TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: '^^119 ^ Date: H ^ I 5 " I 0 

Address: ^(6 3 (\}. 0^ cS+ 

Remediation Contractor: p!?f-,r7Pr^'-f T^-r-^ f^jococ^ ]•?•<>.. irsid'^i Year: ^( J j (J 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

\i Video of property (DVD) 

ffl Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

i Confirmation data 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

i Property close-out check Ust signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

C Utility clearances 

II Property information from Douglas Coimty Assessor's Office 

D 

D 

D 

Signature Date 

30260808 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 4102 N 18 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A,2 issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED: DZ/LS (4'X4') = 109 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 59 PPM @ 4"; DZ = 93 PPM @ 13"; EA = 62 PPM @ SCRAPE (~1") 

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 of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Find Record j 

Backfill: 

Sample Area: 3377 8 - 410 2 N 18 ST 

Owner: 

n Owner Occupied 

Owner Name: 

JSTEINKAMP LOU A 

Owner Addressl: 

Owner Address2: 

)4102 N 18 ST 

City: State: Zip Code: 

lOMAHA ||NE |68110-

Owner Phone Alternate Phone: 

1 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option JOPTION 1 

Remediation Query Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

) 

Owner Address: 

1 

City: State: Zip Code: 

i • • 1 • • 

Owner Phone: Alternate Phone: 

1 • 1 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value j 509.56 

Resident: 

Resident Name: 

SPECK SYLVIA 

Property Address: 

J4102 N 18 ST 

Zip Code: 

J68110-

Resident Phone 

I 
2

' TECHNOUDGIES. INC. 

Property #: "S'57''7 ^ 

Date/Time: 

Quads Excavated: /^ 2.^, p 

EPA Property Close Out 

Property Address: 9 '^ ^ ^ 

Owner's Nanrae: Z^-c -^-reT-t^ \^LtJ-«w:^ 

Contractor Group: Prudent Technologies, Inc., 

E.Kcavation General 

I. ]f necessary, were the correct quadrant(s) excavated and restored? 

2. If necessary, were the correct areas of drip zone e.xcavated and restored? 

Grading Sod and Vegetation 

1. Does the grading aiound the perimeter of the house in excavated areas generally slope away 

from tlie house? 

 Has sod been laid in aJl areas tliat were e.xcavated? 

3. Does tlie 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? 

."i. Are Llie joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

6. Was ihe property graded such tliat water will not pool on the property? 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

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

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

3. Was diunage to gates or fences avoided? (If appiicabie) 

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

Foundation, Siding and Gutters 

f. Was damage to the siding or trim avoided? 

2. Was daniage lo the foundation avoided? 

3. Was dainage to windows avoided? 

4. Was damage to windows or door screais avoided? 

5. Was damage (o downspouts or downspout extensions avoided? 

Sidewiilks and Driveways (Concrete) 

1. Was damage lo driveway surfaces avoided? 

2. Was damage lo walkway surfaces avoided? 

Ves No 

y 

/ 

Yes No 

/ 

/ 

/ 

/ 

V 

y 

y 

Yes No 

y 

y 

y 

y 

Yes No 

y 

y 

y 

y ^ 

y 

*^ 

y 

Yes No 

y 

^ 
Owners coimmeiiiits: 

Imspection notes: 

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

EPA Representative Qo^'::Son Date: lohiho 
ECHNDTOCIES, INC. 

AS - BUILT DRAWING 

OLS # 33778 

Date Excavated: 9/28/2010 OMAHA LEAD SUPERFUND SITE USEPA Signed-OIT Date: 

Name; ;i>f/ ^ i? ^'•<- Omaha Lead Site Date; o-^-'-'' ^ ^^ North Arrow 

/^ddress; HiCi /V ly^ i Site Sketch Time: / i / 5 

Phone. -11^ I - 'V * '2-/^ 5 / 

y^-^y^ y Team _^^Vi BVID #^£ZZZ _ XRF Code 

Sample Number Lead Concentration Confirmation Sample 

A^fYes a No 03 fiVB^c.yy(fi - ?yrv ^ ppm 

ppm /^ZYes n No E

/ ; / Yes a No S 

y>ZYes a No ca­

/'Z_Yes CD No S -

Yes C3 No n 

Yes • No n 

Omaha Lead Site 46130 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
tlon Aq\mem@m 

This agreement documents the completion of removal activities performed on tlie belcw listed pToperTy', 

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

subject property, and that no items are in question, now, or at any time in the future, e.K.cluding any 

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

Property DD: 

Property A.ddress: 4(0 ^ Ki 1 ^ fK ^ W 

Owner: ^^fereJj— \.J5 U 3A-gJ AV1A>^ -

Phone: ^0^ - ^"^{ ^ Q>o ^ n p^ ^ H 

Restoration litems m QmestiOBTi: 

RequiretS covreciEons io compteie ti© propetty: 

1 CjuJbte_r rNe«L_<^ h. poi>­

• 

I I agree restoration is completed, e')(c<^'(v. ag nn^nrt fihouo.^ 

do not agree restoration Is completed 

/d-/y/o 

Date 
Pnidem Technologies, inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcoiAMi^i^ivled soils a] ^lumber of properties located in Omaha, Nebraska, including the property located al 

^f7y^-/7. y^ /C I " ^ ^"f^^ EPAreque.-its your permis.sion lo allow Prudent to perform a soil cleanup at lliis 

pro'perty to'remove lead-coAlauninaled s^il. By signing this form, the property owner grants permission to Prudent lo perform 

activities related to tht cleanup including soil sampling, removal of lead-conlaminated soil, and restoration ofthe referenced property. 

Ifyou 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 about the Omaha Lead Sile cleanup can be directed to the EPA Public Information 

Centers al (402) 73 I -3045 (South Omaha office) or (402) 991-9583 (Nonh Omalia office). 

Property Access Granled By: 

^ ^-i (Please Print T 

Propeny Owner Signature °\jlCiho 

(Date) 

^ y PROPERTY INFORMATION 

(To be completed by resident and/or property owner — pie; 

RESIDENT NAME: [jsK . /\ - ^V'vVXld O rOr ^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS: 

OWNER'S TELEPHONE NUMBER - HOME: ('7(37 > ^ ^ j " <^^7^(Z> WORK: 

AGE OF HOME?: 1 . S YEARS. HOW LONG HAVE YOU LIVED HERE? G ? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? X YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C/> 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 EN VIRONMENT.AL RESPONSE ACTIONS: The artivities to be implemented by EPA under this agreement 

arc pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to Ihe property is provided for in Section 104(e) of 

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

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

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

Kansas City.'MO 64I U Ornaha. Nebraska 63107 San Antonio. TX 78229 

Phone: (81S) 363-3703 Phone: ;402> 753.1168 Phone: {210)822-9688 

Fax: (816)363-3707 Fait­ (402t '33-1883 Fax: (210)579-6677 
ENVfRONMENTALJt IRUDEN' CONSTRUCTIOiS 

TECHNOLOGIES, INC. SERVICE.S 

Property Status Form 

Address: ljIQ Z AJ /(^ ^ ST " Date 

Phone: BVID: 3 5 77S ' 

l^ryi/icL /(^r/ZyJA^ l{pi. y ^ f T)X 

f^- Z ^ CLJ^/) ^ i \l±A^-^/ T ^ t^cyhVy^-t-e. ^' l&fy}Ae< 

iyj> \ n t SC T ^» 

1^ IXA^ fie^^ ^ <^)Ccy\\yAl^ 

t liPLAc t iyJaft ^iyn> 

^ ^ l/Jesj-'Si-^ e^f Uoi^^i tiA<, .A.C - i^CA^A-Tj Ado^y^J ^ (^/>LJ<^ 

'/ n /ACA5 ^ CxcyKydfC A/CUiAi 

Property Own Prudent 

Signature 

8080 Ward Parl(yay, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City, Mp 64114 

Phone: (816) 3B3-3703 

Omaha, Nebraska 68107 

Phone; (402)733-1188 

San Antonio, TX 78229 

Phone: (210)822-9588 C-.«­ lOAC^ tC ^ •»Trt7 C...,. lAri^l Ti-t ^oo•> 
I— Name: Omaha Lead SKe Date: y/^y<:y North Arrow 

Address: H/O I /J/ /g'^j ^ Site Sketch Time: /^^ // ^ 

Phone: H d - ?/> '2-/^ 5 • ^ 

j^-^y-> Team yjjvy BViD# 3)7 1 y XRF Code ^ 

Sample Number Lead Concentration Confirmation Sample 

ppm No 03 


/^ZLYes n No 13 


ppm / > / Yes n No sr 


ppm y^2Yes n lis3i^^3S No ^ 

ppm /'Z-Yes n No CS­ ppm Yes a No D 


ppm Yes O No D 


=**!« 

'•r^fy't^i^ .C-­ . / I^z-la--. U ^ / fc -7^ 

7" 

-* 4 = S­ -r 

.„.„_^./ . 

-yc X^/Z^tr-. /^52f/ ^ 

Y7y.^-^ 

WN 

^ 

-fV /4^-t • ^ 

^ H/o T ; t J^/^^MTP ^ 

..^ . 

I -L- 4: -•^ t • ^ 

- ^ 

|?te=/i:7j^l^5'[ 


< 

i y #-4- yr 

r zL-^y-y 5^^2.7 

i.-^<£. le^/4. 

Omaha Lead Site I ^ 46130 
Page 1 of 1 

/8 Sf 

\UGUST 2008 - DOUGLAS COUNTY ASSESSO 

http://douglasne.mapping-online.com/assessdoc/Photos/03/R0700520000000Ljpg 9/15/2010 
0CXS30aQ0Q 

N 4102 N 18 St 

A Printed: Nov 16,2010 CIS 

www.dcgis org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2600864. 

Original Call Date: 9/24/10 Time: 4:54 pm Op: SIVA18967 


Work to Begin Date: 9/28/10 Time: 5:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4102 Street: N 18TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 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 

httD://www.dhon.ore/irthintemet/DHONNoticeCreation/MessageText.asD?ret=<RESULTS... 9/24/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TECHNOUfiflES, INC 

SOLUTIONS 

SITE SAFfcTY HAZARD ANALYSIS 

,y^ 

Address Excavation Date: 1?- ^ ^O 

Crew: BackflU 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 

idyyAyi 

y^^ 

^7^^ 

eyODtJ 

/ n. 

& ^

y J 

'f&rrfi 

. ^ D 

'^^{• 7 

ye.< 

/ -

Opbof 

Site Safety Office -

Date: ^? ^ 

— 

8080 VK 

Kansas 

Dtf Bariony, SuiiB 4IE 

Gi^,IIO«4114 

5600S 

OmalBifliefe 

>10St 

naska 68107 

4242 Medical Drive, Suite 7250 

San Antonio, TX 78229 

Phone: (8t6)36»703 Plume: (40 3)733-1188 Phone: (2t0) 822.9588 

Fas (81 [6)363^3707 Fax: (402 ) 733^1883 Fax: (210) 579-6577