SAID#: 29052

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

DATE: 1/15 

ADDRESS: 2530 N 14 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[ / PRE AND POST VIDEO OF PORPERTY (DVD) 

( / EXECUTIVE SUMMARY 

0 ^ EPA-PROVIDED PROPERTY SKETCH 

13 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

izf RESTORATION AGREEMENT 

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

Cl CONFIRMATION DATA 

Ef PHOTOGRAPHS 

Q AS-BUILT SKETCH 

Q SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

EJ PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

[^ UTILITY CLEARANCES 

[ / PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

Al^Al.y. ihiljL 

SIGNAIIdR ,p3REDATE 

30217581 

llllll 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2530 N 14 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 = 64 PPM @ 13"; 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 lefl behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Other items to be included in the individual property file, ifavailable, 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
Find Record 'i 

Baclcfill: 

Sample Area: 29052 - 2530 N 14 ST 

Owner: 

D Owner Occupied 

Owner Name: 

JPSCHENICA FRANZ 

Owner Addressi: 

Owner Address2: 

11407 SHERWOOD AVE 

City: State: Zip Code: 

JOMAHA jiyiE J68110-

Owner Phone Alternate Phone: 

r j(402) 203^5880 

Contract: 

contractor: PRUDENT2010 S 

Contract Option OPTION 2 

Remediation Query Lead Remaining Query Property Damage Query 

User Provided Owner Information 

Owner Name: 

JFRANZ PSCHENICA 

Owner Address: 

il407 SHERWOOD AVE 

Cjty: state: Zip Code: 

loMAIHA ^ JNE (68110-

Owner Phone: Altemate Phone: 

r 1 

Assessment: 

Qualifying Group ^400 

Assessment Max XRF Value 477 

Resident: 

Resident Name: 

Property Address: 

32530 N 14 ST 

Zip Code: 

J68110-

Resident Phone 
TECHNOLOGIES, liNC: 

EPA Property Close Out 

Property#: TAO<oA^ Property Address: 'TA) 3*6 /\) I ^^ . 

Date/Time; Owner's Name: FTOLAV- 9SCVQUV;.QC\ 

Quads Excavated: ^ ^ Contractor Group: Prudent 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 

I. Does the grading around the perimeter of the house in excavaied areas generally slope away 

from the liouse? / 

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 fimi and evenly graded? / 

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

time penod) y 

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

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

Gates, Fences and Retaining Walls Yes No 

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

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

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

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

Foundation, Siding and Gutters Yes No 

1. Was damage to tlie siding or trim avoided? 

/ 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? / 

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 

I Was damage to diivewav surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 7^ 
Owners comments: 

Inspection motes: 

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

EPA Representative S^ ^^^ ^Date: ^lbl't> 
ra 

C'HNOLOUIES. INC. 

AS - BUILT DRAWING 

OLS # 29052 

Date Excavated: 10/21/2010 OMAHA LEAD SUPERFUND SITE liSEPASigned-OffDate: 

29052 

Omaha Lead Site Exterior Paint 

Site Sketch • Good 

• Poor 

Sampling Address: 2530 N 14 ST 

U^" Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: -VBTNC 0X'*^W 

RYASCPXA-29052 F1 ^Q- ^ ppm D Date: 5-/^-Z0/ 0 

RYBSCPXA-29052 F2 -i I ^ ppm D Time: IZ'Zol'.yi- RYCSCPXA-29052 B1 Mi l ppm ET D Samples Analyzed RYDSCPXA-29052 B2 _333_pp m D 

nDZSCPXA 20052 BS 

- ppm D D XRF Unil: [QBCoLi Book: 2AD£i. 

nogGcrxA-20002—sa­ ~ ppm D D Date: ro-oH-i o 

nPZeCPXA 20052 PS- ~ ppm D D Time: ML 

Staff: M9W Number of Samples = [ ^ | | Q [ 

Legend: F1 = Front Left, F2 • Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

EKTTEnE D 

MAY l 9 2010: 

Bl =64 PPM® 13" 1.: 6: ^ 

333 

-i- 2-l^J g.Aj7^sr 

303 3\S 

FZ 

M. 

H i4 ;ST Rev :iKIS Crealfd: U,'-M.ny-08 

NO EASEMENT 

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

Property Compietion 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 vv-ith the restoration ofthe 

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. 

1 Property ID: 

Property Address: <** '<:^ ' ^ Q lO V H ^ Pc^. ^ 

Owner: ^^^^^ ^ 

Phone: ^, ^ _ ^^, ^ 

Restoratioo Items in Question: 

1 i agree restoration is completed, except as noted above. 

LJ I do not agree restoration is completed 

Date 
Pnident Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a nuirJjer of properties located in Omaha, Nebraska, including the property located at 

f^ y ? p Mff ftl y y The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remo^ lea'd-cohtamiiuted soil. By signing this form, the property owner grants permission to Prudent to perform 

activities related to the cleanup including soil samphng, removal of lead-contaminated soil, and restoration ofthe 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 al (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By 

Property Owner Signaturl fi>'l9'/t> 

(Signature) (Date) 

PROPERTY INFORMATION 

(TA, e completed by resident and/or property owner — please print) 

RESIDENT NAIVIE: \4 CjLCjgu^i-ir Q ^ Renter 

RESIDENT ADDRESS: Ml^ii^v ^1^ <^^A7^la \A\G 6 ? (( 0 

IF RENTAL, PROPERTY OWNEDBY 

^CCKA~ ^ g^AA., i C-CK_ 

OWNER'S MAILING ADDRESS; 

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 UNDER7 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 pursuantto Section 104 of CERCLA, 42 U S.C; 9604. EPA'sright of access 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, or choosing or taking any response action 

under tliis 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 S6107 San Antonio, TX 78229 

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

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

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 

Phone: 

€>v>^x^ A J. A.1 Arwv-€^/M^ 

8080 Ward Paflcway, SuH 5600 3 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) 579-6577 
29052 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch • Poor 

Samolina Address: 2530 N 14 ST 0 * Not paint 

Sample Number Lead Sample Samples Collected LAB Ck>ncentration Collected Firm: TBTN C DX^-^ ^ 

RYASCPXA-29052 F1 3Q ^ ppm Ef D Date: B'tS-ZDl Q 

RYBSCPXA-29052 F2 

—3_L3_ppm Ef D Time: /2'2o'^-H-

RYCSCPXA-29052 B1 _H2n__pp"i ET D 

Samples Analyzed 

RYDSCPXA-2a)52 82 _333_pp"i ET D 

nOZCCPXA 20052 B2> - ppm n D XRF Unit: \Of^o/ c Book: 2/flf t 

RGEOCPXA 20002 6 * ppm D D Date: Ao - O H - I O 

nPZCCPXA 20052 PiS- ppm n D Time: A M 

Staff: M8Vi/ Number of Samples = [ ^ | | Q { 

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

All quadrants are as viewed from the street, facing property 

MAY l 9 2010: 

^ HT] 333: 

.fel ^ 

I 

Li?-53^Mv^sr 

303 33 

..FJ ...FZ 

1 m 

H 14 ST 

Rev J008 Created: O.l-Mny-Oil 044701 ,01.2.^ 
2530

n 14 'Wm 

Printed: Dec 08. 2010 A www.dcgis.org/dogis 
Page 1 of2 

" > 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2620496. 

Original Call Date: 10/19/10 Time: 9:07 am Op: SIVA18967 


Work to Begin Date: 10/21/10 Time: 9:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2530 Street: N 14TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SE-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 MCINEB MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCINEB MCI 

NO CALL PER 

MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/19/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/19/2010 
SOLUTIONS 

ITTE SAFfeTY HAZARD ANALYSIS 

 A) 1 ^ <S^ Address ; 262>D Excavation Date: 

Crew: Backfill 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 Hazards Corrective Action 

^ ^ 

f ^ 

^ ^ ' {p 

' 

oi^ 

a/^ 

—— 

^ca ^ 

&^<^ 

A T ^ 

a^— 

Site Safety Office 

Date: 

5G00 8108 t 4242 Medical Drive, Stdto 7260 

nflwCVr/MO^II^ OiiUUMf WehfjitlM 68 m 

Ptwiw: {402)733-1188 

San Afltenio.TX 78229 

Phone: (2tO) 82Z-«688 

Fax: (4a2)73»d883 Fax: f21«) 6T9-6677 
Bl 

Z'^ ZOIO