TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID*: 27749 DATE: 1/15 

ADDRESS: 1511 BURDETTE ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC YEAR: 201(t 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Dl PRE AND POST VIDEO OF PORPERTY (DVD) 

E EXECUTIVE SUMMARY 

Di EPA-PROVIDED PROPERTY SKETCH 

Q SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERT/ 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

ID RESTORATION AGREEMENT 

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

d CONFIRMATION DATA 

• PHOTOGRAPHS 

• AS-BUILT SKETCH 

• SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

ID PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

m UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNT/ ASSESSOR'S OFFICE 

D 

D 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address: 1511 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: 

F2 = 222 PPM @ 2"; Bl = 375 PPM @ 2"; B2 = 387 PPM @ 2"; NO EASEMENT 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement includitig 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 (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. 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

BadcTill: 

Sample Area: 27749 - 1511 BURDETTE ST 

Owner: 

D Owner Occupied 

Owner Name: 

jSIXTEENm STREET LTD PTFT 

Owner Addressl: 

1 

Owner AddressZ: 

12221 N 24 ST 

City: State: Zip Code: 

JOMAHA JNE 168110-

Owner Phone Alternate Phone: 

r 

Contract: 

Contractor: )PRUDENT2010_S 

Contract Option JOPTION 2 

User Provided Owner Information Resident: 

Owner Name: Resident Name: 

Owner Address: Property Address: 

]1511 BURDETTE ST 

Zip Code: 

)68110-

City: State: Zip Code: Resident Phone 

^__ _ ^ 

Owner Phone: Alternate Phone: 

1 j 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value 499.65 
TECHNOLCX5IIES. INC. 

Property #: '27'^ ^ 

Date/Time: 

Quads Excavated: F2 , 6 ^ 9>2­

^i^-jhiaS'. / •;' ; V 

EPA Property Close Out 

Property Address: [''^ll ^urrd^-^'^'^ ' 

Owner's Name: 'C^rciv<£el ^^(A.(Z_-

Contractor Group; Prudent Techiraologics, line, 

Excavation General Yes No 

I. If necessary, were the correci quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes, No 

). Does the grading around tlie perimeter of the house in excavated areas generally slope away / from the house? 

2. Has sod been laid m all areas that were excavated? / 

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

/ day lime period) 

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

5. Arc Uie joints between tlie sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) y 

(i> Was the property' graded such tliat water will not pool on the property? y 

7. Was damage to landscapmg or plant materials avoided? / 

Gates, Fences and Retaining Walls 

Yc3 No 

1. Do gates open iuid close freely? (If appUcable) y 

2. Were all gales or fences talcen down during restoration activities reinstalled? (Ifapplicable) y 

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

4. Was damage to retaining walls avoided? (Ifapplicable) 

y 

Foundation, Siding and Gutters Yes ,No 

I Was damage to the siding or trim avoided? .y 

2. Was damage to tlie foiuidalion avoided? y 

3 Was damage lo windows avoided? y 

4. Was damage to windows or door screens avoided? 

'J 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) YeS/ No 

W;is damage lo drivewav surfaces avoided? 

Was damage to walkway surfaces avoided? 

• ^ 
Owners comments: 

Inspection notes: 

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

EPA Representative 9^' ^ j^^^^ . tt/f3//o 
t'HNOLOtMES. INC. AS - BUILT DRAWING 

OLS # 27749 

Date Excavated: 10/20/2010 OMAHA LEAD SUPERFUND SITE USEPA Signed-Ofr Date: 

tJ7H-3 

Exterior Paint North Arrow Owner Name: .=5/>^£-gT/y cS^fET Cfb Oma^a Lead Site • Good Address: / ^/ / £Kei>£Tr£ ^Tl''^^^^! f Sketch • Poor Phone: H: w: 0 Not paim 

Satmple Number Lead Sample Samples Collected LAB Concentration Collected Firm 

RYASCPXA-.?77y'9 Fl 7 H 3 ppm oJ a Date 

RYBSCPXA-J 774^? F2 H 6 1 ppm H D Time 

RYCSCPXA-J77 Vf Bl ^ i I ppm \ i D Samples Analyzed RYDSCPXA-.57 7V5 B2 fSC-)0 ppm Q ' D RDZ8ePXA-^7>^^~©2 ppm D D XRF Unit: lOo n Book: H. l 

RG2€ePXA-:3??4^# Gir ppm n Date: IO ->.7-ft ^ 

-RPZ9€PXA>'-J27yf PZ ppm n n Time: ^r ^ 

Staf^^f, ^ Number of Samples n^ D 

Legend: F1 = Front Left. F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

All quaorants are as viewed from ttie street, facing property 

•o'?^a 

|-'^i\ ••.•^^ ­

r^ 

B2 = 387 PPM (fl V Bl = 37S PPM ffl 2D=^ b! K 

/5//; SoP-Offf^^ Us • ^ • t 

.HU.V.. „ 

222 PPM (Ss. 2 " 

k:^ 

j .gi 

b:^ft:)fni 

NO I.ASF MKM 

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

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: trSW IfSurA^i^^ ^] - Owner: 

Phone: 

. — . -

Restoration Items in Question 

Item 

Required corrections to complete the property: 

I agree restoration is completed. 

L J I do not agree restoration is completed at noted deficiencies above 

Date 
Pmdent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

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 plamied 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 directedto the EPA Public Information 

Centers al (402) 731-3045 (South Omalia office) or (402) 991-9583 (North Ogasha office). 

{V\.i tSjcot^ V^^cXAxCtl> Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: m Jo /^'/2> 

Ignature) (Date) 

PROPERTY INFORMATION 

(To b^cdmpleted by resident and/or property owner — please print) 

RESIDENT NAME: r^TouLJlr \d y Owner Renter 

SIDENT ADDRESS; , ^ ^ /> 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAly^G ADDRESS 

;;^^g.i ^^ ^^ ^ gf X\t..Su K3t t^kD 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

J 1 

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

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

AllTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; 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 tliis title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway. Suite 405 5800 S 10 St 4242 Medical Drive. Suite 4250 

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

Phone: (816) 363-3703 Phone: (402) 733-1188 Phone: (210)822-9688 

Fax:(816)363-3707 Fav: <402i 733-1883 Fax: (210) 579-6677 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: \S\\ %j^f^^€L \ Date: 

Phone 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 SIO St 4242 Medical Drive, Suite 4250 

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

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)733-1188 

Fax: (402)733-1883 

Phone: (210)822-9588 

Fax: (210) 579-6577 
a i r H-3 

Exterior Paint North Arrow Owner H9XM'.^/KTE^Tf^.snieer LTh Omaha Lead Site 

n Good Address: / ^// Sn^l^eTTE ST^'^^l f Sketch • Poor 

Phone: *^ W: Q Not paint [ 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: fQfi t^. CC 

RYASCPXA-^??^^ F1 ppm n Date: lO-tJ^OU 

RYBSCPXA-J 774^^ F2 

H U \ ppm D Time: VUti ^ 

RYCSCPXA-J77 <^^ Bl iLL ppm D 

RYDSCPXA-.?77'/ Samples Analyzed ? 82 5CiO ppm d 

RDZaCPXA"J9»ip'(^ DZ ppm D D XRF Unit: lOQ l . Book: 121. ROZOCPXA :i7?f/9 OZ ppm D D Date: IC> 2 3 . RPZaCPXA"^??^'^ PZ ppm D D Time: 221. ^ 

Staff: j/i^^J - Number of Samples = 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, 9Z - Play 

All quadrants are as viewed from the street, facing property 

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Rev 4 M614I .0123 
151

1 BURDETTE ST: 50 X 137 

A Printed

: Dec 10,2010 

www.dcgis,org/dogi.s 
Page 1 of2 

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Create Another Ticket Back tojrthjnternet Send EmalL 

YOUR TICKET NUMBER IS 2616909. 

Original Call Date: 10/14/10 Time: 8:17 am Op: SIVA18967 

Work to Begin Date: 10/18/10 Time: 8:45 am 

State: NE UGLAS Place: OMAHA 

Address: 1511 Street: BURDETTE ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-SE-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 MCINEB MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCINEB MCI NO CALL PER 

MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/14/2010 
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0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/14/2010 
IBOHNOUkMB, I, INC. CONSTBUCTION 

SOLUTIONS 

SITE SAFtTY HAZARD ANALYSIS 

Address: Excavatioii 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 

Otlier 

Crew Foreman 

Condition 

c ^ ^ 

e^ h^' sy 

• — 

orcar*­

» — 

pce ^ 

cs^*^ 

t r ^ 

a^— 

Hazards Corrective Action 

Site Safety Office 

Date: 

OMI¥faitf«ariamy, S(rito405 5600 SI O St 4242 Modical Drive, Sutt» 7260 

;aisa8C«yiMO«4114 rfmiMaesior San Antonio, TX 78229 

hone: ISW) 363t-3rQS PttORK {402)733-1188 Phone: (2t0) 82Z-0688 

ax: |S ^ 363>3T07 Fax: (402)733<1M3 Fax: (210) «r»-6577 
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