SAID#: 25593 

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

DATE: 1/15 

ADDRESS: 3639 CHARLES ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20lt 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Gf PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

U SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

I RESTORATION AGREEMENT 

D 

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

CONFIRMATION DATA 

PHOTOGRAPHS 

ti AS-BUILT SKETCH 

ti SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

ti PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

u DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

UTILITY CLEARANCES 

tll PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

a 

D 

D 

30237543 

unm 

Superfund 

^fl*« ^ jiiwi i 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address; 3639 CHARLES 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: 

GZ = 321 PPM @ 6"; DZ = 145 PPM @ 6"; EA = 68 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 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 (ifany 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 Remediation Query I Lead Remaining Query | Property Damage Query 

Backfill: 

Sample Area: 25593 - 3639 CHARLES ST 

Owner: 

n Owner Occupied 

Owner Name: 

I MILLER CHARLES E 

Owner Addressl: 

I 

Owner Address2: 

|3639 CHARLES ST 

City: State: Zip Code: 

lOMAHA ~ |N E |68131-

Owner Phone Alternate Phone: 

1(402) 553-2086 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option lOPnON 1 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: State: ZipCode: 

1 i 1 

Owner Phone: Alternate Phone: 

1 1 

Assessment: 

Qualifying Group [400 

Assessment Max XRF Value [ 697.2 

Resident: 

Resident Name: 

I MILLER CHARLES E 

Property Address: 

|3639 CHARLES ST 

Zip Code: 

|68131-

Resident Phone 

I 
TECHNOLOGIBS, INC. 

EPA Property Close Out 

Property #: U)'^^! / Property Address: 3 (^^"^ CWs>j~'^C^ 9^ . 

Date/Time: Owner's Name: CW^e ^ ^r^- T 

Quads Excavated: VZi (<>Z— Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

I If necessary, were the correct quadrant(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 the perimeter of the house in excavated areas generally slope away 

from the house? / 

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

"i. Does tJie sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) / 

4 Are sodded areas generally finn and evenly graded? / 

5. Are tlie joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / time period) 

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

7. Was damage to landscaping or plant materials avoided? / 

Gates, Fences and Retaining WaUs Yes No 

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

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

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

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

Foundation, Siding and Gutters 

Yes No 

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

2 Was damage lo the foundation avoided? y 

Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

5. Was damage lo downspouts or downspout extensions avoided? i\ 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage lo driveway surfaces avoided'? / 

2. Was damage to walkway surfaces avoided? y 
Owners comments: 

Inspection notes: 

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

EPA Representative 9"^ jQ»^ ^Date: \\\tt\w 
I'HNOLOGIFS. INC 

AS - BUILT DRAWING 

OLS # 25593 

Date Excavated: 11/10/2010 OMAHA LEAD SUPERFUND SITE 1SEP.4 SIgned-OIT Datej 

Name: Omaha Lead Site 

Address: Sfc^1r/^/*«i.£5 5T Site Sketch 

Phone: _ 

Team K-Vg/^-/,</; r^^K BVmit ^S5'' f 3 

Sample Number Lead Concentration 

ppm 

ppm 

3So t ^ B pp^i; 

5

6

 Kiyz.^cf>Xyf ­ T^^S'f^ 

 ^<^v^/v' ^ ~7--5yys 

ppm 

ppm 

ppm 

7 ppm 

Date North Arrow : y^A ^ Time : / • </£/ 

XRF Code 7BB 

Confirmation Sample 

f l Yes n No (SI 

^2 Yes CD No 12 

bt 

. 6-

3 

Yes

 Yes

 a 

a 

No

No

 £2 

 t2 

Li/l Yes n No 121 

fc Yes l a No CD 

Yes • No n 

i i ' i Al l 

i

i

 6 

 P ? "rr 

//^yt^y i 

17­-

rar...... 

1)7. = 145 PPM® 6" 

cpct^i^^ :v 

I' 

VI 

'•''"••, 

ir/t 

4 ://SVJ^ . 

?«" 

f ^ 

'.m r i,-^-y^^ K E.V = 68 PPM a SC RAPE (-1") 

Omaha Lead Site 46130 

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

Property Completion Agreement 

This agreement documents the completion of removal activities perfonned 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, ifany. 

Property ID: ^^^13 

Property Address: 3 ^ 2> < rtcy\ ^ ^ ^V -

Owner: gJ^A. ^ 'gd^^T ^ 

Phone: 

Restoration Items in Question 

Item 

L J I agree restoration is completed. 

 I I do not agree restoration Is completed at (noted deficiencies above) 

/ / _ /7 _ -XO/ o 

wner's Signature Date 

I
( 

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

. The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, the propeity 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 fbr 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 hiformation Centers at (402) 731-3045 (South Omaha office). 

Property Access Granted By: th.yU.^A^'A l^ilUr 

(Please Print Name) 

Property Owner Signature: dAM'.yy-'?^/ ^^-' [/y» 

(Date) (Signature) <=^ / i 

PROPERTY INFORMATION 

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

RESIDENT NAME: ["yuyM^ elk. m\<y Owner> Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADpRESS; . - , /i /) 

OWNER'S TELEPHONE NUMBER - HOME: I^OL) S^S'j-.3.6 ^ (^ WORK: 

J 1 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? v/^YYEE S NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: 0 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.) 

AUTHORFTY 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'sright 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 ofthe title." 

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

KansasCity, 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: (402)733-1883 Fax: (210) 579-6577 
corHsTRocrro^ 

TECHNOLOGIES, INC, 

Property Status Form 

Address: -^ ^ j<^ CL^^i^ ^ ^^**'" ///^/z^/ O 

Phone; 

/ne^iAc - /]->g^^f5 A'^ ^ Q> I f i> 

" B/ '^ ^XCAV/S^C^ ijl^^io-Q 

Ay^cl^A/^ Arzjfy- 752 , ,rf ^--^ P?^^7)^^ ^/^ 

mv ?fM 

/Ju/tAAi -£xc^^^Ty/ < /^5^ o 

£Ar^ y ^ ^fcAo>l^y- K (/^y<P p 

r 

L 

Property Owner Prudent Emjjioy^e .'v- ^ 

Signature; A(-'AA/ / sAy^^y^^ 

30S0 Ward i^avHwsv. i^initf 40;> 

viatis. r.k-"b!'astf:;i .'iSuVi y •'i •\y\f.^¥,t:i\ Diivij, :M\xsi it^fiw 

.-^hone; (r.f'iSi :56:"-;-'-'70:> hn;-,f:: •'iiiiii ?;i;;-ri3y C - . y • / ,li>^ \ -r-.-r ..Oi.>-. ' ;'>-«?nf>.; ji:ii:t)r-:S-ji.:-t,S3if 
Name: Omaha Lead Site Date: ">AlC/Ci'b North Arrow 

Address: ^U^ ^ r ^tAlJLf.^ S T Site Sketch Time: / -¥0 

Phone; I 

Team i^Jy>^A^mi:^ y BVID #^SS^3 XRF Code 7BB 

Sample Number Lead Concentration Confinmation Sample 

ppm F' Yes tn No 121 yye'scf='x^ •• ^^^ ^ 

ppm ^2 Yes 1=1 No 12 

ppm Yes n No Q Kyi7^^/=^xy?' z^-^s-^s h i 

ppm 6^ Yes tn No ^ 

ppm 01 Yes tn No EI 

ppm Cy Yes la No a 

ppm Yes 1=1 No • 

^yyi y t^y ^ K 

Omaha Lead Site 46130 
11/4/2010 R19203200000001A.jpg (640x480) 

.mapping-online.com/.../R1920320000.. 1/1 
ui 50x130 

A T^TIP^ 

Printed: Nov 04, 2010 

www.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back tojrth Internet Send Email 

YOUR TICKET NUMBER IS 2634306. 

Original Call Date: 11/04/10 Time: 8:31 am Op: SIVA18967 

Work to Begin Date: 11/08/10 Time: 9:00 am 

State: NE UGLAS Place: OMAHA 

Address: 3639 Street: CHARLES ST 

Twp: 15N Rng: 13E Sect-Qtr: 16-NW,17-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 LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

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... 11/4/2010 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/4/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address Excavation Date: llJO^cfilO 

Crew Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines T^i^o^r 

Gas Line oc^n no i .?.<'e "^^^tieoL 

Water Line 

Sewer Line 

Septic/Leech 

Field 

^^^ n

[),c:^h 

ncA 

 noi

{\0'\

 ^'^-^ 

 3­

Propane/Butane /. ^ 

Sidewalk OP??C^ 

Foundation hli 

Retaining Walls /) 0 

Fences J0± 

Trees ( ^ 

Structures 

Driveway 

oA. m^ 

Sprinkler System Jld. Other n D 

Crew Foreman Site Safety Office 

Date: 

r. Sutte 4IB S800S108t 4242 Medical Drive, Suits 7250 

lC«ly;ilO«4114 OmMa, Nafanafca tttor San Antonto, TX 78229 

Phona: gi6)a6>'3703 l>lMne: (4a2)733-11S8 Phone: (210V822«S88 

Fae (81C) 363-3707 Fax: (4a2)73»<ta83 Fax: (210)679-6577