TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#; SA-^HO DATE: 'l<5-

ADDRESS: A-4-^S >^ 3.^ S.7 

REMEDIATION CONTRAaOR: PRUDENTTECHNOLOGIES. INC. YEAR:_2oiL 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Q PRE AND POST VIDEO OF PORPERTY (DVD) 

of EXECUTIVE SUMMARY 

EPA-PROVIDED PROPERTY SKETCH 

y SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

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

n CONFIRMATION DATA 

PHOTOGRAPHS 

AS-BUILT SKETCH 

0/=SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

13 PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

izf PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

>\\a\\\ ^ 

SIGNATUR ATURE 

t DATE 

30218891 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 4425 N 22 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: 

B2 = 57 PPM @ 4"; NO EASEMENT 

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, ifavailable, 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) fonnat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
Find Record Remediation Query i Lead Remaining Query I Property Damage Query 

Backfill: 

Sampie Area: 34270 ­ 4425 N 22 ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: 

jOMAHA HOUSING AUTHORITY 

Owner Addressl: 

|a O RNANCE 

Owner AddressZ: 

|540 S 27 ST 

City: 

OMAHA 

Owner Phone 

State: Zip Code: 

~ |N E |68105-

Alternate Phone: 

I 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

Owner Phone: 

1 

"

State: ZipCode: 

1 1 

Alternate Phone: 

r 

Resident Name: 

r 

Property Address: 

|4425 N 22 ST 

Zip code: 

|68110-

Resident Phone 

I 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group [Tob 

Contract Option iGPnONl Assessment Max XRF Value | 533.57 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #:1''^^^ ^ Property Address: ^^2.9 V 2Z- 7T ' 

Date/Time: Owner's Name: Oh-«X/t Hoa^Tc/vfrv, ^ uVl^rTVvi, 

Quads Excavated: Y) Z - Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

I. If necessary, were the correct quadjrant(s) excavated and restored? 1 ^ 

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 in excavated areas generally slope away 

from the house? / 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluaie if inspected at a 30 

day lime period) y

4 Are sodded areas generally fimi and evenly graded? y 

5. Arc tlie joints belween the sod strips generally light? (Only evaluate if inspected at a 30 day y time period) 

6. Was the property graded such tl\at water will nol pool on the property? 

y 

7. Was damage to landscaping or plant materials avoided? 

^ 

Gates, Fences and Retaining Wails Yes No 

1. Do gates open and close freely? (Ifapplicable) y ^ 

2. Were all gales or fences lalcen down during restoration activities reinstalled? (Ifapplicable) y 

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

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

Foundation, Siding and Gutters Yes No 

1 Was dajnage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

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? 

y 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage lo diivewav 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 ^"^ ^ ^Date: >U«1" 
niSOLO(JIES. INC 

AS - BUILT DRAWING 

OLS#34270 

Date Excavated: 11/17/2010 OMAHA LEAD SUPERFUND SITE I SEPA Signed-Off Date: 

34270 

Omah Exterior Pain( Owne a Lead Site r Name: BORGESON JOHN A 

Sit • GcxJd e Sketch Address: 4425 N 22 ST • Poor Phone: " w ^'^Nol paint 

Sampt Lead Sample Samples Collected e Number LAB Concentration Collected Firm A.'^w\ft.s i ft-r 

RYASCPXA-34270 F1 H2^ - ppm D Date I r, - n - - o A 

RYBSCPXA 34270 F2 7 > ^ ppm D Time: n • a^g ^ ^ 

RYCSCPXA 34270 B1 188 ppm D Samples Analyzed RYDSCPXA-34270 82 .^3V ppm D 

RDgKCPXA 31370 OZ ppm D D XRF Unit IdlY l Book; HI , 

nCgCCPXA.342ifO G2 — ppm D D Date ll B Ofa 

RP£SCPXA .3.1P7Q RZ — ppm n D Time Pi n 

Number of Samples = ^ Staff r^flu ) 

legend Fl = front Left, F2 = Front Rigtit, Bl = Back Left, B2 = Back Right DZ = Dnp Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed ftom tne street, facing property 

P-UJ^Y 

1 

. . . ; .or.;-, ... i . ./:,,-.i:. . . 

: v!. i: ^ c. i5:\-^ ! 

h\. i Bi1 . ^ B2 = 57 PPM a 4" 

1 ' 

. ^ . . • . . . ; . 

! 

<J 

<L 

1 . . . . ; • ; 

2 1 

< HZ 4, ^H . 1 

. f* . j F2, 

1 

: r '": . 

t^l/SHc- . . 

(n-t X:2-oci t v 046111 1)1 

N O I \Sl\II M 

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

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The propeity owner's signature indicates that the property owner is satisfied with the restoration of the 

subject propeity, 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 Addreas; 4^ 5 N. 22"° St 

Owner: Omaha Housing Authority 

Phone: 402-444-6900x251 

Restoration Items in Question: 

item: The site is snow covered at this time and the sod is dormant. Being unable to 

Item: Inspect the sod; OiHA cannot be certain of satisfaction. Prudent agrees that 

Item: wanranty of woric is extended during winter months through spring, if sod does not 

ttem: take root and become healthy by the end of spring, Prudent to be responsible for 

ttem: replacing sod at that time. 

ttem: 

Required corrections to complete the property: r 

I—I I agree restoration Is completed. 

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

J . '^ > -//WA 7P 

Owner's Signature / / Date 
Pnident Technologies, Inc. (Pnident) is under contract with the U. S. Envinaimeotal Prot^'crASBncy (EPA) to clean up leadcontaminated soils at a nundier of propeities located in Omaha. Ndjtaska, including the property located at 4425 N. 22°^ Street. The 

EPA requests your pennission to allow Pnident to peifimn a soil cleaniqi at this jaapaty to remove lead-contaminaled soil. By 

signing tliis fonn, the property owner grants permission to Prudent to perform activities rdated to the cleanup inchiding soil sampling, 

removal of lead-ccmtamiiuited soil, and restoration of die referenced property. 

Ifyou have any questions about the soil cleanup plaimed for your propeity, please contact Prudent soudi ofiSce fat ibt Omaha Lead 

Site cleanup-at (402) 733-1188. General questions about flie Omaha Lead Site cleanup can be directed to die EPA Public Information 

Centers at (402) 731-304S (South Omaha office) or (402) 991-9583 (Noitii Omaha office). 

Pioperty Access Granted By: Stanley Timm. Executive Director for Omaha Housing Authority 

liease Print Name) 

Property Owner Signature: .TJifZ^MAA ^ V(AAl^l'*^^-' 11-09-10 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Vacant Lot Owner Renter 

RESIDENT ADDRESS: 

N/A ^Z- g A/ Zv^' f Sj-f-^f ^ 

IF RENTAL, PROPERT^T OWNED BY: Th e Omaha HousInQ Authority 

OWNER'S MAILING ADDRESS; 540 S. 27'" Street 

OWNER'S TELEPHONE NUMBER - WORK: (402 ) 444-6900 x251 

AGE OF HOME?: _N/ A YEARS. HOW LONG HAVE YOU LIVED HERE? N/A YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? ^YES NO WA 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: _N/A NUMBER OF OCCUPANTS 7 YEARS OLD AND OLOER 

WA 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

WA 

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 ri^t of access to die property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "detennining tfae need for response, or choosing or taking any response action 

under Ihis title, or oUierwise enfonsing the provisions of tfae tide." 

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, SuKe 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 
ENVIRONMENTAL & 

CONSTRLCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: LJC/26> Nf ^J^ry d S1 ^ '^«*«-

Phone: BVID: 

( (/ly r~tm:r. 

=-= 

rS OIC^ 

^ 

Property Owner 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 S 4(42 Medical Drive, Suite 4250 

Kansas City, MO 64114 Onnaha, Nebraska San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-11. Phone: (210)822-9688 

. /0'te \ oe*> OTAT iAno\ •7'i'* 400a C^ v llt m K7<tJiK77 
34270 

Omah Exterior Pamt Ntocth^tow Owne a Lead Site r Name: BORGESON JOHN A 

Sit • Good e Sketch Address: 4425 N^22 ST D Poof 

Phone: »• W: It/t Not (K M 

Sample Nunnber 

RYASCPXA-34270 F1 

Lead 

Coficentraiion 

_H2__pp m 

Sampie 

Coiecled LAB 

Q 

^HTiprfes Counted 

Fwm: f\Sy> \ila| '^T 

RYBSCPXA*34270 F2 2J i ppm D Time^ i^ • t « x^.r>.. 

RYCSCPXA-34270

RYDSCPXA-34270

 Bl 

 B2 

/ 8 8

^f ^

 ppm 

 tmm 

D I Sample Analyzed 

RDZCCPXA 31270 DZ 

nczccnxA 34270—ez 

RPZSCPXu^. 3'1270 RZ 

*"

•~

""

 ppm 

 ppm 

 ppm 

U 

D 

D 

a

• 

XRF unit: JQCQ _ Book:

Date: l i • 6 • OCo 

, Time: P/») 

 11 3 

Number of Samples = ^ Staff: r>A«t\i3i 

Legend: Ft = Front Let, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drrp 2jone, GZ = Gsmiem, FZ~ Pfay 

Ati quadrants a«e a» vievved fnotn tinestaei fiacin^ proper^ 

I—-pr 1^" • #««^""": . :. ; 

H7L L ^ 

Fill .WZ*^.. 

nsi^ft 

ltiHr4' .,X3-<Tfc^..:S*r:. mtM\!ma 

. -^Jk^^^-ij:^.,.,.. -tS^^.-.te4...£:.,^.i,­
4

0 X 124 

A Printed

: Nov 15,2010 

w-ww.dcgis.org/dogis 

615 
11/15/2010 www.dhon.org/irthintemet/DHONNotic...j 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2642265. 

Original Call Date: 11/15/10 Time: 4:08 pm Op: SIVA18967 


Work to Begin Date: 11/17/10 Time: 4:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4425 Street: N 22ND ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Soil 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 Nuniber 

Utility 

Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

MUDOl 

METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

AH: 

Emerg: 4025047970 

OMAHACOF 

CITY OF OMAHATRAFFICSEWER 

RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 

OMAHA PUBLIC POWER 

DISTRICT 

ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

dhon.org/irthintemet/.../MessageText.as.. 1/2 
11/15/2010 ^^vww.dhon.org/irthintemet/DHONNotic... 

QLNNEIC QWEST LOCAL NETWORK

FTM 

 rX^\^Tr .

LOCATING 

^Day :

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
a n J!. aAi^lLl Y HAZARD ANALYSIS 

fJ l^Yl ' 

Address: —f^ X^i Excavation Date: 

Crew: Backfill Date: 

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 

Crew Foreman 

Condition Hazards Corrective Action 

c:>t<- rj-^^L. J Ltf-x^..., irwi^—j . 1 ^ 

e^ 

(h^' \ y 

" ^ — 

ore 

^ji ^ 

pcayt^ 

cr^ 

<r^ 

o^— 

^ - ^ 

___- ^ 

Site Safety Office 

Date: 

«0 WvtfVwtaMiy. Sute4(B SSOOSIOSt 4242 Medical Drive, Suite 7260 

e»»Ci»MO<411 4 OmtiVi, Wefai MWa 6S107 San Antonio. TX 78229 

KmK (816) 36S47Q3 Plione: (403)733-1198 Phone: (21t» 822^«688 

KpK ) 363^3707 Fax: (402)733^1083 Pax:(210)«r»-6577 
i')-:)V\n 
-— • iV,*. --i v "" • y » •.. V 

M o?5 ^ T 

/^lt^^