TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAIDft : 20695 DATE: 1/15 

ADDRESS: 1235 1/2 S 14 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR : 20l() 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

m PRE AND POST VIDEO OF PORPERTY (DVD) fVl)J[-i' ^^ C^ fe€'\»Ofro . 

Ill EXECUTIVE SUMMARY 

• EPA-PROVIDED PROPERTY SKETCH 

ID SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

ID RESTORATION AGREEMENT 

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

• CONFIRMATION DATA 

m PHOTOGRAPHS 

• AS-BUILT SKETCH 

CD SATISFACTORY RESTORATION SIGNE D BY PROPERTY OWNE R 

m PROPERTY CLOSE-OU T CHECK LIST SIGNE D BY EPA 

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

m UTILITY CLEARANCES 

• PROPERTY INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFICE 

D 

D 

D 

,\,<^^ ^^n 

SIGNATURE DATE 

18586 ni llii 

Sup erfund 
PROPERTY SUMMARY 

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

Property Address: 1235 Vi S 14 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: 

F2 = 321 PPM @ 6"; EA = 201 PPM @ SCRAPE (~1") 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract speciflcations 

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 j Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 20695 ­ 1235 1/2 S 14 ST 

Owner: User Provided Owner Information Resident: 

n CXvnerOrnipled 

Owner Name: 

IHRDLICKA MITCHELL 

Owner Addressl: 

1 

Owner Address2: 

112564 WIRT QR 

City: 

lOMAHA 

Owner Phone 

)(402) 346-3522 

State: Zip Code: 

|NE J68164-

Alternate Phone: 

1(402) 431-9074 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

Owner Phone: 

1 "

State: Zip Code: 

1 1 

Alternate Phone: 

1 

Resident Name: 

I 

Property Address: 

11235 1/2 S 14 ST 

Zip Code: 

J68108-

Resident Phone 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |400 

Contract Option joPTTON 1 Assessment Max XRF Value j 515 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 7- 6 6?*^^ Property Address: (23 5 ^ ^ 5 . '^Sf: 

Date/Time: Owner's Name: ^A,r«-£Wv Hr-Al(~ct<\ 

Quads Excavated: pT- Contractor Group: Prudent Tedhnologics, Inc.. 

Excavation Genera) 

Yes No 

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

2. If necessiuy, 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 liouse'/ 

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

3. Does (he sod appear to be generally healthy and growing? (Only evaluate if inspected al a 30 

day lime period) / 

4 Are sodded areas generally fmn and evenly graded? / 

5. Arc the joints between the sod strips generally tight? (Only evaluate if inspected al a 30 day 

(une penod) / 

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

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

Gates, Fences and Retaining Walls Yes No 

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

i / 

2. Were all gates or fences taken down during restoration activities remstalled? (If applicable) / 

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

/ 

2. Was damage to the foundation avoided? y 

/ 3. Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? / 

5. Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Priveways (Concrete) Yes, No 

t W;is daiiiase lo diivcwav surfaces avoided'? 

Was damage lo walkway surfaces avoided? -7
Owners comments: 

Inspection notes: 

y y ' 

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

EPA Representative iX^ y ^ ^Date: ]\\i\ H 
20695 

KOTNOI.OCMKS. INC. 

AS - BUILT DRAWING 

OLS tf 2069S 

Date Lxcavared: 11/10/2010 OMAHA LEAD SUPERFUND SITE rSEPA Signed-OffDate: 

Omah Exterior Paint a Lead Site • Good Site Sketcti • Poor 

Sampling Address: 1235 1/2 S 14 ST [g'^Not paint 

Sample Numtier Lead Sample LAB Samples Collecled 

Concentralion Collected Firm FPA CC-IZ W 

RYASCPXA-20695 Fl 3'iO ppm D Date; l-S~02 > 

RYBSCPXA-20695 F2 ppm n Time: 10 : 1 3 a m 

RYCSCPXA-20695 Bl ppm n Samples Analyzed RYDSCPXA-20695 B2 ppm D 

nozcopxA-goeos -B i ppm D 

n XRF Unit: (oSH Q Boole XD2

nogccpx/i Doeos - S2 ppm D n Date ^•^l- " nft 

P!PZOCPXA-2009S -fa - ppm D n Time An. Staff f^<' ^ Number of Samples = 

Legend: Fl = Front Lefl, F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla> 

All qLJa^rarts arc as viewed from the street, facing property A-Ij / \ J 

, . - c 3 UO .'ill : , 

! 

..S'l. 0 2000 

--S r 

J55 i..S.;| 4 S.+ < 1­ V

1 = 321 PPM a 6 " '2 

Fl 

3 40 I 5/5: 

. , . . • 

KA = 201 PPM (a) S( RAPI, (1" ) 

. 

£ t ^ '"^ R<-. 5 •'(• * B«i ^.rv.--"? •U..I41 •>l 

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

c 
»EFA 

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: I .7 ' 3 "•i f,.-. 14 ^ SV 

Owner: UlVcX v kVr'X^''-^^ - Phone: 

Restoration Items in Question: 

item: 

Item: 

Item: 

Item: 

item: 

Item: 

^1 1 agree restoration is completed. 

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

Owner's Signature Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a numberof properties located in Omaha, Nebraska, including the property located at 

l/-? ^ Vz - .S I ^ - ^ l . The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property 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 sampling, removal of lead-contaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup plaimed 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 Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted BV. Mi4<LUUfcAl;ctiq 

(Please Print Name) 

Property Owner Signature: >//^^^' ' 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

I

ESIDENT ADDRESS: 

IF RENTi^, PROPERTY OWNED BY; ;tNi AL, KKUKSKr y uwNbu BY: J 

OWNER'S MAILINIGG ADDRESS ADDRESS;; .. , ^r ^ ^ // ^ 

OWNER'S TELEPHONE NUMBER - HOME: J . W.HZb9D>{ WORK: 

J 1 

AGE OF HOME?: 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 


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 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 "determining the need for response, or choosing or taking any response action 

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

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

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

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

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
ENVrRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form . 

Address: 12-3 3 Vz. S 04-Sh Date: i///>/'^' ^ 

Phone: BVID: 

\lacwAr\- Lo4— 

ID>>A.'^ \ QvjtcU ^iC / VeA.cP 

-

-

Pinident Employee 

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

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

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9688 C-.U . lttAC \ '>C» 'STAT C v lOIIW e7«JS<!77 
20695 

Omaha Exterior Paint North Arrow Lead Site • Good Site Sketch • Poor 

Sampling Address: 1235 1/2 S 14 ST [2'^ Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: fi>Pi CC-(l\jj 

RYASCPXA-20695 Fl ±(2. ppm D

Date: J-S^yb ^ 

RYBSCPXA-20695 

F2 5 (S- ppm n Time: IP' HS ai^ 

RYCSCPXA-20695 B1 ppm n 

Samples Analyzed 

RYDSCPXA-20695 82 JJL ppm D 

RDZCOrXA2060S -BZ ppm a D XRF Unit: (QSH Q Book: X M 

nCZCCPXA .20605 -62 ppm D D Date: (^l - I f • DP i 

RPZOCPXA-20G90 -P2- ppm D n Time; 

J ^

Staff Number of Samples = | ^ [ Q nsw 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property /r/l^ V 

"i'T: 'A-»">-^': -"r­ • ,.3h 0 111 'X^X?­ 3 • ,1 " 

S>1 &2 JAN I 0 2008 •< \ 

I- IZ35 V i ..s, 14 5 

I 

Fl ^2. 

3H0 515 I 

S. 14 St '-L>^c 
11/8/2010 R13073000000001.jpg (640x480) 

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50x69 

A Printed

: Nov 08, 2010 ww

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ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFfcTY HAZARD ANALYSIS 

Address: .A^SLS ^ Excavation DaterA-*—' 

Crew: .-^-^^i:^::: ! Backfill Date: -/--^—^ ~ ^ 

Crew Foreman Site Safety Office 

Date: 

yO: ^ 

5600 8108 1 4242 Medical Drive, Suite 7250 

Kansas GMy. MO 64114 Omaba, Mefaraafca 68107 San Antonio, TX 78229 

Phone: («t6) 363*3703 Ptione: (402)733-1168 Phone: (210)822^^9588 

Fax: ^t« ) 363^0 7 Fax: (402)733'1«83 Fax: (210) 5T9-6577 

SOSOWfanfBartonqr. Suite 405 
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