TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: r^^ia^i o Date: 1 T 15 " \U 

Addtess: Ni O M H SJRemediation Contractor: Pp,-, rypr^i-y T^/'-ft N/'yioc, K^<i^ ir>jc,'i Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ Video ofproperty (DVD)

^ ExecutivesTM Executive Summar^y 

a EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

a Restoration Agreement 

 30237524 

 1111111111 1 

Superfund 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

1*5 Confirmation data 

d Photographs 

df As-btiilt sketch 

a Satisfectory restoration signed by Property Owner 

[/ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

B Utility clearances 

• Property information from Douglas Covinty Assessor's Office 

D 

D 

D 

9A'y\ 8l«*>" 

Signature Date 
PROPERTY SUMMARY 

Date: 11/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Montii of: November 

Property Address; 1410 N 17 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: 

Bl = 341 PPM @ 4"; B2 = 368 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) 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. 
Find Record 

Backfill: 

Sample Area: 25656 - 1410 N 17 ST 

Owner: 

n Owner Occupied 

Owner Name: 

lOTY OF OMAHA 

Owner Addressl: 

I 

Owner Address2: 

11819 FARNAM ST #1111 

City: State: Zip Code: 

OMAHA |NE |68183 -

Owner Phone Alternate Phone 

)(402) 441-5150 

Contract: 

contractor: |PRUDEMT2010_S 

Contract Option [OPTION 1 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Code: 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group |4o6 

Assessment Max XRF Value | 530.4 

Resident: 

Resident Name: 

r 

Property Address: 

|1410N17ST 

Zip Code: 

|68102-

Resident Phone 

I 
i^^ .-^li V 

TECHNCtLOGIBSb UMC. 

EPA Property Close Out 

Property #:'^ 5^^ ^ Property Address: \ 410 A-' 17 $ ^. 

Date/Time: Owner's Name: c ^^'-^ o^ C i»^»<»- ^ 6\ 

Quads Excavated: 2>(, ^"2- Contractor Croup: Prudent Technologies, Bnc, 

£.\cavation General 

Yes No 

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

2 If necessarv, were the conrect areas of drip zone excavated and restored? y 

Grading Sod and Vegetationi Yes No 

1 Does tlie 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 tliat 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? y 

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 tlie property? X 

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

Gates, Fences and Retaining Walis Yes^No 

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

2. Were aU gates or fences taken down during restoration activities reinstalled? (If applicable) / ' 

Was damage lo gates or fences avoided? (If applicable) / 

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

A 

Foundation, Siding and Gutters Yes No 

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

2 Was damage to tlie foundation avoided? / 

.3, Was damage lo windows avoided? A\ • ^ 

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

5 Was damage fo downspouts or downspout extensions avoided? / 

Sidewalllis and Driveways (ConcreUe) Yes No 

1. Was damage lo driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? y 
Owners com ments: 

Inspection notes: 

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

EPA Representative JSL ^ > ^ Date: lojislio 
:CHN0L0(J1ES, INC. 

AS T #UJI.T DRAWING 

OLS # 25656 

Date Excavated: 9/29/2010 OMAHA LEAD SUPERFUND SITE USEPA Signed-OfT Date: 

Omaha Lead Site 

Address: 1410 N17 ST 

Owner Name: crtY OF OMAHA 

Site Sketch 

Phone: "• •MISiS O W: 

Sample Number Lead Sample LAB Concentration Collected 

RYASCPXA-25656 F1 ppm D

RYBSCPXA-25656 F2 y no ppm D 

RYCSCPXA-25656 Bl ppm m D

RYDSCPXA-25656 82 H3Q ppm D 

RDZSCPXA-'iMSe DZ- ppm 

Rr!7grPYA.9IWI«i G2_ ppm n D 

D 

RPZSCPXA.256S6 PZ- ppm D D 

D 

Numt>er of Samples = , ^ 

Legend: F1 = Front Left, F2 : Front Right, Bl = Back Left. B2 = Back Rig 

An quadrants afB as viewed from ttie etreet, ( 

25656 

Exterior Paint NoithAmiw 

• Good 

• Poor 

B^o t paint 

Samples Collected 

Finn: H^ ^ ' M^^tJ Q 

Date: 0*4 I t'>^\o<a 

Time: *?: O? Q«M 

Samples Analyzed 

XRF Unit (pS'J Book: li b 

Date: ^•Jg-ot/ 

Time: Aa. Staff: M^V./ 

DZ = Drip Zone, GZ = Garden, PZ = Play 

property 

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, ifany. 

Property ID: 

Property Address: /y^^ ^^^^ ^ 11 ^ S4r-^-h 

Owner: C , U J C>r^KA 

Phone: ^ u,e(v.|. ^)^K\ X 

Restoration Items in Question: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^ ^ agree restoration is completed. 

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

./T-Or(-yfO/0 

Owner's Signature Date 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

/T/ Q AA //" * S/~^ . 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 planned for your property, please contact Prudent south office for the Omaha Lead 

Site cleanup-at (402) 733-1188. General questions atxjut the Omaha Lead Site cleanup can be directed to the EPA Public Information 

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

Property Access Granted By: >Q A<///0^>»7 L-y</ H ^ 

I . (Pleas I e Print Name) 

Property Owner Signature: ^^/^7\IZL ^ ^i^Sr^^-^OlO T (Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: C^// ] c/7 Ay/yyO^A ^ (owner ^ Renter 

' " ^ 

RESIDENT ADDRESS: 

I m p O tn-Hy ,^i ^ 

IP RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

ip^ fi^r^a^ a.^SuiJc^ ml, 0(^ ^ Ay& ad h 

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 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 agreement 

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 entry for "determining the need for response, or choosing or taking any response action 

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

8080 Ward Parkway. Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City,'MO 64114 Onrtaha. Nebraska 68107 San Antonio, TX 78229 

Ptione: (816) 363-3703 Ptione: (402)733-1188 Phone: (210)822-9688 

Fax:(816)363-3707 Fax: (402) 733-1883 Fax: (210) 579-6577 
ENVrROkXMEL\TAL& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 

Phone: BVID: 

n) ^qpc . ^>-<: 

K") ^g W 5sVPSR ^ 

rlc^[ 'oy\ ?^u3 5 Tg)U.^A Q iivD^g odJ Cf^y- ^ 

rS) cP^f-S ?C^noJc^ 0^^ ^ 

(g^ iMif^ Ko^ t n ^ si^ V/ac_c^v^ [t^f 

@ \ m ^ QU-A^O ^ F 

^•^i S frc^^t : t ^

^ X25-0& .fiU^J ^ 

O ff t'^.2q T^lareMC-e 

1^ / iSH s Flo^e<-^iL 

© P'^\L gr.^r^' 

Property Owner Prudent Employee 

Signature: Signature: 

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

KansasCity, MO 64114 Omaha, Nebraslia 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

C^v . I»nt \ T4 1 400-4 C^v- <9int «T0Jt«T7 
25656 

Owner Name: CITY OF OMAHA 

Address: 1410 N 17 ST 

Phone: H: fHISiS O 

Sample Number 

RYASCPXA-25656 F1 

RYBSCPXA-25656 F2 

RYCSCPXA-25656 Bl 

RYDSCPXA-25656 B2 

RnzsrpxA.?5fi96—DZBn7.SnPXA-?fifififi GZRPZSCPXA.?56^ PZW: 

Lead 

Concentration 

173 ppm 

_LKi_Ppm 

5 3 0 ppm 

=^PP m 

_^pp m 

ppm 

Omah a Lead Site 

Site Sketcl i 

Sample LAB Collected 

M 

D 

D 

D 

D 

D D 

D D 

D D 

Number of Samples = ^ 

Legend: F1 = Frcnt Left. F2 = Front Right, Bl = Bacic Left. B2 = Back Rk 

Alt quadrants are as viewed firom the street, 

.iA\o.«^ 

.(b. 9>. 

530 •T 410. 

m. m 

Ft 

VJetvfcv 

Rev4 Ki A'\

 6 t 

Exterior Paint Nottti Arrow 

• Good 

• Poor 

Q^o t paint 

Samples Coiiected 

Firm: Ht » ' t^^ftl Q 

Date: 0<4 I ty^lo ^ 

Time: *?'. O g Cic/v> 

Sampies Analyzed 

XRF Unit: L S ^ Book: /f b 

Date: H Miou. Time: A,M 

Staff: MSV 

D2 = Drip Zone, GZ = Garden. PZ = Play 

property 

1* ^ POL^ 

ENTERED 

APR 15^ 2006 

046141.0123 
K 1410

N 17St 

A JUS

- Printed: Oct 18.2010 

WWW.dcgis.org/dogis 
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Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2592082. 

Original Call Date: 9/14/10 Time: 5:23 pm Op: SIVA18967 


Work to Begin Date: 9/16/10 Time: 6:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1410 Street: ISl 17TH 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 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING . Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
ENVIRONMENTAL 

ENGINEERING ASW 

GON&TRUCTION 

m;jm^ 

TtraeHNotneflEs, mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: I^ie.„.4/.-(2]^.^t . Excavation Date: J-Mr_L2> 

Crew: —^tc^.£^^St^:r:^ 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 

QJi^^j&JL^ 

Condition 

cl^ 

A,n 

I^Al 

An 

np 

n{i 

n.p 

7)0 

A.n 

f)d 

1 

nh 

ilk) 

f\^P 

f\.0 

Hazards Corrective Action 

Site Safety Office 

Date: 

S08O1Mlaftf«arfiN9y;BiM»4O5 iS6005:iaSt 4242Medicat Drtve/.Stiite' 7250 

Kaaas.ia|yj\|l0564114 Omaha, NaboMa «8107 5San'Antonio,iT)( 78229 

PFhona: i f<02r733.1188 t?hone: ((210^^822)9688 

Fax:(81«)^^363«3707 Tax: ft02)733<ia83 !lrax;t210)r5r»«S77