0

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 27562 DATE: 1/15 

ADDRESS: 

2620 PATRICK AV 

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

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS yJ ^ 

1/5-7^ 

 PRE AND POST VIDEO OF PORPERTY (DVD) '«'^>'V<i 

m EXECUTIVE SUMMARY 

• EPA-PROVIDED PROPERTY SKETCH 

Q SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

d SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

Q CONFIRMATION DATA 

a PHOTOGRAPHS 

• AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

O DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

pl PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

s\] ^ ^ ' ^ 

SIGNATURE DATE 

30218578 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2620 PATRICK AV 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESUj&'S: 

B2 = 236 PPM @ 8"; NO EASEMENT ^V 

ATTACHMENTS * s^ 

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. 

TECHNOLOGIES, INC. 
Find Record Remediation Query Lead Remaining Query ; Property Damage Query 

Backfill: 

Sample Area: 27562 - 2620 PATRICK AV 

Owner: 

• Owner Occupied 

Owner Name: 

MOBECO INDUSTRIES 

Owner Addressl: 

Owner Address2: 

111413 HICKORY RD 

City: State: Zip Code: 

JOMAHA NE 168144-

Owner Phone Aiternate Phone: 

174027342-2820 f 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option [oPTION 2 

User Provided Owner Information 

Owner Name: 

i 

Owner Address: 

City: State: Zip Code: 

Owner Phone: Alternate Phone: 

i 

Assessment: 

Qualifying Group J400 

Assessment Max XRF Value 

Resident: 

Resident Name: 

] RESIDENT 

Property Address: 

]2620 PATRICK AV 

Zip Code: 

168111-

Resident Phone 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: Z 7 %2 - Property Address: 2^Z(^ PaV^^V. <4l^«-. 

Date/Time: Owner's Name: /X<3bec<3 Xi^M ­

Quad.s Excavated: (^"2 Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessary, were the correci quadrant(s) excavated and restored? 

2, If necessary, were the correct areas of drip zone e.xcavated and restored? / 

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 house? 

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 lime period) y 

4. Are sodded areas generally fmn and evenly graded? A 

5, Are tlie joints between tlie sod strips generally tiglit? (Only evaluate if inspected at a 30 day 

lime period) X 

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

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

Gates, Fences and Retaining Walls 

Yes No 

y 1.

 Do gates open and close freely? (If applicable) 

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

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

Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? y 

3. Was damage lo window s avoided? . y 

4. Was damage to windows or door screens avoided? 

^ 

5. Was damage lo downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes No 

 Was damage to drivewav surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

I
Owners comments: 

Inspection notes: 

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

EPA Representative ^^^s^L- Date: njtjib 
nTTiNoixXiir-is, INC. 

vS - BUILT DRAWING 

OLS n 27562 

Date ^:\ca^aU'd: 10/20/2010 [A LEAD SUPERFUND SITE ISEPA Signed-OffDate: 

27562 

Omah Exterior Paint North Arrow a Lead Site 

Sampling Address: 2620 PATRICK AV Site Sketch • Good i • Poor Phone: H (402)342-2820 ALT: [ ^ Nol painl 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Firm FP/I P9-(:< : RYASCPXA-27562 Fl ppm D Date ? - 17--Jll . RYBSCPXA-27562 F2 ppm Tjme U • |ga m n RYCSCPXA-27562 Bl ppm D Samples Analyzed RYDSCPXA-2756

nOZCOPXA 2750

2

2

 B

 B2

2 

­

ppm I D

ppm D D XRF Unit: (o5H2 . Book. //? y 

nozocrxA-27002—e? ppm D D Date RJRfCri 

RPg3CPXA-27502 P2- ppm Time ? h ' 

a a Staff M9>U Number of Samples = U 

Legend: Fl = Front Left, F2 = Front Right. 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All Quadrants are as ubEUMedfrorn the street, facing property 

ENTERED 

JUL 2 7 2007 

B2 = 236PPM ®8" 

^ 7 2 

Bl = 200 PPM ffl! 8" 

z m p(j.ff-/cK /fl/'. 

f 

119 

r\. n 

173 

Pcihtok Av. 

t'rcacd 6;l2.;oci710 47 4» NO K.ASEME.NT 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
hlS>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: Q^CSio pr>^nri : /r^> ^ 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

lidn agree restoration is completed. 

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

Owner's Signaturev ^ Date 
Pnident Tectaologies, Inc. (Prudent) is under contract with the U. S. Enviromnental Proteaion Agency (EPA) to clean up leadcogLarninated soils/rt a number of properties located in Omaha, Nebraska, including the property located at 

(7^ ^ WL P fOrt'C* - " V ^^"^ ^^'^ requests your permis.sion 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. 

If you have any questions about the soil cleanup planned for your property, please contact Prudeni 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: 3^f^Afi-l> ^( 3 fZiaLljO F ^ ^ /^0^£CQ jT^ ^ •^'^C 

(Please Print Name) 

Property Owner Signature: ^^PdhMc^J.. (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: (/AKL/A/T " Ct> T Renter 

RESIDENT ADDRESS: 

e^^l a fATl^lCJC At/ ^ 

IF RENTAL, PROPERTY OWNED BY: fOlk 

OWNER'S MAILING ADDRESS; 

/I'f 1 3 /^/cKoitU 1^^ omAHj^ 

OWNER'S TELEPHONE NUMBER - HOME: (4^2 ^ 1> 1 2 ' Z-% "2^ 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: A'/ A 

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

ALTHORITY 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 of access 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 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) 36^-3703 Phone: (402) 733-1188 Phone ; (210)822-9588 

Fax: (816) 363-3707 Fait: (402) 733-1883 Fax; (210)679-6677 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2618625. 

Original Call Date: 10/15/10 Time: 4:01 pm Op: SIVA18967 

Work to Begin Date: 10/19/10 Time: 4:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2620 Street: PATRICK AVE 

Twp: 15N Rng: 13E Sect-Qtr: 09-SE,16-NE 

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 LEVELS MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHATIAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhoii.org/irthmternet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULT... 10/15/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/15/2010 
TBBHMOLO^^ , WC. CONSTBUCnON 

SOLUTIONS 

SITE SAIi^TY HAZARD ANALYSIS 

Address; -^iA:f>-. fcJ^^cl^ /> y Excavation Date: 

Crew: Backfill Date: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leecli 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

c^ ^ A=^.) i-t^. 

>-r-5 -s

e^ 

h^' 

v^ 

• 

Orca/^ 

m 

(f^C^ ^ 

Cf>^ ^ 

i T ^ 

C7^— 

____- — 

Site Safety Ofiice 

Date: 

seoosiost 4242 Medical Drive, Suite 7260 

nsM;a)lyillO«4114 OmAtai, NalM<B6k8 48107 San Antonio, TX 78229 

tone: fSM) SSS-STOS PhonK (402)733-11SS Phone: (2t0) 82Z-«688 

x: ^n ) 383«3707 Fax: (4aZ)73»»-MS3 F« : {210) «r»-«577 
27562 

Omah Exterior Paint North Arrow a Lead SHo 

Sampling Address: 2620 PATRICK AV Sita Sketch • Good 

• Poor 

Phons: "• (402)342-2820 ALTj ^ Notpalnt \ 

Sample Number Lead 

Concentratton 

Sample 

Collected LAB Samples Collected 

Firm: _Fei_JiliX _ RYASCPXA-27562

RYBSCPXA-27562

RYCSCPXA-27562

RYDSCPXA-27562

 F1 

 F2 

 B1 

 82 

11 ^ ppm 

» T 3 ppm 

*^ 7 2. ppm 

_±L5:3_ppm 

D 

D 

D 

D 

Date:

Time:

 ?-//-o7 ^ 

 » ' jQom 

Samples Analyzed 

RDgOOPXA 270Gg BSh " ppm D D XRF Unit (o5H2 . Book: lfi* f 

ROZOOPXA-27GG2 6 ? - ppm D D Date: ,0Jf^/Ol 

RPZOCPXA-2750g P2­ ~ ppm D D Time: ^ 

Number of Samples = t| Q Staff: MS) / 

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

ENTERED 

JUL 2 7 20Q7 

B l I ; i r 

Hiz 1... ,^S i . 

2i clQ.ffihi.cK.Av. .. 

t 

m 

f\ ;.Fz'.... 

1 /73; 

' i : 

/Vlq(.fC Al/. : i ; 

Rev 5 Creaied: 6/12/2007 104749 046141.0123 

(NT no* SOT MV JKT x n )mr n v jn i x«r ae< xei itc* x»^ j«it xcr jo r ic r xiT lev JST jem JW* • » xoi »t'3W7 >«:-»e> jw i ID*; ncf aa: MEI r xtAt mi lom KWH MP VDT xautB^ IBl xtntof XIV xmxct 3001 tan jaaXIV imi •»> aow jem x»' jatmrmr m mr jw a 
w 262

0 Patrick Av 60x126 

A Printed

: Nov 30, 2010 

www.dcgis.org/dogis 
Vi 

31,SZ 

ZlZoio