TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FDLE FOLDER 

SAID* /^4'n3S l Date: 11-15-1 0 

Adtoss: I m l M .5 5 ^ 

Remediation Contractor: Pi?,, r>PrM"7 7^/^41 NOtLoc, l<^ q.^ ir\ic.>i Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

H^ Video of property (DVD) 30237514 

^

I2r

 EKecuUveS.. ^

 EPA-provided property sketch 

11111 

Superfund 

1 

/ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaipent property 

B Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

a Confirmation data 

/ Photographs 

/ As-built sketch 

Satisfactory restoration signed by Property Owner 

a Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

B Utility clearances 

a Property infonnation from Douglas County Assessor's Office 

Q 

D 

D 

^V y tiitlii 

Signature Date 
PROPERTY SUMMARY 

Date: 11/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 1017 N 33 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 = 104 PPM @ 9"; F2 = 98 PPM @ 9"; Bl = 351 PPM @ 9"; DZ = 115 PPM @ 10"; EA = 211 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 (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. 

TECHNOLOGIES. INC. 
Find Record 

Backfill: 

Sample Area: 24832 - 1017 N 33 ST 

Owner: 

n Owner Occupied 

Owner Name: 

IGOKIE DANIEL 

Owner Addressl: 

I 

Owner Address2: 

11017 N 33 ST 

City: state: Zip Code: 

JOMAHA ~ [NE |68131-

Owner Phone Alternate Phone: 

r 

Contract: 

Contractor: jPRUDEriT2010_S 

Contract Option |BASE 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1. 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: Altemate Phone: 

1 " 1 

Assessment: 

Qualifying Group |400/CHILD 

Assessment Max XRF Value \ 591.36 

Resident: 

Resident Name: 

(RESIDENT 

Property Address: 

11017 N 33 ST 

Zip code: 

|68131-

Resident Phone 

I — • 
.....I •-•l^'K'^.il.^lry: \u 

TECHNOLOGIBS, INC. 

Property #: ^"^^^Z -

Date/Time: 

Quad.s Excavated: p [ p2_iD2- ^ 1 

EPA Property Close Out 

Property Address: {Oly h "S"? 9-^. 

Owner's Name: -yTo-U.^ f^u.?j^a^ftrv 

Contractor Group: Prudent Technologies, Inc., 

Excavation General 

I If necessary, were tlie correct quadrant(s) excavated and restored? 

2. If necessary, were the correct areas of drip zone e.xcavated and restored? 

Grading Sod and Vegetation 

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Wails 

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

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

3, Was damage lo gates or fences avoided? (If applicable) 

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

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage fo downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1 Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

/ 

Yes No 

/ 

/ 

/ 

/ 

/ 

/ 

/ 

Yes No 

y ' 

y 

/ 

y 

Yes, No 

/ 

y 

y 

y 

A 

Yes, No 

/ 

r 
Owners comments: 

Inspection notes: 

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

EPA Representative Qp j ^ ^ Date: \(i\\i\^ 
M CHNOLOGIES, INC. 

AS - BUILT DRAWING 

OLS # 24832 

Date Excavated: 09/03/2010 

lISEPASigned-OfTDate: OMAHA LEAD SUPERFUND SITE

Name: P/l^'~ /-//f/OOJE''-' 

Address: / ^ f ? K J V ^ ^ r 

Phone: 

Omaha Lead Site 

Site Sketch 

Date: 

Time: 

ihj/o- i North Arrow ^ 

Te«Ti C'^£^/.LA^J:C//i-^<^ ' BVID# '?M33S - XRFCode 9^0 H 

Sample Number Lead Concentration Confirmation Sample 

P-rA^dPXA--^M-?l7 

B.yg<cPxA--XM-73'2­

ppm 

ppm 

RYes a 

riYes Q 

ftfYes CD 

OiVes n 

Yes • 

Yes • 

ppppmm I YeYess n LJ

Bl Landscape = 21 PPM a Scrape;

2'x30'

No C3 

No 0 

No 0 

No E3 

No a 

No CD 

N

Noo • U •;=:.•-

( ^ , 

k ^ _ 

Omaha Lead Site 46130 EA=2I1 PPM ra Scrape 

CONTRAa #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Property CompSetion Agreement 

This agreement documents the completion of removal activities perfonned 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 fiiture, excluding any 

remaining warranty (30 days total) except those items listed below, ifany. 

Property Wi: 

Property Address: \0\ 1 M ^'h<( ^ 

Owner: ^^^4,, ^ M IAAJ^ ^o^f ^ 

Phone 

Restoration items im Question: 

item: 

item: 

Itern: 

item: 

Item: 

item: 

Required corrections to complete the property: 

C3<J- <2_/ J

(HD f^ ^d ^ 

[ 2A I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

Tmr^^^—^ <^'2l-lO 

Owia<ef's Signatun Date 
\ 

T5C1-i'^':^ICXi3?^'"JV:: 

i^rudent Technologies, Inc (Prudent) is under contract witti the U S Environmentai Protection Agency (,£PA) to clean up Icadconiammated soils al a number of properties located in Omaha, Nebraska, including the property located at 

^Ot*^ Kl ^ J ^ ^ * ^ ^ ^f ^ requests your permission to allow Prudent to peTt'orm a soil cleanup al ihis 

properly to remove lead-contaminated soil By signing this form, the property owner grants permission to Prtidenl to perform 

activities related to the cleanup includmg soil sampling, removal of lead-contaminated soil, and restoration of :he lelerenced pioperty 

If you have any questions about the soil cleanup plarmed for your property, please contact Prudent • •' ••'•..•• . : n . ibr the Omaha 

Lead Site cleanup, at (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can b; diiected lo the EPA 

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

Property Access Granted By Uar-^'t.} CpolC.'-t^ 

(Please Print Name) 

Property Owner Signature A/O/rluAi yjiyjice ^ ^'^^ ' 'C> 

(Signature) (Dale) 

PROPERTY INFORMATION 

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

RESIDENT NAME: A/Onu/ yjryHea. (jOwn^L ^ Renter 

RESIDENT ADDRESS: 

/a/ n A/ori^ '32rJ ^/ . CD^K/IC, Aye ' ^a/? / 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; , ^ . 

OWNER'S TELEPHONE NUMBER - HOME: (VCQ\ SS & ' ^S'SCs . WORK: 

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

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ' NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

a 

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.) 

AUTHORITY l-OR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA .mder this agrecmc-nt 

are pursuant to Section 104 ofCERCLA, 42 U S C 9604 EPA's right of access to the property is provided f c in Section 104(c) of 

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

under this title, or otherwise enforcing the provisions ofthe title," 

808 0 War o P.-i;Kw.;,-, r.-• ' ••/•.-.1....1 '•••.•:. ^\::i v ^Z 

Kansa s Cltv . M C 64'-'• : • •' ^^:v•..••-. •"••,•';••;^' 

^'hoiif. fP-i«: ib i .."• ' ' • • ' • " •';••• •- ? 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Date: 

Phone: BVID: 

J^ r Zt>-^f 1^ P^/J 7 ^fl~Ace Uj/'Tj, Mu^c^f'Se>^ri\ "^iTy^ S)^/H-<% 

3ACI ^ /Afi-h ///45 8/gP<; "gy X^-/ ^ S*o/ 6f ^Xfr^i^ i t S'ccrC, 

U Cst(( A^IL^T) So SlitT>-y C^^^ S^i' /^g>c/^-& 

lAx'i\j»Ae \^ \AJy\^^Ai^^t ^ul ^LA^I' ^ \A€ ^.^^/ f ^Aje d CY,<^y/!L 

i tt^\(KCJe uJl4tv ^ ^ iLcS X l\t4LAl?) 

Vi^.A\Kr^ (-^ 

^ / ^. ^ ^ ^KCAUAf^ /((ZZMAJ kU<> ^£Ary^u t^J\rtf foK 

Property Own^ Prudent Employee , 

m^ nature: Signature: 

8080 Ward Parkway. Suite 405 5600 S 10 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)822-9688 
f7 ^ .«"-

­

36)' 

(^^ ' /c3 

'ic^eW t^'''7) f BiSf ^ 
rtiK•ag c 1 U i 1

ion N ZZ S7­

./.,....»oo^^,./pv.^tr^c/^Q/R^An8<^'^^^n^^n^l ino 8/23/2010 
Print Preview rag e i Ul z. 

Douglas County-Omaha, NE 

Parcel ID

Owner

Name

Property

Address

C//y

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

zm 

Sec-TwnRng 

 0608650000 | Addition

 iGOKIE

 i DANIEL

 h01 7 N 33 

\ ST 

1 OMAHA 

68131 

1017 N 33 

ST 

OMAHA 

NE 

68131 

17-15-13 

: 

 iTM"'^'^

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

M/ h f

Link

Assessor

Website

Link

 1BEMIS PARK 

: ' 

13 

42 X 120 

0.11302647 

 http://webapps.ciotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

 Parc=0608650000 

 j http://douglasne.mapping­

] online.com/DouglasCoNe/static/accountinfo.jsp? 

1 accountno=R0608650000 

. 1 / ^ „ o/'^o /o m A 

2 
Page 1 of2 

"> 

gai^iSjiahltj^MiB^t gef?^.^g^» 

YOUR TICKET NUMBER IS 2580210. 

Original Call Date: 8/30/10 Time: 2:59 pm Op: SIVA18 967 

Work to Begin Date: 9/01/10 Time: 3:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1017 Street: N 33RD ST 

Twp: 15N Rng: 13E Sect-Qtr: 16-NW-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 LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Plione Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Etnerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

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 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/30/2010 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhoii.org/irthmteriiet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULTS... 8/30/2010 
TEOHNoukCHes, mc . 

ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAITfcTY HAZARD ANALYSIS 

Address: -Zl-_/-_Z--_ZL---iJL_-i2L 

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 

Condition 

^^p>L SS£ 

q^ncT • A ^ 

L 

« L 

ooi 

^ 2 

yp\ 

? ^ SA 

M ^ 

^ ^-oi-yo 

Excavation Date: 

Backfill Date: 

Hazards Corrective Action 

Cy(ht<jAeJ[ r/yf^rfaf/. 

Cjy^o fer IL jLAJnr^c. 

Site Safety Office 

Date: 

^ - ^ : 2_:.^-i. 

8080 Wanf«ariHfay. Si«B 405 5600S108t 4242 Medical Drive, Suite 7250 

Ka«a» cay, IKX4114 Omaia, Nebnsfca 08107 San Antonio, TX 78229 

PfMnK fStS) 363^703 Phom : (402)733-1188 Phone: (210)822-9588 

f^DC (816)383-3707 Fax: fM2)733'1883 Fax: (210)579-6577 
« ./\ 

^ 1 7, :; illil kmM^:4t 1017 ^ I M l 

"SSsr . 

• V.VI

i