TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28020 DATE: 1/15 

ADDRESS: 2623 GRANT ST 

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

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

ef EPA-PROVIDED PROPERTY SKETCH 

d 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.) 

d CONFIRMATION DATA 

d PHOTOGRAPHS 

d AS-BUILT SKETCH 

d SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

H PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

d UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

a 

n 

9^ %

SIGNATURE ^

 t/'j" 

 DATE 

30217609 

lIM i 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2623 GRANT 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: 

B2 = 112 PPM @ 6"; EA = 58 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. 

TECHNOLOCIES. INC. 
Find Record 

Backfill: 

Sampie Area: 28020 - 2623 GRANT ST 

Owner: 

n Owner Occupied 

Owner Name: 

JMORELLO BERNARD J 

Owner Addressl: 

1 

Owner Address2: 

111413 HICKORY RD 

City: 

lOMAHA 

State: 

|NE 

Zip Code: 

|68144-

Owner Phone 

1(402) 342-2820 1 

Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option |OFnON 1 

Remediation Query I Lead Remaining Query | Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: State: Zip Code: 

1 1 1 

Owner Phone: Alternate Phone: 

I " 1 

Assessment: 

Qualifying Group J46b 

Assessment Max XRF Value ) 524.12 

Resident: 

Resident Name: 

I 

Property Address: 

|2623 GRANT ST 

Zip Code: 

J68111-

Resident Phone 

I 
TECHNOLOGliisrtNC. 

EPA Property Close Out 

Property #:^9-OZ 0 Property Address: 2-632./ " (STOW K y ^ . 

Date/Time: Owner's Name: g^rtjir ^ ^v^liC) 

Quads Excavated; 92- ^ Contractor Group: Prudent Technologies, Unc, 

Excavation General Yes No 

1. If necesscirv. were the correcl qiiadrant(s) excavated and restored? / 

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

Grading Sod and Vegetation Yes No 

1. Does the grading around tlie perimeter of the house in excavated areas generally slope away / from Ihe house? 

2. Has sod been lajd 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 Inne period) 

4 Are sodded areas generally finn and evenly graded? / 

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

tune penod) y 

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

7. Was daniage to landscaping or plant materials avoided? 

^ 

Gates, Fences and Retaining WaUs

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

 Yes

y 

 No 

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

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

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

y 

y 

Foundation, Siding and Gutters

J. Was damage to the siding or trim avoided? 

2. Was damage to tlie foundation avoided? 

3 Was damage to windows avoided? 

 Yes

y 

y 

y 

 No 

4. Was daniage to windows or door screens avoided? 

5. Was daniage lo downspouts or downspout extensions avoided? 

y 

y 

Sidewalks and Drivcw;tys (Concrete) 

I Was damage to driveway surfaces avoided'? 

Was damage to walkway surfaces avoided? 

Yes

/ 

y^ 

 No 
Owners consinents: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod w^arranty: 

EPA Representative ^"^ J ^ Date: a\t\^o 
I'HNOLOGIES, INC 

AS - BUILT DRAWING 

OLS # 28020 

Date Excavated: IO/O.S/2010 

rSEPA Signed-Off Date: OMAHA LEAD SUPERFUND SIT 

28020 

Omah Exterior Paint NoithAmw Owne a Lead Site r Name: BERJWip J MpRELLO 

Site • Good Sketch Address: 2623 GRANT ST • Poor Phone: H: 402-342-2820 W; 

g^Not paint 

1. 

Lead Sample 

Samples Collected Sample Number I.AB Concentration Collected Firm: _E35_m/££ _ RYASCPXA-28020 Fl M q ppm D Date: O'iJ PM Job 

RYBSCPXA-28020 F2 Time: V •'J 6 /r/77. 

RYCSCPXA-28020 Bl .32,3 ppm D 

Samples Analyzed 

RYDSCPXA-28020 B2 SI H ppm D 

RDZ6CPXA 28020 -DZ 

ppm D D XRF Unit: Ji22_ _ Book:ii24L •RCZSGPXA-2802Q -ez ppm D D Date: '^-31-0 ^ 

RPgSGPXA 28020 -Pi- ppm 

D D Time: Al ^ 

lab RYBSCPLA-28020 Staff: i^u J 

Number of Samples = M­ -Result 80.3 ppm 

Legena: r

 1 = riom Leu, n . - Front Right. 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the £tidet. fadng property 

ENTEBED 

.323 

MAV 2 6 Xm 

u 

< B2= 112 PPM a 6" 

^2_tor4ii6"l._^x 

.m :^i. 

?\ 

TSZ 

i;7.r:akli.yk 

KA = .SS PPM (a} SCRAPE (~l") 

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

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: £) f. Q Q. OKO.. . it 9^ 

Owner: 

Phone: 

Restoration Hems in Question: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I agree restoration is completed. 

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

s Signature y Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadaontaminated soils at a numberflf properties located in Omaha, Nebraska, including the property located at 

/-to 2- ^ Ct/yPLy^ T "^ ^ The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to reiflove 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 of lead-contaminated soil, and restoration of the 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 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 ^ ^ < A I A ^ : fyiO/^€'LU i 

Tf^ _ /-Pio.o.; Prijjl Name) 

Property Owner Signature (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: \[ci^C nnV U Ir Renter 

RESIDENT ADDRESS: 

P^ Cr£i y C^<^o^n^ .^J ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: ^ 0 2.) 3 7^ ' J - 6 X ^ WORK: 

( ) 

AGE .AJ/A - OF HOME?: £/A. 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 


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

AUTHORTTY 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 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 this title, or otherwise enforcing the provisions of the 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) 363-3703 Phone: (402) 733-1188 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402) 733-1883 Fax:(210)679-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^jl ^ & r aUL Ir §] ^ »«te: 

Phone: L^ ^ ^ ^ . ^^^ ^ ^ ^ ^ ^ BVID: 

/)petA tAr../ - ^o/> 

Property Owner Prudent Employei 

Signature: Signature: 

8080 Ward Parkway. Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 9/^/e^ 

5600 S 10 St 

Omaha, Nebraska 68107 

Phone: (402)733-1188 

^^24a-Medita 2-Mediball prive, Suite 4250 

"" ^ San Antonio, TX 78229 

Phone: (210)822-9588 
28020 

Omah Exterior Paint North Anow Owne a l«act Site r Name: BERNARD J MORELLO 

SHe • Good Sketch Address: ^aj^ANTST _ • Poor Phone; "- 402-342-2820 W: 

[^Not paint i

Samfto Numtier Lead Samples Collected 

Concenbation Firm 

RYASCPXA-28020 Fl Date: 

RYBSCPXA-28(eO F2 Time: 

RYCSCPXA-28020 B1 

RYDSCPXA-28020 B2 Samples Analyzed 

RDzecpxAagoao—62 XRF Unit 907 . Book: U ^ 

nOZSGPXA 28020 G2 Date: z?-?/- ^ 

RPZ6CPXA 28020 P2- Time: A& i 

jLab RYBSCPLA-28020 

_s Result 80,3 ppm Number of Samples = Staff. i^U / 

Legena r i = rrotii Leir, n - Front Right Bl = Back Left. B2 = Bacl< Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AS quadrants ara as viewed from the street, feeing property 

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3 Grant St 25x120 

A Printed

: Nov 30, 2010 

www.dcgis.org/dogis 
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

Create Another Ticket Back to iftii Internet j Send Email 

• YOUR TICKET NUMBER IS  2605477. 

Original Call Date: 9/30/10 Time: 12:34 pm Op: SIVA18967 


Work to Begin Date: 10/04/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2623 Street: GRANT ST 


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


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 

lof 2 9/30/2010 12:34 PM 
http://www.dhon.org/irthiiitemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU., 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNElC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:34 PM 
mc CONSTRUCnON . SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

 ^^ ^ ^c^^J^yl ^ Address : Excavation Date: 

Crew: BackfiU 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 

c ^ ^ 

e^ 

h^' p 

O/c. 

a/^ m 

P<U>L, 

O^'^ 

^ ^ 

o*^— 

___ ^ 

Hazards Corrective Action 

A=>*j L^^ . (^ C ! • / O Ke,<0 

'-' ^ -1 

Site Safety Office 

Date: 

m o Wmfevfomy . Suito405 SSOOSIOSt 4242 Medical Drive, Suite 7250 

OiitiAa, NalMMkB 60107 San Antento,TX 78229 

ifione: (818) 363*3703 Ptwne: (402)733-1108 Phone: (2t0)822!«688 

^KfSIS) 363.37117 Fiac f402) 733^683 Fax: (210)«T9-<577 
j.i.. . .»& J - - 5 

4