m 

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 33386 DATE: 1/15 

ADDRESS: 4005 N 26 AV 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 30237546 

< / EXECUTIVE SUMMARV HMHI 

/ Superfund 

• EPA-PROVIDED PROPERTY SKETCH 

• SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

O SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

^ RESTORATION AGREEMENT 

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

El CONFIRMATION DATA 

d PHOTOGRAPHS 

[^ AS-BUILT SKETCH 

H SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

d PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

n 

D 

y y" 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address: 4005 N 26 AV 

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 = 63 PPM @ 6"; EA = 74 PPM @ 2" 

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 sketchi) Shall includefinal 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. 

TECHNOLOCIES, INC. 
Find Record 

Backnil: 

Sample Area: 33386 - 4005 N 26 AV 

Owner: 

n Owner Occupied 

Owner Name: 

jBENE^ GLENNON J 

Owner Addressl: 

IC/O GEORGE C ANDERSON JR 

Owner AddressZ: 

11604 SPRAGUE ST 

City: State: Zip Code: 

jOMAHA INE 168110-

Owner Phone Alternate Phone: 

Contract: 

i Contractor: PRUDENT2010 S 

! Contract Option jQPTlGN 2 

Remediation Query Lead Remaining Query Property Damage Query 

User Provided Owner Information Resident: 

Owner Name: Resident Name: 

:1 ' 1 ^ 

Owner Address: Property Address: 

r |4005 N 26 AV 

Zip Code: 

J681liCity: State: Zip Code: Resident Phone 

j 

Owner Phone: Alternate Phone: 

• 1 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value j 492.78 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ?5 ^ '^Ao Property Address: ^c5 " >-^ • 2 6 Au-C 

Date/Time: Owner's Name: ^7*^ c^ OiySyu\ 

Quads Excavated: 9 2 - Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

2, If necessary, were the correct areas of drip zone e.xcavated 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" 

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 lime period) ^ y 

Are sodded areas generally fmn and evenly graded'! 

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

time period) 

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

1. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining >VaUs 

Yes No 

i. Do gates open and close freely? (If apphcable) / 

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

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

Was damage to retaining walls avoided? (If applicable) 

r 

Foundation, Siding and Gutters 

Ye Yess No

Was damage to the siding or trim avoided? 

2. Was damage to tlie foundation avoided? r 

Was damage to windows avoided? y 

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

fl. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yea- No 

1. Was damage to diiveway surfaces avoided'!' 

y 2.

 Was damage to walkway surfaces avoided'? 
Owners comments: 

Inspection notes: 

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

EPA Representative Oa^^J^ Date: itjisl/o 
TrnKuuKiihs. \si 

OI,S# 33386 

»a(f F.xravati'd: 12/08/2010 

I SEPASigncd-OfTDatc: 

Owner Name: GLENNON J BENE' 

Address: 4005 N 26 AV 

Phone: H:

Sample Number 

RYASCPXA-,33386

RYBSCPXA-33386

RYCSCPXA-33386

RYDSCPXA-33386

-F»ZSef%0r-^33e6­

•£ 

• ^' • 

•k 

'^<y? : 

^yjjy 

Omaha Lead Site 

 Fl 

 F2 

 Bl 

 B2 

 B^-. 

AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

Omaha Lead Site 

 W: 

Lead 

Concentration 

iO iS^ ppm 

ppm 

S^y^ ^ ppm 

'^ R y pp"^ 

ppm 

ppm 

ppm 

Number of Samples =

•Mt-/x,t •s y^i: -

Site Sketch 

Sample LAB Collected 

nr D 

C3' D 

0 D 

[!f D 

D D 

D n D D 

 *"/ 

•i c t S . . yw: P-.i. y^. 

•9 •<• y\ . 

\i..\ - 74 I'PM // 2'­

lllllillilliliilliliii 33386 

Exterior Paint 

• Good 

• Poor 

Q ^ Noi paint 

Samples Collected 

Firm: /}<.-y cy£i-. 

Date: ?/i./^ V 

Time: -^^ y 

Samples Analyzed 

XRF Unit: % \ \ Book: \ \ 

Date: 

Time: 

yyy Staff' 

y B2 = 63PI' M fl 6" 

yK D 

\ ^ 3 

wil 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 

45130 
Property Completion Agreement 

Tliis agreement documents the completion of removal activities performed on the below listed propeity. 

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, ifany. 

Property ID: 

Property Address: HUO^i A/ ^^fl-^ /X-i.' 

Owner: 

Ck -,-1 (A.-.^Ux 

Phone: 0 

'-iOj-'-/w'-/' '-u^(A 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

I agree restoration is completed. 

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

y / 9 y 

A /'i - rjtff ..••-.(^ .>i.wo i lA'' A( yy{-^y 

Owner' np«s Sionntiirp- Signature ^ Date 

I
Prudent Technologies, Inc. (Prudent) Is under contracl with the U. S. Environmental Protection Agency (EPA) lo clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

Vrt^f" ^',)rth ^(i AjiAt/C . The EPA requests >'our pennission to allow Prudenl to perform a soil cleanup at this 

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

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration ofthe refaenced property. 

If you have any questions about the soil cleanup planned for your property, ptease contact Prudent south oflice .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 bifotmation 

Centers at (<I02) 731-3045 (Soulh Omaha office) or (402) 991-9583 (North Omaha oflice). 

Property Access Granted By: /^/'/mi-yi l^iyU/}i> h 

(Please Prim Name) 

Propeity Owner Signature: 

(Signature) (Dale) 

PROPERTY INFORMATION 

(To be completed by resident and/or properly owner ­ please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: _ 

IF RENT>U,, PROPERTY OWNED BY: 

^ 

OWNER'S MAILING ADDRESS; 

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.) 


AUTHORfTY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreement 

arc pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right of access to the properly is provided for in Section 104(e) of 

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

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

8080 Ward Parkvray, Suite 405 6600 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 

Fax:(816)363-3707 Fax: (402)733-1883 Fax: (210) 679-6677 
ENVIRONIVIENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form " 1 

Address: MO 0 S Date: lo|;2-^tf ^ 

Phone: BVE): 

JZ^FCoF 

14 U 0 \<i^ 

Property Owner Prudent Employe 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St Lcal Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68107, an Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

IAnO\ T^J^ 400 ^ C^v . I-HIW K70JSR77 
33386 

Owner Name: GLENNON J BENE' 

Addrass: 4005 N26AV 

Phone: H: W: 

Omaha Lead Site 

Sample Number Lead 

Concentration 

Sample 

Collected 

RYASCPXA-33386 Fl 1 U p ppm cr 

RYBSCPXA-33386 F2 

RYCSCPXA-33386 B1 <^ ^ ^ ppm Ef 

RYDSCPXA-33386 82 ^ 0^ " ^ ppm Gf 

nozoopxA'OQOoe—9^ D 

RGZSCPXA 38386 6Z- _PPm D 

nrZGOPXA 03366 PZ- ppm D 

Number of Samples = 

ENTERED 

mt 9ZQ0^ 

• ' • ' » J -rntrSm' • tft/cifije^ 

• ^ . 

LAB 

n 

D 

a 

D 

D 

D 

n 

Exterior Paint North Arrow 

• Good 

• Poor 

Q^Not paint 

Samples Collected 

Firm: /?<c ^ f-^-^^ 

Date: ?AiAo i — 

Time: 3L:// 9 

Samples Analyzed 

XRF Unit: "j^ \ \ Book: 5i i 

Date: C\ • ^ - O 4 

Time: A 

Staff: 

^ e 

A5. 

Site Sl(etch 

'^.o6:^..^.^.4^\r. 

H ^ F.3L. 

HO 

01 

i^nidiJi. 

M a < yy . 

Otnaha Lead Site 46130 
^ $ sM 

( & 

^ % . 

4005 N 26 Av. 

A Printed: Dec 15.2010 

\\ u w .dcgi.s iirg/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2629457. 

Original Call Date: 10/29/10 Time: 9:16 am Op: SIVA18967 


Work to Begin Date: 11/02/10 Time: 9:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4005 Street: N 26TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 04-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead soil remediation project 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: Y Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber 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 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/29/2010 
SOLUTIONS 

jir a SAF*:TY HAZARD ANALYS W 

Address: AfM C—KL ?Jt 0^ Excavation Date: 

Crew: Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines C^< ' ^i-^ J /uf~ -

Gas Line ^ ^ " ^ • e^ 

Water Line (h^ \ L ) ' Sewer Line . Septic/Leech 

Field 

Propane/Butane 

Sidewalk ore 

Foundation or- Retaining Walls 

Fences PC£^ 

Trees cy^ 

Structures a^^ 

Driveway o*-^ 

Sprinkler System — — 

Other -

Crew Foreman Site Safety Office 

Date: 

1080 Wuifltariany , Suito 40S SSOOSIOSt 4242 Medical Drive, Suite 7250 

(anaa«Ct|yiMa«4114 Oadlia, NeiMaMBa S8107 San Antonio, TX 78229 

ihanKf81«)36»37S3 Phona: f4a3)733-1ias Phone: (2t0) 822-«588 

Fax: (402)73»'1«S3 Fax; {210)«r94577 
. AIS^ ^N