TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#:^2I!ML _ Date: Jlli^LllO ^ 

Address: ,3ML ^ P/rJTlCJt A\l 

Remediation Contractor: RPM nPrM7 %r.^ N^oq i» ^^ /AJT ,7 Year: ^ U 1 (j 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[/ Video of property (DVD) 

a Executive Summary 

EPA-provided property sketch 7 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaipent property 

0 Restoration Agreement 

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

a Confinnation data 

Photographs 

0 As-built sketch 

[/ Satisfactory restoration signed by Property Owner 

0 Property close-out check list signed by EPA 

n Description of areas not meeting ROD cleanup criteria 

a Utility clearances 

d Property information from Douglas County Assessor's Office 

D 

D 

• 

Signature^"^ Date 

niiiii 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 2415 PATRICK AV 

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: 

Fl = 81 PPM @ 2"; Bl = 120 PPM @ 2"; B2 = 365 PPM @ 2"; EA = 111 PPM @ SCRAPE (~1") 

ATTACHMENTS 

1) Property slcetch 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 fmal 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, ifavailable, 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. 

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

Backfill: 

Sampie Area: 27446 - 2415 PATRICK AV 

Owner: 

n Owner Occupied 

Owner Name: 

ICTTY OF OMAHA 

Owner Addressl: 

|C/0 RNANCE DEPT 

Owner AddressZ: 

|1819 FARNAI^ ST 

City: State: ZipCode: 

lOMAHA |NE |68183-

Owner Phone Alternate Phone: 

1 1 

Contract: 

Contractor: jPRUDEI^T2010_S 

Contract Option lOPnON 1 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: State: ZipCode: 

1 1 1 

Owner Phone: Altemate Phone: 

1 • 1 

Assessment: 

Qualifying Group pOO 

Assessment Max XRF Value j 541 

Resident: 

Resident Name: 

[RESIDENT 

Property Address: 

|2415 PATRICK AV 

Zip Code: 

|68111-

Resident Phone 

I 
TECHNOLOGIES, INC. 

Property #: Z 7 ^ ^ ^ 

Date/Time: 

Quads Excavated: F 1, ^ ' i '2'Z-

EPA Property Close Out 

Property Address: Z- ^ • *? pMr^cVl A ^J^^ 

Owner's Name: ^"7+-i^ o^ (•^WA.OXV. <=^ 

Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessar\', were tlie correct quadrant(s) excavated and reslored? 7 

2. If necessar>, were the conect areas of drip zone excavated and restored? y 

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? y 

2. Has sod been laid in all areas tliat were excavated? y 

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

7 day time period) 

4. Are sodded areas generally firm and evenly graded? t ^ 

5. Are the joints between the sod strips generally tight? (Only evaluate ifinspected at a 30 day i 7 time period) 

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

y 

7. Was damage fo landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls Yes No 

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

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

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

y 

4. Was damage (o retaining walls avoided? (Ifapplicable) 

y 

Foundation, Siding and Gutters Yes No 

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

2 Was damage to the foundation avoided? 

y 

3. Was damage to windows avoided? J 

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

5. Was damage fo downspouts or downspout extensions avoided? ^ 

Sidewalks and Driveways (Concrete) Yes No 

I. Was dajnage (o driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative .^La^iL Date: lo/sajih 
CHNDCDGIES, FNC. AS - BUILT DRAWING 

OLS # 27446 

Date Excavated: 9/28/20f0 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-Off Date: 

27446 

Omah Exterior Paint a Lead Site 

Sampling Address: 2415 PATRICK AV 

• Good Site Sketch 

• Poor Phone: H: (402)342-2820 ALT: [7] Not paint 

Sample Lead Sample Samples Collected Number LAB Concenfration Collected 

I Firm 

RYASCPXA-27446 F1 .^L H ppm Date 

RYBSCPXA-27446 F2 2 ; R ppm 

D Time: 

RYCSCPXA-27446 B1 

"iO ^ ppm D Samples Analyzed RYDSCPXA-27446 B2 BH l ppm D 

nDZCOPXA 27446 B^ •~ ppm n D XRF Unit: 65V 2 Book: ig^ L 

RGZGCrXA-27440 e2 - — ppm n D Date: g-/y-0 7 

Lab RYASCPLA-27446 D D Time AIL — ppm 

-Result 416 ppm Staff: A1SIV Number of Samples = i i / 

Legend: F1 = Front Left, F2 = Front Rigtit, Bl = Back Left, B2 = Back Rigtit DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are apA/iaw^^ m the street, facing property 

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

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed propeily. 

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, if any. 

Property ID: 

Property Address: ^ y / p p ^ /,.,. ^. /?.<: 

Owner: ^.'• / .,.^: ^•;;^^^ ^ , 

Phone: ^-^ v'/tA^/VV/ 

Restoration Items In Question: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

\M \ agree restoration is completed. 

L J i do not agree restoration is completed at (noted deficiencies above) 

rhy yi 70/ ^ 

Owner's Signaluire Date 
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 

yQl\ r^T/'Icly. . The 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. 

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 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; l^ll/l/?f ^ l-^K^3^' h 

(Please Print Name) 

Property Owner Signature: 

' ^ ' (Siffli (Signature a ) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Ownar Renter 

RESIDENT ADDRESS:, 

^ H ^5 -P^Jhr:^ tr fW-^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

(^//^ > wv - <-o^y 

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 ENVTRONIvIENTAL 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 tothe 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 Omaha, Nebraska 68107 San Antonio, TX 78239 

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

Fax: (816) 363-3707 Fax; (402) 733-1883 Fax: (210) 579-6677 
ENVIRONMENTAL* 

CONSTRUCTtOlS 

TEGHNOLOGIES SERVICES , INC. 

Property Status Form 

Address: 

Phone: BVID: 

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Property Owner Prudent Employee 

Signature: Signature: 

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

KansasCity, MO 64114 Omaha, l^tebraska 68107 San Antonio, TX 78228 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 
27446 

Omah Exterior Paint NorthArrow a Lead SHe 

Sampling Address: 2415 PATRICK AV SKo Sketch • Good 

• Poor Phona: H: (402)342-2820 ALT: ^ Not paint [

Sample Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm: ft) A PS-C C 

RYASCPXA-27446 F1 

ppm Ql Date: '^-f l -Ql -

RYBSCPXA-27446 F2 2>ft ppm D 

Time: fO'c^i^ Qn \ 

RYCSCPXA-27446 Bl J±£23. ppm D 

Samples Analyzed 

RYDSCPXA-27446 B2 ^"i l ppm n 

nDgGOPXA27M6 BS ppm D n XRF Unit (DSH I Book: /8 ¥ 

ROZOCPXA £7440 62- ppm D D Date: B-lie^T f 

Lab ppm RYASCPLA-27446 n Time: A H 

^Result 416ppm n Staff: iUSi,^ Number of Samples = t^ / 

Legend: F1 - Front Left. F2 = Front Right, B1 = Back Left, B2 = Back Rigtit DZ = Drip Zone, GZ = Garden. PZ = Play 

All quadrants am ji^^nftt^ifom the street, facing property 

& © ENTERED 

JUL 2 7 2007 \103. ^Hl • 

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Rev 5 Cleaied: bn 2/2007 10:47:49 O46I4I0I23 
A Printed: Oct 19,2010 

www.dcgis.org/dogis 
Page 1 of2 

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Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2592079. 

Original Call Date: 9/14/10 Time: 5:22 pm Op: SIVA18 967 


Work to Begin Date: 9/16/10 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2415 Street: PATRICK AVE 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-SW,15-NW,16-NE 


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 LEVELS 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-TRAFFIC,SEWER 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 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 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 
- -

ENVIRONMENTAL 

ENGINEERING AND 

TEOHMOLOMBB, mc . CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: -2fVl#_^^-c^_^ _ Excavation Date: 

Crew: 

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 

BackfiU Date: 

Condition Hazards Corrective Action 

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/ ' y 

P

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— 

^ ^ ^ 

US-^e- pt-'r ci^cti i 

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f ^ 

^ 

/ » ^ 

— 

— 

us ^ t^Yuj»>i^<L 

f^ — 

Site Safety Office 

Date: 

SSOOSIOSt 4242 Medical Drive, Sttts 7260 

lCi)ly;Ma«4114 OmaiUr NetaaBha 68107 San Antonio, TX 78229 

Phone: (MC) 3^^3703 l^hofie: (402)733-1188 Phone: (210) 822.4S88 

Fac (816) 363-3707 Fax: (402)73»'1883 Fax; (210) 679-S577 
Fiyi.Bz 

YfiCANrr L7)T~ 

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