SAID#: 28376

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE; 12/15/2010 

ADDRESS: 2406 N 21 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d\ PRE AND POST VIDEO OF PORPERTY (DVD) 

Q EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

Q] SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTi' 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

m RESTORATION AGREEMENT 

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

Cl CONFIRMATION DATA 

l i PHOTOGRAPHS 

m AS-BUILT SKETCH 

01 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

\h PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTiON OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

III UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

jy ^ 

SIGNATURE DATE 

30260834 

Superfund 
Find Record d Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 28376 - 2406 N 21 ST 

Owner: User Provided Owner Information Resident: 

• Owner Occupied 

Owner Name: Owner Name: Resident Name: 

JHARRINGTON JEFFERf 1 j 

Owner Addressl: Owner Address: Property Address: 

1 • I2406N21ST 

Owner AddressZ: Zip Code: 

|2322 N 21 ST llesuo^ 

City: State: ZipCode: aty: state: ZipCode: Resident Phone 

lOMAHA | N Y ^68110- ! " " ; 1 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

i ' r "' 

Contract: Assessment: 

Contractor: PRUDENT2010 S 

I I Qualifying Group J400 

Contract Option OPTION 1 Assessment Max XRF Value 504.61 
PROPERTY SUMMARY 

Date: 12/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 Month of: December 

Property Address: 2406 N 21 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 = 374 PPM @ 12"; B2 = 391 PPM @ 10"; NO EASEMENT 

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 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 

iv) Signed form verifying satisfactory restoration 

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

TECHNOLOCIES, INC. 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: Property Address: 2-*40 (> tsl 2 . I S -H 

Date/Time: {"^ [ ^ Owner's Name: iZTc^^ HOLY V i" nJ -H? )^ 

Quads Excavated: Contractor Group: Prudent Technolo^fei, Inc., 

Excavation General Yes No 

1. If necessary, were the correct quadiant(s) excavated and restored? 

/ 

2. If necessary, were the correct arp^is of drip zone excavated 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 y from the Itouse? 

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

3. Does tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day lime period) 

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

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

time period) y 

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

7. Was dainage to landscaping or plant materials avoided? y ^ 

Gates, Fences and Retaining WaUs Yes No 

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

y 

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

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

xy 

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

• ^ 

Foundation, Siding and Gutters Yes No 

^ 1.

 Was damage 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 daniage to downspouts or dovkaispout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage 10 driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? y 
Owners comments: 

Inspection notes: 

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

EPA Representative 9<^^^ ^Date: IO/D-I/'O 
M C'HNOLOtilES, INC. 

AS - BUILT DRAWING 

OLS # 28376 

Date Excavated: I0/7/20I0 OMAHA LEAD SUPERFUND SITE USEPA Signed-OfT Date: 

28376 

Omaha Exterior Painl NoiViAmiw Owne Lead Site r Name: JEFFERY HARRINGTON • Good 

Address Site Sketch : Z«»N 21 ST • Poor Phone: "•• 402-684-5073 W: 402-813-1184 [Tf Notpaint 

Sampl Lead Sample Samples Collected e Number Concentration Collected LAS 

Firm: A^^^' AjF/ylJ 

RYASCPXA-28376 Fi 3lti O ppm D Date: o^/yi/ot 

RYBSCPXA 28376 FZ D Time: >^-.»o ^ ^ 

RYCSCPXA-28376 Bl ^ d S ppm 0" D 

Samples Analyzed RT'P5ePXA-2837fr- 82 _iLU___PP" i E" D 

'RDZOCPXA'20J70 -BZ- ppm D D XRF Unit IDQT Boofc l^ G 

RCZCCrXA-2g376- -G2- ppm n D Date: 1-n-c^ RPZSCPXA-^ajTC • ppm D Time: -ivxv 

Staff: JSJiS ^ Number of Samples = H i 

Legend: F1 = Front Left F2 = Fnsnt Right, Bl = Back Left B2 = Back Right 02 = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from Ihe street, facing property 

•E:MMKE-BAu^y ': i m 2 t) 2036 

Bt =374 PPM @'^" L^ : B2 = 391 PPM @ 10" 

jm^ 

BOB­ 4MBI 3X 

.3U.0. 

pa n 

M614I.0I23 

NO EASEMENT 

CONTRACT tt: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
JlEFA 

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. 

Property ID: 

Property Address: Ql^iji p \ ^ HJ ^ 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

agree restoration is completed. 

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

^-^llrnifl/x 10 /y//o 

wner's Signature Date 
m 

Prudent Technologies, Inc. (Prudsnl) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaimnaled soils at a numte' ofproperties located in Omaha, Nebraska, including the property located at 

P ^D(o A/> 3^/.^^ • Tlie EPA reque.sts your pennission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, the property owner grants pennission to Prudent to perfonn 

activities related to the cleanup including soil sampling, removal oflead-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 SHe cleanup can be directed to the EPA Public Informalion 

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

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: jM l y~u^^ L -^jy^'o 

(_^ ' (Signature) ' ^ ^ (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME Renter 

RESIDENT AODRESS: ^19 9 M< 71^- O/nctJin, ^e &ViO 

IF RENTAL, PROPERTY OWNED BY: yi 

OWNER'S MAILING ADDRESS; 

Srl^^e /^-f /!?^Pt>e 

OWNER'S TELEPHONE NUMBER - HOME: ( Voa > SB^-SOl S WORK: 

(^01) ^03 ' 9iS0'^ 

AGE OF HOME?: 

^3 YEARS. HOW LONG HAVE YOU LIVED HERE? % YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? A YES NO 

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

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

JiCOMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

(JAUP JArae doGi /M \Aiie> . Ce^K S^ €Ka\.iyKi^'tf^ LeflAS s o 

/i.fvi^.p fn^t^pr CAist inoL-P arrAi^^P/^eM'lr ijy alo£/s 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activhies to be implemented by EPA under this agreement 

are pursuant to Sertion 104 ofCERCLA, 42 U.S.C. 9604. EPA's right of access lo 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 aaion 

under this title, or olherwise 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 

Phofie: (81SJ 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

Fax: (815)363-3707 Fax: (4021 733-1283 Fax:(210)579-8577 
ENVIRONMEiVTAL& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

^V(9G , Property Status Form / , 

Address : gOQ^KSil' Date: ?/VP^/C:) 

?hone:f/0^^03-d^SOS BVID: ^ ^ J 7Q 

)l\it.jte&r' j-v^es iH int rQK/^edhJ or ^^edeJ area . 

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Property Owner 

Pnident Employee 

Signature 

Signature: 

S080 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 

t^-­ to^e \ ^c ^ ^TrtT 

Phone: (402)733-1188 

c.,..' i4nn\ T7t loo^ 

Phone: (210)822-9588 

Cov- /•>'llt\ li7ttJiK77 
^ mil l mi D 28376 

Exterior Paint North Arrow Owner Name: JEFFERY HARRINGTON Omaha Lead Site • Good 

Address: 2408 N 21 ST Site Sketch • Poor t ^ ^ 

Phone: »'• 402-884-5073 W: 402-813-1184 

[ 3 Not paint 

Sample Number 

RYASCPXA-28376

RYBSCPXA 28376

 Fl 

 P^ 

Lead 

Concentration 

30>O ppm 

2L R ppm 

Sample 

Collected 

IT 

LAB 

D 

D 

Firm:

Date:

Time:

Samples Collected 

 /^^ ^ Ajf//^S 

 oi>//i/oi i 

 l^'. ^ f/ ^ 

RYCSCPXA-28376

R'l'DSCPXA-28370

 B1 

 B? 

_-Sfi5

Ml !

 ppm 

 ppm [ ^ 

D 

D Samples Analyzed 

'RDZ0CPXA-2037G

RG2SCPXA-20376

RPZSCPXA-2B376

 -BZr 

 S2­

 P?" 

ppm 

ppm 

ppm 

D 

n 

D 

D 

D 

XRF Unit: 

Date: _ 

Time: 

/ODI Book: \6L P 

-\-\-\-ckj . 

i^V 

Number of Samples • 

Staff. _4i^sJi»L 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, ^cing property 

Rev4- 046141.0123 
N 240

6 N 21 ST:88X 173 

A Printed

: Dec 03.2010 

www.dcgis.org/dogis 
(..uwsiKucriON 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

. 2-1/^0 I- rv 27 ff 

Address: Excavation Date: /*/^/jaLgCrew: Backfill Date: t^/a^Astia. 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foandation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

c:^^ O C 1— /T ) «r&jO 

e^ 

(h^' P 

• 

ore 

a/*­

pcy>i^ 

c/y^ 

^f<4 ^ 

o*^ • 

— 

__^ 

Site Safety Office 

Date: 

8080 Wafitf«aflany, Sute 405 SSOOSIOSt 4242 Medical Drive, Suite 7250 

Kanstt Giiy> BIO«4114 Omatoa, Nebcasfca C8107 San Anterrio, TX 78229 

Phone: (816) 363'3703 Pbone: (402)733-1188 Phone: (210) 822-S588 

F^s:(8t6)363''3707 Fax: (402)733^883 Fax: (210) S79-6577