TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 29094 DATE: 12/15/2010 

ADDRESS: 1419 Ohio St 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

• PRE AND POST VIDEO OF PORPERTY (DVD) 

[^ EXECUTIVE SUMMARY 

• EPA-PROVIDED PROPERTY SKETCH 

cf SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

^ CONFIRMATION DATA 

13 PHOTOGRAPHS 

\ ^ AS-BUILT SKETCH 

0 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

d PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

• D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

d UTILITY CLEARANCES 

[^ PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30260826 li 

Superfund 
Find Record 

Backfill: 

Sample Area: 29094 - 1419 OHIO ST 

Owner: 

D Owner Occupied 

Owner Name: 

jCFTY OF OMAHA 

Owner Addressl: 

|c/ 0 PUNNING DEPfi kRTN lENT 

Owner AddressZ: 

J1819 FARN AM ST #1 111 

City: state: Zip Code: 

loMAHA JNE [68183­

owner Phone Alternate Phone: 

1 r 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option jOPnON 1 

Remediation Query | Lead Remaining Query 9 Property Damage Query 

User Provided Owner Information 

owner Name: 

i 

Owner Address: 

City: State: Zip Code: 

1

•J 

- ­ ^ 1 1 

Owner Phone: Alternate Phone: 

1 • 1 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value | 522 

Resident: 

Resident Name: 

Property Address: 

J1419 OHIO ST 

Zip Code: 

|68110-

Resident Phone 
PROPERTY SUMMARY 

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

Property Address: 1419 OfflO 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: 

Bl = 309 PPM @ 6"; B2 = 257 PPM @ 6"; 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 (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. 

TECHNOLOCIES, INC. 
TECHNOLOGIES, BMC. 

Property #:2'^i ^ 4 

Date/Time: 

Quads Excavated: ^7^9"Z ­

••i:"^t~:f 

EPA Property Close Out 

Property Address^ |i-f \fL Ov>.v<i 

Owner's Name: Cv^> .'^Ct.v-'^*^ 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

1. Does die grading around the perimeter of the house in excavated areas generally slope away y from die house? 

2. Has sod been laid in ali areas diat were excavated? 

y 

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

day time period) y

4. Are sodded areas generally fimi and evenly graded? 

y 

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

6. Was (he properry graded such diat water will not pool on the property? y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining WalJs Yes No 

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

y 

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

3. Was daniage lo gates or fences avoided? (If applicable) 

y 

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

y 

Foundation, Siding and Gutters Yes No 

!, Was damage to the siding or trim avoided? y 

2. Was damage to die foundation avoided? 

y 

3. Was damage to windows avoided? 

y 

4. Was daniage to windows or door screens avoided? 

y ^ 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes No 

I. Was daniage to driveway surfaces avoided? y 

Xy

2. Was daniage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative .gL., ^ ^ Date: /o/^ ?// 
HJHNULOGIES, [NC. 

AS - BUILT DRAWING 

OLS # 29094 

Date Excavated: 9/24/2010 

USEP OMAHA LEAD SUPERFUND SITE A Signed-Orr Date: 

iimillll l 29094 

Omah Exterior Paint North Arrow a Lead Site 

Site • Good Sketch 

• Poor 

Samolina Address: 1419 OHIO ST 

0 * Not paint 

Sample Numt>er Lead Sample Samples Cotlected LAB Concentration Collected Firm:1»'. tVg r CH'*'R W 

RYASCPXA-29094 Fl .^3^^ ppm 0*. D Date: S-lSSt^/ e RYBSCPXA-29094 F2 0* D Time: I/:00 AM . RYCSCPXA-29094 Bl -522 ppm B* D Samples Analyzed RYDSCPXA-29094 B2 ^(rxOi ppm B" D 

RDZ3CPXA-29094 B * " • ppm D D XRF Unit fOfiV' > Book: l/^i R 

ROZOCP)(A-i!0004 62' — ppm n Date: fn-O H -IC) 

rXPZCOPXA-gOOOt pa­ n ___=_ _ ppm n Time: P M 

staff: M^U / Numtjer of Samples = / j \ \ ^ | 

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

All quadrants are as viewed from the street, facing property 

EUTTERE D 

MAY19'201(| 

52Z\.H&(ff. 

B l = 2-S7 PPM @ 6" 

^ 

f 

. * ^ mnortoV 

fl.lfZr 

3dPi 350 

^^^i ^ 

Rtx :008 !A i-fj'-' - l.1-M3r-aS MOST. ^O^fi<;gmfc=TST 

CONTRAa #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
/ 2 ^ 

Property Completion Agreement 

This agreement documents the completion of removal activities perfonned on the below listed property. 

The property owner's signature indicates that the property owner is satisfied with the restoration ofthe 

subject propert)', 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: /y^o; ^;^^^^ <^'lrc^4-

I Owner; (^(•1-^ ••-''/ Oytn:^-l-A. 

Phone: ^ ^y/'-i-'-/3H)r 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

[^ , I agree restoration is cotnpieted. 

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

c^'S -Ock/>-a^ -.<PO/Q rtti>noi-> Owner'c CinnoViit-. / / ' V s SignaiureC/ Date 
wRUDEN 

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

•ill C^/I/Q . Tlie EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminaled soil. By signing this form, the property owner grants penrussion lo Prudent to perform 

activilies related lo 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 conlacl Prudenl south office for the Omaha Lead 

Site cl«anup-al (402) 733-JI %%. General questions about the Omaha Lead Site cleanup can be direaed to the EPA Public Information 

Centers ai (402) 731-3045 (South Omalia office) or(402) 991-9583 (North Omalia office). 

Property Access Granled By: yilifiiyyi LryicA\h 

(Please Print Name) 

Property Owner Signature: My ^ 

gnature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: d!w'>f c/T ^•>->i» ^ (Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

/fl ^ rfJQr^Ayyi ^/ ^ Suil c (lll ^ Ol ^ hfi- A/ & Co m 6 

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 lo Section 104 of CERCLA, 42 U.S.C. 9604. EPA'sright of access to the property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entj-y for ""detennining the need for response, or choosing or taking any response action 

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

8080 Ward Parkv/ay. Suite 405 5600 S 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 
mmm EN\T;RO.M\JEiVT.AL & ' CONSTRLiCTrON 

TECHNOLOGIES, INC. S£RVICE.S 

Property Status Form 

Address: OL(La^ U ^ »»"= ^loU ^ 

Phone: BVID: 

A^>^ ' 

rE) cP^f-5 yM-Wojc^ 

@ iMiD r^ \n ^ sw V/ac_o^vAJ^ 

I Property Owner 

I Signature 

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

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 

C.. . ro^C\ .. O OTA? 

Phone: (402)733-1188 

V Pttone:

Co».

 (210)822-9588 

 Iinn \ e7«J5«T7 
illllllillllilllli 29094 

Exlertor Paint Kforth! Arrow Omaha Lead Site • Good Site Sketch 

Sampling Address: 1419 OHIO ST 

•

0*1^0

 Poo

1 poin

r 

t V

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm:"^/^. -Q/Cy O:!'*'RW 

RYASCPXA-29094 Fl ri"^ ^ ppm D Date: 5yg'Z0/ C 

RYBSCPXA-29094 F2 E* D Time; l/.-OQ /{./j. 

RYCSCPXA-29094 B1 522 . ppm D 

Samples AnafyzaJ 

RYDSCPXA-29094 82 HCrtGi ppm D 

RDZ3CPXA-29094 BS" "^ ppm n D XRF Unff: 

Book: 7L9 i 

RGZGCPXA 20004 G * — ppm D • Date: 

RPZOCPXA' 29004 P2- «~ ppm D Tinr>e; 2n. 

Numbe Staff: nsw r of Samptes - ^ [ Q | 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drtp Zone, GZ = Garden, PZ pray 

All quadrants are as viewed- frorrr the street, facing property 

"~T~" 

I 

MAY 1 9 Zdtd 

522^6 6 

Bl l.bl 

..~ll. ^ 

I^j^ O/^oS/­

fLlfZ. 

3d^i350 

^ ...I js-g iiimjL. r^—wijfv— ^ 

.mo ST. 

li...r->linv lA.i ...•....•I- ll-Mn r lM470!(.a(.23 
K 

A Printed

: Oct 06, 2010 www.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2592083. 

Original Call Date: 9/14/10 Time: 5:24 pm Op: SIVA18967 


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


State: NE County: DOUGLAS Place: OMAHA 


Address: 1419 Street: OHIO ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-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 : PB.UDENT 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 MCINEB MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 8002893427 


NO CALL PER MCINEB MCI Alt: MEMO 

Emerg: 8002893427 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRJCT 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

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

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.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
• j^.mpi » • SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: l(kL£LMhL.±L. Excavation Date: (nj^^O 

Crew: BackfiU Date: '^jMlQ.. 

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 

c:>/ ^ 

(h^' 

^ 

w 

- — 

oreay^ 

. — 

pcy:^ 

cy^ 

r^* ­

o*— 

• _ _ 

Hazards Corrective Action 

/_«i*i J /M^-W^ . _ . t^Si=> /P""/ ^ 

Site Safety Office 

Date: 

no Waftf^earimsy, Sute 40S 5S00 S 10 St 4242 Medical Drive, Stdte 7250 

insasCify;ABa«4ll4 Oui^JUr Neliusha 6Siu/ San Antonio, TX 78229 

: f018)'363-37O3 nuiie : (402)733-1138 Phone: (210)822^588 : (8 ^ 363-3707 Fax: (402) 73»>1«a3 Fax: (210) 579-6577 
^^•• t "^* ^ 

F/^/ ^ OHIO S 

yi^CAvr lor 

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