TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 35784 DATE: 1/15 

ADDRESS: 2028 GRAND AV 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20li 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 PRE AND POSTVIDEO OF PORPERTY (DVD) 

H EXECUTIVE SUMMARY 

0 EPA-PROVIDED PROPERTY SKETCH 

S^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

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

0 CONFIRMATION DATA 

T ^ PHOTOGRAPHS 

W AS-BUILT SKETCH 

0 ^ SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

^ PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

TT / UTI LITY CLEARANCES 

CK PROPERTY INFORMATION FROM DOUGLAS COUNTS ASSESSOR'S OFFICE 

D 

D 

D 

Bc^-sft^ 3)lZ/li 

SIGNATUR JNATl E DATE 

30218361 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2028 GRAND AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 298 PPM @ 2"; EA = 62 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 Checlclist 

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: 

Remediation Query Lead Remaining Query Property Damage Query 

Sample Area: 35784 ­ 2028 GRAND AV 

Owner: User Provided Owner Information Resident: 

D Owner Occupied 

Owner Name: 

AUCHJEREMY J 

Owner Addressl: 

Owner AddressZ: 

J2014 GRAND AVE 

City: 

loMAHA 

Owner Phone 

(402)672-7540 

State: Zip Code: 

NE |68110-

Alternate Phone: 

Owner Name: 

Owner Address: 

City: 

Owner Phone: 

State: Zip Code: 

Alternate Phone: 

Resident Name: 

Property Address: 

}2028 GRAND AV 

Zip Code: 

68110-

Resident Phone 

Contract: Assessment: 

Contractor: jPRUDENT2010_S Qualifying Group 400 

Contract Option jOPTION 2 " Assessment Max XRF Value f 475.17 
TECHNOLOGIES ' , INC. 

"yn'^.-..y s^'^ 

EPA Property Oose Out 

Propeity #: "? ^ 7 S:' ^ Property Address: '7 6 2 ^ ^ " ^ ^ ^ 

Date/Time: Owner's Name: "S.t.T-cwv.-v 'T<^OCA/\ 

Quads Excavated: m Contractor Group: Prudent Technollogies, Inc., 

Excavation General 

Yes No 

I. If necessary, were the correcl quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas of drip zone e.xcavated 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 tlie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) y

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

5. Are die joints between the 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? y 

7. Was damage to Lindscaping or plant materials avoided? y 

Gates, Fences and Retaining WalSs Yes No 

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

2. Were all gales or fences taken down diuing restoration activities reinstalled? (If apphcable) y 

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

y 

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

y 

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? 

y 

3. Was damage to windows avoided? 

y 

y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage lo downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes No 

Was damage lo diivewav surfaces avoided? y 

Was damage to walkway surfaces avoided? 

y^ 
Owners comments: 

Inspection notes: 

y^/ . . 

y 

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

EPA Representative ^"^ ^ ^Date: A^ 
CIINOUXilES, INC. 

AS - BUILT DRAWING 

OL.S # 35784 

Date Excavated: 10/22/2010 OMAHA LEAD SUPERFUND SITE IISEPA Signed-OfTDate: 

i.' 

Omah a Lea d Sit e 

Sit e Sketc h 

Owns r Name: DOMINICK J ZAPPIA 

/Wddress: 2028 GRAND AV 

Phone: H W. 

Sampl Lead Sample e Number LAB Concentration Ccllected 

RY.ASCPXA-35784 Fl .'7 6 ppm n 

RYBSCPXA-357e4 F2 3 5 / ppm T3r n 

RYCSCPXA-35784 Bl W7T ppm n 

RYD3CPXA-35784 B2 .9 2,'7 ppm D-' D •Re2Sef'XA'95-?-84 ©2- — ppm D D — ppm D D 

RPZ0CPXAOG7C4 P?- - ppm D n 

Number of Samples = 4-

H16 

Bl = 298 PPM a: 

O 

i c T % G^t'»'^d Rv 

-i^:^— - ­

^ P\ F L . 

n 35.1. s : i 

•>-Ja-i>^ 

.'. UO.!^. A >\ 

35784 

Exterior Pain! 

• Good 

• Poor 

P^Mot paiM 

Samples Collected 

Date: f-,5 • '.X- c U 

Time I: .A n p ^^ 

Samples Analyzed 

XRF-" Ur^it: 9C X Book: li£i_ 

Date: 7 -? 

Time: Al±. Staff: r'^.^A^ 

ENTERED 

HAY 

'>n«h8 I «id Site 4M30 E.\ = 62 PPM .-d SCRAPE (-1") 

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

AS - BUILT DRAWING 

OLS # 35784 

Date Excavated: 10/22/2010 OMAHA LEAD SUPERFUND SITE ISEPA Signed-Off Date: 

Owner Name: DOMiNicK J ZAPPiA Omaha Lead Site 

A.d(ircss: 2028 GRAND AV Site Sketch 

Phone: H W: 

S ample Number Lead 

Concentration 

Sampte 

Collected LAB 

RY/ASCPXA-35784 F1 / 7 8 ppm n 

RYBSCPXA-35784 F2 -3 5 / ppm D 

RYCSCPXA-35784 Bl _M12_Pp m \3r D 

RYDSCPXA-35784 82 o* 2.-°? ppm B-' D •ez­ ~ ppm D D 

"xycr ~ ppm D D 

RPZ0CPXAOG704 -PZ­ ~ ppm D n 

Number of Samples = 4­

(»i\« \ 

V . • .6 2, 

Bl =298 PPM a 

f 

CJ 

'L % OfV^nd Rv 

- i ­

i 

.•c^ 

F> FL 

r/8 35/, 

V-i a-jv^ 

U«in (i. '.fi'J 

35784 

Exterior Paint North Arrow 

n Good 

• Poor 

0^Not paint 

Samples Coliected 

Firm: FJ^M \ RSi QJ 

Pate: r,S- i g - Qj. 

Time I: ^ n p N^ 

Samples Analyzed 

XRF Unit: 902 . Book: tl8 

Date _^yi2__o(s_ Time A£± 

Staff: f^.TW 

ENTERED 

HAY 2 i. mm 

Omaha I .cad Site If. 130 EA = 62 PPM @ SCRAPE (-1") 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
0

«ERIV 

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: • l^ o L "i (^^^^^ J 0 ^ ^ ^t-y ^ -^^-C T^c 

Owner: -f^^^-x y 0 ' A^oi , 

Phone: {HoZ ^ ^"7 ^ -"7 J ^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required • corrections to complete the property 

S.oM u^cS t C ^ - ^ r — fA .s ^ ^ b h/^c K£y[ S r d-^n 

j y c l tf. ^^^" f / ' 5.ct - '^'-i y 0 ^ »^^ . 

 I agree restoration is completed. 

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

y ^ \QA y / ^ iV-^-i u 

Owner's Signature Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soUs at a number ofproperties located in Omaha, Nebraska, including the property located at 

3 - 0 H R WfCKir^UK A\/ The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to tetnoii lead-contamuiated soil. By signing this form, ttie 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. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent South Omaha Office for the Omaha 

Lead Site cleanup.at (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office). 

Property Access Granted By: yji cy-c A^cC 

(Please Print Name) 

Property Owner Signature: 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: ^ k A r)w.^>X^ 4y(/ O --^ ^ 

IF RENTAL, PROPERTY OWNED BY n 

^ 

OWNER'S MAILING ADDRESS; Y ' Y ^<y^ r ' (\ ^^ . 'Z. ^ 

TXA 

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

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 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 ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess 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'" 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 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^ D 2 - ^ CUcoiodl A v>-^ Date: I O | Z* ^ ) ( Q 

Phone: BVID: 

y^ 

Property Ch^ 

8080 Ward Parkway, ^uite 405 5600 SIO St MMHcal 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) 579-6577 
35784 

Owne r Name: DOMiNiCK J ZAPPIA Omah a Lead Site 

/Wddress: 2028 GRAND AV Site Sketch 

Phone: "^ w: 

S ample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-35784 Fl I2_a. ppm \3r D 

RYBSCPXA-35784 F2 ^1?l ppm D 

RYCSCPXA-35784 B1 ppm D 

RYDSCPXA-35784 B2 ppm n 

RD200PXAO0704 BZ­ ppm n n 

RQJ0GPXAO5704 GZ­ ppm n D 

RPZ0GPXAf357(M PZ­ ppm D n 

Number of Samples = ; 4* 

"<*lVe\ 

H16 

> 

"C ­

<3\­

' X ?, Cf f avta ftv 

-iI 

/76 I 

35/. 

Exterior Paint North AmNtf 

• Good 

• Poor 

0^Not paint 1

Samples Collected 

Firm: Pbft \ R&lr»> 

Dale: iiS;_LiJ^.a£^ 

Time: Ji2uM2J!a-

Samples Analyzed 

XRF Unit: 902 . Book: IIQ 

Date: _ ^ Z-^ •CT-' 

Time: A M 

Staff: M<i\f.f 

HAY 2 2 ^ 

Wa-^i 

.QUrflifx «i. - i^v^. 

Omaha Lead Site 46130 
Lega

l Description: 32 X 125 

A ViHiiiM Printed: Oct 25, 2010 

www.dcgis.org/dogis 
Ticket Text and Map display for Ticket: # 262547 5470 0 ht^://w\yw.dhoaor^irthintemet/MessageTexl/MessagpTextAndMap.a. ^irthi .

Original Call Date: 10/25/10 

Work to Begin Date: 10/27/10 

Time: 11:32 am 

Time: 12:00 pm 

Op: SIVA18967 

State: NE 

Address: 2028 

County: DOUGLAS 

Street: GRAND AVE 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 03-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 : 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 

OMAHACOF 

CITY OF OMAHATRAFFICSEWER 

RICH/TRAFFIC

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER 

DISTRICT 

ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK 

ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

View Map 11 Close Map 

lofl 12/23/2010 11:19 AM 
me CONSTHUCTION . SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: 2/? 2yi -^sgrua^JLJ&/.- Excavation Date: 

Crew: BackfiU Date: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Wails 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Othier 

Crew Foreman 

Condition Hazards Corrective Action 

c:/ ^ A=^.> 1..,^. 

"-^3 -i 

e^ 

h^\ j ' 

; 

or<­ ay^ 

PC£><^ 

csy^ 

<r^ 

o*-^ 

-

Site Safety Office 

Date: 

BO Wtafd Vaitaray. SuilB 4ff5 SSOOSIOSt 4242 Medical Drive, Suite 7260 

nsasa)y;Ma««114 OiKttar NebnMtai 08107 Son Antonio, TX 78229 

ftaiM : (402)733-1108 Phcme: (2t0)822«588 

C inS) 363.J707 Flax: (402)733^1083 Fax: (210) cr9-6«77