0

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28820 DATE: 1/15 

ADDRESS: 2011 OHIO ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: lOlt 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

 PRE AND POSTVIDEO OF PORPERTY (DVD) 

13 EXECUTIVE SUMMARY 

IZI EPA-PROVIDED PROPERTY SKETCH 

0 ^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

B^ RESTORATION AGREEMENT 

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

1 ^ CONFIRMATION DATA 

^PHOTOGRAPHS 

Cr AS-BUILT SKETCH 

Q^SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

Q^PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

Q ^ UTI LITY CLEARANCES 

a PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

SIGNATURE DATE 

30218362 Hill 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2011 OHIO ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infomiation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 244 PPM @ 6"; EA = 135 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Find Record 

Backfill: 

Sample Area: 28820 - 2011 OHIO ST 

Owner: 

D Owner Occupied 

Owner Name: 

lOTY OF OMAHA 

Owner Addressl: 

|C/0 PLANNING DEPARTMENT 

Owner AddressZ: 

|1819 FARNAM ST 

City: State: Zip Code: 

lOMAHA JNE |68183-

Owner Phone Alternate Phone: 

1 i 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option ]BASE 

Remediation Query | Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

r 

City: 

r 

state:

1

 Zip Code: 

1 

Owner Phone: 

r 

Alternate Phone: 

' 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value 

414 

Resident: 

Resident Name: 

TENAI^TS 

Property Address: 

|2011 OHIO ST 

Zip Code: 

|68110-

Resident Phone 

I 
TECHNOLOGIES; INC. 

EPA Property Close Out 

Property #: £.8-8^2^ Property Address: 2.0J\ O^i^a '?^ , 

Date/Time: Owner's Name:<i'5.|.^ a^<3 n^A^tL 

Quads Excavated:(^ 1 Contractor Group: Pnident Technologies, Inc., 

Excavation General 

Yes 

1. If necessary. were tlie correcl quadrant(s) excavated and restored? 

/ 

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

/ 

Grading Sod and Vegetation 

Yes 

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

2. Has sod been laid in all areas tliat were excavated? ^ 

r^. Does tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day lime period) y 

4. Are sodded areas generally firm and evenly graded? 

y 

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

time period) y

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

/ 

7. Was damage lo landscaping or plant materials avoided? 

7 

Gates, Fences and Retaining Walls 

Yes

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

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

Was dainage to gates or fences avoided? (If applicable) / 

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

y 

Foundation, Siding and Gutters Yes 

] Was damage lo the sidmg or trim avoided? / 

2. Was damage fo the foundation avoided? 

/ 

3. Was damage lo windows avoided? 

y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

^ 

Sidewalks and Driveways (Concrete) Yes

 Was damage lo diivewav surfaces avoided? 

2. Was damage to walkway surfaces avoided'? 

y 

No 

No 

 No 

No 

 No 

I
Owners comments: 

Inspection notes: 

y , y .A y y 

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

EPA Representative Oo^'Aq ^Date: i/xshi 
m rmrocoGiEs. INC 

AS - BUILT DRAWING 

OLS # 28820 

Date Excavated: 11/10/2010 OMAHA LEAD SUPERFUND SITi rSEPA Signcd-OfT Date: 

y^Tii^m 

Omah Exterior Paint a Lead Site n Good Site Sketch • Poor 

Sampling Address: &di 1 1 Oht Q iST" (J3^ot paint 

Sample Number Lead Sample Samples Collected, 

Concentration Collected LAB Firm: f^ JH',, f^]7/^W 

RYASCPXA- saaeof^ 2ftC> ppm D Date: lO-iU-^Z-OU 

RYBSCPXA-<f aaa? F2 2.4Z ppm D Time l2.-50?.y[. 

RYcscpxA-ajaeo BI Ht H ppm D Samples Analyzed RYDSCPXA-^ggao B2 3^1 ' ppm 

RDZSCPXA CddSO OZ — ppm D D XRF Unit: \CXiUf Book: 2^ft 

RGZOOPXA C880DGZ — ppm n D Date: 

RPZSCPXA SaOd O PZ — ppm D Time: _EC1 . 

Staff: Number of Samples = ^ L n^w 

Leflend: Fl = Front Left, F2 = Front Right. B1 -Back Left, 82 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Ray 

All quadrants are as viewed from ttie street, facing property 

; - V 

ENTERE D f- • 

r - i OCTl 42010 

Bl =244 PPM a 6 " 3=10. r:i HN^ ; 

.61.: ...Y... .^Z 

(4 , n 

6ff»Pi ?r 

r- — > 

^ 2 ^ : Zf2 

a: , rz 

^. . 

1 . -> 

• ^5' 

y ^ 

LOIilio.ST.. KevICXWHI Creaua 16.Mcy.08 

EA = 135 PPM (fl) SCRAPE (~I") 

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

Property Completion Agreement 

This agreetnent 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: ^g, ^ ^y^^.^ ^y^^^ y_ 

0^^"'^'-= yr.k. y Or.^ ^ 

Phone: (J ^/c^^,. c/^c/^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

S ^ I agree restoration is completed. 

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

7'iy&v' 7 0 

Owner's Signature Date 
TTaiNJ6iMrtit>x: 

Pmdent Technologies, taKlP ) is undl t wiOn the U. S. Environmental Protection Agency (EPA) to clean up leadcontwllaated soils at a/umb I'hfrmnrTtiri^nriifta in Omtihn, Nebraska, including the property located at 

yCyy l yfnp^ A requests your permission to allow Prudent to perform a soil deannp at this 

: to remove leacRS^Staminated s ' signing this fcnm, the property owner grants peimission to Pmdent to perfonn 

activities related to the cleanup including soil sampling, lemoval of lead-contaminated soil, and restoration ofthe referenced property. 

Ifyou have an>' questions about the soil cleanup plaimed for your pioperty, please contact Prudent South Omaha Oflice for the Omaha 

Lead Site cleanup.at (402) 733-1188; 733,^5 . General questions about th^i^aha Lead Site cleanup can be directed to the EPA 

Public Infoimation'Centers at (402) 73 l'304S'($o\^ OmdilaofBce) a < . y 1 

Propert>- Access Granted By: 

Print Name) 

Propett\-Owner Signature: >l ^ / 0/9-1/^010 

ignature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

C' 

OWNlbt'S MAILING ADDRE^ : / W y 7 ^ y^y y / ^ 

OWNER' •STELEPHOhJi NUMBER-HOME: ( ) WORK W : 

J I 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 _YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLO: . 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.) 


AUTHORTTY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agte«anent 

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

CERCL.\ 42 U.S. C 96Q5(e), which prm'ides entry for "determining the need for response, or choosing or taking any response action 

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

8080 Ward Parkway, Suite 405 5600 8.10"" Street 4242 Medical Drive, Suite 4250 

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

Phone: (816)363-3703 Phone: (402)733-1455 Phone: (210)822-9588 Fax: (816)363-3707 Fax: f4021 733-1B8.? 
TECHNOLOGIES, INC. 

Address:

Phone: 

.^y / 

Property Status Form 

^yy ^jr/: 

Date: 

BVID: 

Propertj' Owner Prudent Employee 

Signature: ^ ^7 / Signature: 
id&y~ y^r^f^pm gd^gg 

Onnah ExtBrior Paint North AiRW a Lead Site 

Site • Good Sketch 

• Poor 

Sampling Address: &^ U Ohi a t ^ Q44at paint 

Sample Number Lead Sample |^ ^ Samples Coneded. 

Concentration Collected ^ ^ 

RYASCPXA-f-^atfOFI 

Date: l6'lU''2J)J I8-IU'^2J)JI a 

F(YBSCPXAr£86&? P2 

Time: 

RYCSCPXA-ajaaO Bi 

Samples Analyzed RYDSCPXA-e5Q£D B2 ,^«^/« Dom B* I^ 

nDZCOPXA CQOCO OE — ppm D D XRF Unit: SOeUgL. Bode .2 ^ 

nozcopxA e86£poz • •— pom n D Date:_ 

— ppm D O Time:_ -En 

Staff. Number of Samfdes = l^ | J U 

USh ^ 

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

AO qiJabants ara as wawBd from tfw street, facing property 

1 . . ^•.. • 

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04«141.0123 
201

1 OHIO ST: 45 X 122 

A Printed

: Dec 10,2010 

www.dcgis.or g.'dogis 
Page 1 of 1 

Create Another Ticket Back to Irth Internet Send Email ^ 

YOUR TICKET NUMBER IS 2627992. 

Original Call Date: 10/27/10 Time: 3:39 pm Op: SIVA18967 

Work to Begin Date: 10/29/10 Time: 4:15 pm 

State: NE UGLAS Place: OMAHA 

Address: 2011 Street: OHIO ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: SOIL LEAD REMEDIATION PROPJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: Y Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day:

Alt: 

 4025047823 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE IC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/27/2010 
GRAHAM, WESTON & ANDER^ 

*Ptovidets ^^ 1 'ustom Painting, Windows, Construction antndHn d Evironmenta i l Soludoa^ 

SITE SAFETY HAZARD ANALYSIS 

PROPERTY ADDRESS: 2011 Ohio Street 

EXCAVATION CREW: /y}ci/7iy/y y i^ ^ i f BACKFILL CREW: 

EXCAVATION BEGIN DATE: BACKFILL BEGIN DATE: t7 I fn /£ 0 . 

EXCAVATION END DATE: ro/fi> BACKFILL END DATE: 

^ 

OPERATOR'S SIGNATURE: ^yt/f/:y7i^s l i^ydyC y OPERATOR'S SIGNATURE: 

ITEM (YES) (NO) CONDITION HAZARDOUS 

(YESV(NO) 

CORRECTIVE ACTION 

OVERHEAD LINES 

GAS LINE 

PROPANE/BUTANE 

SEPTIC/LEECH FIELD 

SEWERLINE 

WATER LINE 

DRIVEWAY 

A^O 

\ ^ C 

7 y 

y^r^P 

Vt* S 

7 ^ 

v-*.»k. 

C'^ivL. 

C4>^^^^^ 

FENCES 

FOUNDATION 

Vf s PocO ^ 

RETAINING WALLS 

rJC? 

SIDEWALK 

^ o 

^ o 

SPRINKLER SYSTEM 

STRUCTURES (I.E. 

HOUSE, GARAGE,ETC.) 

OTHER 

yJ O 

tJ' ^ 

2505 North 24* Street, Suite 211-A 

Omaha NE 68110-2279 

(402) 402-502-2068 www.gwaentetprise8.com (402) 451-3728 (Fax) 
Payroll Services Human Resource Services 

Taxpay* Retirement Services 

Direct Deposit PAYCHEX COBRA Administration 

Bank Reconciliation Handbook Sen/ices 

Garnishment Payment Service 

State Unemployment Insurance Service 2010 Payroll Calendar Workers' Compensation Payment Service 

Section 125 (FSAand POP) 

Time and Attendance 2637 South 158th Plaza, Suite 100 Human Resource Administration 

Online Reports Omaha , NE 68130 Group Health Insurance 

Phone 402-331-6600 / Fax 402-339-2353 

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