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TRANSiVIITTAL OF OiVIAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28722 DATE: 12/15/2010 

ADDRESS: 2608 N 33 ST 

REMEDIATION CONTRAaOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

a RESTORATION AGREEMENT 

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

[^ CONFIRMATION DATA 

13 PHOTOGRAPHS 

a AS-BUILT SKETCH 

• SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

[^ PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

^ UTILITY CLEARANCES 

a PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^V v ^\^'^^'' 

SIGNATURE DATE 

30260756 

Superfund 
Find Record Remediation Query Lead Remaining Query : Property Damage Query •—~~^ - ' . — - • — - — - —•—^^.-^—^^ — 

Backfill: 

Sample Area: 28722 - 2608 N 33 ST 

Owner: 

D Owner Occupied 

Owner Name: 

JCTTY OF OMAHA 

Owner Addressi: 

JC/0^3TY FINANCE 

Owner Address2: 

11819 FARNAM ST 

City: State: Zip Code: 

lOMAHA ^ |NE |68183-

Owner Phone Alternate Phone: 

j(402) 441^150 ~ r " 

Contract: 

Contractor: PRUDENT2010 S 

Contract Option jOPnoFTT 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

State: ZipCode: City: 

; • r—.^ 1 

1 

^ 1 1 

Owner Phone: 

il Alternate Phone: 

^ ! 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value 488 1 

Resident: 

Resident Name: 

I^T -—— 

Property Address: 

12608 N 33 ST 

Zip Code: 

168111-

Resident Phone 

I 
PROPERTY SUMMARY 

Date: 12/15/2010 Oniaha Lead Site Reinedial Action Contract # EP-R7-07-06 TO#l Month of: December 

Property Address; 2608 N 33 ST 

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: 

Bl = 220 PPM @ 6"; EA = 151 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 sketch ­

i) Shall include final lead levels v) Legend 

ii) Contaniination 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. 

TECHNOLOGIES. INC. 
•HECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 2-^72-'Z- Property Address: Z(£>C/?> M "^^ 91% 

D ate/Time: Owner'sName: (TTVIA^ C)-$-<^WVA.VVX\^ 

Quads Excavated: ^ \ Contractor Group: PrMtSent Technologies, Inc.. 

Excavation General 

Yes No 

I. if necessary, were the correct quadrant(s) excavated and restored? / 

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

Grading Sod and Vegetation Yes No 

I. Does the grading around the perimeter of the house in excavated areas generally slope away 

from the liouse? y

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

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

day time penod) y 

4. Are sodded areas generally firm and evenly graded? y ^ 

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

tune penod) y

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

7. Was diiniage fo landscaping or plant materials avoided? ^ 

Gates, Fences and Retaining Walls 

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

Yes 

/ 

No 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 

y 

y 

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

Foundation, Siding and Gutters 

Was damage to the siding or trim avoided? 

Yes, No 

Was damage to the foundation avoided? 

Was damage lo windows avoided? 

4. Was damage to windows or door screens avoided? 

y 

y 

-i. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage (o diiveway surfaces avoided? / 

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

Inspection notes: 

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

EPA Representative v"^- ^ ^Date: \\\•^\^ 
KHNOLOCIES. INC. 

AS - BUILT DRAWING 

OLS # 28722 

Date Excavated: 10/07/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-OIT Date: 

Name-. Ch . cfO/yioU o Omaha Lead Site Date: Bf/g/oi/ N o * Arow 

Address: 3(^0^ fJ. i?.3.'^.S4 Site Sketch Time: 9.'VS 

Phone: iP 

Team tiri,:.Jf/.lLy^^ Bvio^MlTA. XRF Code <^S^S 

Sample Number 

Lead Concentration Confirmation Sample 

E ppm r- Yes n No E3'" 

ppm •TJ Yes n No O" ' 

ppm 

i?. Yes • No S" ' ^<Js 

ppm e?Yes a No S ^ 

ppm Yes n No CD 

Ppm Yes • No n 

ppm Yes • No a 

JcLGL 

.yin-fi-t kfeU 

ifer^ - — I

 • ; vtV V f —

...l..J..r.?j..il«f.P 

TMH.L,;.....|. . Bl =220 PPMffi 6" i ^

 -H -

- -fciSr—<--#' 1- / i-. 

b^ofla M.3^ 

-f-f .1:^.1 - \A i +• 

-tu 

i...^. 

""••"••" T "• M 

^ulPyo'C;/^ 

"eJImm}'' 

't!'3trfS{'. 

E.'\ = 15l PPM@SCR,4PE(~I"') 

Omaha Lead Siie 

46130 

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

Property Completion Agreement 

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

The property o\vner's signature indicates that the property o\yner 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: ^ Si^l^ ^ 

Property Address: 360 ^ iUorHv 33rJ l S\f^A -

Owner: c '>u y CVY-AUV 

Phone: Hoj-MWH-HJi^ ^ 

Restoration items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

" ^ I agree restoration is completed. 

\Z} I do not agree restoration is completed at (noted deficiencies above) 

9'Muuy,^-^oyO 

Owner's Signi Date 
Pnident iVchnoloyies. Inc. (Prudent) is under conu.icl wilh lhc U. S. Environmenial Proieciion Agency (RPA) lo clean up leadcomaminalcd soils al a liiinibcr orjirbpchics Ihcaled in Oni.ilia. Nebraska, including lhc properly located al 

yb06 A/jfl/y y/Jtry. S -J- . Jlie HPA requests your permission to allow Prudeni to perform a soil cleanup al ihis 

property lo remove le.ia-contaminaied soil. Hy signing Ihis form, the properly owner grants permission to Prudeni tb pcrfbrni 

activiiies related lo the cleanup including soil sampling, removal of lead-contaminaled soil, and restoration ofthe referenced property. 

ifyou have .-iiiy questions about the soil cleanup planned for jour property, please contact Prudeni south pITicc .for lhc Oni.iiia Lead 

Siie cle.iiiui>-.nl (402) 733-118S. General (|uesiions aboul lhe Om.Tlia Lead Site cleanup can bedireclcd to the EPA Public Informalion 

Ceiilcrs al (402) 731-3045 (.South Omaha office) or (402) 991 -9583 (North Omaha ofTice). 

Property Access Granted By: /^//J/l-hvy.. Z.-^z/^'/ii ^. 

(Please Print Name) 

Property Owner Signamre: %^ W y r pT ^ -/ ^ SyC7iiy27JjL 

'/ y (Signature) (Date) 

PROPERTY INFORMATION 

(To bc completed by resident and/or property owner - pic.ise print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

?jno ? i\i -^^ Tir 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

///^/ fi^rnAm Sk ^^;L lll l /y^ M yy- b/i/'-^ 

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

yo-<\'ik'i- ^/^v/ 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? 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 lobe implemented by EPA under this agreenient 

.ire pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right of .nccess lo lhc property is provided for in Section 104(c) of 

CERCLA. 42 U.S. C 9605(e). which prpvides enlry fnr 'deiemiining the need for response, or choosing or taking any response action 

under ihis title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 S600S10SI . 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

Fax: (816)363r3707 Fax: (402)733-1883 Fax: (210)579-6577 
Name: Ci ^ Dt O/I^i^ka Omaha Lead Site Date: ^//S/p ^ North Arrow 

Address: Si^nR iJ . ?3lMSi Site Sketch Time: 9'V ^ 

Phone: 

Team m/^^rj/mlilL^^'^ ^ BviD#_^22^A_ XRF Code Z^S^S 

Sample Number Lead Concentration Confirmation Sample 

12. ppm f« Yes CD No E ^

ppm No S — fa Yes n

^W k ppm p, Yes a No t3^ 

ppm '6';Yes n No S- ^ 

ppm Yes D No CD 

ppm Yes • No • 

ppm Yes O No • 

t-:'JfTtV/-i 

Omaha Lead Site 46130 
H 260

8 N 33 ST: 40 X 100 

Printed: Dec 06, 2010 lii A www. dcgis. org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet I Send Email 

YOUR TICKET NUMBER IS 2609466. 

Original Call Date: 10/05/10 Time: 4:35 pm Op: SIVA18967 


Work to Begin Date: 10/07/10 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2608 Street: N 33RD ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Worlc: 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 RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 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 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/5/2010 
CONSTRUCTION ,me. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: .i^^O'B N ^.S f ^ Excavation Date: ^^1 ^b ^ 

Crew: BackfiU Date: (^I'^h^ 

Item 

Overhead lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Wails 

Fences 

Trees 

Stractures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

c ^ ^ 

e^ 

h^' (t7 

ofi^ 

ay*­

. — 

^ce ^ 

cy^ 

a*­

a^— 

Hazards Corrective Action 

'-' S <" /T? fTiTi 

Site Safety Office 

Date: 

5600 8108 1 4242 Medical Drive, StdtB 7250 

a»gjif i 11064114 ifiOtOT San Antonio, TX 78229 

OK I8I 9 363'3'V (402)733-1108 Phone: (2tO>8224588 

: (SIS) 383nS7l07 FaE (402) 73»*1083 Fax: (210) 6T9-«577 
ZC/08> f^ 3 S tA 

IZ I'3/20/0