TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#; 28522 DATE; 1/15 

ADDRESS: 2412 N 17 ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20lt 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ PRE AND POST VIDEO OF PORPERTY (DVD) N^lSAiiv^ Rlfxffit o ^\iJl ^ 

IZ( EXECUTIVE SUMMARY 

• ^ EPA-PROVIDED PROPERTY SKETCH 

• SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

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

\ i CONFIRMATION DATA 

^ PHOTOGRAPHS. 

Q AS-BUILT SKETCH 

• SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

0 PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

m UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30218375 llillil 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2412 N 17 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 = 95 PPM @ 13"; Bl = 277 PPM @ 13"; EA = 68 PPM @ 2" 

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 veriiying satisfactory restoration 

v) Description ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
3

li-yR iiiiiiOij TECHNOLOGIES, INC. 

EPA Property CSose Out 

Property #: 2^5 " Z'Z- Property Address: 24'2. /O- I? $f. 

Date/Time: Owner's Name: V\bi>jk Pa^vl^i^) 

Quads Excavated: F f^ ^ / Contractor Group: Prudent Teclmologies, Inc., 

Excavation GeneraJ 

Yes No 

I. If necessary, were the correcl 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 ui all areas that were excavated? / 

 Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 / day time period) 

4. Are sodded areas generaUy finn and evenly graded? / 

5. Arc the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / time penod) 

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

y 

7. Was damage lo landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls 

Yes No 

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

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

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

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

Foundation, Siding and Gutters Yes No 

1, Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

3. Was damage lo windows avoided? y 

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

.^. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to diivewav surfaces avoided'? y 

2 Was damage to walkway surfaces avoided? y 
Owners cominents: 

Inspection notes: 

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

EPA Representative jdo^ 3 ^ Date: i^fijr^ 
CHNOLOOIES. INC 

AS - BUILT DRAWING 

OLS # 28522 

Date Excavated: 10/07/2010 OMAHA LEAD SUPERFUND SITJ USEPA Signed-OffDate: 

2-ii5ZZ 

Name: _/><»/iS«// /'^«K« f 

Address; Z^IZ. N . 11+bSh 

Phone: V53-S5- 7 3 

Omaha Lead Site 

Site Sketch 

Date: f­ i.^'S' 

Time: //.S j 

North Arrow 

Team F{>A MT/r^/<U/ ' BVID # ''^^t,l<i XRF Code /g3 7 /iooK'-iz.'h 

Sample Number Lead Concentration 

50 3 

? 3 9 

^g g 

32 ? 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Confimiation Sample 

p i Yes 1^ 

F 2 Yes CD 

8 i Yes • 

**2.Yes •=• 

V6S P 

T-(J!. • 

Ttfe D 

No El, 

No Q 

No ca 

No ^ 

NO P 

Wu O 

Tfi •5~T" 

+^ I BgU£{-< pp-­ - 4 4-. 

-[ ]— 

! i 

^?5i _32;3L 

it^i 31 

BI=277PPV1 fl 13' 

Zir'f^ n, ils r 

^ ( 42. •-^ h 

FI=95PPM@13 " 543 3:3<^ 

-t^(­ ; wAttic 

i i i>l 

K\=68PPM fl 2" 

CONTRACT tt: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
dERfV 

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: ^^/ ^ fV )") ^/ ^ 

Owner: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I 

Required corrections to complete the property: 

13^1 agree restoration is completed. 

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

y^-M? 

Date 
4 

vV H.^- .'•

a.(^vv r^f' ^ 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcofltaminated soils at,a numbetvgf projjf rties located in Omaha, Nebraska, including the property located at 

g^^/i ? / v / Y " ^ O'T'^i e EPA request.^ your permission to allow Prudent to perform a soil cleanup at tliis 

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. 

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

Site cleanup-at (402) 733-1188. General questions about tlie 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 oft'ice). Umaha office)

) or(4U7)) 991-9583 (Ni 

/ 

Property Access Granted By: 

ease Print Name) 

Property Owner Signature: q-^^0 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT Owner Renter NAME: |//\C/^A/ T L o 

RESIDENT ADDRESS: .ey/^ /O n^ sr 

IF RENTAL, PROPERTY OWNED BY: fmy^l hih&i 

OWNER'S MAILING ADDRESS

•m^ (t^^iAst 

OWNER'S TELEPHONE NUMBER - HOME: ..'^-4^\' ^ 

WORK: 


i^l,x^ :IJOX-1?^^ ^ 

AGE OF HOME?-W- YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: v\ P 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: 

iOMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under thi.<; agreement 

are pursuant to Section 104 ofCERCLA, 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 "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 406 5600 s -.est ''i242 Medical Drive, Suitn 42S0 

Kansas City.'MO 64114 Omsna. Weic-ij;.=;jiB 631'j7 Hm Antonio. TX 78229 

Phone; (816) 363-3703 Phonft; (210) 822.B888 

Fax:(816)363-3707 FMX: (210) 579-^}677 
EiNVfRONMENTALA 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

Property Status Form 

Address: ^ V/ 2 / J H' ^ %r Date: ^/^ZL^XOI O 

^jyif-Q/AL ,/{^LLA^ f/.TJ / 

y 

€^€LA\J.A^^ ^ IL£ ^ .Scyy-^ 

8080 Ward Parkway, Suite S600 S 10 St 4242 Medical Dnve, 9nite 4250 

Kansas City, MO 64114 Onnaha, Nebraska 68107 Sart Antonio, TX 78229 

Phone: (816) 363-3703 Phone; (402)733-1188 Phone: (210)823-9688 e..!.. rt>He* *i6'% '•TAT c:.«v­ iAc\n\ .fi t iOo-^ Ci v /tin t ETOJSIITT 
- •uaav.-ja^tai'.jyt^-.v.'^ateii.-;^ v -

BfEa 

Name: /^ronz.e.11 Fa.nl/Le.'^ Omaha Lead Stte Date; f-ig- S MDCtti /\MCMV —c 

Address: Zmz . N . l7-^S h Site Sketch Time: .U • 3c> 

Phone: ^^53-85^7 3 

Team F^ 4 UX/r\ J tl)K( BVID # ^1^5 ^ Z XRF Code /g3 7 /?oc*::ta<» 

Sample Number Lead Concentration Carrf-irmation Sanrtple 

•22 

3B 

4) 

m 

6 

7 

/2YOyC/*XA-28ga2 

33*? 

JiSSL 

32? 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

/=2 Yes n 

8^ Yes O 

^2-Yes "^ 

TBS O 

No ^ 

No ra 

No g ^ 

No IJ ^ 

NO D " 

Nu P 

f<u D -

<5^/­ 7^Y(. 
mits^^^ 

2412 n 17 St 

A Printed: Dec 08. 2010 

WAS w. dcgis.org.''iloi;is 
http://www.dhon.org/irthmtemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU., 

Create Another Ticket 11 Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS  2605485. 

Original Call Date: 9/30/10 Time: 12:36 pm Op: SIVA18967 


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


State: NE County: DOUGLAS Place: OMAHA 


Address: 2412 Street: N 17TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-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 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 12:36 PM 
http://www.cihon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHATRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:36 PM 
Vivci; 

ENVIRONMENTAL 

NGINEERING AND 

CONSTRUCTION 

SOLUTION!^ 

SITE SAFETY HAZARD ANALYSIS 

Address: ^M' X

Crew 

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 

 /l^-/7^? f 

Condition 

-vkjuC ^ 

(vT 

Vi* 

/ /A 

^rt 

'n/fl 

vi«r\. Im 

i^M 

^ h 

'pk^

'fn 

Wf, 

WfV 

/y«r 

/ 

I^A^ 0LJi^^ . 

Excavation Date: MLJall D 

BackfiU Date: 

Hazards Corrective Action 

Site Safety Office 

Date: 

^ • ^ 

M M Wanf BMtany, Sut e 405 seoosiost 4242 Bledical Drive, Stiite 7250 

KaisasGity;iK>««114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (8t<) 3634703 Phone: (402)733-1188 Phone: (210) 822-«588 

Fax: (SIS) 363^0 7 Fax: (402)733^1883 Fax:(210)«7M577 
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