TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^nn^ ^ Date: /0/ft/2^t o 

Address: (^^OS , J l SJ " • 

Remediation Contractor; Rl?f,rypn'J T^r^ NOCOC, t^ q.^ /r^ y Year: '^lO ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B ^ Video of property (DVD) ^ ^ i Pc> 'g,VB ' Executive Svimmary 

"S/ EPA-provided property sketch 

C / Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

V Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

Sr Confinnation data 

^ Photographs 

•B^ As-built sketch 

ly Satisfectory restoration signed by Property Owner 

B^ Property close-out check list signed by EPA 

S/ Description of areas not meeting ROD cleanup criteria 

w Utility clearances 

M Property mformationfirom Douglas County Assessor's Office 

D 

D 

44 :i 

iture VH\ \ Oate 

30262413 

•lUmiMMI 

Superfund 
- ' PROPERTY SUMMARY ' <^^f>o/>g^ 

Date; Ift 7i^f[^ I Omaha Lead-Site Remedial Action Contract # EP-R7-10-0S | Month of: SfepliBwiier. 

Property Address; 1340 S 27 ST. 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

\ 

AJ Issues Resolved:. NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: CONTAMINATION LEFT BEHIND BY PO'S REQUEST 3' x 3' DZ/LS 

570 PPM @ SCRAPE. 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 198 PPM @ 9", B2 = 217 PPM @ 9", DZ = 80 PPM @ 9", F2 = 281 PPM @ 9", 

EA = 198 PPM @ SCRAPE, 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreenient 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 yi) 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. 

MH6i6t\tSi iHC. 
Rnd Record Remediation Query I Lead Remaining Query I Properly Damage Query 

Bacicflii: 

Sample Area: 20034 -134 0 S 27 ST 

Owner: User Provided Owner Infomiation Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

[JANSA HEIDI D 1 |JANSA HEIDI D 

Owner Addressl: Owner Address: 

1 Property Address: 

|1340S27ST 

Owner Address2: 

11340 S 27 ST 

Zip Code: 

|68105­ m 

aty: 

|Oi^AHA 

State:

|NE

 Zip Code: 

 |68105­

aty: 

1 

State: Zip Code: 

1 1 

Resident Phone 

1 

Owner Phone: Alternate Phone: Owner Phone: Alternate Phone: 

|(402) 559-4024 1 1 

Contract: Assessment: 

Contractor: jPRUDE|y|T_2010_S Qualifying Group [400 

Contract Option |BASE Assessment l«lax XRF Value: | 463.11 
if \ 

[QLOGnSiINC. EPA 

EPA Property Close Out 

Property #: 7.00?' ^ Property Address: V 3 ^ ^ . Z 7 9*"^ 

.. Date/Time: Owner's Name: f-) eTA* 1<>2^ 

> Quads Excavated: p Z, P21S • i ^ Z, Contractor Group; Prudent Technologies, Inc., 

Excavation General Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas 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 

from the house? y

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 inspecied at a 30 y day time period) 

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

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

6. Was the property graded such that water will not pool on the propeity? y 

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

Gates, Fences and Retaining Walls Yes No 

I. Do gates open, and close freely? (Ifapplicable) / 

2. Were all gates orfences taken down duringrestoradon activities reinstalled? (If applicable) y 

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

4. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and Gutters > Yes No 

1. Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / ; 

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

S. Was damage to downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? J 

2. Was damage to walkway surfaces avoided? •J 
Ownen comments: 

-

I- Inspection notes: 

' " .-^ ^ 

J 

\ 

/ 

1 

/ 

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

EPA Representative Date: 

aan ^ 
im OTOUCDGIES, INC. 

AS - BUILT DRAINING 

OLS # 20034 

Date Excavated: 08/10/2010 OMAIIA LEAD SUPERFUND SITE USEPA Signed-Ofr Date: 

Name. AvigiW/ fi, '\^i^y^a ^ Oinaha Lead Site Date: l/Z/fAc'} North Arrow —i 

Addressl fS*yo ^ Zy" * S T Site Sketch Time: _£2£ 

Phone: fetoZ:) Sg<? -yg>2 ^ 

Team A^< . .X^^^^T/p <fc ^ BVID # ZLO^^ ^ XRF Code 5^^ ^ 

Sample Number Lead Concentration Confirmation Sample 

A?Yes ° No nj ^ / j 4 %i , PP^ y^ZYes n No ^ 

/?/Yes • No H mills y/^Yes n No ^ : 

^ 2 . Yes a No CS 

Yes • No • 

Yes • No • 

117^: r i 

Omaha Lead Site 46130 

EA= 198 PPM @ SCRAPE (-1") 

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

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 thie restoration ofthe 

subject property, and that no items are in.questioiij now, or at any time in the future, excluding any 

remainiqg warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address; j 3 ^ g S ^ T ^ ^>— 

Owner: 

ii sUL E A- Phone: 

Restoration Hems in Question: 

Hem: 

Item: 

Hem: 

Hem: 

Hem: 

Hem: 

Required corrections to complete the property: 

u y I agree restoration is completed. 

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

^ ^Q/^; ^ 3 ^ ^"Hi 

T ^ hiiiJ Qiy^<^ 

Tn-/o 

iwner's Signature Date 
PnuUnt Tecfanologiei, lac. (Prudent) it under cootnct with the U. S. Envinmmenlal Protection Agency (EPA) to clean up leadcontuninBted loil* at a number ofnopatiet located in Omaha, Nefanika, Induding the property located at 

I'^^ O ^ S_"7 ^r * The EPA requesta your permiuion to allow Prudent to perform a soil cleanup al this 

property to remove lead-oontaminated toil. By ligiitngthiB firm, the property owner graitfa 'pennisaion to Prudent to perform 

activitieB related to the cleanup including soil sampling, removal of lcad<ontaminated soil, and reatcration ofthe refereaced property. 

Ifyou have any ciuestions about the soil c\taaap planned for your property, pleaae coitact Prudent south office /or the Omaha Lead 

She cleanup-at (402) 733-1188. General queatiooa about the Omaha Lead Site cleanup can be directed to the EPA Public Infonnalion 

Centers.at (402) 731-3045 (South Omaha ofBce) or (402) 991-9383 (North Onuha otRce). 

Property Acceaa Granted 

J (Please Print Name) 

Property Owner Signatura: 

(Signroe) (Date) 

PROPERTY INFORMATION 

(To be completed by nMtpt and/or IMIHICIIJI oimcr ~ pleaae leawj^tf) 

RESIDENT NAME: _J^i:£.AAj L %» • ^Owner 1 Renter 

RESIDENT ADDRESS: <2n ^ ^ r c:^t^^^X<K ^)-p (^%\o 5; 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'SJ^MUNG ADDRESS; 

i?0<^ f 

OVmiER'S TELEPHONE NUMBER - HOME: J L WORK: 

AGE OF HOME?: \0- % YEARS. HOW LONO HAVE YOU LIVED HERE7 (L. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDING SINCE 1978? 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD; J _ , . NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

9— 

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

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

AUTHORrry FO R ENVIRONMENTA L RESPONS E ACTIONS : Tie activities to be implemented by EPA under this agreemeot 

are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of acceu to the property is provided for in Section 104(e)of 

CERCLA, 42 U.S. C 9603(0% which provides entry for "determining the need for response, or choosing or taking any response aclion 

under thia title, or otherwiae enforcing the provisicos of the title." 

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

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

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

Fax: 1816)363-3707 Fax: (402)733-1883 Fax: (210) 97»-«e77 
ENVmONMENTALA 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: j^tf O 5 3 7/t^ ^SV ®*'*= ^/^£»/^ O f D 

BVID: Phone: MOX-2-^t) - ^'^^p*? 

'patrvtnvJnQ 

JQQU, ii 

P Z p^o ^ A^'j^ p'Cb .-^fU Qg 

/>£>tvJULL>^ j l ^ .g^-^ ^ >^ ^ 

A. 

P - o • L^f_ C ^ f O^l^l ­

< ^ G-yU7fl fXyO J^TTm Q ^ 

C ^ ' b^^^fl^^ 

2£iL 

^ 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 406 5600 S 10 St rive, Suite 4250 

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

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9688 f--.. . iJAA l V« « .4AA4 
Name: rf^a J Omaha Lead Site Date: 7/7^/^^^ North Arrow —i 

Addressl I'S'^Q -S ^>><•^'' ^ 5T Site Sketch Time: '^iP^ 

Phone: iVd^Z ; S?<? -^c^^^ / 

Team '7^/i7>i. y^c^c*, y ? ^H ; BVID# ^O Q 'l ^ XRF Code ^^^^ ^ 

Sample Number Lead Concentration Confirmation Sample 

^4q f a I /7Yes n No ^ ppm 

/^^Yes n No ^ S ppm 

^ / Yes n No S 

y^ZYes n No ^ 

^XYes n No la 

ppm Yes • No a 

ppm Yes • No n 

s. ^ 7 y / / . 
Page I of 1 

/3MQ s. a-T^S' 

http://douglasne.mapping-online.coni/assessdoc/Photos/19/R12385200000001.jpg 6/11/2010 
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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

1238520000 

JANSA 

HEIDI D 

1340 8 27 

ST 

OMAHA 

68105 

1340S27 

ST 

OMAHA 

NE 

68105 

28-15-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

HANSCOM PLACE 

14 

10 

N35FT 

35X151.7 

0.12 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=1238520000 

http://dougiasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R1238520000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/10/2010 

2 
Ticket Text and Map display for '"'-.ket: # 2559450 Page 1 of2 

Original Call Date; 8/03/10 Time: 3:40 pm Op: SIVA18967 


Work to Begin Date; 8/05/10 Time: 4:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1340 Street: S 27TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE 


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 


: 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 LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


utility Service Area Contact Phone Nuniber Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 


Emerg: 8773668344 


Day: 4025047823 


METROPOLITAN UTILITIES MUD02 SANDY Alt: DISTRICT 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 402444516 1 

Emerg: 4024445160 

ELM Day: 4067289343 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT LOCATING Alt: 4062071494 


http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DH... 10/19/2010 
Ticket Text and Map display for Ticket: # 2559450 Page 2 of2 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: . 4062071494 

Emerg: 8887289343 

View Map Close Map 

http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DH... 10/19/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Addr.»:-l2H0_S2afl 

Crew: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Bntane 

Sidewalk 

Foundation 

Retainine Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Xx. 

Condition 

^(IWDJ) 

^ ^ 

li^Kt\7L 

AjarJL 

> 6 ^ 

a-A/to.tK*'^) 

\J^ ^ 

iS^r 

c ^ 

P o ^ 

(y»J( 

iiro,^\^^ 

/Mv€ . 

Excavation Date: -£i^»^ -

Backfill Date: ^"f^~/^ 

Hazards Corrective Action 

• 

*. , 

-

Site Safety Office 

Date: 

^ - 70r A 

810 at 4242 MWdlcal Drive, Suite 7250 

i€l|y.'W>M114 San AntonicilX 78229 

:(SH)1SS^PD3­

'Rac fSIt) SSS4?B7 

>:(4a2):73S-11S8 

Fac:(4e2)733^1SU 

'Phon«:!(210):82Z«588 

Fax: (210)-67ft«577 
1 JA* fc ~i

' ''••' 

, ^ 

9fM^*^„ ^ ^ 1 

m m liHf ^^^^^^ H -I/(xrm e 

^ l ^ J