TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 20055 DATE: 12/15/2010 

ADDRESS: 317 WOOLWORTH AV 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

Di EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

U\ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

m RESTORATION AGREEMENT 

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

ID CONFIRMATION DATA 

Dl PHOTOGRAPHS 

m AS-BUILT SKETCH 

h SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

h PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

h UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

n 

n 

<h'^<y\ 

SIGNATURE DATE 

30261092 

Superfund 
Find Record Remediaaon Query Lead Remaining Query ; Property Damage Query 

Backfill: 

Sample Area: 20055 - 317 WOOLWORTH AV 

Owner: 

• Owner Occupied 

Owner Name: 

ROBERTSON JAMES J 

Owner Addressl: 

1 ~ "^' ' 

Owner Address2: 

1513 S 4 ST 

City: State: Zip Code: 

lOMAHA JNE 68108-

Owner Phone Alternate Phone: 

1(402) 593-0525 

Contract: 

Contractor: PRUDENT2010_S 

Contract Option OPTION 1 

Jser Provided Owner Information 

Owner Name: 

Owner Address: 

1 

City: State: Zip Code: 

1 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value | 504.36 

Resident: 

Resident Name: 

1 

Property Address: 

317 WOOLWORTH AV 

Zip Code: 

168108-

Resident Phone 
PROPERTY SUMMARY 

Date: 12/15/2010 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: December 

Property Address; 317 WOOLWORTH AV 

A. EXECUTIVE SUMMARY 

A,l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Infonnation: UC = 69PPM@6" 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 220 PPM @ 6"; EA = 134 PPM @ 2" 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement inciuding 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. 

TECHNOLOCIES. INC. 
TECHNOLCHSIES, INC. 

Propert 'ZC'^^'^ y #: 

Date/Time: 

Quads Excavated: ^ \ 

EPA Property Close Out 

Property Address: 1 ( 7 O) ^ W^ K >W ^ 

Owner's Name: "5 cu^e<T 6<r ix*rV><; /> 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

If necessary, were Uie correcl quadrant(s) excavated and restored? / 

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

Grading Sod and Vegetation 

1. Does the grading around the perimeter of the house in excavated areas generally slope away 

from lhe Iiouse? 

2 Has sod been laid in all areas that were excavated? 

-T. Does the sod appear to be generaJly healthy and growing? (Only evaluate if inspected al a 30 

day lime period) 

4 Are sodded areas generally finn and evenly graded? 

5. Arc the joints belween Uie sod strips gener.^ly tight? (Only evaluate if inspected at a 30 day 

lime period) 

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

7. Was damage to landscaping or plant materials avoided? 

Yes 

y 

/ 

y 

y 

y 

y 

y 

No 

Gates, Fences and Retaining Walis 

1. Do gales open and close freely? (Ifapplicable) 

2. Were all gales or fences taicen down during restoration activiiies reuistalled? (If applicable) 

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

4. Was daniage to reiaining walls avoided? (If applicable) 

Xes 

/ 

/ 

y 

No 

' 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage lo the foundaiion avoided? 

3. Was damage lo windows avoided? 

4. Was damage lo windows or door screens avoided? 

5. Was dainage lo downspouts or downspout extensions avoided? 

y 

y 

y 

y 

A 

Sidewalks and Driveways (Concrete) 

1 Was damage lo diiveway surfaces avoided? 

2. Was damage lo walkway surfaces avoided'' 

Yes 

^ 

^ 

No 
Owners comments: 

Inspection motes: 

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

EPA Representative ^"^ " ^ Date: v\\v^lu^ 
;CHNOLOGIES. INC. 

OLS # 2005.'! 

Date Excavaied: 09/28/2010 

rSEPA Signcd-OfT Date: 

AS - BUBLT DRAWING 

OMAHA LEAD SUPERFUIVD SITE 

20055 

Owner Name: JAMES ROBERTSON 

Address: 317 WOOLWORTH AV 

Phone: H: 402-S93-OS25 W: 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

• Good 

• Poor 

g-' ^ paint 

North Arrow 

<. 

Sample Number 

RYASCPXA-20055 

RYBSCPXA-20055 

RYCSCPXA-20055 

RYDSCPXA-20055 

nDZGCPXA-200SG 

ROZ3CPXA"g005S 

RP23CPXA-20055 

Fl 

F2 

B1 

B2 

-BZ-

-es-' 

-P? 

Lead 

Concentration 

3 82 

J3iu 

50H 

g i g 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

uy 

D 

D 

D 

LAB 

D 

D 

D 

D 

D 

D 

D 

Number of Samples = ; L^ • 

Firm: 

Date: 

Time: 

Sampli es Collected 

l o nL'D -o r 

/ l-Jy> A ^ 

XRF Unit 

Date: 

Time: 

Staff: 

Samples Analyzed 

I031 Book: /33 

n-S'oS-

'± 

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 

:OCT 07 m 

llC(10'.\15') = 69PPMfg!6' 

, ICVX.IO* 

Bl =220 PP.M®6" 

5 a 14 

•- \ •- Q 

(•i__ ___ _: _ V / 

i i ; © 

302 I I'ii ^ 

\ j r f 

.4i... Tt vx,^ 

^Y »P 

Vo m - ^ 

UioolubtfH : K^ 

EA = 134 PP.M® 2-

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
p RIDEN 

P^o^isrVif Completion kgm<Bm®m 

TlliS S.gfec'li'Ciit CiO"JUiiicl';.tS tiit 'J.-.',\iipic:t'i-C)i: 0"; TclJiC/i'ai aCtiv'iiiri pci'iOiiiicd Oii yif; bciC'iV ilS""ic;d pi'LipciTy 

The prope-iT}.' ovvnev's iignatiiie indicates that the prope.rty cw'nev li ia?ii:fie'j vviti-i xiie ('estoia.tion ot the 

subjecl propenv. a;-id tbat sio neTVi rire in q"j-5Sl;ion, riovv., or a'i &riy' time in the fafire, cxcjudiiig any 

reiiiaining ivaiTaat;,-' (30 days tota?) e.iccept those items listed beiow, if any. 

Frop<ir>:-^ iB- L.SLoo£Cl 

.p,o.... -uic/-nc/^n 

lestoffBiitiioi"! lii'^iiiriis m QnsestScrii: 

ftercs: 

ietrr 

SteiiT';-

SteiiTii; 

ReqiiJSFed ci-rreeftcoi^s to comiiolete^ ihs P'f'opsir^iy: 

• II 

LlS^i ?.gi'e* rss'foration is completed, except as noted abovs 

i ! I -10 not agree restoration is ccrnpieled 

OW85£r'S ijJg.Criiiu Jifliie 
Prudenl Technologies, Inc. (Prudenl) is under contracl with the U. S. EnvironmentaJ reelection Agency (EPA) lo clean up leadcotjiaminated soils ata number ofproperties located in Omaha, Nebraska, including the property located al 

t>^ \ \AJ)prO\<J^Oir-TY\ The EPA requests your permi.ssion lo allow Prudent lo perform a soil cleanup al this 

property lo remove lead-contaminated soil. By signing this form, the property owner grants permission to Prudent to perform 

activities relaied to the cleanup including soil sampling, removal of lead-contanninated soil," and restoration ofthe referenced property. 

Ifyou have any questions aboul the soil cleanup planned for your property, please conlacl Prudenl south office .for the Omaha Lead 

Site cleanup-al (402) 733-1188. General questions about the Omaha Lead Site cleanup can be directed lo the EPA Public Information 

Ceniers at (402) 731-3045 (SouthOmaha ofiRce) or (402) 991-9583 (North Omaha office). 

Property Access Granied.Bfr fsu^-^ 

Jll Name) 

PropertyOwner Signature: ( ^ (si5 

RESIDENT NAME: 

gnature) 

PROPERTY INFORMATION 

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

Owner 

(Date) 

\ l \CQ^^ \ fo (- Renter 

RESIDENT ADDRESS: 

0(\.v^>JLg. \SP iz^ I o ^ 

IF RENTAL, PROPERTY OWNED BYt 

OWNER'S MAILING ADDRESS Itrt/NtK i l IVtAlLINtj AUUKti>i>; (. 

OWNER'S TELEPHONE NUMBER - HOME: _i _ 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: 

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

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSi The activities to be implemented by EPA under th;s agrcemcm 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's righl of access to the property is provided for m Section 104(e) of 

CERCLA, 42 U.S. C 9605(e). which provides eiiti-y for "detennining 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 

Kansas City,'MO 64114 

Phone: (816) 363-3703 

Fax:(816)363-3707 

S600 S -0 St 

Omaha. Nebraska 68107 

Phone: (402) 733-1188 

Fax: (402) 733-1883 

4242 Medical Drive, Suite 4250 

San Antonio. TX 73229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
•RUDEN: 

TECHNOLOGIES, INC. 

ENV[RO;VMEi\T.AL & 

CONSTRLCTION 

SERVICE.S 

Property Status Form 

Address: 3^- ^ KiootcOOYH. A.-^-^ ^ ^^*^-

Phone: BVID: 

61 O-Ay [Q-1^ 

^ Kn^^y-y t >vNrI^.. V. .^. (] ^ t^^t^-^ ^ €-<_ , 

Prudent Employee 

3080 Ward Parkway, Suite 405 

KansasCity, MO 64114 

Phone: (816) 363-3703 

^oie* o o "JTAT 

5600 S 10 Sl 

Omaha, Nebraska 68107 

Phone: (402) 733-1188 

4242 Medical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

C..V- /9Hn> C70j:s7 7 
1 Owner Name: JAMES ROBERTSON 

Address: 317 WOOLWORTH AV 

i Phone: »• 402-593-0525 W: 

Omaha Lead Site 

Site Sketch 

illllll iniiiii 

Exterior Paint 

• Good 

• Poor 

Q'^fiot paint 

20055 

North Arrow 

Sample Number 

RYASCPXA-20055 F1 

RYBSCPXA-20055 F2 

RYCSCPXA-20055 B1 

RYDSCPXA-20055 82 

RDZOCPXA-20055 B2-

RQZ3CPXA-200G5 S?-

RPZ3CPXA-20050 P? 

Lead 

Concentration 

362 m^ 

s o ^ 

^ I g 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

• 

D 

D 

LAB 

D 

D 

D 

n 

D 

D 

D 

Number of Samples = | Lj \ 

Samples Collected 

Firm: V ^ M T \ (^(l. 

Date: l O C:L5 O T 

Time: / / •' J. D Ar ^ 

XRF Unit: 

Date: _ 

Time: 

Staff: 

Samples Analyzed 

t03 l Book: 133 

ll'^'OS -

^ 

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 firom the street, facing property 

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legal dimensions: 33X132 

Printed: Dec 02.2010 

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Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2594313. 

Original Call Date: 9/16/10 Time: 3:06 pm 

Work to Begin Date: 9/20/10 Time: 3:30 pm 

State: NE 

Address: 317 

County: DOUGLAS 

Street: WOOLWORTH AVE 

Op: SIVA18967 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 26-NW 

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 : 

Contact Name: 

PRUDENT TECHNOLOGIES 

SIVA JAMPAMA Phone: (402)733-1188 

Work Being Done For: EPA 

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

Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWESTNE 

Service Area 

CXCATV 

LEVELS 

MUD02 

COX COMMUNICATIONS, INC 

LEVELS COMMUNICATIONS, LLC 

Contact 

HEIDI 

NA 

METROPOLITAN UTILITIES DISTRICT SANDY 

Phone Number 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

Utility Type 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
Page 2 of2 

Alt: 4062071494 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 8002834237 

QWESTNE QWEST LONG DISTANCE Alt: 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
TEeHNOUMieS, INC. CONSTRUCTION 

SOLUTIONS 

SITE SAFi:TY HAZARD ANALYSIS 

Address: .^i^-^iJiMlil_i±' . 

Crew: 

Excavation Date: -JU-^I^ — 

BackfiU Date: ^M.\J ^ 

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 

Condition 

i ^ ^ 

e^ 

h^' 

v^ 

ore 

a/"^ 

pcc<^ 

csy^ 

,S"<-

a^— 

— — 

y_^^ 

Hazards 

l^C^^ i A.<4-M5. ^ 

' J ^ 

Corrective Action 

O C (=» / P ifc ^ 

\i 

Crew Foreman Site Safety Office 

Date: 

1080 WanH?aritHay, Sute 405 

Cansas City; Ha64114 

•hone: (8f6) 363^3703 

^ac (816) 363^3707 

:»00S10St 

Phone: (402)733-1188 

Fax: fUO) 733^1883 

4242 Medical Drive, Stdte 7250 

San Antonio, TX 78229 

Phone: (2T0) 822:^588 

Fax; (210) 579-6577