SAID*: 25358

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE: 1/15 

ADDRESS: 1132 N 20 ST 

REMEDIATION CONTRACTOR; PRUDENT TECHNOLOGIES. INC. YEAR: 20l t 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

• PRE AND POST VIDEO OF PORPERTY (DVD) 

EXE(:UTIVE SUMMARY 

EPA-PROVIDED PROPERTY SKETCH 

J SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

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

ca CONFIRMATION DATA 

PHOTOGRAPHS 

AS-BUILT SKETCH 

J SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

U PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• , UTILITY CLEARANCES 

m PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D ^ _ 

D 

SIGNATURE DATE 

30218280 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 1132 N 20 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 = 275 PPM @ 13"; 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 25358 ­ 1132 N 20 ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

|R AND W CORPORATION 

Owner Addressl: Owner Address: Property Address: 

11132 N 20 ST 

Owner Address2: Zip Code: 

15616 FORT ST 168102-

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

lOMAHA |NE 168104-

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1(402) 457-5979 |f402) 453-4022 

Contract: Assessment: 

Contractor: PRUDENT2010 S Qualifying Group 400 

Contract Option OPTION 1 Assessment Max XRF Value 527 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: Z'^^f^z^ Property Address: "52 ­ A) ­ ~2-0 4+--

Date/Time: Owner's Name: *Ku.f:^ (^i?(ler^o^ 

Quads Excavated: ^"2 - Contractor CJroup: Prudent Technologies, Inc., 

Excavation General Yes No 

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

2. If necessary, were the correct areas ofdrip zone e.xcavated and restored? J 

Grading Sod and Vegetation Yes No 

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

from tlie liouse? J 

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

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

dav time period) / 

4. Are sodded areas generally finn and evenly graded? 

/ 

5. Arc tlie 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? / 

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) / 

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

3. Was damage to gates or fences avoided? (Ifapplicable) / 

4. Was damage to retaining walls avoided? (Ifapplicable) / 

Foundation, Siding and Gutters Yes No 

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

2 Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / 

4 Was damage to windows or door screens avoided? / 

."j. Was damage to downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

I Was damage to driveway surfaces avoided? J 

y­ 2

 Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative Q^Ay ^pate: tlishi 
KrnNnroGiKs. INC 

AS - BUILT DRAWING 

OLS n 25358 

Dale Excavated: 11/10/2010 OMAHA LEAD SUPERFUND SITE ISEPA Signed-Off Date: 

25358 

Omaha Exterior Paint Lead Site • Good Site Sketch • Poor Sampling Address: 1132 N 20 ST [ J Not palm 

Sample Lead Sample Sapnples Collecled Number LAB Concentration Collected Finn: 

RYASCPXA-25358 F1 /ft p rom 

Ef Date: ';-zZ'0 9 

RYBSCPXA-25358 F2 2 9 5 ppm • 

Time: If.oo Ai ^ 

RYCSCPXA-25358 Bl Z B Q ppm • 

Samples Analyzed 

RYDSCPXA-25358 B2 5Z1 ppm If D 

RDZSCPXA 36368 O i r ppm D D XRF Uni t: \hPtU1. Book: m \ 

nOZCCPXA-25358 - Gi ~ ppm D • Date: 

RPZOePXA-25350 ~" ppm D D Time: ?V>s 

Lab RYASCPLA-25358 Staff: MSVsl Result Number of Samples = | ^ | l i 

207 ppm 

= Front Right. B1 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pia^ 

All quac^rapts are as viewed from Jhp street, facing property 

T 

ENTERED 

MAY 2 9 2009 

286 ^ 5Z1 

B2 = 275 PPM fl 13" 

sz 

.U3.^..^ zo ^ 

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Z°iS leo. 

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NLD5 L Rtf\-2'»''K •'rettliNl 'I5-KOV-J,I8 

NO E,\SEMENT 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
&EPA 

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 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: j ( 3 Z KJ ^O ^ S ^ 

Phone: Q 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

agree restoration is completed. 

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

Date 
jfKTKr 

Prudent Technologies, Inc. (Prudent) is under conlract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontfipjnated soils a^a number of prmierties located in Omaha, Nebraska, including the propeity located at 

12^ A / (y^O " ^ ^' ' • Tlie EPA requests your permission to allow Prudent to perform a soil cleanup at this 

piiperty 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 plaiuied for your property, please contact Pnident South Omaha Oflice for the Otnaha 

Lead Site cleanup,.at (402) 733-1188; 733-1455. General questi<$ns)about the Omaha Lead Site cleanup can be directed to the EPA 

Public hiformation Centers at (40Z)i 731-3045 (South Omaha off 

Property Access Granted By n 6-f i/7 ^.rS / ^ 

(RHase mn t Name) V 

ll/'i/ZofO 

Property Owner Signatui 

(Date) 

"ROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

^ O/v ^ T I 

IF RENTAL, PROPERTY OWNED BY: //fr/?^/ 7 

OWNER'S MAILING ADDRESS; 

OVyNER'S TELEPHONE NUMBER - HOME: //<92^ ^ S Z-^O'Z^'L. ^ WORK 

AGE OF HOME YEARS. HOW LONG HAVE YOU LIVED HERE? 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 

t OF OCCUPANTS UNDER 7 YEARS OLD: A///mmBE R OF OCCUPANTS 7 YEARS OLD AND OLDER 

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 of CERCLA, 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"* Street 4242 Medical Drive, Suite 4250 

KansasCity, MO64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)733-1455 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax:(210)579-6577 
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^ 25358 

Omah Exterio

r Paint Nort

h Arrow 

a Lead Site 

Sit

• Good 

e Sketch 

• Poor 

Samolina Address: n32 N 20 ST [ j Not paint 
N LTGAL

: 60 X 133 & 1/2 VAC 

A Printed

: Nov 08,2010 

WW w. dcgi s. org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2637907. 

Original Call Date: 11/09/10 Time: 8:45 am Op: SIVA18967 

Work to Begin Date: 11/12/10 Time: 9:15 am 

State: NE County: DOUGLA UGLAS S Place: OMAHA 

Address: 1132 Street: N 20TH 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 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: Y 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 0MAHA-TRAFF1C,SEWER RICH/TRAFFIC

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /9/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.., 11 /9/2010 
TEOHN! lOUIOfla, .HiC CONSTHUCnON 

SITE SAFETY HAZARD ANALYSIS 

SOLUTIONS 

Address: . lh:: 

Crew: 

^il4> )/\ ^ 

Excavation Date: 

BackfiU 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 

Otlier 

Crew Foreman 

Condition Hazards Corrective Action 

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Site Safety Office 

Date: 

OM Wanf«wtany , SuitB 44» SSOOSIOSt 4242 Medical Drive, Stdte 7260 

;ansasa|lyiW>«4114 nhi'jilra S8107 San Antonio, TX 78229 

iMMia: (81<) 36S>3783 PlwnK fUO) 733-1188 Phone: (2t0) 8224688 

a c IMS) 363.3707 Fax: (402) 73»<1883 Fax: (210) «TO-«577 
4