TEeRRsrsETEsrnJcr 

PROPERTY SUMMARY SHEET 

dihaha Lead Site Remediar Action Contracts EP-S7-10-05 

Said: 29140 

Executive Suinmary: 

.•i - Issiies Encpiihtered: None. 

•.; issues Resdived: None.. . 

• Uhique Findings: 

• Other Relevant Information: 

• CONFIRMATION SAMPLING DATA/RESULTS: B1 

EASEMENT. 

Attacliments : 

Documents Included in the Property File: 

.PropertyAddress;2711 N 26 ST 

30261384 

ilium 

Superfund 

= 422 PPM @13"; B2= 206 PPM @13"; NO 

Property sketch provided by EPA pursuant to contract specifications 

Signed Access Agreement; including access agreements obtained (if required) for crossing 

onto adjacent properties . 

Pre-excavation agreement details (if any are made with the Property owner) 

Pre-iExcavation.digital video dip 

Sampling data sheet.. 

Post-Excavation digital video clip 

Documentation - Completed EPA close-out checklist 

As-Built sketch 

, Omaha Lead Site Database sample information documerit. . 

Signed form verifying satisfactory restoration 

Other Dpcunients: 

30 day SOD warranty pictures 

Utility clearances doicument 

Property informatiori from Douglas County Assessor's office. 

Settlement documents (i.e. for any damages, replacement of plants, etc:) 

Site safety hazard analysis document with pictures. 

Legend: Yes -: Included In the File; No - Not included in the File; N/A -' Does not Apply. 

Prudent Representative: ^o V EPA Acceptance: 

>\\ 

Date: y Date: 

^ 

Yes No N/A 

V 

V 

V 

.-v... 

v: 

V 

V . 

V 

V 

V 

V 

V 

V 

V 

V -' -

Prudent Technologies, Inc. j 2505 N. 24TH Street, Suite 308 jOmaha, NE 68110 USA | Tel. 402.504.1004 j 

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation j Construction 
• i i i III IIII III 29140 

Exterior Paint North Arrtw Owner Name: MARLA M WYNN Omaha Lead Site • Good Address: 2711 N 26 ST Site Sketch • Poor 

Phone: H: W: •• * 

[yNo t paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected 

Firm: A5\M £ M kA^ 

RYASCPXA-29140 Fl ua ppm D

i Date: ^-3L\-OV.^ 

RYBSCPXA-29140 F2 2:\-l ppm a Time: ^-'^fi 

RYCSCPXA-2914 fei. 0 Bl H3,l ppm D 

RYDSCPXA-2914 Samples Analyzed 0 B2 5U O ppm n 

RDZOCrXA-20140 BZ­ ppm D XRF Unit 700 1 Book: J{ft3L 

ROZOCPXA 20140 S i ppm D n Date: 8ZZ'OCr> . nrzocpxA 20140—pz- ppm D Time: /Vrvi D Staff: fAgs^ ; Number of Samples = [ ^ 

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

All quadrants are as viewed from the street, facing property 

61 mr. ENTERED 

AUG 2 12006 

3^-711 \n -zy sr 

431 5(pO 

.?2r 

.m Zll 

W9.I0 Sr 

Rev 4 046141.0)23 
PROPERTY ACCESS FORM 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency 

(EPA) to clean up lead-contaminated soils at a number ofproperties located in Omaha, Nebraska, including the 

property located at ^ ^4-1 I K^if OJ.CQ^'T^ . The EPA requests your permission to allow Prudent to 

perform a soil cleanup at this property tp remove lead-contaminated soil. By signing this form, the property owner 

grants permission to Prudent to perform activities related to the cleanup including soil sampling, removal of leadcontaminated soil, and restoration ofthe referenced property. 

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

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 Omaha office) or (402) 991-9583 

(North Omaha ofTice). 

Ifyour property has a gravel or dirt driveways or parking areas then the removal and replacement ofthe soil 

and/or gravel during the remediation process doeinot make your illegal gravel/dirt driveways or parking areas legal. 

Property Access Granted By: ' < '7/yVlil7K y 7s\.y2iPyhi'*y > 

*• (Pleas^rint Name) 

Property Owner Signature: ^hai

(Signature) ^ (Date) 

Property Accessed (Prudent Employee Name)

''• _....G^\.£redjQ__J^kDii2:£ia. 

PROPERTY INFORMATION (To be completed by resident and/or property owner ~ please print) 

\>i RESIDENTNAME: ( S«^rt e <^^ £LDcN&- ) /^Owner] Renter 

2.V: IF RENTAL, PROPERTY OWNED BY: /V)/ A 

3.410WNER'S MAILING ADDRESS; ^^'j ^ Kyjpj d U T 

4. J<OWNER'S TELEPHONE NUMBER - HOME: (V^ ^ ^ll^^ L WORK: J _ 

5. TENANT'S TELEPHONE NUMBER - HOME: ( ) WORK: _ L _L 

6.y AGE OF HOME?: N// V YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

7i<; HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 _YES V NO 

Z ^ # OF OCCUPANTS UNDER AGE OF 7: (\) D # OF OCCUPANTS AT OR OVER 7 YEARS OLD^ 

94^# OF CHILDREN UNDER AGE OF 7 WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

1 ^ COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, NEIGHBORING PROPERTY 

ETC.) 

AUTHORIT ORWYe PO FR f NVIR0NMEN NVIRONMENTA1 L RESPONSE ACTIONSi 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 fbr 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." 

Prudent Technologies Inc. 5600 S. IO*** St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: 9.'^lV(sJL- 'St<o IT T Date:Cl-3.q^l( 

Phone.'i ''•[7\<^y\ 

NOTICE TO BE GIVEN TO: /OWNER I TENANT BOTH , ^ 

HOW MUCH NOTICE IS NEEDED: 24 HOURS /48 HOURS ^ HOURS < 

OTHER NOTICE NEEDED (PLEASE SPECIFY): 

PHONE # AND NAME TO WHOM NOTICE NEEDS TO BE GIVEN: 

lto.r\aZ\M^(\r\ - 4ox^ S7A ^67^ 

WILL NEIGHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES NO 


jlF NEIGHBORING PROPERTY WILL NEED TO BE ACCESSED WHAT IS THE ADDRESS: 


WAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES NO 


twILi L A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YES NO 

IF ANSWERED YES TO NUMBER 12 PLEASE PROVIDE LOCATION OF FENCE: 

lis THERE PRE-EXISTING FACIAL DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND DESCRIPTION 

)FSUCH: YES NO SPECIFY: 

IS THERE PRE-EXISTING CONCRETE DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH: YES NO SPECIFY: 

Property Owner Prudent Employee 

signature;. Signature; CjjJj^J\li€>y^^cMj2< ^ 

J 

^DATE: ^7J^^/JPC>/ , 

Prudent Technologies Inc. 5600 S. lO"" St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Inspection Form 

Address: ol"^ I ( M- ^l ^ ^ ^ Date: C^--Q.«-{ - 1 ( 

Phone: (M,Q ^ BVID: oi q i q b 

Pre-Existing Damage: Please write in detail and included location 

and description of damage; 

Concrete Damage; 

Facial Damage Including Siding: 

Does Basement have history of leaking or flooding? YES NO JC hflK 

Does Homeowner want sod replaced in all areas?(YES J NO If NO please provide what 

^ areas are not to be sodded and what needs to be replaced instead of sod (i.e. mulch, rock, 

leave bare) if mulch or rock please specify what type and color; 

ANY OTHER DAMAGE OR REQUESTS; A /V/A 

Property Owner , Prudent Employee 

Signature: H* ^i^'J^SL^tJ^fX^ ; Signature: Cy-Lx-J^J^ ^Q-^&idU^hi 

I DATE: ^ '^/^^i?QI / DATE; ^ - 0^^.-<| 
ENVIRONMENTAI. & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES • t m 

XRF CLEARANCE SHEET 

PROPERTYADDRESS: 7^!.[(' I/.,^^t^*^ ^ --.2 

PROPERTY ID:. .^: [• ^ 5 • ' 


iVlAP HAS BEEN REVIEWED AND NO MISSED AREAS EXIST: NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHFiRE AND DIMENSIONS: 

GREW: 

XRF TECH 

DATE DEPTH QUADRANT 

Fl 

.^F2;. .,•; 

READING 

. • ' ' . '•• • 

READINGS DOCUMENTED IN 

LOGBOOK?/ ^ NO 

m 

f/i^f . 1 

yz' • \V" 

Bl 

B2 

GARDEN 

'^-^ ^ 

y^\, . 

• ' • . • 

PLAYZONE 

EASEMENT 

. • „• ' ­

. ...,.,. 
• y i-i.'B [• v^s'Sv •^•• ^ jis^irr^Rfcrr ^•\yy£dJlM ^ 

-raCHNOLOGIBS, INC. 

Property #: 2.^1^ 6 

Date/Time: 

Quads Excavated: ^( , ig ^ 

EPA Property Close Out 

Property Address:-^7// AJ '2.<i ^f ^ 

Owner's Name:/A^y.\^ {jiii>^-.-\Y\ 

Contractor Group: Prudent Technologies, Inc, 

Excavation General Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? v 

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

Grading Sod and Vegetation Yes No 

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

2. Has sod been laid 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 time period) . • 

4; . Are sodded areas generally firm aiid evenly graded? / 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspecled at a 30 day / timeperiod) 

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

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates ope.n andclose.freely? (Ifapplicable) / 

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

3. ^yasdaJ^^age.(.o gates or fences avoided? (Ifapplicable) . ' y . 4. Was dainage tb retaining walls avoided? (Ifapplicable) . y 

Foundation, Sidiiig and Gutteris Yes .No. 

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

2. Was damage to the foundation avoided? y

Wa -7 s daraage to windows avoided? 

4. Was dantage to wiiidows or door screens avoided? y

5. Was damage to downspouts or downspout extensions avoided? 7

Sidewalks and Driveways (Goiicretc) Ye» No 

1. Was da.niage to diiveway surfaces avoided? f 

2. Was damage to walkway surfaces avoided? 7
Ownes's comments: 

Inspection notes: 

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

EPA Representative A^jjC- Date: ufaofn 
AS - BUILT DRAWING 

Sample Area; 291+0 - 2711 N 26 S*. 

Date Excavated; 10/14/2011 OMAHA LEAD SUPERFUND SITE 

Sampled By:; Isaac CONTRACT #: EP-S7-10-0S 

29140 

Omaha FxlRrior Paini Lead Site Owner Name: MARLA M WYNN 

Site Sketch • Good Address: 2711 N2GST • Poor Phone: H w Q ' Not pai>it 

Sample Number Lead Sample Samples CoUected LA8 Concentration Collected Firm; isy.ii xj.i. y.-y-

RYASCPXA-29140 Fl _ ppm D Date 

RYBSCPXA-29140 F2 y zn _ ppni • Time: 

RYCSGPXA-29140 Bl ^3 1 PP'Tl D

0" Samples Analyzed 

RYDSCPXA-291.40 B2 5 inO ppm D 

RO-ZSePXA"?*t4e ©2­ • ppm • XRF Unit: iOC.y[ Book. j(p'^. 

Re£S€-f^A-?9140—GZ ppm D • Date: 6 • ^ 3 • C-LD 

RF*S€PJ<A-29440- P^­ ppm D Time: n 

Staff: K^v ^ Number of Samples = 

Legend F» = Front Left F2 = Front Riglit, 81 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Play 

AH ouadrants are as viewed trom lhe street,, facing pfoperty 

• • '' t I 

bi. EMTB \iy p m. 81 = 422 PPM @13" 

:r?n iN y{c'-f^ 

431 5(pO­ B2 = 206 PPM (5) 13" 

>^. 

iTKavs 

^...^ y 

Ft 

.\n 

NO EASEMENT 

• Ni 9lir> ST •; 

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Renetiwtion Query I I L«(JR«moiwKjQurfv I ! Property DBBWOC Query I 

Pnyarty laib | dean-up Info Ssmple Info cmilninef CallB | SMwwu* Repair 

^Hopl e Area: 2914 0 2711^^6S T 

Sarrpi" D3'« . Cmadcant .t; Paramete. XRF R( . IXRF Rw . lExc . M = L*?^ Pe""?irin . In?. Sampled 6 -t QA Confirmee . Lab_Res' 

IMttWiHI '•' LEAO ^^SKS^f. 13 M/A 

10 '. _ i: r LEAD 422,mg/kg IJ _ ^ ISAAC J-l/A _ 

"" LEAD "im^ g y' ' 0; J L ^ ' !N<A _ L 

M ». ••?• •'• f'•:•- Sur * •n,..?-.. ,» „ 

l)e«i<d M . 1 «f I 

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Thiis aigreeiiieRfl.crdctaanfents.lfte cojnptetraiji o-f iJemoval! actiiv-iliies pciiiformed .on ttee belbw Ifeiied, pFopeity. 

The pEoperdj 05WBier''s' s%i3at;u*e Wieates thafet&fi ptoperty ©wnei*fe. satisfied witli the. j:est©Fa4.ian; ofthe 

sabjecti. p«0fieirt?., atid: fli^t no. ifems af& m. jquestfeni, now,, oi at. aniy tttne H* tiie fatur-e,..exelu!dmg any 

retiHaiitirig warmity ^30. days, tofal^} except tiiose kietai^^ 

pyoperty IP; J X ^ ^ S Q 

Plrofwjrftjf! Ad'dressr. J^L""! ^ \ 2t­ €>wffler: HwT A^ 

PfeoRer. tAno - < n 

R6slorati1<m: in Qccestionr 

ll agree restbratibn is com pteted 

I- cto no* agsee restoration is eompleted at (noted deficieneies above). 

Owner*s' SifnatjifiFe ~/7~ Date- \ ' 

IRTH One Call Page 1 of 1 

< >IM C -ti l 

Digaers Hctlin* 

Of 

Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2873885. 

Original Call Date: 10/11/11

Work to Begin Date: 10/13/11

 Time: 12:59 pm 

 Time: 1:15 pm 

Op: ASHLEIGH18 967 

State: NE 

Address: 2711 

County: DOUGLAS 

Street: N 26TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 09-SE 

 Sect-Qtr: • : 

Type of Work: LEAD SOIL REMEDIATION PROJECT 

Location of Work: ENTIRE PROPERTY 

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

: UNSURE CORNERS 

Company 

Contact Name 

Alt. Contact 

PRUDENT TECHNOLOGIES 

ASHLEIGH ANIKPUTA 

NONE 

Phone: (402)733-1188 

m 

Work Beina Done For: EPA 

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Printed: .Apr 1 1,2011 

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Addres .yf W L ZX\& 2 ^f'^'-:•:-;:.>:-:^> Date 'J^ - -^Q 

' ' .^Analysis Completed By .|-' /"|;r^\--.| f, \f7\777 y Pnident Technologies Health and Safety Officer ly ^"€-.y.. -yx-/zyx/y\j y yw-^^ SHyy-y > y uy... ^^^i 

Item 

Overhead Power Lines 

Gas Lines 

Water Lines 

Sewer Line 

Septic TanJc 

Propane/Butane 

Foundation (DZ) 

Driveway 

Side walk 

Trees 

Plants/Garden GZ 

Access to Property 

Busy Street (need to close 

off Lane) 

Hand Dig 

Pets /bees/wasps/ticks/red 

ants/spiders 

Poison Ivy/Poison Oak 

Miscellaneous •« f , . , 

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Condition Hazards 

Electrocution 

Underground Gas, water 

Utilities leaks 

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Corrective Action 

S~v?^7\4!Ji^S*? 

Call Digger Hotline Prior to perfonn locates prior to 

beginning work on property 

If utihties are not located contact Supervisor, Safety 

Personnel to notify them of issue 

Go to another property to work as directed 

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