TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 31259 DATE; 1/15 

ADDRESS: 3030 EMMET ST ^ ^ 

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

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POSTVIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

M EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

d CONFIRMATION DATA 

d PHOTOGRAPHS 

d AS-BUILT SKETCH 

Q SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

ft^^ 3M L 

SIGNATURE DATE 

30218423 

iHII 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 3030 EMMET 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: 

B2 = 416 PPM @ 13"; EA = 96 PPM @ 6" 

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 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 (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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Rnd Record Remediation Query I Lead Remaining Query , Property Damage Query 

Backnii: 

Sampie Area: 31259 - 3030 EMMET ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

(BATES KEITH A r~—^ 

Owner Addressl: Owner Address: Property Address: 

r jSOBO EMMET ST 

Owner AddressZ: Zip Code: 

JP 0 BOX 11429 168111-

City: State: Zip Code: City: State: Zip Code: Resident Phone 

JOMAHA JNE lesiii- ' I p- I 

Owner Phone Alternate Phone: Owner Phone: Altemate Phone: 

1(402) 457-5443 1(402) 917^202 

Contract: Assessment: 

Contractor: JPRUDENT2010_S Qualifying Group |400 

Contract Option JOPTION 2 Assessment Max XRF Value | 489.72 
3

TTECHNOlJOGliSS, INC. 

EPA Froperty Close Out 

Property #: ' 3-1^ "2- 6 ^ Property Atldress: 5<3"5<3 t h^r^v^i" ^"^^ 

Bate/Time: Owner's Name: ^ «.T4-v^ ^.cc^e^ 

Quads Excavated: V "Z.. Contractor Group: Prwilfinf TecltiniologicSi Unc.., 

Excavation GeneraJ 

Yes No 

I. If necessarv. were Ihe correcl quadraiit(s) excavated and restored? / 

2. If necessar}'. 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? / 

 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. Arc tlie jomts between the sod strips generally tight? (Only evaluate if inspected at a 30 daiy / time penod) 

(). Was the property graded such tliat water will not pool on the property'^ 

/ 

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

Gates, Fences and Ketaining WaUs 

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

Yes 

/ 

No 

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

3 Was daiu;;ge to gates or fences avoided? (If applicable) / 

-1. Was damage to retaining walls avoided? (If applicable) / 

Foundation, Siding and Gutters 

Was damage lo the siding or trim avoided? 

Was damage to the foundation avoided? 

Was dama£;e lo windows avoided? 

Yes^ 

y 

y 

4. Was damage lo windows or door screens avoided? 

5 Was damage fo downspouts or downspout extensions avoided? 

y 

Sidewalks and Brivcways (Concrete) Yes ^No 

Was damage to diiveway surfaces avoided'? 7f 

2 Was damage to walkway surfaces avoided? 

y­
Owners comments: 

Inspection notes: 

AV ^ 

r

,tJ' k­ y.1^' y ( y 

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

EPA Representative 06" AH ^Date: il^itil 
rHNDEDGlES. INC. 

AS - BUILT DRAWING 

OLS #31259 

Date Excavated: 10/18/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-OfT Date: 

31259 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: KEITH A BATES • Good Site Sketch Address: 3030 EMMET ST n Poor Phone: H: W: ^ Not paint 1 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm; 

RYASCPXA-31259 F1 Q 1 ppm D 

Date: 

RYBSCPXA-31259 F2 2.2.q ppm \2r D Time: g-3 6 (^-^ 

RYCSCPXA-31259 B1 -^Of i ppm D Samples Analyzed RYDSCPXA-31259 B2 ^qr > ppm B D 

RDZSCPXA 31250 OZ ppm D D XRF Unit lOO n Book: iisPi 

-ReZSePXA-31259 SZ ppm D D Date: B-r^|-O U 

RPZ9CPXA-31209 PZ ppm D D Time: p m 

Staff: MS\A/ • 

Number of Samples = 

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

All quadrants are as viewed from tlie street, facing property 

ENTERED • 'i* ^ fbLt 

- ml ^.iuiia 

3Qe. H90. 

B2 = 4I6PPM a 13" 

%\- ^7 

^ 

^!) 0 e.tvv*5i*| 

t Z­ -TV 

M zm 

VjOaVl^ . 

Ct-t-vVi-l St 

EA = 96 PPM (ffi 6" 

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

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 ofthe 

subject property, and that no items are in question, now, or at any time in the fiiture, excliiding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address: ^^^f ) l j JO'^l^^d;^-~ 

Owner: 

Phone: L^^l - S'^^-S 

Restoration Items in Question: 

Item: , 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

 I I agree restoration is completed. 

it/rl do not agree restoration is completed at (noted deficiencies above) 

Owner's Signature Date 
ENVIRONMENTAL & 

CONSTRUCTION 

TECTHNOLOGIES SERVICES 

PROPERTY CONTACT ATTEMPTS 


Property n>: 2>\'75'^ 

Property Address; 3Q3 o €Av»vig^ S.^ 

Owner Name: ICjt»H> 12>aki 

Owner Phone: Ly5>^ — S^^^^ 

Below please find a listing of unsuccessful attempts to reach the above 

property owner. 

Date Time Initials Result 

U/27^'0 il'.cna p>0- VOar\+*4 UJ^ Vo d o -K^-O 

lAskole lot- tu-t" uoc, u*€y^ KA ^ 

^1^ ^ ow t U3K\4-CUfV\»A<L4 eUAJtW'^*' 

Po - *'«-f-^AA«ct 4-0 S^^i^ ^+Ue ­

/A/-/ > 

Date 

Prudent Technologies, Inc., 

Acknowledgment signature Date 

EPA 

8080 Ward Parlcway, Suite 406 2505 N. 24*^ Street Suite 308 4242 Medical Drive, Suite 7250 

Kansas CHy, MO 64114 Omaha. Nebraska 68110 San Antonio, TX 78229 

Phnnn- (AlA) 363-3703 Phone: (402)604-1004 Phone: (210)822-9588 
"m. 

Pmdent Technologies, Inc. (Prudent) is under contracl with the U. S. Enviromnental Protection Agency (EPA) to clean up leadcontaminated soilsat a number ofDpsperties located in Omaha, Nebraska, including the property located at 

2o^ O 3-yy)y>ia/ ' i The EPA requests your permission lo allow Prudenl 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. 

Ifyou 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 at (402) 731-3045 (South Omalia office) or (402) 991-9583 (North Omaha office) 

Property Access Granted By: 

II j,.-~. \ y y (Pleas ^ (Pleasee Prin Printt Name) 

Property Owner Signature Azy^^-^EAA^ i^////d

(Date)

Y y ^ (Signature) XTT f

PROPERTY INFORMATION 

/fi l be completed by resident and/or property owner — please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS;— r") . «». /\ ><f .^ ^ . ^ 

3o-^>o g^w^ ^ S f C)(NuA^ tO(s 6g^(/ f 

IF RENTAL, PROPERTY OWNED BY: 

^oy\ < %r^.Uy>. 

OWNER'S MAILINOADDRESS; 

"KK^LJ^ grV f^touJL ^ M|Er Q^( { (^ 

OWNER'S TELEPHONE NUMBER - HOME: ( ^b^ ) M 3 '~? *~ cS> ^ H ^ORK : 

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 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: (I.E. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agrcemeni 

are pursuant to Section 104 ofCERCLA, 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 entiy for '"detennining the need for response, or choosing or taking any response aclion 

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

8080 Ward Parkway, Suite 405 5600 S tO St 4242 Medical Drive, Suite 4250 

Kansas City.MO 64114 Omaha. Webraska 68107 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: •;402) 733-1168 Phone; (210)822-9688 

Fax: (816) 363-3707 Fair: (402) 733-1883 Fax: (210) 679-6677 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form . . Address = 30-3 0 Q^,,^^ ^ ,D„e:fO/////o 

Phone: BVID: 

Proj^erty Owii| Prudent Employee 

Signature: Signature: 

8080 Ward Pai 5600 SIO St Medl<;al Drive, Suite 4250 

Kansas City, IMO 64114 Omaha, Nebraslta 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)733-1188 

Fax: (402)733-1883 

Phone: (210)822-9588 

Fax: (210) 579-6577 
1 31259 

Owner Name: KEITH A BATES

Address: 3030 EMMET ST

Phone: H: W: 

 Omaha Lead Site 

 Site Sketch 

Exterior Paint 

• Good 

n Poor 

0'^ Not paint 

North Amjw 

\ 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

J* ^ AfA^fmO 

RYASePXA-31259 F1 D Date: ^ItZ-lOfo 

RYBSCPXA-31259

RYCSCPXA-31259

RYDSCPXA-31259

RDZSCPXA 31259

RGZSCPXA-312S9

 F2 

 B1 

 82 

 DZ 

 GZ 

2.g.q ppm 

30 ^ ppm 

_iiaD__Ppm 

PPm 

PPm 

\3r 

sBD 

D 

D 

D 

D 

D 

D 

Time: 3-.36 (>«^ . Samples Analyzed 

XRF Unit JOD'7 Book: 

Date: 6-:^|-o U 

IL") 

RPZ30PXAO1259 PZ ppm D n Time: ;w. 

Number of Samples = j ^f Staff: M5U/ 

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, fadng property 

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A Printed

: Oct 12,2010 

www.dcgis.org/dogis 
Page 1 of 1 

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Create Another Ticket Back to lilh Internet Send Email 

YOUR TICKET NUMBER IS 2614186. 

Original Call Date: 10/11/10

Work to Begin Date: 10/14/10

 Time:

 Time:

 2:19 pm 

 7:15 am 

Op: SIVA18967 

State: NE 

Address: 3030 

County: DOUGLAS 

Street: EMMET ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 09-NE-NW 

 Sect-Qtr: 

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 o f Excavation : 6 FT Corne r Lot 

Involve s Tunnelin g o r Horizonta l Borin g 

CXCATV MUDOl OMAHACOF 0PPDGPR5 

N 

N Exp l 

QLNNEIC 

Front :

osives :

 Y

 N 

 Rear : Y 

Service Area Contact Phone Number utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDO1 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day:

 Alt:

 4024447197 

 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.(ihon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/11/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTKWV ICDHIIOUMMBS, INC. 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: ^O^ g

Crew: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Stmctures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

 t^A^h ^ 

Condition 

h)t>r< 

/Uo.-Jl 

Mfl/tc 

kUr^ 

ho< 

fJo<^C 

UoHl 

XJ^M 

UoM. 

l ) ^ 

(S«C 

SJQAS^ 

L)<y^ 

h)6J^ 

Excavation Date: ^0-/^-/ 0 

BackfiU Date: 

Hazards Corrective Action 

Site Safety Office 

Date: 

seoosiost 4242 Medical Drive, Stdte 7250 

>(aty;iio««ii4 Omdiia, NaiMaaka 6B107 San Antonio, TX 78229 

PhaoK (8W)3P'3?D3 PtanK (402)733-1ia8 Phone: (2t0)e22-«588 

Rac fSn) 3634707 Fac (402)733^1«83 Fax: (210)«7»«577 

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:'JO^O ^I^^-" :i '^'>*m£'mti. 

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