TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 31234 DATE: 1/15 

ADDRESS: 3206 EMMET ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 20lt) 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

m EXECUTIVE SUMMARY 

0 EPA-PROVIDED PROPERTV SKETCH 

m SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTV 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

M CONFIRMATION DATA 

[Z PHOTOGRAPHS 

0 AS-BUILT SKETCH 

0 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

ET PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

El UTILITY CLEARANCES 

Q PROPERTY INFORMATION FROM DOUGLAS COUNTV ASSESSOR'S OFFICE 

D 

D 

D 

^ 4n ztiln 

SIGNAfURE ~ " ~~ DATE 

30217632 

•11 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 3206 EMMET 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 = 166 PPM @ 6"; EA = 300 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-Buih 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 I 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES. INC. 
Find Record 

Backfill: 

Sample Area: 31234 - 3206 EMMET ST 

Owner: 

D Owner Occupied 

Owner Name: 

I DAVIS-MOSS PATRICIA G 

Owner Addressl: 

Owner Address2: 

|3404 JOHN CRHGHTON BLVD 

City: State: Zip Code: 

lOMAHA |NE {68111-

Owner Phone Alternate Phone: 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option |OPTION 2 

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: 

1 

Alternate Phone: 

1 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value [ ~ 477.61 

Resident: 

Resident Name: 

Property Address: 

3206 EMMET ST 

Zip Code: 

|68111-

Resident Phone 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: Property Address: SZXXp ^""^'^ ^ ^ 

Date/Time: Owner's Name: 

Quads Excavated: Contractor Group: Pnident Technologies, 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? 

y 

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

day time period) y

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

5, Are tlie joints between the sod strips generally tight? (Only evaluate if inspecied at a 30 day y lime penod) 

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

y 

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

Gates, Fences and Retaining Walls 

Yes No 

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

~y 

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

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

y 

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

y 

Foundation, Siding and Gutters Yes No 

1. Was daniage to the siding or trim avoided? 

/ 

2. Was damage to the foundation avoided? 

y 

3. Was damage to windows avoided? 

y 

4. Was damage to windows or door screens avoided? 

y 

5. 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? 
Owners comments: 

Inspection notes: 

V 

.x*-

y^ 

/ 

^* / y y 

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

EPA Representative A*-^*^ ^Date: izlisfto 
rtCHNUl.UUIKS. INC. 

AS - BUILT DRAWING 

OLS #31234 

Date Excavated: 10/19/2010 

I SEPA Signed-Off Date: OMAHA LEAD SUPERFUND SITE 

3fa3¥ 

Omaha Lead Site Exterior Paint rtontiAmw Owner Name: . .p^ YHi l»>» Oftiot •yftof.i Site D Good Sketch Address: 3^0( ^ . g»?*>»rf . • Poor 

Phone: H: VJJ - f^fH w • Not paint 

Sample Numt>er Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 Q> 0 ­ f g JOr ^ 

RYASCPXA-2>va.3>4 Fl 30- 1 ppm D Date: Sj)7JOt / 

RYBSCPXA-3\a3,\^ 

RYCSCPXA-2)v2^34 

RYDSCPXA-J^\:i3ti 

F2 

Bl 

82 

^O" ? ppm 

'-j l 9^ ppm 

P I­ ppm 

D 

D 

D 

Time: J&l^ ^ 

Sampies Analyzed 

BSZOCPXA­ ®r 

B2^ 

ppm 

ppm 

ppm 

Number of Sampies = 

D 

D 

D 

J_ 

D 

D 

D 

XRF Unit: ?.1 \ Book: ^ 

Date: q^;;iar)4. Time: _ 

Staff: i±S t 

ENTERED 

AUG ?i a 2005: 

v..^% i. Bl = 166 PPIVI ® 6" % ^ 

yA ^ ' 

?^ ?,07, 

tj-n a 

Omaha Lead Site 46l3f> 

EA = 300 PP.M @ SCRAPE (-1") 

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

«ER(V 

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 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. 

PropertylD: ^ ; 2-Improperly Address: y^ ^ f'g^yy.tJ- ^ 

Owner: 

Phone: 

Restoration Hents in Question: 

Item: 

. £ 2 i^Xfire^ ^ , ,^- ^ Tkrx W ^ KfK>fk \tr~% ^ r ^ 

Kem: 

Item: 

- B^f/^ ^ ^^^-^ j ^ t2 Zv,e^ fr^ 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^ I agree restoration is completed. 

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

B c ^ ^'^fe^ "ppcpJ ^ <rf ^ (ii(i^hQ 

Owner's Signature Date 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES SERVICES 

PROPERTY CONTACT ATTEMPTS 


PropertylD: 

Property Address: ^ ^o („ ^yr\yx\(sJh' <iv 

Owner Name: VCA W^ r A a 'bo.^.Q M O&JS 

Owner Phone: 4 6 5 - Ll-S^^C^ ^ \ 

Below please find a listing of unsuccessful attempts to reach the above 

property owner. 

Date Time Initials 

\ \ O T ^'':^n I^OLWVIVA 

WJ[W^ U ^

.V/^UU^ 

^ 

Signature 

Prudent Technologies, Inc., 

A'tta. 

^ 

Acknowledgment signature 

EPA 

8080 Ward Paricway. Suite 406 

Kansas City, MO 64114 

Phnna- ffllAI 363-3703 

Result 

 JlojuLXk^. ' P~D" tS n o y 

Vo<^ 

^ 

t D -jjO^vvirfU^ YW^.u4,jL ^ Iq^ ^ 

\2. ^iff^ 

Date 

tufisfio 

Date 

4242 Medical Drive, Suite 7250 

San Antonio, TX 78229 

Phone: (210)822-9588 

2505 N. 24*^ Street. Suits 308 

Omaha. Nabiaska 68110 

Phone: (402)504-1004 
^•^•y-- y^ ' 

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

a^-O b g|'tt^^6• T S T Tlie 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. 

Ifyou have any 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) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By. 

7 (Please Print Name) 

?[<]')o\{} Property Owner Signature' i^e\jAJLLCy<^</lyi W_^0_t' 

(Signature) 

PROPERTY INFORMATION 

o bi completed by resident and/or property ovmer — please print) 

RESIDENT NAME: c^rA.A^ ^ fco ^ Owner Renter 

RESIDENT ADDRESS: 

IFREI fS(;tAL PROPERTY OWNED BY: W . 

0 ^^cS 

OWNER' 

•S MAILING ADDRESS; ^-^ - f ^ r ^ /I "V\>C^r^<?v ) 

WNER'S TELEPHONE NUMBER - HOME: { > WORK: 

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.) 


AUTHORITY 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 ofaccess to the property is provided for in Section 104(e) of 

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

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

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)822-9588 

Fax: (816) 363-3707 Fax: (402) 733-1883 Fax: (210) 679-6677 
ENVfROMMEOT.'VL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

Property Status Form 

Address: 3^ 0 ^ &^^.,. ^ <- ^ "^^^'^ lo/^lo(() 

Phone: BVID: 

.o 

Hy^ 

Prudent Employee 

Signature: 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)822-9588 

IOHC\ t o ^TAT /4AOI T-^1 -leo ^ 
3/23 ^ 

Omaha Lead Site 

LAB 

a 

D 

D 

n 

n 

n 

D 

Exterior Paint North Arrow 

• Good 

• Poor 

• Not paint 

Samples Ck)llected 

Firm: Q>Q * f g JOi ^ 

Date: 8)n)0l J 

Time: /G:VO 

Samples Analyzed 

XRF Unit: % \ \ Book: ^ 

Date:_3^^V4 

Time: 

Staff: 

i±mE 

. 

•

r 

r 

V.9. X

% t

*«\ 

^v 

3i07 

Owner Name: |*^>-Wit»y» r^ntfiS- ^Of J 

Site Sketch Address: 32.00' Sf»ff>Off 

Phone: H: V5? ' ^j2f W: 

Sainple Number 

RYASCPXA-2>\2.3>4 

RYBSCPXA-3\;;^3,v^ 

RYCSCPXA-5jy3^3v| 

RYDSCPXA-3\2.3L L 

RPZCOPXAF1 

F2 

81 

B2 

ST 

£ 2 -

ENTERED 

AU&2 :a 2005 

Lead 

Concentration 

Sample 

Collected 

T'^O'l ppm 

_35S-PPf" 

_3_b _ ppf" 

.ppm 

.ppm 

.ppm 

D 

D 

D 

Number of Samples = X 

-v,^ H"tSS...i 

r¥\ 

^ ' 

3an 

t ^ ^t*\lf\ty 

Omaha Lead Site 46130 
Lega

l Description: 50 X 128 

A Printed

: Oct 08, 2010 

www.dcgis.org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2609834. 

Original Call Date: 10/06/10 Time: 9:02 am Op: SIVA18967 


Work to Begin Date: 10/08/10 Time: 9:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3206 Street: EMMET ST 


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

OPPDGPR5 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=<RESULTS... 10/6/2010 
TCOHNt IOUMS|| L CONSTRUCTION 

mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: •'^2 ^ ^ gono-ttoA" / / Excavation 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 

Other 

Crew Foreman 

Condition 

c^<­

e^ 

h^P ' 

' 

O/car^ 

pc^ ^ 

a^'^ 

a^ 

o*— 

— — 

.___ -

Hazards Corrective Action 

t - 11— /fD ire- Q 

1 .^- 1 r r m -y t t^ 

Site Safety Office 

Date: 

IOWafdVaftainy.8uMe40S SSOOSIOSt 4242 Medical Drtvo, Suite 7ZS0 

iisasC«y;ilO«4114 OmMutf Mtbit M San Antonio, TX 78229 

ana: (8K) 36S«3703 1>lwm: (402)733-1188 Phone: (2t0) 822^«588 

cISIS) 363.3707 fax : (402)73><18S3 1=W. (210)679-6577 
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