TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 31463 DATE: 12/15/2010 

ADDRESS: 2911 PINKNEY ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

• PRE AND POST VIDEO OF PORPERTY (DVD) 

^ EXECUTIVE SUMMARY 

0 EPA-PROVIDED PROPERTY SKETCH 

id SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

a RESTORATION AGREEMENT 

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

ID CONFIRMATION DATA 

ID PHOTOGRAPHS 

D AS-BUILT SKETCH 

• SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

ID PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

D UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D ^_ ^ 

D 

D 

SIGNATURE - DATE 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 31463 - 2911 PINKNEY ST 

Owner: User Provided Owner Information Resident: 

I

i

I

i

 I—,

U Owner Occupied

 Owner Name: 

 JVAUGHAN CLYDE L

 Owner Addressl: 

! ' 

Owner Address2: 

I3330N37ST 

City: 

loMAHA 

Owner Phone 

I 

' 

State: Zip Code: 

|NE J68111-

Alternate Phone: 

! 

i 

Owner Name: 

Owner Address: 

City: 

Owner Phone: 

State: Zip Code: 

r^i 

Alternate Phone: 

r 

Resident Name: 

Property Address: 

12911 PINKNEY ST 

Zip Code: 

lesiiiResident Phone 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group J400 

Contract Option jOPTlON 2 Assessment Max XRF Value f 502.58 
PROPERTY SUMMARY 

Date: 12/15/2010 Omalia Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Montli of: December 

Property Address; 2911 PINKNEY ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 134 PPM @ 2"; B2 = 299 PPM @ 2"; EA = 122 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 (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. 

TECHNOLOGIES, INC. 
TECHNOLOGiis, INC . 

EPA Property Close Out 

Property #: 2>''^^ ^ Property Address: 2^\ { Pi'r\ ^ n€-^S>}• 

Date/Time: 10/2 ^ Owner's Name: Cl»^ di €. VOLUJRUCI>A 

Quads Excavated: Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

1 If necessary, were the correct quadjtant(s) excavated and restored? y 

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 

?i. 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? y 

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

Gates, Fences and Retaining Walls 

Yes No 

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

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

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

Wa X " s damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters Yes No 

Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Wa l y s damage to windows avoided? 

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

5, Was damage lo downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes

S JVJVCo 

Was damage to driveway surfaces avoided? 

Was damage to walkway surfaces avoided? 

1
Owners comments: 

Inspection notes: 

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

EPA Representative ^ ^ Date: \b\2filie^ 
fHNOLOOlES. INC. 

AS - BUILT DRAWING 

OLS # 31463 

Date Excavated: 10/14/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-Oir Date: 

31463 

Omaha Exterior Paint Lead Site Owner Name: CLYDE L VAUGHAN 

Site • Good Sketch Address: 2911 PINKNEY ST • Poor Phone: H: W; Q^o t paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: ffif i ?)C\JG 

RYASCPXA-31463 F1 fa _3 ppm D Date: ^j/t.JQ'^ i RYBSCPXA-31463 F2 f^. ^ ppm Time: II'.SS 

RYCSCPXA-31463 Bl \C ) ppm n

D Samples Analyzed RYDSCPXA-31463 B2 P^C)'^ ppm 

•RDZSCPXA.31dB3 DZ n . ppm D XF?F Unit: ^ M Book: H_

RCgGCr'XAO1403 6 2 ppm n D Date: 4-9^-04 

RPZ6CPXA 31163 P ? D . ppm D Time: Pl M 

n Staff: { Number of Samples = ^ J ^ 

ENTERED 

AUG 2 3.Z.005 

Bl = 134 PPM @ 2" 

<^' e^'H •303 

211 

0 a 3.'\.'o. 

Omaha Lead Site 

PihKne^ ST. 

IA/AL K 

> 

r^ 

r~ 

fh 

EA= 122 PPM ff SCRAPE 

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

46130 
%B>A 

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 2^ tl^-'vti uxp ^ 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Kem: 

Kem: 

item: 

Required corrections to complete tlie property: 

M I agree restoration is completed. 

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

^^"4^'^ . "Z^tw^t^-v ^ }o /%y^ / h 

Wner's'Signature 7 ©ate /" 
Pnident Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protertion Agency (EPA) to clean up leadcontaminaled spjJs at a number of nf^perties located in Omaha, Nebraska, including the property located at 

^7 M On ^ /<A>^.»~-«V^ The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contan4nated soil. By signing this form, the property owner grants permission to Prudent to perform 

activities related to the cleanuifincluding 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 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 Omalia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By 

/' ^ (Please Pri 

Property Owner Signature: 

y° ^ . (Signature) >^ ^ (Date) 

PROPERTY INFORMATION 

y \ (To e and/or property owner — please print) (To bbe complete completedd bbyy residen residentt and/ 

RESIDENT NAME•• \/di Cr«.c^ 3- ln ^ Owner Renter 

RESIDENT ADDRES 

K^<?' a - S t (^\MAA3. i j g" cr 

IF RENTf L, PROPERTY OWNf D BY: 

A ^ . 

OWNER'S MAILING ADDRESS; 0.-lt^ U ^^^JUa K3^ ^ ^ 1 M

OWNER'S TELEPHONE NUMBER - HOME: J _ 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 6 HOURS OR MORE PER WEEK: 


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


AT.1THORITY 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 form Section 104(e) of 

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

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

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4260 

Kansas City, MO 64114 Omaha. Nebraska S8107 San Antonio, TX 78229 

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

Fax: (816) 363-3707 f?:c (402i 733-1883 Fax:(210)579-6677 
ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

^Property Status Form , . Address; ^ ^ 1 1 Date: f D 

Phone: ^Q'^ ^ ^^o ^ ^ ^ BVID: 

8080 Ward Parkway, Suite 405 5600 S 10 St '4242 Medical Drive, sbite 4250 

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

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)733-1188 

Fax: (402) 733-1883 

Phone: (210)822-9588 

Fax: (210) 579-6577 
31463 

Omaha Lead Site Exterior Paint North Arrow Owner Name: CLYDE L VAUGHAN 

Site Sketch • Good Address: 2911 PINKNEY ST • Poor 

Phone: H: W: 

[3^o t paint 1

Sample Number Lead 

(Doncentratlon 

Sample 

Collected LAB 

Firm:

Samples Collected 

 fOf t \^C\3 G 

RYASCPXA-31463

RYBSCPXA-31463

RYCSCPXA-31463

RYDSCPXA-31463

 Fl 

 F2 

 Bl 

 82 

3 W ppm 

39\±) ppm Ila ppm 

PS'O ^ ppm 

n 

D 

D 

D 

Date:

Time:

 9/lCJ6^ 

 lI'.SS 

Samples Analyzed 

RDZSCPYrt.-^l^fi^ DZ ppm D D XRF Unit: ^1 1 Book: 3^ 

RCgOCPXA'31403—-€E ppm D D Date: ^•^C^•C)^4 

RPZ6CPXA81463 Pi: ppm D D Time: PiM 

Number of Samples = j ^ Staff: 

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PihKrve^ ST. : : ; ; : : 

Omaba Lead Site 46130 
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: Oct 28. 2010 

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Original Call Date: 10/12/10 Time: 9:06 am Op: SIVA18967 


Work to Begin Date: 10/14/10 Time: 9:30 am 


State: NE Count.y: DOUGLAS Place: OMAHA 

Address: 2911 Street : PINIOIEY ST 

Twp: 15N Rng: 13E Sect-Qtr: 09-NE-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 Number 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-TRAFFIC,SEWER RicnmiAFFiC

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 

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TEOHtmLOOn^ l CONSTRUCTION 

mc. SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: ..43iL_ftnk^t Excavation Date: M4^ ^ 

Crew: — BackflU Date: —tP-/u]l2.. 

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 Hazards Corrective Action 

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Site Safety Office 

Date: 

mo Wm^Csartaaay. 5uito4<K 5«00 810 8t 4242 Medical Drive, Stdte 7260 

San Antonio, TX 78229 

V^anr. (402)733-1188 Phone: (2t0) 822-«S88 

4ac (SIS) SBS-^srar Fax: (402)73341883 Fax: (210) «7».«577 

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