SAID#: 27705 

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

DATE: 1/15 

ADDRESS: 2619 BURDETTE ST 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201(|) 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

PRE AND POST VIDEO OF PORPERTY (DVD) W\g3LS IMC, 4W-^o ^ ffe-^^'/j-2.. 

6 EXECUTIVE SUMMARY 

EPA-PROVIDED PROPERTY SKETCH 

i SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n 

SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

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

CONFIRMATION DATA 

PHOTOGRAPHS 

L AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

b PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

h UTILITY CLEARANCES 

L PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^\xt\^ yvy 

SIGNATURE DATE 

30218579 

IIIIIIII 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2619 BURDETTE 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: 

BI = 308 PPM @ 10"; EA = 120 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 sketchi) 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. 

TECHNOLOCIES. INC. 
Find Record 

Backfill: 

Sample Area: 27705

Owner: 

Remediation Query Lead Remaining Query Property Damage Query 

­ 2619 BURDETTE ST 

User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: 

JMOBECO INDUSTRIES 

Owner Addressl: 

Owner Address2: 

111413 HICKORY RD 

City: 

I OMAHA 

Owner Phone 

1(402) 342-2820 

State: Zip Code: 

|NE 168144-

Aiternate Phone: 

Owner Name: 

Owner Address: 

City: 

Owner Phone: 

State: Zip Code: 

Alternate Phone: 

Resident Name: 

Property Address: 

12619 BURDETTE ST 

Zip Code: 

168111-

Resident Phone 

Contract: Assessment: 

Contractor: PRUDENT2010_S Qualifying Group 400 

Contract Option JOPTION 1 Assessment Max XRF Value 539.36 
TECHNOLOGliS, iNC. 

EPA Property Close Out 

Property #:'2^770^ Property Address: 2<^l^ Bc^y-flAe+i-f" ?f' 

Date/Time: Owner's Name: M^'fc-aco 31^3^' 

Quads Excavated: (h ^ 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? / 

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

time period) / 

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

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

Gates, Fences and Retaining Walls Ves No 

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

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

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

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

y 

Foundation, Siding and Gutters Yes No 

1. Was damage to tlie sidmg or trim avoided? y 

2. Was damage to the foimdation avoided? y 

/ 3.

 Was damage lo windows avoided? 

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

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

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided'? y 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

yyy 

^ 

y y 

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

EPA Representative fl,^3de^ Date: //yj/// 
^HNOLOUIES, INC. 

AS - BUILT DRAWING 

OLS # 27705 

Date Excavated: 10/05/2010 

USEPA OMAHA LEAD SUPERFUND SITE Signed-Off Date: 

27705 

Exterior Paint 

Noitti Arrow Owner Name: MOBECO iNDUSfRiES Omaha Lead Site • Good Addres8:26i9BURpETTEST Site Sketch • Poof Phone: »: 402:342:2820 \W; 

f 

0 Not paint 

Sample Lead 

Sample Samples Collected Number LAB Concentration Collected Firm: F m Tfe DB 

RYASCPXA-27705 Fl .ppm D Date: ^)Z^ J^, RYBSCPXA-27705 F2 ppm I S i D Time: i^iOD fi ^ 

RYCSCPXA-27705 81 5ASL ppm D Samples Analyzed RYDSCPXA-27705 B2 Z(^' . ppm D 

RBiSGPXA-SWOe OZ­ . ppm D D XRF Unit: ^0 1 Book: JOU> 

RCiZSGPXV27-766 GZ , ppm D D Date: "^-yt'OU 

ppm D D Time: An. Staff: t^SW Numtjer of Samples = [ 4 

Legend: F1 = Front Lett, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from tne street, facing property 

•'": iftVififip^f : " 

•f 

SHTERBD 

nmi^'m'^ 

53°l\ ZUX 

Bl =308 PPM® 10" 

gi l>l . 

~yf^r HS 5^ 

15U-: ISl 

f \ • 

: I n

:.v?STit 

6uflCelrt' 'sr 

EA = 120 PPM &• SCRAPE (~1") 

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

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: 

ProptHy Address: at,l<= l 3 , ,rf< P W ^ S( -

Owner; ^ E Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

item: 

Required corrections to complete the property: 

Li j I agree restoration is completed. 

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

K /xsk 

Owner's Signatiire / ^ Date 

I
/ 

Prudent Tectmologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminaled soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

^•fo I " RcX r Cx e^lA^C - ^ I 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 planned for yovir 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 ofBce) or (402) 991-9583 (North Omaha office). 

Property Access Granted Bv: B^T ^ AfU > . ^^^^^^/X ^ J ^/^O^ 

(Please Print Name) . ^ ^ ^ Q "^^e ^ ii****— 

^ 

Property Owner Signatu ^Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Renter \/(XcAn4- to K 

RESIDENT ADDRESS: 

^(h\° { ^orrJpfcg p iSV 

IFRENTAL, PROPERTY OWtNED BY: ^ ^ -

OWNER'S MAILING ADDRESS; 

fi^h O^^^UJL^ »ot: k,t\ ^ 

OWNER'S TELEPHONE NUMBER - HOME: [fd ^ ,? j'Z^'^ ^k^D-/^ WORK: 

JL L_ 

AGE OF HOME,.? . t^jk YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

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

NUMBER //A 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.) Ai/ ^ 

ALUHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSi 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 "detennining 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 405 5600 S 10 St 4242 Medical Drive, Suite 4260 

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

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

Fax: (816) 363-3707 Fax: (402)733-1883 Fax:(210)579-6577 
ENV[ROiVMEr<fT.AL& 

CONSTRLCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^\ ^ ^^^r<{ eH e S^ ^^*^' ^l2 ^ / I 'O 

Phone: Ho2-347^^_^^2 ^ °^^ ­

h^^ \Jt\tfXiJt~ V^t~ 

Property Owner Prudent Employe 

Signature: Signature: 

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

Kansas City, MO 64114 

Phone: (816) 363-3703 ^ 9 I ^ f2 ^ Onnaha, Nebraska 68107 

Phone: (402)733-1188 

San Antonio, TX 78229 

Phone: (210)822-9588 

C^v ­ l4A'i \ Tl- ^ .fOO^ 
I, 

Owner Name: MOBECO INDUSTRIES Omah a Lead Site 

Address: 2619 BURDETTE ST Site Sketch 

Phone: »• 402-342-2820 W: 

Sample Number 

RYASCPXA-27705

RYBSCPXA-27705

RYCSCPXA-27705

RYDSCPXA-27705

RDZCCPXA 27706

RGZSCPXA 27706

Lead Sample LAB Concentration Collected 

 Fl ppm D 

 F2 i^X ppm D 

 B1 .^AB. ppm D 

 82 Zlt.'L ppm D 

 OZ- ppm O D 

 6Z ppm O D 

ppm D D 

; 

Number of Samples = j M 

^ 

Exterior Paint 

• Good 

• Poor 

^ Not paint 

27705 

North Anow 

\ 

Firm:

Samples Collected 

 Fff l P B Oft 

Date:

Time:

 S)2iUsLz 

 9<gp fr ^ 

Samples Analyzed 

XRF Unit: <iC>1 Book: 7oG> 

Date: ^ -3t-C>G 

Time: A/*1 

Staff: A15W 

Legend: F1 = Front Left F2 = Front Right. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants ara as viewed Anom the street, facing property 

ENTERED 

Sl'^i 

Bl 

•rz 

-Mr 

Rev 4' 046141 0123 
N 2619BurdetteS

t 30x126 

A Printed

: Nov 30, 2010 

www.dcgis.org/dogis 
http://www.dhon.org/irthmtemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU... 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS  2605472. 

Original Call Date: 9/30/10 Time: 12:32 pm Op: SIVA18967 


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


State: NE County: DOUGLAS Place: OMAHA 


Address: 2619 Street: BURDETTE ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

lof 2 9/30/2010 12:32 PM 
http://www.dhon.org/irthmtemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 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 

2 of 2 9/30/2010 12:32 PM 
CONSTBUCnON TEOmfl 

SOLUTIONS 

SITE SATfcTY EDVZARD ANALYSIS 

. zi\ i il?>^-<)*^ i"- Address: Excavation Date: 

Crew: BackfiU 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 

c ^ ^ 

e^ 

h^' \V 

- — 

O/i^ 

or­ —— 

pci>t^ 

o/^ 

<^«* ­

o*^— 

_ _ ^ 

Hazards Corrective Action 

(^ Q1— r o r-c^O 

• 

Site Safety Office 

Date: 

MO W8fid«art(May. Siae4l » seoosiost 4242 Medical Drive, Sutte 7260 

:sMa8Qllr<*K>«*'<14 OnUta, NoiMBBka 08107 San V^fltonio. TX 78229 

lione: (S18) ses-afOS PHons: {402)733-11S8 Phone: (2t0) 8224588 

« c (SIC) 363.^3707 Fax: f««2) 733^083 Fax: |210)«7»-«577 
/ACAAyr Lc r 

b 

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