TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 33039 DATE: 1/15 

ADDRESS: 3819 N 18 ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20H|l 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^

^

 PRE AND POST VIDEO OF PORPERTY (DVD) 

 EXECUTIVE SUMMARY 

30237540 mim 

d EPA-PROVIDED PROPERTY SKETCH Superfund 

m SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

• RESTORATION AGREEMENT 

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

a CONFIRMATION DATA 

U PHOTOGRAPHS 

d AS-BUILT SKETCH 

13 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

ffl DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

a UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^I K •ilaMft 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address; 3819 N 18 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: 

Bl = 346 PPM (@ 4"; NO EASEMENT 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract speciflcations 

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 hiterim ROD cleanup criteria. 

ECHNOLOGIES. INC, 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sampie Area: 33039 ­ 3819 N 18 ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

ISCOTTANN 1 I MARTIN IRENE 

Owner Addressl: Owner Address: Property Address: 

1 )3819 N 18 ST 

Owner Address2: Zip Code: 

)3821 N 18 ST |68110-

City: State: ZipCode: City: State:' ZipCode: Resident Phone 

JOMAHA |NE |68110­ 1 1 1 I 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1 1 1 

Contract: Assessment: 

Contractor: jPRUDENT2010_S Qualifying Group |400 

Contract Optii 3n |BASE Assessment Max XRF Value j 506.27 
TECHNOLOGIES, INC. 

EPA Property Close Out 

?ro[itrty#.-^303 ^ Property Address: ^ Br 1 ^ A> \9 ­ '? K 

Date/Time: Owner's Name: /4n(v "^O ^ 

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

Excavation Genera) Yes No 

I. If necessarv. were ihe 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? / 

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

day lime 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 penod) 

6. Was the property graded such tliat water will nol pool on llie property? / 

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

Gates, Fences and RetainingWaiis 

Yes No 

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

2. Were all gales or fences taken down during restoration activities reinstalled? (If apphcable) / 

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

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

Foundation, Siding and Gutters 

Yes No 

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

2, Was damage to the foimdation avoided? y 

3. Was damage to windows avoided? / 

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 

Was damage to diiveway surfaces avoided? 

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

Inspection notes: 

." '

..^ 

 ^ . ^

/ 

3-

/ 

.Jl ' ^ K 

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

EPA Representative Qoy -^o^ ^Date: njislio 
•X'ilNOl.OOlKS. INC. 

AS - BUILT DRAWING 

()l.S # 33(139 

Date Kxcavated: 11/22/2010 OMAHA LEAD SUPERFUND SITE ISEPA Signed-On Dale: 

3303S 

Omah Exlerior Paint North Arrow a Lead Site • Good Site Sketch • Poor 

Sampling Address: 3SI"1 N IS* ^ S + 

[g'Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm ASW 

RYASCPXA-3303«l F1 ppm D Dale <b/2g>/<:>3 •TiYDGOrXrai 3303^ PS ppm D D Time 

RYCSCPXA-3303*} B1 ppm [ ^ D 

Samples Analyzed RYDSCPXl^ 3303'-} Ba ppm D D 

RDZSCPXA aaOiiS DZ ppm D XRF Unit: 5S0 4 Book: . n RGZSCPXA 3303q SZ. ppm D Dale: <£./Z7/o3, 

•RPZOCrXA 93t53'^ PZ' ppm D D Time: D pm 

Numbe Staff: B^V r of Samples = 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

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

Property Completion Agreement 

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

The property ovmer'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: '^1> Q 3 ^ 

Property Address: ""^ <^ j (^ ^ i ^ fi ^ St ( ^ 

Owner; -^Nf ^ ^Q , 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I agree restoration is completed. 

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

O.AAA ^(-C ^ \^y\ y

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Owner's Signature Date 
Pmdent Tectaologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of prooerties located in Omaha, Nebraska, including the property located at 

y ^ ^ ' \ ^ fsj I oH > S f Tlie 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 property owner grants permission to Prudent to perform 

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

If you have any questions about the soil cleanup planned for your property, please contact Prudenl 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 al (402) 731-3045 (South Omalia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: (Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Cj(n\ \ ^ ^ -^Q X / ~ /•^wner y Renter 

RESIOENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

A.r\r\ S> Ci^M 

OWNER'S MAILING ADORES

t ^ 

OWNER'S TELEPHONENUMBER - HOME: J L WORK: 

i%2i 4S3 -IbliW 

AGE OF HOME?: H O ^ YEARS. HOW LONG HAVE YOU LIVED HERE? \< V ^\YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: I Q 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 INSTRUC : (I.E. DOGS, ENTRY GATES, ETC.)

ALITHORITy FOR ENVIRONMENTAL RESPONSE ACTIONS. The activities to be implemented by EPA under this agreement 

are pursuantto Seaion 104 ofCERCLA, 42 U S.C. 9604. EPA's right of access to the property is provided form Section 104(e) of 

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

underthis title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 42S0 

Kansas City,'MO 64114 Omaha. Metiraska 62107 San Antonio, TX 78229 

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

Fax: <816) 363-3707 Fai-­ (402) 733-1883 Fax: (210)579-6677 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address:3^2l t ^ li^ ^ Si - ^^t^'-11 - t (^ - A Q 

Phone: J^£ ^-^-/^J ^ 

Property Owner 

Signature: (CQA/ L fee 

B080 Ward Partcway, Suite 405 

KansasCity, MO 64114 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

5600 S 10 St 

Omaha, Nebraska 68107 

Phone: (402)733-1188

Fax: (402)733-1883 ^ 

y 

4242 Medldtil Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
3303q 

Bcterior Paint N0i6iArrDB( Omaha Laad Sito 

Q Good Site Sketch • Poor 

Sampling Address: 3A\<i Kl la ^ S f Q'Not paint 

Sampte Numlper Lead 

Conoentrat on 

Sample 

Collected Rmi 

Sampies C (MeOM 

RYASCPXA­ l<!7 ppm \ar cn Date ^/2i<^/0 ^ 

ppm n cn Tims: H;t>Sam 

5Q ^ ppm 

ppm 

\3r 

D 

C] 

c: Sampies / nalyzed 

ppn D cn XRF Unit: 55Qfc> Book: 

RCZSCPXA 3C100T OZ ppm D cn Date: ^ ^ 

•RPzoopxA sitegs ^ ^ ppm D cn Time: |2D1 

Number GFSam]:Ae5=: 2. Staff: £L ^ 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Bacdc Ri| ^ DZ = Drtp Zone, GZ = qam«t, PZ = Play 

All quadnirte > are as vicweti fforn tte stnaatfaitng , f p"y ^ 

-9t >«— »* 

.Bl.­

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KJ jg*^ s-iRev2008.BL Cre«tcd: 16-M^ . 0«£l4lSil-n 
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A Printed

: Nov 16,2010 

www.dcgis.org/dogis 
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Create Another Ticket Back to Irth Internet 

Send Email 

YOUR TICKET NUMBER IS 2642958. 

Original Call Date: 11/16/10 Time: 12:29 pm Op: SIVA18967 


Work to Begin Date: 11/18/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3819 Street: N 18TH ST 


Tv*p: 15N Rng: 13E Sect-Qtr: 03-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 


Company : PRUDENT TECHNOLOGIES 

Contact Name: SIVA JAMPAMA Phone: (402)733-1188 

Work Being Done For: EPA 

Depth of Excavation: 6FT Corner Lot: Y Front: Y Rear: Y 

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 lElDl Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SAND )Y

Alt: 

Emerg: 4025047970 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

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CONSTRUCTION mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: •^&}c, ^ . j ^ Excavatioii Date: 

Crew: Backfill Date: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Stractures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

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Site Safety Oflice 

Date: 

M60 WiRl-ViarfBHBy, SSOOSIOSt 4242 Medical Drive, Suite 7260 

iCanas Gi^< 1K>«4114 ie8t07 San Antonio, TX 78229 

phona: f81S)36M7D3 (402)733-1100 Phone: (2t0)822«588 

fax: f»nq 383.3707 Tacc (402)73341083 Fax: {210)67»«S77 
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