PROPERTY SUMMARY SHEET 

Oniaha Lead Site Remedial Action Contract # EP-S7-10-05 

Said: 31509 Propert y Address: 352 4 N 4 3 ST 

Executive Summary: 

Issues Encountered: None 

30261120 Issues Resolved: None 

Unique Findings: 

Superfund 

Other Relevant Information: 

CONFIRMATION SAMPLING DATA/RESULTS: B2=274 PPM @ 4"; F2= 73 PPM @ 4"; DZ= 64 PPM 

@10'; EA= 74 PPM (SScrape. 

Attachments : 

Documents Included in the Property File: Yes No N/A 

Property sketch provided by EPA pursuant to contract specifications V 

Signed Access Agreement; including access agreements obtained (if required) for crossing V 

onto adjacent properties 

Pre-excavation agreement details (if any are made with the Property owner) V 

Pre-Excavation digital video clip V 

Sampling data sheet V 

Post-Excavation digital video clip V . 

Documentation - Completed EPA close-out checklist V 

As-Built sketch V 

Omaha Lead Site Database sample information document. V 

Signed form verifying satisfactory restoration V 

Other Documents : 

30 day SOD warranty pictures V 

Utility clearances document V 

Property information from Douglas County Assessor's office. V 

Settlement documents (i.e. for any damages, replacement of plants, etc.) V 

Site safety hazard analysis document with pictures. V 

Legend: Yes - Included In the File; No - Not included in the File; N/A -. Does not Apply. 

Prudent Representative EPA Acceptance: 

Date: Date: ^ 

PrudentTechnologies, Inc. j 2505 N. 24TH Street, Suite 308 (Omaha, NE 68110 USA j Tel. 402.504.1004 | 

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation j Construction 
iiini 31509 

Omah Exterior Paint North Arrow 

Owne a Lead Site r Name: OBED OAS • Gdbd Site Sketch Address: 3524 N 43 ST g ] Poor 

Phone W: : H- Q Not paint 

Lead Sample Samples Collected Sample Number LAB Concentration Collected Firm: atL 

RYASCPXA-31509 F1 D Date: \t 11 hhi n 

RYBSCPXA-31509 F2 D Time: rAX RYCSCPXA-31509 Bl D 

Samples Analyzed RYDSCPXA-315G9 B2 D 

RDZSCPXA-31509 DZ D XRF Unit: 

RGZSGPXA-34508 GZ D Date: _ 

RPZSGPXA-a4509. P2- D Time:

 _ 

Staff: Numberof Samples = 0 \^0i I

 \AZ 

f T-T ^ 

: ; • 

DEC 0 b 20S4 

t 

.?V. F 3Ji 

'\f 3^5 

i; i 

i2i. 

ZFH'^H 

•^1$ .N..y^.^. 

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pi. 

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l^.H^^t 

Omaha Lead Site 46130 
RX Date/Time .-,,„.^ . ^^^^

 _ 

PROPERTY ACCESS FORM 

Prodfliit TKhRol«gia, lae. (Pnideirt) is under eontract with ftc U. S. Bovironnwrtal ProtDCtion Agency 

(EPA) to clean up tead-comatninated soils at a number pf properties located m OmshA. Nebraska, including the 

pnpaxy located at - ^ ^>>'2-M J^ ) Vf7> -Cei ^Th e EPA requests your pemrisaon to allow Pnidem to 

pefftriB a soil cleamq) at tihis^openy to ranovc leadTcooiaaiiiialed soil. Sy signing this fomi, the property ovner 

giants pennission to Pradeni to perfomi activities reiated to the clesmip includiiig soil sampling, removal of lead­ contaminated soil, and restoration ofthe referenced propeny. 

If yov have any questioa'? about the soil cleanap planned for your property, please contact the Prodent 

OfTice for the Oniaha Lead Site cieannp a« <402) 735-1188. General questions about the Omaha Lead S'lte cleanup 

ean be directed to the EPA Public InformaHon Centere at (A02) 731-3M5 (South Omaha ofRce) or (402) 991 -9583 

(North Omaha ofTiceV 

If your property has a grave) ordirtdrivcwBysarparfcingareasth.cn the removal and rcpltcemenT ofthe soil 

and/or gravel during: the remediation process docs not make your illegal gravel/dirt drive^^ays or parking areas legalPnipwiy Access Otanted By: . £^££ V ^ >4> 

(PtsBsc Prifli Name) 

(Signaiure) (D&te) 

Property Ac««»cd by. ^^^JW y cLcOJ^^^^^- ^ ^'^''*" ^"^ ^ "*"' ' 

PROPERTY INFORMATION (To be computed by resident and/or ptroperly owner •• please print) 

1. RESIDENT NAME: iS^-y > Cfi^Rrep , ' Owner A^^& ) 

2. IF RENTAL, PROPERTY OWNED BY: ^gSl ? ^A- S 

3. OWNER'S MAIUNG ADDRESS; Bi(t > 10, :e j i i*-S gi L,<^ S. l)g . Sfe--w6.>./Lt,g A- C fc® « 3. 3 

d. OWNER'S TELEPHONE NUMBER - HOME: t-lo> H ^/- ^ o d U WORK: ( 1 

5. TENANr s TELEPHONE NUMBER - HOME: fWoX \^'^\ll&>\<^ WORK: [ ) 

6. AGE OF HOME?: ^ 0 - h YEARS. HOW LONG HAVE YOU LIVED HERE? " - ^ YEARS. 

7. HAS TME EXTERIOR BEEN PAINTED OR COVERED WITM SIDING SINCE 19787 /^fes J NO 

8. « OF OCCUPANTS UNDER AGE OF 7:, # OF OCCUPANTS AT OR OVER 7 YEARS OLD 

9. P OF CHILDREN UNDER AGE OF 7 WHO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

10. COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, NEIGHBORING PROPERTY 

ETC.) 

AUT>iORrrY FOR ENVIRONMENTAL RESPONSE ACTIONS: Tlw activities K> bs ImptamontBd by EPA under fills 

asreamenl are itufsvmtto Section 104 cf CERCLA, 42 aS.C. 8804. EPA's riglit of access lo tha pt«petty Is 

prwiaed tar In Section 104(e) oT CERQA 42 U.S. C 8S05(B), wfilefi provides enby for "detatmhrins the need for 

rrapmse. or ehoostng or taking any response action under liiis tide, or otherwise entorcing the piovtsions of the 

titn. 

Prudent Technologies Inc. S600 S. 10*^ St. Omaha, N£ 68107, 402.733.1188 (Office) 402.733.1883 (Fax) 
RX Date/Time 05/10/mi 09:05 A _ P.002 

uuutu/uii \)o.9a Hp f ^ 

^ ' ENVJRCWMENTAL& 

CONSTRUCTION 

SERVICES 

V *Hf>^. ^ Property Status Form , Addr^^r'S^^ H O ^iS'- d ^; . r Date: ^ S |0 ^ j ^i o M 

NOTICE TO BE GIVEN TO: OWNER (^ENAJj ) BOTH 

HOW MUCH NOTICE IS NEEDEDy^M HOUR^ 48 HOURS 72 HOURS 

OTHER NOTICE NEEDED (PLEASE SPECIFY): 

PHONE « AND NAME TO WHOM NOTICE NEEDS TO BE GIVEN: ^fiujt ? <1AK'7^ ^ 5"?I/0«^« » 

WVILL NEIGHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES ^<^ ) 

IF NEIGHBORING PROPERTY WILL NEED TO BE ACCESSED WHAT IS THE ADDRESS: 

WAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES X NO 

WILL A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YES VNO 

IF ANSWERED YES TO NUMBER 12 PLEASE PROVIDE LOCATION OF FENCE: 

IS THERE PRE-EXISp^G FACIAL DAMAGE TO TME PROPERTY AND IF SO PLEASE PROVIDED IXKIATION AND DESCRIPTION 

OF SUCH: YES /^o ) SPECIFY: 

IS THERE PRE.EXISnNG CONCRETE DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH: YES ^f ^ SPEOFY: 

Propert y Owne r Pmdent Employee /' ^ Y) 

Sisnatnre c c.^*^BSf-^ ••*;?. Signatnre; v(..jg<llvvu U. <CsY^ ^^UA A 

DATE : r-t-/ / 

Pmdent Tecbnologies Inc. 5600 S. 10^ St Oinaha, NE«S107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
Em'lRONM ENTAL & 

CONSTRUCnON 

TECHTfOLOGIES SERVICES , INC. 

Property Inspection Form 

Address: ^ S 2-*^ N M S^^J^ 8t ^ Date: 

Phone: BVID: 

Pre-Existing Dainage: Please write in detail and included location 

and description of damage: 

Concrete Damage: ^ e «^ M 

Facial Damage Including Siding: /./o ^-^ 

Does Basement have history of leaking or flooding? YES <1^0^ 

Does HomeoTvnerwant sod replaced in ali areas? ^^E ^ NO If NO please provide what 

areas are not to be sodded and what needs to be replaced instead of sod (i& mnlch, mck, 

leave bare) if mnlch or rock please specif what type and color; 

ANY OTHER DAMAGE OR REQUESTS: 

Property Owner Pmdent Employee 

Signature: ^.^^^f—»—. Signatnre: 

J^Kv^^/ui?^ DATE: ^'9.-1 1 DATE: Wu k 
ENV1RONMENT.4L& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

XRF CLEARANCE SHEET 

PROPERTY ABBRESS^ AS::^ ^ ' f-J. -i"^''^'''^ - O ' 

^. \ ^;r\ PROPERTY IB: 6 \ O'-. .' 

MAF HAS BEEN REVIEWED AND NO MISSED AREAS EXIST:^<^ NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE AND DIMENSIONS:/vX) 

CREW:,/-\KiU-tx^5 

DATE DEPTH QUADRANT j READING 

XRF TECH: k. • \oKr)3-.-> 

•J' ^ -yy 

Fl 

F2 

••(-: ) 

READINGS BOCimiENTEE IN J L 

Bi 

LOG BOOK? (YES"' KO N // B] J 7 7 

GARDEN 

/ PLAYZONE 

EASEMENT -7Z7 

2A a El loFi 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 3 / $< ^ .lerty Address: 3 ^2* ^ /Vl ^ ?. 5"^-

Date/Time: Owner's Name: ( ^ 9 7 r^i^CJ:^ 

Quads Excavated: ^ ^ p>2 -^2 - Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessarj-, were llie correct quadrant(s) e.xcavated and restored? / 

2. If necessary, •were the correct areas ofdrip zone excavated ajid restored? / 

Grading Sod and Vegetation Yes No 

1. Does the grading around Uie perimeter of the house in excavated areas generally slope away / from llie house? 

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

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

day time period) / 

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

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

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

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

Gales, Fences and Retaining Walls 

Yes No 

I. Do gates open and close freel)'? (If applicable) y 

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

3. Was dajiiage to gates orfences avoided? (If applicable) / 

4. Was dajnage to retaining walls avoided? (Ifapplicable) 

y 

Foundation, Sidmg and Gutters 

Yes^ No 

1. Was dajiiage to the siding or trim avoided? 

y 

2. Was damage to the foimdation avoided? 

/ 

3. Was damage to windows avoided? y 

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

5. Was damage to downspouts or downspoui extensions avoided? 

/ 

Sidewallks and Driveways (Concrete) Yes No 

1. Was damage lo diivcwav surfaces a\'oided? / 

2. Was damage to walkway surfaces avoided? y 
Removal and restoration activates complete including the 30-day sod warranty 

EPA Representative ^'^ ^ Dale: JfM[!L_ 
i

.i,.J-l'.J:J!-,,A' , ^^__^^!jMP|^'^TECHNOLOCI£S. IMC. 

iirvy:^f.rsz : .il5:; v - 352v iO <^j S?. 

Sa:-.".p-ad Cy. L;0:'-T:sar. 

Owner Name: OBED_OAS 

Acidress: 3524N 43_ST 

Phone: ^ 

Sample Number 

RYASCPXA-31509 F1 

RY3SCPXA-31509 F2 

RYCSCPXA-3-i509 Bl 

RYDSCPXA-31509 B2 

RDZSCPXA-31509 DZ 

RG2SCPXA-3--1509 -GZ 

R PZSCPXA-3-1509.- —PZOmaha I .ead Site 

AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

CONTRACT #: EP-S7-10-05 

Otnah a Lea d Site 

Site Sketc h 

Lead Sample 

Concentration Collected 

ppm 

~'. '-^y-i ppm 

^^pp m 

'' <: ^ . ppm 

^TP j ppm d 

ppm • 

ppm 

Number of Samples = 

1: 

LAB 

D 

D 

n 

D 

D 

n 

D 

tv:-^i Vi' i 

JJ %U 

M.yj.si; 

.;, . . .1 . 

• v­vJ;i. ! ^'!^­

1

C-.

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 t:,::^^^ ; i-l l i . ..., ._:.J.lJ,.; : L

... . 1 J • ..'.'•. .'*.'' ' , • . • 

31509 

Exlerior Paint 

Option 

\ ^

Q

Firm:

Date:

Time: _ 

XRFUn 

Date: 

Time:. 

Staff­

 Poor 

 Not paint 

Samples Collected 

_ AJiiV: ft,-! / A -.•] 

_ ll- y h--{ 

^W^ , 

Samples Analyzed 

t: ^ W Book:\'-.a 

R M ^ 

K a^- ^ 

.;.... . OJ>) .J..-J:J i.\j£.ji i>J. 

• lit:',. •;; f,i it;ls* 

46130 

Prudent Technologies, Inc. | 2505 N. 24TH Street Suite 308 |Omaha, NE 68110 USA | Tei. 402.504.1004 j Fax: 402.504.1005 

Environmental Engineering & Services | Remediation | Construction 
; Find Record i6on Query 1 I Lead Remaaung (Juery i t Property Dd^^B^uery CloProperty Info Clean-up Info Sample Info Customer Calls j Sidewalk Repair j 

Sample Area ; 3150 9 352 4 N 4 3 ST 

Sample Oate . Quadrant .t Paramete . XRF RE ­ XRF Res » Exc ­ Marker Place Lead Remainin »'ln; . Sampled B-t QA Confirmee­ Lab_R 

_ [ 9/2/2011 B2 LEAO 274 mg/kg ''. " Q LKi»®e W N/A 

9,/2/2011D1 LEAD 64 mg/kg 10 B B ! LJOHNSON N/A 

9/2/2011 El ^LEAD J74 mg/kg 1; H n i .LJOHNSON N/A 

9/2/2011 F2 !LE/« 3 J73[mg/kg H D ; LJOHNSON N/A 

-r ILEAD : mg/kg _L. N/A i 

Record: M M • i "ifii No Filter i Searcti EE 
Fsid Record I l^^n^tK l^^n^tKmm Quer Queryy |j j iLea LeaddRemainrt Remainrt^ gQuer Queryy j I I IPropert Propertyy Dai^^Bue Dai^^Huerr y I Clo

Property &ifo C3ean-up Info Sample Info Customer Calls Sidewalk Repair 

Sample Area: 31509 - 3524 N 43 ST 

l.aj_Resul » Lab Result Unit: » Remarks 

0 mg/kg 

0 mg/kg 

0 mg/kg ^___ 

0 mg/kg 

0 mg/kg 

w • ; "i i No Fitter , Search l< 
P.001 

RX Date/Time 09/27/3 n:59 

09/26/2011 08:56 • P.002/003 

PfQperty Completion Agreement 

Tbi? igreeujwjt documeutis the.completion of removal activities performed, on the belovy listed 5roperty. 

The.property .^owb-M-'s'signatureipdic^ owiicr is; satisfied with.Oie re^tora^i >n of the 

subject p/9p«i4yi aid; tihat; -np.: items; are! ifl' ^u.estion,;. now, or .it'siny. •tiinei in the futurcj, c^xcli ding' any. 

.recha^mg w^raiity'(36Klays tptel) except 

wm. 

a? /r QhtSRestoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

' I agree restoratioh is corripteted. 

L J I do r>ot agree restoration is completed at {noted deficiencies abotfe) 

f - ^ 6 - / / 

Owner's Signature Date 
. >• ' ••••• , •••x-. V 

'F^yS... ••.h \ ' 

^ym^' 

- ^ss^*- .r ' ,^Mgt # J % f.44 'J^fe,^" "^ * » 

V i 1^' 

'4 

1 

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Mebraska 

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Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2831293. 

Original Call Date: 8/25/11 Time: 9:15 am Op: ASHLEIGH18967 


Work to Begin Date: 8/29/11 Time: 9:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3524 Street: N 43RD ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION 


Location of Work: ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: EMAIL ALL CLEARS TO: AANIKPUTA@PRUDENTWEB.COM 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: ASHLEIGH ANIKPUTA Phone: (402)733-1188 


Alt. Contact: NONE 


Work Being Done For: EPA 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketlD=803560 8/25/2011 
IRTH One Call Page 1 of 1 

• Oni: Ccjl 

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• Of 

Niebriiska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2838762. 

Original Call Date:

Work to Begin Date:

 9/02/11

 9/07/11

 Time: 9:48 am 

 Time: 10:00 am 

Op: ASHLEIGH18967 

State: NE 

Address': 3524 

County: DOUGLAS 

Street: N 43RD ST 

Place: OMAHA 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 08-NW 

Sect-Qtr: 

Type of Work: LEAD SOIL REMEDIATION PROJECT 

Location of Work: ENTIRE PROPERTY 

Remarks: FAX ALL CLEARS TO: (402)733-1883 

: EMAIL ALL CLEARS TO: AANIKPUTA@PRUDENTWEB.COM 

: UNSURE CORNERS 

Company 

Contact Name 

Alt. Contact 

PRUDENT TECHNOLOGIES 

ASHLEIGH ANIKPUTA 

NONE 

Phone: (402)733-1188 

Work Being Done For: EPA 

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

Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

 Rear: 

http://www.dhon.org/IRTHOneCal l/Ticket/TicketCreation.aspx?ViewTicketID=813100 9/2/2011 

K 352

4 N 43 St 

A Printed

: Mar 30. 201 ww

w dcgis org'iliipis 
^Sit e Joti Ha::ard Anab^ IS 

Address 3 5 3 V M3' .-spt Date nh5 ( I /

Analysis Completed By_ Prudent Technoiogies Health and Safety Officer 

Location 

Item Bl @ Condition Hazards Corrective Action 

Overhead Power Lines Electrocution 

Gas Lines Underground Gas, water Call Digger Hotline Priorto perfonn locates prior to 

Water Lines Utilities leaks beginning work on property 

Sewer Line If utilities are not located contact Supervisor, Safety 

Septic Tank Personnel to notify them of issue 

Propane/Butane Go to another property to work as directed 

Foundation (DZ) 

~AXDJJ ^ 

Driveway 

Side walk 

Trees 

Plants/Garden GZ 

Access to Property 

Busy Street (need to close 

off Lane) 

Hand Dig ^^yA" IVG^C" O 

Pets /bees/wasps/ticks/red 

ants/spiders^ 

Miscellaneous 

2-C'! PKo'T^ t^^K.\--^SL^ 

Time Print Name ofeach Signature ofeach Changes in conditions resulting in additional 

Date Reviewed Reviewed crew member crew membe; safety assessment ifapplicable 

"U^ ^ygff^iC . ^rf^-li Ofe-2QM H (Mv\ Yafn^ 

rif^cfi'-a '^YL m/^K^My/^7 

Audited by Date ^/'hi 
•-V,''' 

m ' ^^^^^•n. .->.( 

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