TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28105 DATE: 12/15/2010 

ADDRESS: 2760 GRANT ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ PRE AND POST VIDEO OF PORPERTY (DVD) 

m EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

Q SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

la RESTORATION AGREEMENT 

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

m CONFIRMATION DATA 

0 PHOTOGRAPHS 

\ ^ AS-BUILT SKETCH 

n SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

El PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

m UTILITY CLEARANCES 

E PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

SIGNATURE DATE 

30218296 

iIBi 

Superfund 
Find Record 

Backfill: 

Sampie Area: 28105 - 2760 GRANT ST 

Owner: 

D Owner Occupied 

Owner Name: 

ICTTYOFOMAHA 

Owner Addressl: 

|C/0 CTTY FINANCE 

Owner Address2: 

J1819 FARNAM ST 

City: State: Zip Code: 

JOMAHA ^ JNE [6818i-~ 

Owner Phone Alternate Phone: 

1(402) 444-5180 |(402) 444-6140" 

Contract: 

Contractor: jPRUDENT2blO_S 

Contract Option foPTlON^ 

Remediation Query { Lead Remaining Query j Property Damage Query 

User Provided Owner Information Resident: 

Owner Name: Resident Name: 

1 ' '" 

Owner Address: Property Address: 

i2760 GRANT ST 

Zip Code: 

|68111-

City: State: Zip Code: Resident Phone 

Owner Phone Alternate Phone: 

Assessment: 

Qualifying Group J400 

Assessment Max XRF Value 1 469.3 
PROPERTY SUMMARY 

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

Property Address: 2760 GRANT ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A 3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 179 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) BVDD 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. 

ECHNOLOCIES. INC. 
TECHNOLOGIBS, INC. ^.. . •

 - V " •.-!•••. v i T v

EPA Property Close Out 

Property #: 2^^^ / Property Add«.ss:2.'7^f> <^''^-^ '^ ^ 

Date/Time: Owner's Name: (Z'A^ c«?. C fvu^V"^ 

Quads Excavated: "p \ Contractor Group: Pruaent Technologies, Inc., 

Excavation General Yes No 

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

2. If necessary, were the correct areas of drip zone excavated and restored? V 

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? 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 

day time period) / 

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

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

time period) ^

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

7. Was damage to landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walls 

Yes No 

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

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

3, Was damage to gates or fences avoided? (If applicable) / 

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

Foundation, Siding and Gutters 

Yes No 

I. Was damage to tlie siding or trim avoided? / 

2 Was damage to tlie foundation avoided? y 

Was damage to windows avoided? 

/ 

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

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

/ I

 Was damage lo driveway 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 ^"^ J^ , ^Date: \b\t'\ \ i6 
IRI l 

(.'HNOliXJlES. INC 

AS - BUILT DRAWING 

OLS # 2810S 

Date Excavated: 10/07/2010 

I'SEPA Signed-Off Date: OMAHA LEAD SUPERFUND SITE 

28105 

Exterior Paint Noun Arrow Owner Name: CITY OF OMAHA Omaha Lead Site • Good Address: 2760 GRANT ST Site Sketch • Poor Phone: " .t02r«ll-6150 W; •''Not paint 1 1 

Sample Number Lead Sample Samples Collected 1 LAB Concentration Collected Firm; ^5^^- -^''^^r 

RYASCPXA-28105 Fl ^W ^ Dom B^ D Date; o"'-c»-ot 

RYBSCPXA-28105 F2 7<^S Dpnn 0' D Time: *^-iC/»^. 

RYCSCPXA-28105 Bl Zo6? Dom 0 0 Samples Analyzed 1 RYDSCPXA-28105 B2 /o"1 Dom 0- n 

-ROZSCPXA-26t05 OZ • Dom D D XRF Unit !cx=>-i Book: f^ ^ 

.Lab RYCSCPLA-28105 • 

Dom D D Date: ~1-?,1 -n{ t 

^Result 269 ppm ppm 

D a Time: P, ^ 

Staff: f^\<,,-, Number of Samples = H 

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

All quadrants are as viewed from the street, faong property 

St f>2 

10:t .u:\. 

Hy'3....\.Zc^ 

&f>KNT' DT 

NO E.ASEMEM 

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

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; ^-^^^^ t^.A^.lSrf/cU 

Owner; 

Phone; '^/vV- v^vf 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^f \ agree restoration is completed. 

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

^f^ (ykk>xr -Jd/C^ 

Date 
Prudent Technologies, Inc. (Pnidcni) is under contract with the U. S. Environnicnial Protection Agency (EPA) lo clean up leadcontaminated soils at a number of properties located In Omalia. Nebraska, including the property located at 

3/irO 6^^/v/- iSJ/t-t-j- . The 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 ouner grants permission to Prudent to perrorm 

activities related lo Uie 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 ofTice .for the Omaha Lead 

Site cicanup-at (402) 733-1188. General questions about the Omaha l.ead Site cleanup can be directed to the EPA Public Infomiolion 

Centers at (402) 731-304S (Soulh Omaha office) or (402) 991-9S83 (North Omaha ofrice). 

Property Access Granted By: <<y.///i/vt L.,yt<^r) 

(Please Print Name) 

Property Owner Signature: i.jT/yA s-Ory-fjo/Q 

(Date) V /y i (Signature) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDEN 3ENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

/U^, R^r^^i^ Sh ^ ^:/ c 1/1/ O^y^Lc^ f^(r Oi l 13, 

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

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 10787 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 6 HOURS OR MORE PER WEEK: 

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 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 'deteimining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions of Ihe title." 

8080 Ward Parkway, Suite 406 5600 SIO St 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Oinaha, 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) 679-6577 
28105 

Exterior Paint North Arrow Owner Name: CITY OF OMAHA

 Omaha Lead Site • Good Address: 2760 GRANT ST

 Site Sketch • Poor Phone: H: 402-441-5150 W: 

CJ^Iot paint \ 

Sample Numt>er Lead Sample 

Samples Collected LAB Concentration Collected Firm 

RYASCPXA-28105 Fl _iiLd_PPm D Date: o^-a^-o^ 

RYBSCPXA-28105 F2 ?g>5" ppm cr D Time: ^'•l^^A^, 

RYCSCPXA-28105 Bl "Z-O^ ppm 0' 0 Samples Analyzed RYDSCPXA-28105 B2 /n l ppm 

D •RDZOCPXA-20105 BZ-

ppm n n XRF Unit: Icx^-i Book: t^<) 

^Lab R^VS:SCPLA'281Q6 ppm D D 

Date: 1 - ^.i ' nu. SR^tilt 269ppm ppm u a 

Time: P ^ 

Staff: Msx. i Number of Samples = i H 

Legend: Fl = Front Lefl, F2 = Front Right, B1 = 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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: Oct 25, 2010 

www.dcgis.org/dogis 
Page 1 of 1 

Create Another Ticket Back to Irth Intemet i I Send Eifnail 

YOUR TICKET NUMBER IS 2609477. 

Original Call Date: lO/05/lo' Time: 4:38 pm Op: SIVA18967 

Work to Begin Date: 10/07/10 Time: •5:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2760 Street: GRANT ST 

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

Alt: 

 4025047823 

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]C QWEST LOCAL NETWORK. ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

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SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: ~^.i£P-^iaivJ:. ^ Excavation Date; lol^l^'^^^ 

Crew: BackfiU Date: t£d3li^l'^ 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leecli 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

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Site Safety Office 

Date: 

lew Wmtltaitany. S«rito405 I SIO at 4242 Medical DHva, Suite 7260 

tonaas CHIy; MO^^H ^ Omala, Nafaiaaka «8107 San Antonio, TX 7S229 

)|iaas:tS1O36»3703 

^ K |8W) 383-4707 

PlwnK (W^TSS-lias 

Fax: (4a2)73»*1«83 

Phone: (2t0) <2Z-«688 

Fax: (210) 679-6677