SA1D#: 22393

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE: 12/15/2010 

ADDRESS: 704 S 25 AV 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

A PRE AND POST VIDEO OF PORPERTY (DVD) 

\tl EXECUTIVE SUMMARY 

Ul EPA-PROVIDED PROPERTY SKETCH 

dl SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

m CONFIRMATION DATA 

lb PHOTOGRAPHS 

m AS-BUILT SKETCH 

ct SATlSFAaORY RESTORATION SIGNED BY PROPERTY OWNER 

a PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30218629 

M 

Superfund 
Find Record ] 

Backfill: 

Sample Area: 22393 - 704 S 25 AV 

Owner: 

n Owner Occupied 

Owner Name: 

IHERMAN BROS INC 

Owner Addressl: 

1 

Owner Address2: 

|2565 ST MARYS AVE 

City: State: Zip Code: 

JOMAHA JNE |68105-

Owner Phone Alternate Phone: 

i 

' 

Contract: 

Contractor: jPRUDENT2010_S 

Contract Option JOPTION 2 

Remediation Query | Lead Remaining Query j Property Damage Query 

User Provided Owner Information 

Owner Name: 

|,,„ 

Owner Address: 

I 

City: State: Zip Code: 

1 1 1 

Owner Phone: Alternate Phone: 

1 

Assessment: 

Qualifying Group p»00 

Assessment Max XRF Value f 489.29 

Resident: 

Resident Name: 

Property Address: 

j704 S 25 AV 

Zip Code: 

|68105-

Resident Phone 
PROPERTY SUMMARY 

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

Property Address: 704S25AV 

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 = 938 PPM @ 13"; EA = 373 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) 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. 

TECHNOLOCIES, INC. 
I

TECHNbUOGnSS, iNC: 

Property #: 2-"^ ^ "^^ 

Date/Time: \<^/l/20ft) 

Quads Excavated: ^ | 

EPA Property Close Out 

Property Address: "TOM- S ^ S A^/ 

Owner's Name: ^VJLT \C_ PtrN " ^ 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

 If necessary, were the correct quadrant(s) excavated and restored? / 

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

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? y 

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

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

y day time period) 

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

5. Are tlie joints between the sod strips generally tiglit? (Only evaluate if inspected at a 30 day y time period) 

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

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining "Walls Yes No 

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

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

I. Was damage to the siding or trim avoided? 

/ 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

­

- 4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewallts and Driveways (Conci-ete) Yes No 

 Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

I
Owners comments: 

Inspection notes: 

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

EPA Representative • SG/Q X ^ ^Date; n|gi|o 
=CHNOl,OUIES, INC. 

AS - BUILT DRAWING 

OLS # 22393 

Date Kxcavatcd: 10/18/2010 

ISEPASigncd-OtTDatc: OMAHA LEAD SUPERFUND SITE

22393 

Omah Exterior Paint Owne a Lead Site r Name: HERMAN BROS INC • Good Site Sketch Address: 704 S 25 AV^ • Poor Phone: H W; 0^Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

RYASCPXA-22393 F1 ppm D Date; lo-lta-flC i 

RYBSCPXA-22393 F2 ^1 5 ppm IT D Time: 'a •• l S yt«< 

RYGSCPXA-22393

RYDSCPXA-22393

WDZ3CPXA-22393

ROZOCPXA-22393

r^rgOCPXA-g2393

 Bl 

82 

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G i 

P i 

wfiq ppm 

ppm 

ppm 

ppm 

ppm 

[ T 

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D 

D 

D 

D 

n 

D 

D 

D 

Samples Analyzed 

XRF Unit: it^C?! Book:

Date: /O .J^ - ol p 

Time: /\ ^ 

1*73 

Number of Samples = Staff: jThu l 

Legend: Fl = Front Left, F2 : Front Right, B1 = Back Left, B2 = Back Right D2 = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing propeity 

ENTERED 1 

rocT 102006 

1 

Bl =938PI'M nl 13" _^_^ ^ 

: 1 : 

... %n : 1 -2.14 

^ ' : \ . ^-^^ 

; : 1 : : 

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0461*1 ,,,SL:.-2-5 ^ ft^^--^..^. 

KA = 373 PPM Ca] SCRAPI. 

CONTRACT tt: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
RX Date/Time 10/29/21 15:18 p.003 

10-29-10 14:43 FROM-TransWood' 1. T-233 P.003/003 F­

&EP^ 

Property Completion Agreement 

This agiMinent documiBafs ^ B coinplBtion of removal activities peifonned aa tiie below listed propeily. 

The jvoperty ovvner's. signature indicates that Ifae property owner is satisfied with the restoratioii of Hie 

subject property, and, Ifaat no items, are in question, now, or at any time in the future, excluding any 

i«maining wairanty (30 days totaO except those items listed below, if any. 

.-.. . PropertyQ): 

Property Addreas: "-loL j . r<S 2 5 ^ Arw 

Owner: . . , 

rbQBe; • 

Restoration Items in Quintlon: 

Kem: 

Item: 

Hem: 

item: 

Rem: 

Item: 

Required corrections to complete the property: 

^ 

BlaI agre g e restoration Is completed. 

Q t do not agree restoration is completed at (noted deficiencies above) 

^^y^-ry^ 

Owner's SSignatnre Date 

/e'«ii ninriarmt 
P.002 

«0985 P.002/002 10/06/2010 09:41 RX Date/Time r.»vw««* f""' 

10/06/2010 08.41 


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P.003 RX Date/Time 10/06/2loQ w 06:55 

T-139 p.003/003 F-357 10-06-10 06:2 FROM-TransWood' NE . CONSTIUICnON 

TECBNOLOQIES, mC . 6ERVICK 

Property Status Form 

Address: TCiq ^ «P5Vl, ^y, ^ . Date: /^A/^ 

BVO): 

i/Arc/hy^ Lrf ^ 

Properly Owner Piudent Enployee 

jSttgnatnre! /^AAo Signature: 

80B0 ward PmiicMV. Sulla 405 SSflBSlOSt 4342 Madloat Drive, SiiKa 4260 

Kanaaa City, MO 64114 Omsha, Nabraika 68107 Ban Antonto, IX 7S328 

PIWIWS (SIEJ 363-3703 Phono: (402) 733-1 laa Phena: (210)6224688 Fax: |S18) 3834707 Fax: (402)733-1«B3 Par.(2iS)S7ft«n 

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22393 

Omah Exterior ParnJ North AiTow Owne a Lead Site r Name: HERMAN BROS mc • Good Site Sketch Address: 704 S 25 M_ ^ 

Number of Samples = j J ^ j 

D Poor 

Phone: H: W: g^Nof paint 

Sample Number Lead 

ConcentratJon 

Sample 

Collected LAB 

Firm;

Samples Coliected 

ftjtvAtiia\ fter 

RYASCPXA-22393 F1 JJIH. ppm n Date: IQ-tft-gfi . 

RYBSCPXA-22393 F2 Zi5 ­ ppm D Time: "atlS^T ^ 

RYCSCPXA-22393

RYDSCPXA-22393

 B1 

 82 2J±L 

ppm 

ppm 

D 

n Samples Analyzed 

RDZSCPXA-22383 Bf* ppm u D XRF Unit Ifxp l Book il 3 

RGZOCPXA-22393 SZ ppm D D Date: /O • 1 ^ - nist 

RPZGCPXA-223Q3 PS ppm D n Time: /\yY-i 

Staff: Al.^u/ 

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 

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egal dimensions: 35 J^ 6 r 

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A Printed: Nov 03, 2010 

www.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email _ . j 

YOUR TICKET NUMBER IS 2610371. 

Original Call Date: 10/06/10 Time: 12:57 pm Op: SIVA18967 


Work to Begin Date: 10/08/10 Time: 1:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 704 Street: S 25TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 21-SE 


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 LEVELS MUDOl OMAHACOF 0PPDGPR5 TEC QLNNEIC 

Utility Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS. ^^^ ^ 

Alt: 4029340469 INC 

Emerg 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, ^ ^ 

Alt: 

Emerg 8773668344 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRICT 

Emerg 4025047970 

Day: 4024447197 

CITY OF OMAHA- OMAHACOF RICH/TRAFFIC Alt: 4024445161 TRAFFIC,SEWER 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/6/2010 
Page 2 of2 

OMAHA PUBLIC POWER 0PPDGPR5 ELM LOCATING DISTRICT 

NO NEED TO CALL OUT PAETEC PAETEC COMMUNICATIONS EMERGENCY 

QLNNE IC QWEST LOCAL NETWORK ELM LOCATING 

Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/6/2010 
SOLUTIONS 

SITE SAFfcTY HAZARD ANALYSIS 

Address: —^ItL^-ja^-Ay ^ Excavation Date: Ji^ilMl ^ 

Crew: BackfiU Date: -^-LQMML^.— 

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 

CP/^ ­

e^ h^' \ ^ 

—— 

O/car^ . — 

PC£>C, 

c!y<­

i^^ ^ 

a^— 

—.-— 

-

Site Safety Office 

Date: 

080 Wafld-FariONay, 8uitB4<l5 asoosiost 4242 Medical Drive, Suits 7250 

Omata, NataraOfca 68107 San Afltonto, TX 78229 

iKMiK {StS) 3«t|3nn PlMno: (402)733-1188 Phone: (210)8224688 

ax: laM) 3S3>3707 Pa e (402)T3»dSS3 Pax: (210) 67».«577