TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 23616 DATE: 12/15/2010 

ADDRESS: 4402 CHICAGO ST 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

• PRE AND POST VIDEO OF PORPERTY (DVD) 

oi EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

ID SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

[J RESTORATION AGREEMENT 

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

A CONFIRMATION DATA 

t l PHOTOGRAPHS 

i l AS-BUILT SKETCH 

D SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

m UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

gy>^ ^ ^\v\\ft 

SIGNATURE DATE 

30218622 

Superfund 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 23616 - 4402 CHICAGO ST 

Owner: User Provided Owner Information 

i n 

n Owner Occupied 

Owner Name: i Owner Name: 

fSWANSON ELAINE E 

Owner Addressl: Owner Address: 

Owner Address2: 

|4402 CHICAGO ST 

aty: 

JOMAHA ~ 

State:

|NE

 Zip Code: 

^

 ^68131­

I City: State:

'I— ! 

 Zip Code: 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1(402)^^4 0 ~ 

Contract: Assessment: 

Contractor: JPRUDENT2010_S Qualifying Group |400 

Contract Option JOPTTON T Assessment Max XRF Value j 421.6 

Resident: 

Resident Name: 

JSWANSON ELAINE E 

Property Address: 

J4402 CHICAGO ST 

Zip Code: 

|68131-

Resident Phone 

I 
PROPERTY SUMMARY 

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

Property Address; 4402 CHICAGO ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: B1 LAB SAMPLE UTILIZED 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 86 PPM @ 6"; DZ = 68 PPM @ 13"; EA = 124 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 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. 

TECHNOLOCIES, INC. 
4

^iy TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 2-3» fc t t. Property Address: i^ O X Cht'c^J^ O S^t" 

Date/Time: IO/'2,-^/fjo | o Owner's Name: g,\a{n t .5M3C»JOSoy^ 

Quads Excavated: Contractor Group: Prudent Technologie-s, 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? / 

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

/ day time period) 

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

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

time period) y

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

y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls 

Yes No 

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

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

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

 Was damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters 

Yes No 

1. Was daJiiage to the siding or trim avoided? y 

2. Was damage to tlie foundation avoided? y 

3. Was damage to windows avoided? y 

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

3, Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

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 Qr^ ^. ^ Date: /o/3.gy/o 
m iCHNOLOGIES, INC. 

AS - BUILT DRAWING 

OLS #23616 

Date Excavated: 10/12/2010 

USEPA Signed-OfT Date: OMAHA LEAD SUPERFUND SITE

—(>/yp Name: S'L^A'JS-QJ J Omaha Lead Site Date: •<yA/'ll7 Noitti Arrow 

Site Slcetch Time: MiHS^ - Phone: IVC3) ir^/~'^/^/d> A 

Team :Svr2^.^'n^x.j/'l^y/^^// ' BVID # D^<^y( ^ XRF Code "?& & 

Sample Number Lead Concentration Confirmation Sample 

^VAScPKA-33Q^ 3SZ±M-0 „„„ f l Yes O No Sft r.<YeYess D i^ ^ 
 NoH , cog FVA- Z5^1 >& ^/ Yes ^ ^ -Yf^^PXA-^^^t4 6^ Yes ^
 gpgCPxA-:z36|(^ No SI J^P-Yes a 

ppm Yes • No a 

ppm Yes U 

RYCSCPLA-23616 No • 

Lab 

237ppm 

Omaha Lead Site E.4= 124 PPM ® SCRAPE 46130 

CONTRAa #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Property Completion Agreemerit 

This agreement documents the completion of removal activities performed on tlie below listed property 

The property owner's signature indicates that the propertj- 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, if any. 

Property 

Property Address: V^Q^ , (i/UCCka Q S/>^~] ^ 

Owner 

Phone: 

Restoration litems in Questioini: 

1 agree restoration is completed, except as noted above 

LJ I do not agree restoration is completed 

.l±.i,ty(L-­ Ownier's Sigoature Date 
Pnident Technologies, Inc. (Prudent) is under contract with the U. S, Environmental .Protection Agencv (EFA) lo dean up leaclcontaminated soils at a numbei' ofproperties located in Omaha. Nebraska, including the property located at 

^^O ^ Cl4lCA<^€> Sy ^ The EPA requests; your permission to allow Pnident to perform a soil cleanup at tJii.s 

property to remove lead-contarainated soil By signing this tbrm, the property owner grants permission to Prudent to perforni 

cictivities related to the cleanup including soil sampling, removal of lead-contarainated soil, and resi oration ofthe referenced property 

D'yoii have ar.y questions about the soil cleanup planned 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) 7,31 -3045 (South Omaha office) or (402) 991-9583 (North Or.naha ofllce) 

Propeily .Access (jianted By ' y^/^^/'y^J ^ ^yy^yi^^^A / 

(P)ease Print Name) 

Property Owner Signature; 

(Signature)

^/iyy^ 

 (Date) 

PROPERTY INFORMATION 

(Tc he tompleted by residc-iit and/or property owner -- please piint^ 

RESIDENT MAME:. ^/-^/9y/y ^ ..'^(y^ /fyS<!>A/ /jwnerj) Renter 

RESIDENT ADDRE^JS; 

IF REIMTAL, PROPERTY OV\/NED BY: 

OWWER'S MAILIMG ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: l.^^ ^ 4T/ ^ ^/i' ^ V\tORK: 

J J 

AGE OF HOME?: fj ^ YEARS. HOW LOWG HAVE YOU LIVED HERE? ^ S VEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? >< YES f^O 

NUMBER OF OCCUPANTS UWDER 7 YEARS OLD: g> NUMBER OF OCCUPANTS 7 YEARS OLD AMD OLDER 

NUMBER OF CHILDREN UNDER ? YEARS OLD WHO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEKCOMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS. ENTRY GATES, ETC.) 

.A.IITI-IORITY FOR ENVIRONMENTAL RESPONSE ACTIONS, The activities to be implemented hy f.PA under this agreement 

arc pui-siianrio Section J 04 of CERCLA, 42 U S.C. 9604. EP.A's right of access to the property is provided for m Section 104(e) of 

CERCLA. 42 U.S C 960:)(e), which, provides entry for ''detenTiinrngthe need for response, or choosing or taking any response action 

under tlus title, or otherwise enforcing the provisions ofthe title." 

8080 vVaret PdrrRvjay. Sifirs 4y;r 5r;0.> i -f; .'.'ir .r:>A7. S/ieu(cal Drivfi, Sijiiw 42^0 

Kansas Citv, MG fi-^l 54 C(u2;J!ft, :'!fii:.irt:,;c;* iviiiir 'Uw Arit(;ni<). 'i')J /y2iS 

Phone; (816) 363-3703 Pttcne: :4Q;; r:^>--f;s?r Pftoiui: (210) C!22.0ftf;3 

ra;;: (815; 363.:;T07 i^Af .^ifi;- ^•-v:;-t3Si:: '-Wi.: \%^(^'\ Kl <^-mil 
ENVliU>r'JME;NTAL>t 

CONsTRUCnO?-: 

HNOLOGIES SEKV!CK5 , INC. 

Property Status Form 

Address: Vy ^ 2 . Cl^/^c ^ Date: lOU(l^o /o 

Phone: BVID: 

CI/?Ji'S<l-HIHcy 

Q^l^fyr^DfAL fi/2y^/ir< fiec^ S Z ^.l^-Z ^ 

X)2 

fcvt^ r ^ 7?i £^<:^^J^y^e "Pfi^i/Jiy A^CAIJTS f-^i^ulc k Q^T y 

^i^ r 5/c)^ ^y^c^j/i^rt A^^ ^ fc>5f tS^^L -/V)M<.CK AtU>i^A Qlz,^\ 

5 <? Ul^f / SO IT) tT)'^t £^C. A\JJ^7£- t\ (2fr 5, 'or> 

h Sot) ^-lo f u^^5r ^^X)C T)Z. 

flj2. Ey<^A\/^Tf <, (-^50 ^ 

L. 

Property Owner Prudent Em 

I Signature: ^ ^ Signature: Z^M ^ 

SOSf) Ward PavKwav- Suiip ^iO.S 

riw. MRDICEI orivtj, Sutto 42eo 

rCansas Ciiv, iWO 84114 

Onana, i-JebrasK-s 6C107 Haw Antonio, I'X 70i28 

Phor^e; (8iei36r>-'i70.3 

PhODfi: !40Z! ?3;;-!l«-c! i'hoiie: (aiO) r.l22.9S8H 

l^.iai ' '^ f.-'r -r'^f.-i 

r;.ov' *^^-i(\\ liTtt ea-y-T 
(,/.h/p 

Name; J> "O^A^J.S'OJJ' Omaha Lead Site Date: -^Vyfe y North Arrow —i 

M6TesB~^jC/02. CA-cgg-c S? Site Sketch

Phone; iVc^) .<'</-"^M/O 

Tea.m '^::^i~ • iT x,^y4^^3mr^ BVID # i^JCy' & 

Sample Number Lea(j Concentration 

J^^HCt(c 

 Time: •jb^f'i£>­

5 r,?& r*^ IA 

XRF Code -yes 

Confirmation Sample 

f l Yes a 

Fa Yes ..D^,^ 

^^ Yes ^^a"^­

e * Yes Q 

iJf^Yes n 

Yes n 

Yes D 

No ®-

No 123-"-

No S 

No D 

No • 

Ornftha Lead Site 46130 
Page 1 of 1 

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H Legal Description: 40 X 128 

A II III I iMf Printed: Oct 07, 2010 

www.dcgis.org/dogis 
Page 1 of2 

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Create Another Ticket Back to Irtli Internet Send Email 

YOUR TICKET NUMBER IS 2610742. 

Original Call Date: 10/06/10 Time: 5:22 pm Op: SIVA18967 

Work to Begin Date: 10/08/10 Time: 5:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4402 Street: CHICAGO ST 

Twp: 15N Rng: 13E Sect-Qtr: 17-SW,20-NW 

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: SPVA 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 


BSHPCLKS CXCATV MUDOl OMAHACOF 0PPDGPR5 PAETEC QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523460 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS,

INL 

 ^^^ ^ 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/6/2010 
Page 2 of2 

OMAHA PUBLIC POWER OPPDGPR5 ELM LOCATING DISTRICT 

NO NEED TO CALL OUT PAETEC PAETEC COMMUNICATIONS EMERGENCY 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING 

Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/6/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TESHNOuianB, mc. SOLUTIONS 

Address: V^^ ^

Crew ^ : 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Stmctures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

SITE SAI^TY HAZARD ANALYSIS 

 ^^^^^ ^ Excavation Date: ^"^ ^"^^ 

BackfiU Date: 

Condition Hazards Corrective Action 

O K 

O K 

(^iC 

OL 

• • 

/^o ^ 

AJo( ^ 

<Lit>A<^ 

tfO(J>P 

'K. t 

h^o- ^ 

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CfVrik 

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Site Safety Office 

Date: 

IO­ 13'l b 

SGMSIOSt 4242 Medical Drive, Suite 7260 

tC>|ly;ilO«4114 Omilia, Nataraaka 48107 San Antm^CTX 78229 

PfMnK g1t)368'aT03 flWiw: (40Z)733-1ia8 Phone: (2t0y822^8588 

Fac |8tt) 363-3707 Fax: (402)73»'1«83 Fax: (210)679-6677