TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28392 DATE: 1/15 

ADDRESS: 2028 WILLIS AV 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 PRE AND POST VIDEO OF PORPERTY (DVD) 

0 EXECUTIVE SUMMARY 

0 EPA-PROVIDED PROPERTY SKETCH 

0 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.) 

\ y CONFIRMATION DATA 

e f PHOTOGRAPHS 

0 AS-BUILT SKETCH 

0 ^ SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

0^PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

0 ^ UTILITY CLEARANCES 

Q ' PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

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SIGNATURE DATE 

30218312 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2028 WILLIS AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infomiation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 77 PPM @ 3"; F2 = 66 PPM @ 3"; Bl = 75 PPM @ 3"; B2 = 83 PPM @ 3"; 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, 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. 

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'TECHNOLOGIBS, INC. 

Property ft: 2-'^}>^2 -

Date/Time: 

Quads Excavated: Pl, pZ ,^' | ^Z_ 

EPA Property Close Out 

Property Address: Z^^S ' ^'' " '^ ^"^^ 

Owner's Name: Pea^eu ^ (£>f^o\ 6K^p-^lXt (IIMUTCI^ 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

1. 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? y 

3, Does the sod appear to be generally liealthy and growing? (Only evaluate if inspected at a 30 

day time period) y 

4 Are sodded areas generally firm and evenly graded? y 

5. Arc tlie joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

(ime period) y

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

7. Was dainage to landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walls 

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

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

Yes 

y 

/ 

No 

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 damage to the siding or ttim avoided? 

2. Was damage lo die foundation avoided? y 

3. Was damage to windows avoided? y 

y 4.

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout e.xtensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damaae lo diivewav surfaces avoided'? y 

/^ 2.

 Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

y^ 

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

EPA Representative ^ Date: \\i'>V u 
EM ciiNOLUUiES. mc . 

OLS n 28392 

Date Excavated: 11/23/2010 

IISEPA Signed-Off Date: 

AS ­ BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

28392 

Omah a Exterior Paint North Mow Lea d Sit e Owner Name: PLEASANT GREEN BAPTIST • Good Sit e Sketc h Address: 2028 WILLIS AV 

Phone: H: W: 

r>yNol paint 1

Lead Sample Samples Collected Sample Number LAB Concentration Collected^ Firm: 

RYASCPXA-28392 F1 

Date 

RYBSCPXA-28392 F2 

Time 

RYCSCPXA-28392 B1 

Tsy^^u Samples Analyzed RYDSCPXA-28392 B2 13^ n 

RDZSCPXA 3830a 9 ^ D D XRF Unit 

nogGCPXA 20302 8 2 

D D Date 

RPZ3CPXA-28398 PS-

Time: 

Numtjer of Samples • W Staff: top fc 

v/ic/9/vT.j.A,<?r 

ENTERED 

JUN 07 2004 

bl - H^^ 63^ Mia. 

BI=7.SPPiV 3' l a 3 " B2 = 83PPM(a

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f l -'"^^ Fl =77 PPM fl 3 • 

F2 = 66PPM@3 ' 

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LJ; i 1.1^3. ...jio. Omaha Xjcui Site 46130 

NO EASEMENT 

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

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: ^ Q ^<g ^ '^'''ULO s A"-^ ^ 

Owner: P n /^< j g ^ t (Sr •ean .firt/pHtsV -C l^t^rrL 

Phone: 

Restoration Items in Question: 

I Item: 

item: 

Item: 

Item: 

Item: 

item: 

Required corrections to complete the property: 

^ I agree restoration is completed. 

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

Owner Date / /

^""'(2AurcAC/frl < 

1 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

^Oalrl CO/tlii . The EPA requests your permission to allow ftiident to perform a soil cleanup at this 

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

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration of the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent south 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 office). 

Property Access Granted By: 

I (Please Print Name) 

Property Owner Signature 

^i Q V J ^Signature) 

PROPERTY INFORMATION 

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

RESIDENT NAME: \ j Ci r a iry r \n V • Owner Renter 

RESIDENT ADDRESS: . . . 

I^^MNTAL, PROPERTY OWNED BY: r-v y-\ f ) A 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J i^.l2^i0^^Si . l WORK: 

J i 

YEARS. 

YES NO 

NUMBERlOF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WH(VPLAY IN THE YARD FOR 5 HOURS ORMORE PER WEEK 

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

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: 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 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 seoosiost 4242 Medical 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 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^OQ. ^ LOlll u A</-^ Date: /r-/2-/o 

Phone: ^b ^ 3%'g^2' ^ ^^^' ' 

Prudent Employee 

8080 Ward Parkway, Suli Lr>la^, y 5600 SIO St 4242 Medicat Driwb, Suite 4250 

Kansas City, MO 64114 It / rCA t (^(Zt/ ^ Omaha, Nebraska 68107 San Antoliio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 TRonenSTO) 822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-«577 
28392 

Omaha Lead Site Exterior Paint Nortti Arrow Owner Name: PLEASANT GREEN BAPTIST 

Site • Good Sketch [ Address: 2028 WILLIS AV • Popr' 

Phone: H: W: 0^0 1 pai ; painr t 1

Sample Number 

RYASCPXA-28392 F1 

RYBSCPXA-28392 F2 

RYCSCPXA-28392 Bl 

RYDSCPXA-28392 B2 

RDZSCPXA 2830a 9 ^ 

nczcGnxA 20302—ez 

RPZ3CPXA-2e392 P?-

Lead Sample Samples Collected LAB Concentration Collected^ Firm: i^£^ (y<-^/fr\±>^ 

ppm D Date; h> M ' ^ 

ppm D Time; ^ HO A/Vy 

ppm B^.^n 

ppm 0^ Samples Analyzed n 

ppm XRF Unit ^\ \ Book.ba 

ppm n a Date 

ppm D D Time 

Number of Samples = ^ W Staff: 

1 

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ENTERED 

m 072004 

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\:U.1U5-..A0. Omaha Lead Site 46130 
egal dimensions

: 30 x 122 

A •«_...6IS,.. Printed: Nov 18,2010 

www.dcgis.org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to irth intemet Send Email 

YOUR TICKET NUMBER IS 2644873. 

Original Call Date: 11/18/10 Time: 2:01 pm Op: SIVA18967 


Work to Begin Date: 11/22/10 Time: 2:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2028 Street: WILLIS AVE 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW 


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 OMAHA-TRAFFIC,SEWER RICHA-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK 

Day: 4067289343 

ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://wvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/18/2010 
TBommutalm, wc CONST»UCTI(»f 

SOLUTIONS 

SITE SAITfcTY HAZARD ANALYSIS 

Address: —-2<a3«4'„_i:^i&^l. Excavation Date: 

Crew: BackfiU Date: — 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retainins Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

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Site Safety Office 

Date: 

«0 Wa(tf«vta«ay. Suae 4( » SGMSIOSt 4242 Modical Drivo, SuSto 7250 

•i9asafy/MO««114 Omatai, ItabnM a C8t07 San Antonio, TX 78229 

Phono: HaZ)733-11« Phone: (2t0) 82Z<«588 

x : (SIS) 963'3707 Fte : (402)73»*1«S3 Fax: (210)SW-«n 
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