SAID#: 25172 

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

DATE: 1/15 

ADDRESS: 1110 N 20 ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

^ EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

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

k CONFIRMATION DATA 

T PHOTOGRAPHS 

m AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

UTILITY CLEARANCES 

PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^ ^ ,\.'*" 

SIGNATURE DATE 

30218284 

llllll 

Superfund 

N 
PROPERTY SUMMARY 

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

Property Address; 1110 N 20 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: 

F2 = 158 PPM @ 9"; 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 (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 Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
TECHNOLCXJIES, INC. 

EPA Property Close Out 

Property #: 2^'"^ ^ Property Address: /// 0 /U- '7-(^^'^-

Date/Time: Owner'sName: (^fo^ixi-^ CaKoov^ 

Quads Excavated: p'Z_- Contractor Group: Pnident Technologies, Inc., 

Excavation General 

Yes No 

I. If necessary, were llie correci quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas ofdrip zone e.xcavated 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 the 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. Arc tlie joints between the sod strips generally tiglit? (Only evaluate if inspected at a 30 day 

time period) / 

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

7. Was damage lo landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walls Yes No 

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

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

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

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

Foundation, Siding and Gutters 

Yes No 

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

2 Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / 

4. Was damage to windows or door screens avoided? 

/ 

5. Was damage lo downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) Yes No 

I Was damage to drivewav surfaces avoided'? / 

Was damage to walkway surfaces avoided? 

T 
Owners comments: 

Inspection notes: 

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

EPA Representative ^ ^ ^Date; 'I'^lu 
ECHNOLOUIES. INC 

AS - BUILT DRAWING 

OLS #25172 

Date Excavated: 09/22/2010 

IISEPA Signed-OfT Date: OMAHA LEAD SUPERFUND SITE 

25172 

Omaha Exterior Paint Owne Lead Site r Name: RALPH H FROST 

Site • Good Sketch Address: 1110 N 20 ST 

Phone: "• W: • Poor 

Q Not paint 

Sample Number 

RYASCPXA-25172 Fl 

Lead

Concentration

'2.2.1 ppm

 Sample

 Collected 

H '

 . . „ 

• 

Firm

Date:

Samples Collected 

 y^f^ H:r/f?iJ:-

 "9- ZC S ' 

RYBSCPXA-25172 F2 Time: l l 2s ' 

RYCSCPXA-25172

RYDSCPXA-25172

 Bl 

 B2 

31 ^

2.^/0

 pp"i

 ppm

 \2'

 Ef

 D 

n Samples Analyzed 

- ROZ6GPXA-25^?a -02­ - ppm n D XRF Unit: 103 1 Book: 13' ^ 

-RGZSGPXA-g&l-W GZ­ " ppm n D Date: l\--i-C<S~ 

~ ppm D D Time: /4>»y 

Number of Samples ­ -U. — Staff. d-A 

Legend: F1 = Front Left. F2 = Front Right, Bl = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

Hr'2? 'm% T 

.i.jjjii.N^c.'^ : 

4^ 

312. 

6;Z 

F2 = 1.S8 PPM @ 9" 

y^ 

¥ — ^ i -^ X: ^ \ 

147^ ^ - ^ 

NO EA.SEMEM 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
p.003 RX 15:46 4029326892 Date/Time 12/15/2010 

GINNY HEBERLY a 003 12/15/2010 14:44 FAX 402932689 

12/15/2010 1530 ' TO P.003A|DI 

dEM 

Property Completion Agreement 

This agreement docvonests tfae completion of removal acdvities perforawd on tiie below listed proper^'. 

The property owner's signature indicates that die property owner is satisfied with tlie restonidon ofthe 

subject property, and taat no items are in queation, now, or at aiiy time in the future, exsiudiAg any 

remsinbig warranty (30 daya total) except those items listed below, ifany. 

Property n): 

Property Addrass: »o *2^Hv . ^icy­ 4U. ^""'^e^ ^ 

PiH»e: 4n;^-ioR - I?>}1 

Restoration Itenw In QMStlon: 

Item: 

Ham: 

Rsquhttd correetienc to complvte tht property: 

0 ^ I agraa raotoration is completed. 

ED I do not agree restoretion Is comptstod at (noted defiofendes atiovB) 

/6^r-<?^ /-</ /r . La/fi 

Owaif ^ u Sigiiatare Sate 
RX Date/Time 12/15/2010 15:46 4029326892 P.001 

Qooi 12/15/2010 14:43 FAX 402932689| ^ GINNY HEBERLY 

KNVIRONMXNTAL& 

CONSTROCTION 

TSCHNOLOGH^ INC. SIRVICB8 

OtiCVv^ 

Prudent Technologies Inc. (Prudent) Is under Contract with the U.S. 

£nvironmental Protection Agency (EPA), Contract # R7'10-10248, to conduct Lead Soil 

Rennedietion in Omaha, Nebrasica. 

As of this date we have completed work on your property. We would like to do an 

hspectton of the work done and get some close out fomns signed. This is our last 

attempt at contacting you, please get in touch with us or send in the signed close out 

forms in the pre-stamped envelopes as soon as possible. 

If you have any questions please feel free to call our Omaha soil field office at 

402-733-1188 or address all emails to rBhreathafiPprudentweb.com. Our fax number Is 

402^733-1883. You can also visit the EPA website www.epa.govyiead/pubs/leadlnfo.htm 

for additional informatton. 

8080 Ward Parkway, Suite 405 5600 SIO"* St 4242 Medical Drive, Suite 7260 

KarMsa CRy. MO 64114 Omaha. (Nebraska 68107 San Antonio. TX78229 

Phone: (816) 36&-3703 Phone: (402)733-1188 Phone: (210) 822-8588 

Far (816) 363-3707 Fax: (402)733-1445 Fax: (210) 579^577 

eoo/ioo'd (XtA OCS I 0L0Z/5L/2i 
Prudent Technologies, Inc. (Pmdeirt) 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 

|^~y.-0 p J 2- 0 ^N' ^ . 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-contaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup plamied 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 directedto the EPA Public Infonnation 

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

Property Access Granted By: >r,c. M. bcT* r (Please Print Name) 

Property Owner Signature: Cj^.^ . (2„r71 9-/^-;o 

(Signature) (Date) 

PROPERTY INFORMATION 

. (Tp be completed by resident and/or propertj' owner — please print) 

RESIDENT NAME: Renter \ j K C.A.^Or Owner 

RESIDENT ADDRESS: 

\ I y o NJ I)oHv ^ 

IF RENTAL, PROPERTY OWfNED BY: 

OWNER'S MAILING ADDRESS; f ' O 

]i-)RCf S g>^ - ^ (.1^10 ^ 

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

J 1 

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 ANO 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 to be implemented by EPA under this agreement 

are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access 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 

imder this title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 5600 8 10 St 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 
TECHNOLOGIES, INC. 

ENVrRONMEtVT.ALA 

CONSTRUCTION 

SERVICE.S 

Address:

Phone: 

 H ^ o (\J

Property Status Form 

 "^jS? H-v ^ V ^^^^' 

BVID: 

(. fi_L, 

'Qon..JL' a,r A^ ^ "^ ^ 7 

(P- 0 

Ik 0(^^^ "^^^I 

i^ It CK k 

^Cb?.S:9Q- -</Gc^^^ AJ^ I 

-^Qo}-a):^-V^9V =. ^ 

'~^ 

Property Owi Prudent Employee 

Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St :al Drive, Suite 4250 

KansasCity, MO64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 Cv - /JA'l t Ti t .lOO-^ 
25172 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: RALPH H FROST • Good Site Sketch Address: 1110N20ST • Poor 

Phone: Jji _____ W: Q Notpaint 

Sample Number Lead 

Concentration Firm:

Samples Collected 

 /^< » Hrt/l^t J 

RYASCPXA-25172 Fl Date: "j-ZQ-S -

RYBSCPXA-25172 F2 Time: / / Zs- RYCSCPXA-25172 81. 

RYDSCPXA-25172 82 Samples Analyzed 

nDZCCPXA 36172 D2^ XRF Unit: \0¥ 1 Book: I? 3 

nCZOCPXA 26172 62 - Date: W-'^-a ^ 

nPZSCPXA 26172 —PZ~ 

Number of Samples = 

Time: 

Staff; 

yiasAA. 

Legend: F1 = Front Left, F2 = Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

All quadrants are as viewed rrom the street, feeing property 

ENTERED 

SEP. I? : 2Bm T 

fjffi.//.10.<;>r 

:i: 

312. 

( 

n ^z 

7.Z7 sm 

i 5[ 

2^**. -^r: ttcv4- 046I4I.0I23 
N 

11 ION 20 ST 

A fill # Printed: Dec 10.2010 

www.dcgis.org/dogis 
Ticket Text and Map display for Ticket: # 259212128 8 http://www.dhoaorg/irthintemet/MessageText/MessapTextAndMap.a. /irthir
 . 

Original Call Date: -9/14/10 Time: 5:49 pm Op: SIVA18967 

Work to Begin Date: 9/16/10 Time: 6:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1110 Street: N 20TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 15-NW-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 LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 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 

lof 2 12/23/2010 11:13 AM 
Ticket Text and Map display for Ticket: # 2592121288 http://www.dhoaorg/idiiintemet/MessageText/MessageTextAndMap.a, http://www.dhoaor^iriWn 

I View Map 11 Close Map 

2 of 2 12/23/2010 11:13 AM 
TBOtMlJ lOUfeMj^ CONSTRUCTION mc. SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: ^iSi^^^JdUd L Excavation Date: 

Crew: Backfill Date: 

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 

c^<- U C 1— (r> <r<V3 

e^ 

h^' sy 

• — ^ 

orcar^ 

pcayc 

C!«^ 

i T ^ 

o^— • « 

• 

• 

Site Safety Office 

Date: 

1080 WMf«aila«ay. Sute40S SSOOSIOSt 4242 Medical Drive, StiMe 7260 

ansasCi|yiaK>e4114 Omtta , ftabraeka 48107 San Antonio, TX 78229 

•hone: (SK) Ses-STOS Phone: (402) 733-1188 Phone: (2t0) 822-e688 

:ff:(S16)363'4707 Fax: (402)733^883 Fax: (210)«r»-<5r7 
IIIO 

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