TRANSMrrtAL of OMAHA LEAD SITE 

son . REMEDUTION FILE FOLDER 

SAID#: lA^I' ; I^ ^ l^jl'^o l 

Address; __2Si2^_i_l S S L 

, ^ g^ 4^^ , A T^. . Yc«: ^£1 ^ Remediation Contractor: 

SOIL REMEDIATION 

PROPERTY FILE EOLBER DOCUMENTS 

2f Video of property (DVD) ^ 

B^ Executive Summary 

13^ EPA-provided property sketch 

IET ' Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja^^nt property 

Qf^ Restoration Agreement 

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

a^ Confiimation data 

ET Photographs _. 

B As-built sketch 

0 Satisfectory restoration signed by Property Owner 

0 Property close-otrt check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

Sl Utility dearaxxces 

B^ Property informationfrom Douglas County Assessor's Office 

Q 

D 

D 

Signature ^ ^ 

30217981 ill 

Superfund 
Find Record 

Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 16415 - 2512 S 25 ST 

Owner: 

Resident: Contract: 

D Owmer Occupied Resident Name: Contractor: 

Owner Name: [ANDERSON PAUL F PRUDENT2009 S 

JANDERSON PAUL F 

Property Address: Contract Option 

Owner Addressl: J2512S25ST |OPnON 3 

I 

Zip Code: 


Owner AddressZ: |68105 
 Assessment: 

|2512 S 25 ST Resident Phone 


Qty: State: Zip Code: Qualifying Group 

I 

jOMAHA [ NE [68105 poo 

Owner Phone: Altemate Phone: 

Assessment Max XRF Value: 

|(402) 991 6132 j(402) 829-1287 r 425.81 
mWfllHHIMIWSHITillWmMlKy 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address: 2512 S 25 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: 

Bl =210 PPM @ 8"; DZ = 376 PPM @ 13"; EA = 114 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 includefinal 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. 

INOmCEESjINC. 
« 

'raCHNOLOGIES.INC »EPA 

EPA Property Close Out 

Zfii- Property #: l(,i^\ S Property Address: ;L£/ ^ ^ 

Date/Time: Owner'sName: g^U-l A^^^^^^' ^ 

Quads Excavated: fLl^VZ- Contractor Group Pi iident Technologies 

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? 7 

Grading Sod and Vegetation 

Yes No 

1. Does the grading around the perimeter ofthe house in excavated areas gener^ly 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 ipspected at a 30 

day time period) / 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

6. Was the property graded such that water will not pool on the property? y 

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

Gates, Fences and Retaining Walls Yes No 

I. Do gates open and close freely? (If applicable) 7 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 7 

3. Was damage to gates or fences avoided? (If applicable) 7 

4. Was damage to retaining walls avoided? (If applicable) 7 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 7 

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 

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: 

vcurH sioc Ol' rk. Rf ^ 

<x> 

.0 ^rA^\^'^ 

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

EPA Representative :Qc^Am Date: ^W ^ 
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, cuid that no items arc in question, now, or at any time in the fliturc, excluding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property IB: 

Property Address: ' ^ 5V 3 ^ r •^5 " f ^ 

Owner: /^ ^ / >^^^/-^^ ^ 

Phone: f^Q^ ^ ^^Cf) - {p j 33 i 

Restoration items in Question: 

Item: riAi5fl l S^orJ }\eUii\4 ^G^dtr^^c^^ 

Item: 

/ ^ <i^dik7'^i> hiBcy<7 %r> y^yir^ Le^s>^') 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

kS I agree restoration is completed. 

I 1 do not agree restoration is completed at (noted deficiencies above) 

y.^7c^^^ /^A 7/.^ 

Owner^ Signature Date 

I
Prudent Technologies, Inc. (Pnident) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcgntamingtfd soi]^ at a numljpr ofproperties located in Omaha, Nebraska, including the property located at 

e r a / fi. .y I ^ D ii r * . The EPA requests your permission to allow Prudent to perfonn a soil cleantq> 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 your property, please contact Prudent's Administrative Clerk for the 

Omaha Lead Site cleanup. Ms. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleaniq) can be 

directed to the EPA Public hiformation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

RUAI ' f i^darsoir^ Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: X f C^^y [ 4 " (D—^.-y" ^ I / Z L j t> l 

(Signature) (Date) 

PROPERTY INFORMATION 

(To hbe compiete completed by1^ residen residei t and/or property owner — please print)

RESIOENT NAME: *7^y?l/l /"OwneT y Renter 

RESIDENT ADDRESS: 35-12. ?. 25^ 5d. 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; Sa/he 

OWNER'S TELEPHONE NUMBER -HOME: 1^?, ff/'i'/^ ^ ,„„K: /^^y - <?P'7'- /^^ Z 

J 1 

AGE OF HOME?,:: / 90^ YEARS. HOW LONG HAVE YOU LIVED HERE? r/- ^0^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WFTH SIDING SINCE 1978? V 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.) 

0OO " iTl^ld y 

AUTHORITY 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 ofaccess 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 405 250S N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO64114 Omaha, Nebraska 68110 San Antonio, TX 7822S 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
tUDENT ^TECHNOLOGIES, INC. 

Property Status Form 

Address: 96^' ^ ^ - 9^^ Sh Date: f- ^^" ^ f 

Phone: ^0^ " fV'6/3? . BVID: /^^/vT ' 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

pi- 0t.,y»f hu,h M o^ c^^iO/ ''^y^^ 

^ O^Atr h {cyjuM e {c7 r^//yiy^^^^^^^ ^ ' 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking'? y Yes — No 

Item# Description & Location 

On Map fB h ttoioki> i7) y^iTh/y J.t€7ru7ct/k ^e^^rs^) 

p^?- C^T^c^k^ />n i^7tya.4e stJ'eu/ccU^ Ceccs.^) 

//^3 Craclcs^ fTi cl7iiy€ oucc^y Cce^-h. 

ffH - Stf^l'Tiy ^pcctyC r hr^t^k s ^SouAk ) 

Property Owner Prudent Employee 

Signature: yarx^^^^y y CA^—*-— Signature: 

8080 Ward Parkway, Suite 405 2S05 N. 24"' Street, Suite 308 4242 Medical Drive, Suite 4260 

Kansas Cfty, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1001 Phone: (210)822-9588 iQAe:\ fi^ ^ -ITrt-T 
^UilNOi.OtilES. INC. 

AS - BUILT DRAWING 

<)l.S#:16415 

Date KNcavattd: l(»/13/2tHH) OMAHA LEAD SUPERFUND SITE I SF.P.\ ,Sign«l-Ofr Date: 

Name: _ Omaha Lead Site Date: yy2.7.yoi> North Arrow 

Address: z<r/t. i. ?irt> y . Site Sketch Time; 

Phone: 7 

/6 y/-y XRF Code 5-5-^ V 

Sample Number Lead Concentration Confirmation Sample 

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No 23 

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Yes n No • 

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Omaha Lead Site 46130 

KA = 114 1'1'M « S( RAIM ( 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES. INC. 
Omaha Lead Site Date: 7/^2. Zx ^ 5 North Arrow 

Address: 2<r/J . ^ Z^rZi ^ 7 . Stte Sketch Time: 

Phone: >* i - 777 - ^/ > ^ 

Team /(P^y XW^w-- ^4-BVID # // ^ Vy.<^ XRF Code. ^s-oH 

7 y Sample Number 

Lead Concentration Confimiation Sample 

ppm 

/^/Yes No (3 i^-/RscpxA-/t^*i\s; M±IL , Dom 

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• ppm Yes No • 

Omaha Lead Site 

46130 
ust 1999 - Douglas Countv Assesso 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

2533260000 

ANDERSON 

PAULF 

2512 S 25 ST 

OMAHA 

68105 

2512 S 25 ST 

OMAHA 

NE 

68105 

33-15-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

WILCOX ADD 

6 

3 

E 108 FT 

47.5X108 

0.12 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=2533260000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R2533260000 

http://vvww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/17/2009 
Page 1 of2 

"> 

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• YOUR TICKET NUMBER IS 2375354. 

Original Call Date: 9/29/09 Time: 2:31 pm Op: SIVA18967 


Work to Begin Date: 10/01/09 Time: 3:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2512 Street: S 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-SE,33-NE 


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 


: 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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 

ATTNEBRl CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 

QWESTNE 

Service Area Contact Phone Number Utility Type 

Day: 80024136249 

ATTNEBRl ATT/T Alt: 

Emerg: 80024136249 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/29/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE IF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QWESTNE QWEST LONG DISTANCE 

Day: 8002834237 

Alt: 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/29/2009 
CON.STRUCTiOiV 

TECHNOLOGIES, IIMC. SOUJTiO^iS 

Hazard A^ialysis a) 

Address: ^S7 ^ S- ^ S Si: 

Crew: ^ ^ 

Date: •7-^ 0 c?*? 

Itern 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Drivewav 

Sprinkler System 

Other 

Crew Foreman 

Conditjorr 

C^C^ ^ 

,.7)1 J r t/ctei 

] 

y-)t./r /lOrl 

/tyy^ 

yV^r 

/^«-y>«^ 

r-^./.^ 

7^/^z 

/Pete-x.­

/p<ZC^ 

7 

yty^ 

Corrective 

Hazard^i. Actjori 

ha* J 7's^^rHi 

1 

f 

t->j-ar xjP4/^<5;,/is.a-«=^ 

• 

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/^T^ 4=>Cf^. r^ y 

Site Safety Officer 

8080 Ward ."arkway. Siiits ^GS ?505 'vl. 24'" Sti-eet, Gtii":e 30g 3:--cs; Orivs. 3:j!t£ "250 

Kansas Citv. MC 6411-'1 Omahr;, Nebraska 68110 £:?,n Antonio, TX 757:29 

. Phor.e: (SIC) 363-3703 Pi-;c:-:e: (402) SQ'MOC^ ?;-oni:: ;::;'iu} 523-9s83 

??.-.: i-'rl>:^,) c04-'i005 T:';:; ;21C) 579-3577 

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