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TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAIDff: 29185 DATE: 1/15 

ADDRESS: 

2812 MIAMI ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 20l() 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

 EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

• SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

Ef RESTORATION AGREEMENT 

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

d CONFIRMATION DATA 

a PHOTOGRAPHS 

d AS-BUILT SKETCH 

[ / SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

d PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

• DESCRIPTION OFAREAS NOT MEETING ROD CLEANUP CRITERIA 

d UTILITY CLEARANCES 

PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

• 

a 

i/i/n 

SIGNATURE DATE 

30217604 

Hiin 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2812 MIAMI 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 = 220 PPM @ 8"; B2 = 342 PPM @ 8"; EA = 132 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) Docimientation - 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-excavationagreementdetails(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 of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC, 
Find Record 

Backnil: 

Sample Area: 29185 - 2812 MIAMI ST 

Owner: 

D Owner Occupied 

Owner Name: 

JBALLARD ELAINE A 

Owner Addressl: 

1 

Owner Address2: 

|3483 SPRAGUE ST 

City: State: Zip Code: 

lOMAHA |N E |68111 -

Owner Phone Alternate Phone: 

|(402) 451-6129 1 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option JOPTION 1 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State: Zip Code: 

1 1 

Owner Phone: Alternate Phone: 

1 ' 1 

Assessment: 

Qualifying Group [400 

Assessment Max XRF Value | 505.49 

Resident: 

Resident Name: 

I 

Property Address: 

|2812 MIAMI ST 

Zip Code: 

|68111-

Resident Phone 

I 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 7 ^l'^^ ' Property Address: ^S'l 2. KTarAt M^ » 

Date/Time: Owner's Name: \I-^<\\DW 9xt%C ^ 

Quad Contractor Group: Prudent Technologies, Inc, s Excavated: '(^\^^ ^ 

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 aroxuid the perimeter of the house in excavated areas generally slope away y from the house? 

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

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

day lime period) ' y 

4 Are sodded areas generally firm and evenly graded? y 

5. Arc Ihe joints belAveen the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

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

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

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 

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

y 

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

y 

Foundation, Siding and Gutters Yes No 

1. Was damage to tlie siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

3. Was damage lo windows avoided? / 

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

5 Was damage lo downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

Was damage lo diiveway surfaces avoided? Y 

Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative 9°-^ A ^ ^Date: uKI'Q 
[•CHNOLOOIES. INC. 

AS - BUILT DRAWING 

OI,S#2yi85 

Date Kxcavated: 11/17/2010 OMAHA LEAD SUPERFUND SITE ISKPASigned-OlTDate: 

y i ^ } & S 

Name; f/«i/i e BI/(A» W Omaha Lead Site Date: Cfi >t5 OS' North Arrow 

Address 2.^12. MxW^\ Si- Site Sketch Time: ff. M^-A ^ i 

Phone: 'A'5\-t,lZ.'=^ 

5t-a/r : ^ ^ P«ife : •?-'2-''5" 7r/.e:flj> 

Team l £ />-tT' ^ fe>^ BVID# J/iiar XRF Code /g3 7 gooK : /2,<i 

Sample Number 

Lead Concentration Confirmation Sample 

fi.1Ac;cP^A - quits' ..sL ^ 

ppm /•"/ Yes CD No S ­

ppm fV Yes Q No Q-" ...^a v^g ppm /5|i Yes a No 3 ^ 

^ 0 ^ ppm /i>. Yes a No t3 ^ 

ppm -¥69—Oppm • Yes-O- -N<r-appm Ye8_a Na-O0 Ml 

' I : : ; 1 1 ^ 

i -r-t:T-T?X^--fr----^ 

\ \ ^»-fi-J.-«—"-^[.."-.-' j. ^^^m \ 

\ [ 1 

j i Bl =220 I'I'M a 8" \-Jr- \ \ ^ IJ2 = 342 PPM « 8" :

i

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I ; i i —1 1 1 

j- \ 4" — 1 i 

i l l ! 

- 4tr 1 M 4­

1 1 \Mk '^4*'^ 

; ! i 1 1 : : : ; 

i ; ; 1 i 1 1 M 1 I i 

f ^ \ i ^ 

35^ 1 j i Y^s' i i 1 i i 

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: ! 1 ! i IMi i •• ...... , ; ; ( : ! : 

L . J \ \ 1 i 1 '^l^'^^^^r 1 iT i 1 1 1 1 

K\=132I>PM u S(RAI'K( 1") 

Omaha Lead Site 46130 

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

6ERI\ 

Property Completion Agreement 

This agreement docimients 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:^ g , 2, ^ > M » ^ - ­ ^ ^ 

Phone 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

 I I agree restoration is completed. 

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

^.-^ }^.dy /^-/-y^ 

Owner's Signature Date 
Prudent Technologies, Inc. (Pnident) is under contract with Ihe U. S. Environmental Protection Agency (EPA) to clean up leadcontanjinpte^ |p|l ^ a numbCT of prop^e s located in Omaha, Nebraska, including the property located at 

f~a^ r'O/, -j ^ j/y^/^./Tt / • The EPA requests your pennission to allow Prudent to perfonn a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, tlie property owner grants permission to Prudent to perform 

activities related to the cleanup inchiding soil sampling, removal of lead-contaminated soil, and restoration of the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent South Omaha Office for the Omaha 

Lead Site cteanup.al (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha ofBce). 

Property Access Granted Bv:X Y/^/^KfOAi /. A^/fA^A 

(Please Print Name) 

Property Owner Signature^\4o...^ ^ l i&d/.l _y^^zy^^p > (Signature) (Date) fSiotifliiire^ ( 

PROPERTY INFORMATION 

ffo be completed by resident and/or property owner - please print) 

RESIDENT NAME: i^-^ / Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY; 

^^,y)^^.y^ M '^j'^y 

OWNER'S TELEPHONE NUMBER - HOME K {'/02 X ^^^f~ ~ / ^ Q .^JWORK: 

( 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: 

>MMENTS OR SPECIAL JNSTgWDONS: (I.E. DOGS, ENTRY GATES, ETC-L, j l 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under fliis agreement 

are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for m Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "determinmg the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing &e provisions of the title." 

8080 Ward Parkway, Suite 405 5600 S. 10*^ Street 4242 Medical Drive, Suite 4250 

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

Phone:(816)363-3703 Phone:(402)733-1455 Phone: (210) 822-9588 

Fax: (816) 363-3707 Fax: (402) 733-1883 Fax: (210) 579-6577 
Address: .2Jjt2.^M&a£iLS.t 

Phonet «Jg1-£>/2.<r 

Team P^ ^ /rt^4-(s K SVIO# XRPCtMie /03rj Bh€ll£:iZf^ 

Sampl Coililiiu&oo^lHU'itdfr e NtBitbo' 

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Onaaha Lead SttB^ 46130 
281

2 MIAMI ST: 32X92 

A Printed

: Dec 02, 2010 

WM-wdcgisorg/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2632339. 

Original Call Date: 11/02/10 Time: 11:45 am Op: SIVA18967 


Worlc to Begin Date: 11/04/10 Time: 12:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2812 Street: MIAMI ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 

Day: 4029340469 

CXCATV C OX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELMLOCATFNG Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
If INC. CONSTBUCnON 

SOLUTIONS 

SITE SAFi:TY HAZARD ANALYSIS 

Addres .^X^..£^^£i2-U^ . s : Excavation Date: 

Crew: BackfiU Date: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Wails 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

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Site Safety Office 

Date: 

180 IdtetfBartaMy. Suil»4IB SSOOSIOSt 4242 Madical Drive, Suite 7250 

imnaiy/llO«411 4 Ontfta, Nataaika 08107 San Antonio, TX 78229 

tone: CaW) 36Sg7l>3 Pliena: (402)733-1188 Phone: (210)8224588 

PC 19^383^37117 Fax: (4Q2)73»<1«83 Fax: (210)579-6577 

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