TRANSiVIITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 29376 DATE: 12/15/2010 

ADDRESS: 2616 N 19 AV 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[Zf PRE AND POST VIDEO OF PORPERTY (DVD) 

a EXECUTIVE SUMMARY 

S( EPA-PROVIDED PROPERTY SKETCH 

SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

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

0 CONFIRMATION DATA 

ffl PHOTOGRAPHS 

AS-BUILT SKETCH 

a SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

0 PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

a UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^ ^ <\V'^ >V' 

SIGNATURE DATE 

30260754 

Superfund 
Find Record Remediation Query i Lead Remaining Query Property Damage Query iJ 

Backfill: 

Sampie Area: 29376 - 2616 N 19 AV 

Owner: 

n Owner Occupied 

Owner Name: 

JACE WELDING AND^PM l INC^ 

Owner Addressi: 

1 ^ ' 

Owner Address2: 

|2611 FLORENCE BLVD ^ 

City: State: Zip Code: 

[OMAHA " JNE J68110-

Owner Phone Alternate Phone: 

Contract: 

Contractor: jPRUDENTTOlO" 

Contract Option JOPTION 2 

User Provided Owner Inforniation 

Owner Name: 

1 •" 

Owner Address: 

City: State: ZipCode: 

1 j 

Owner Phone: Alternate Phone: 

' 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value f 480 

Resident: 

Resident Name: 

I 

Property Address: 

12616 N 19 AV 

Zip Code: 

J68110-

Resident Phone 
PROPERTY SUMMARY 

Date: 12/15/2010 Omaha Lead Site Remedial Actioii Contract # EP-R7-07-06 TO#l Month of: December 

Property Address: 2616N19AV 

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: 

B2 = 333 PPM @ 6"; EA = 279 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-Buih 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 (ifany 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
TECHNOLOGIKS, INC. 

EPA Property Close Out 

Property #: 'L°<1>7(D Property Address: "2^^'^ "^ l^^^vtf, 

Date/Time: Owner'sName: "S^iwvPr-'Jt-^ 

Quads Excavated: \/L— 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 of drip zone e.\cavated and restored? y 

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? y 

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

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

day time period) y 

4. Are sodded areas generally firni and evenly graded? y 

5, Arc die joints between die sod strips generally tight? (Only evaluate if inspected at a 30 day ^ time period) 

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

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences aod Retaining WalSs Yeg No 

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

y 2.

 Were al! gates or fences lalcen down during restoration activities reinstalled? (If applicable) 

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

4. Wasdamage to retaining walls avoided? (If applicable) 

y 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to die siding or trim avoided? y 

2 Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

. ^ 4.

 Was damage to windows or door screens avoided? 

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

Sidewalk.s and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? y 

. Jf... 

2 • . Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative ^'^ "^ ^Date: iiff/'o 
:CHNOLOGIES, INC. 

AS - BUILT DRAWING 

OLS # 29376 

Date Excavated: 10/28/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signcd-OfT Date: 

liiiii i 29376 

Exterior Paint North Amw 

SanqMng AddiOTK ^16NJ9AV^ Site Sketch • Good 

Omaha Lead Site 

• Poor ALT: Q'Not paint 

Sample Lead Sample Samples Collected Numtwr LAB Concentration Collected Firm: l\irl Nf/I f 

RYASCPXA-29376 F1 1 3 5 ppm Ef D Date: o-j-il-Zcci i 

RYBSCPXA-29376 F2 .^1- ^ ppm ET D Time: t.'.oo ?«A 

RYCSCPXA-29376 Bl 3 2 B ppm Ef D Samples Analyzed RYDSCPXA-29376 B2 Hfia ppm [T D 

nDZCOPXA a0076 BZ- ppm D D XRF Unit: fe5H2 Book: IR H 

RCZSOPXA 20076 6 ^ ^ ppm D D Date: ^•ll-Q l 

RPZSCPXA 30376 P2- — ppm D D Time: M. Staff: Number of Samples = W n^w 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AO quadrants are as vievted trom the stieet, facing propeity 

ENTERE D 

CONTRAa #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
SEPA 

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 ofthe 

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, ifany. 

Property ID: 

Property Address: M U M­ ^^H \ .gwp ^ 

Owner: 

Ali y^^v pii^\^e^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Reqiiired corrections to complete the property: 

L J I agree restoration is completed. 

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

\v\o--\o 

(Jvwier^ Signature Date 

I
Pnidait Techiwlogies, Inc. (Prud^nL) is un.der.'ConIract. with tiie U.S. Environmental Proiection Agency (EPA) to clean up leadcontamiiiated'soils.at a nuniber of properties locaied in Oniaha, Nebraska, including the property located.at 

' ' . .! Tlie EPA requests your permission to allow Prudent to perform a soil cleanup atthis 

property to remove lead-contaminated soil: By signing this fonn,.the property owner grants pennissio'n.to Prudent to perform 

activities related to the cleanup including soil sarnpling, removal of lead-cohtaminated soil,- and restoration ofthe referenced property. 

Ifyou have aiiy questions aboutthe soil cleanup, planned for your propeity, please contact Prudeni southoffice for the Orhaha Lead 

Site cleaiaip7at (402) 733-1188:..General questions about the Ornaha.Lead Site cleanup.can be directed to the EPA Public Information 

Centers at (402) 73 U3045 (South Oiiulia office).or (402/^5T^583 (]>Jorth Oniaha office). 

Property- Acceiss Granted By 

Property Ownva' Signature; 

y / . (Date) 

PROPERTY INFPRMATION 

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

RESipENT NAME: Vj XX^CJ^X^—rJ':^ \ O l^ Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED B^ 1 

^ 

Ac^- ^^\'ii ..^p^ J L 

^ 

OWNER'S MAILING ADDRESS; ' 

.!h ^ 

- & •d'^=^ ^ f^^ kVyi-^ 

OWNER'S TELEPHONE NUMBER - HOME: ( ) WORK: 

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

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBEROF 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.) 

AirrHORITY FOR.EMVIRONMENTAL RESPONSE ACTIONS: The aaivities to be implemented by EPA under this.agreemerrt 

are pureuant to Section 104 of CERCLA, 42 U.S.C: 9604. EPA!sriglitof access to die property is provided, for.in Section 104(e) of 

CERCLA, 42 UvS. C 9605(e). which provides entry for "determining the need for response, or choosing or talking any response action 

•imderthisUtle,.or otherwise emfprcing the provisio'ns ofthe title.-" - ' 

8080 Ward Parkway, Suite 405 •5600 S 10 St 4242 MedicalOrive, Suite 42S0 

Karisas City, 'MO 64114 Omaha. Tvebraska 62107 San Antonio, TX 78229 

. Phone: (81S) 363-3703 -Phone: ;402) 733-1188 Phone: (210) 822-9588 

Fax: (815) 363-3707 , Fat! (4025 733-1883 .Fax: «210) 579.6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^ \ ^ 10 \qH^ A^L ^ Date: ^Q j ^ ^ 

Phone: BVID: 

8080 Ward Pai 5600 SIO 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 
29376 

Omaha Lead Site Exterior Paint North Arrow 

SampUng Address: 2616N19AV Site Sketch Q Good 

[[] Poor 

Phone: H^ ALT: Q ' Not paint 

Sample Number Lead Sample Sampies Coiiected UB Concentratiort Collected Firm: AsW i^fll f 

RYASCPXA-29376 Fl 1 35 ppm D Date: 0-7-2 7-zoo •» 

RYBSCPXA-29376 F2 Jil- ^ ppm D Time: "^'-Oo P' A 

RYCSCPXA-29376 Bl _JL2B ppm D 

Samples Analyzed RYDSCPXA-29376 B2 ppm E^ O 

RPZCCPXA 20376 BZ- ppm D D XRF Unit: fe5H2 Book: mi 

nOZCCPXA . 1 . a93?6 G£- ppm D D Date: Q-/y-/5 7 

RPZ6CPXA - 00376 PS- ppm n D Time: AM 

Staff: nSl / 

Number of Samples = <-/ 

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

All quadrants are as viewed from the street, facing property 

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N 2616 N 19 Ave 

A Printed: Nov 11.2010 

www.dcgis.org/dogis 
Page 1 of 1 

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Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2622430. 

Original Call Date: 10/20/10 Time: 5:26 pm Op: SIVA18967 


Work to Begin Date: 10/22/10 Time: 6:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2 616 Street: N 19TH AVE 


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: Y 


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 

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 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/20/2010 
CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: f^^lA H I I (^^ Excavation Date: 'Q/^^^' ^ 

Crew: BackfiU Date: lo 12-^1 (9 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foandation 

Retaining WaUs 

Fences 

Trees 

Stmctures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

C3/ ^ 

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O^i ­ (pircJ=i 

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Site Safety Office 

Date: 

nao WanHAHkway. SUIB405 SlOS t 4242 Medical Drive. SuHe 7250 

SS107 San Antonio, TX 78229 

; (S16) 363:^8703 f«B)733-1-U» Phone: (210) 822.-M88 

:|91S) 383^707 fUQ)733^ie83 Fax: (210) ST9-8577 
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