrective Action 

< ^ ^ 

h^' 

f ^ 

sy 

- — 

orca / ^ 

p<u>t^ 

a>^^ 

a^i^ 

C7.*— 

^__, -

Site Safety Office 

Date: 

o n WanfVarfemy, SnibsMtS SMOSIOa t 4242 Madical Drivs, Stdte 7260 

:«nsasO)ly/Ma««114 OiirtlMi, MabrKlm BfrtO? San Antonio, TX 78229 

hone: (SW) S^i^ra s Ptwos: (402) 733-1118 Phone: (210)82Z«688 

BC (916) 363f3707 f=ax: (402)73»'in3 Fax; (210) 6T9-S577 
" yk 

mii> /tHOZAS 

1 //^2/2 Olo