HNOLOCIES, INC. 

PROPERTY SUMMARY SHEET 

Omaha Lead Site Remedial Action Contract # EP-S7-10-05 

Said: 55642 Property Address;2007 MIAMI ST 

Executive Summary: 

• Issues Encountered: None 

• Issues Resolved: None 

• Unique Findings: 

• Other Relevant Information: 

• CONFIRMATION SAMPLING DATA/RESULTS: F2= 283 PPM @4"; B2= 265 PPM @>4"; EA=326 PPM 

@3". 

Attachments : 

Documents Included in the Property File: Yes No N/A 

Property sketch provided by EPA pursuant to contract specifications V 

onto adjacent properties 

Other Documents: 

Legend: Yes - included in the Flle; No - Not included in the File; N/A - Does not Apply. 

Signed Access Agreement; including access agreements obtained (if required) for crossing V 

Pre-excavation agreement details (ifany are made with the Property owner) V 

Pre-Excavation digital video clip V 

Sampling data sheet V 

Post-Excavation digital video clip V 

Documentation - Completed EPA close-out checklist V 

As-Built sketch V 

Omaha Lead Site Database sample information document. V 

Signed form verifying satisfactory restoration V 

30 day SOD warranty pictures V 

Utility clearances document V 

Property information from Douglas County Assessor's office. V 

Settlement documents (i.e. for any damages, replacement of plants, etc.) V 

Site safety hazard analysis document with pictures. V 

Prudent Representative: ^i ' EPA Acceptance: Yr 

oy 30261765 

^ ^ ' 

Date: llll Date: 

Superfund 

Prudent Technologies, inc. | 2505 N. 24TH Street, Suite 308 |Omaha, NE 68110 USA | Tel. 402.504.1004 j 

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation j Construction 
iniJIHilil SS642 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch • Good 

• Poor 

Sampling Address: 2007 MIAMI ST ^ Not paint r 

Sample Number Lead Sample Samples Collected 

i 

LAB Concentration Collected Firm: FDA FBC & 

RYASCPXA-55642 F1 1 3 H ppm D Date: 6//7/0 7 

RYBSCPXA-55642 F2 5^ 8 ppm D Time: 'Z-'Z^ 

RYCSCPXA-5564 ' fl ^ 2 B1 3 I I ppm D Samples Analyzed RYDSCPXA-55642 B2 •5"*/? ppm D 

RDZaCPXA-.5504g BZ " ppm n n XRF Unit: (afH2 . Book: jai . RQZOGPXA-S5042 92 ~ ppm a Date: 9/24/0 7 D nPZCCPXA 666'ia P2- •" ppm Time: D n am. Staff: Number of Samples = '• t| 7l3V 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play All quadrants are as viewed from the street, facing property 

ENTERED ! 

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I'ROPERTY ACCESS FORM 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency 

(EPA) to clean up lead-contaminated ^lls at ainumboBJT properties located in Omaha, Nebraska, including the 

property located at ^di ^ Dn^/^t/i l j?Y ^ ^ ^ ^ requests your permission to allow Prudent to 

perform a soil cleanup at this property tp 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 leadcontaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact the Prudent 

Oflice 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) 73I-304S (South Omaha office) or (402) 991-9583 

(North Omaha'office). 

Ifyour property has a gravel or dirt driveways or parking areas then the removal and replacement ofthe soil 

and/or gravel during the s s not e r Illegal gravel/dirt driveways or parking areas legal.

le rcmediatuu rcmediatuuii

 proces process doe does not mak make you your illegal gravelA 

Propert)' Access Granted 

7 [ (Please Print Name) 

Property Owner Signature 

(Si^ature) (Date) 

Property Accessed by. (Prudent Employee Name) 

PROPERTY INFORMATION (To b&completed||^ resident and/or property owner - please print) 

1. REBIDENTNAME: JM Owner Renter

6^^ . 2. IF RENTAL, PROPERTY OWNED BY: 

3. OWNERS MAILING ADDRESS: P^ 6, Bx. lid^ ^ ^/A/fJ/ J J fll^ ^^^^ ^ 

4. OWNER'S TELEPHONE NUMBER - HOME: (^ ^ > O^/"^'^ * WORK: t ) 

5. TENANT'S TELEPHONE NUMBER - HOME: ( 1 WORK: J L 

6. AGE OF HOME?: / / - YEARS. HOW LPNG HAVE YOU LIVED HERE? 

7. HAS THE EXTERlOFrBE»l^;4l^C(r6brCOHERED WITb 

8. # OF OCCUPAKT S UNDER AGE OF 7: # OF OCCUPANTS APO R OVER 7 YEARS OLD 

9. # OF CHILDREN UNDER AGE OF 7 WHO PLA E YARD FOR 5 HOURS OR MORE PER WEEK: 

10. COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATESTNEIGHBORIN G PROPERTY 

ETC.) 

PV htf lud&e - (em oetctmMl' /W ' ^ -/wii^/l ffi/P^^ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be imptementeted Iby EPA under thi^ | / . JLjifi£ 

agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access ttoo tlthe property is /t/jF S QCV^' ^ 

provided for In Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry fbr "determinin erminlngg th I e need far

response, or choosing or taking any response action under this title, or otiierwise enforcing the provisions of the 11th f A ^ 

/AMI7 bcsi/^^ 

Prudent Technologies Inc. 5600 S. IO*** St. Omaha, N£ 68107, 

402.733.1188 (OfTice) 402.733.1883 (Fax) 
mJDEN ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^^ 1 ^//fM.) 5 Y ""*'= 7'/^ ' / / 

Phone: ^^ ^ ^ 3 y^ ^^j j BVID: 5"5VVS^ 

NOTICE TO BE GIVEN TO: /^OWNER/ TENANT BOTH 

HOW MUCH NOTICE IS NEEDEDy ^ ! 24 HOURS ^ / 48 HOURS 72 HOURS 

}( 24 HOURS/ 481 

OTHER NOTICE NEEDED (PLEASE SPECIFY): 

PHONE # AND NAME TO WHOM NOTICE NEEDS TO BEGiVEN: ' / 

-3^1-^^/ ^dimij( /fi/mei^^ l^ ^ ooice mf^l 

WILL NEIGHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES 1 


IF NEIGHBORING PROPERTY WILL NEED TO BE ACCESSED WHAT IS THE ADDRESS: 


WAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES ( ^ 

/ILL A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YEjs(^7 : ) 

IF ANSWERED YES TO NUMBER 12 PLEASE PROVIDE LOCATION OF FENCE: 

IS THERE PRE-EXISmiG FACIAL DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND DESCRIPTION 

OF SUCH: YES jji^jjv'SPECIFY: 

l/iK/lA/ / l/>f- IS THERE PRE-EXISTING CONCREIE DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH: YES ( NO^ SPECIFY: 

'TiiCM/f (i t 

^ ^ T : Prudent £ 

Signature: Signature: 

DATE: -f- /^ ' 

Prudent Technologies Inc. 5600 S. lO"* St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

r Pmperty Inspection Form 

Address: ^^^ 7 IYl//^fiAI ^T Date: ^^/3^' H 

Phone: ^d^'S j h ASt 3 / BVID: Soi^i ^ 

Pre-Existing Dainage: Please write in detail and included location 

and description of damage: 

Concrete Damage 

fJA/^AfJi LM. 

Facial Damage Including Siding: tJL 

^ 

Does Basement have history of leaking or flooding? VES NO 

MtSW 'iH ^ 

Does Homeowner want sod replaced in all areasT YE ^ NO IfNO please provide what 

areas are not to he sodded and what needs to he replaced instead of sod (i.e. mulch, rock, 

leave bare) if mulch or rock please specify what type and colore 

6utll f/csS ^ mm^ pfi/fiith^ hefm OJMM lesi/^i I 

M^/ ^ M^pir m Dl/^tAJl5i/)AJ Mo/l 6 U/JiJ/> d/i lAJ£>/l\i 

\ \ OTHER DAMAGE OR REQUESTS: J ht6/l/}k 

Property Owner Prudent Empi 

Signature: Signature: 

DATE: "7 " / DATE: 7"/ ? / / 
Em'lRONMINTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

XRF CLEARANCE SMEET 

PROPERTY ABBRESS^ "^^ •u\'-- \J\ /*,., y^-

TTV IB: r^b't*^^ 

AA^ HAS BEEN REVIEWED AND NO MISSED AREAS EXIST: fYES . NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE AND DIMENSIONS: ^y' / 

CREW: Kxy^y^ 

DATE DEPTH QUADRANT } READING 

Fl XRF TECM: "t S<i2^C 

^jy H " i i ' 

F2 

Bl PREADINGS DOCUMENTED IN , • '" I

LOG BOOK? ¥ESy NO 

B2 yyy 

GARDEN 

PLAYZONE 

-7 '- • EASEMENT "^Z--; . y-" 
lECHNOLOGIBS, INC. 

Property #: ^ 5 64^2-

Date/Time: 

Quads Excavated: p'Zi^'i . 

SEPA 

EPA Property Close Out 

PropertyAddress: 2LOe>"7 K^A.«rv">'7'V. 

Owner's Name: PjfVr'C^C- Sit^ilcr^ 

Contractor Group: Pnident Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

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

from tlie house? / 

2. Has sod been laid m all areas that were excavated? / 

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

day time period) / 

4 Are sodded areas generally firm and evenly graded? y 5.

 Aie tlie joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) / 

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

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

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and close freely? (If apphcable) / 

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

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

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

Foundation, Siding and Gutters Yes No 

1 Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

3. Was dainage to windows avoided? / 

4 Was damage to windows or door screens avoided? 

5 Was damage to downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representati^ve P*^ j^> ^Dale: ulsajn 
"A 

:i4N0L0Cies. i»ic. AS - BUILT DRAWING 

Sample Area: 5564:2 - :2UU7 Miami St 

Date Excavated: 08/29/2011 OMAHA LEAD SUPERFUND SITE 

Sampled By: Issac CONTRACT #: EP-S7-10-05 

55642 

Omaha Lead Site Extwior Pant 

Site Sketch • Good 

n Poor 

sampling AddiMs : 2007 MIAMI 3 T ^ Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Colle ^ 

I 

Fimi: fDA Ri-C£> RYASCPXA-SSe42 Fl —Lil—pp m D Date: ei//7/? 7 

RyBSCPXA-55642 F2 ^a B ptwi D Time: Z -Zv pn\ 

RYCSCPXA-SS642 Bl 3 I > ppm D Samples Analyzed RYDSCPXA-SSe42 B2 ^*^ i ppm i D

WPJeoCPKA-55048 -ez "• PPtn D XRF Unit: ta^Hl . Book: 79 3 

ROn00P)(A-ii!i042 -oa ~ ppm a D Date: f j 2.t,/Ot 

RPZSCPXA MB<a -PS - D 

I 

D Time- A m 

• Stan Myii/ ~ Numlier of Samples • 1. / I 

Legend: Fl = Front Left, F2 = Front Right. Bl = Back Left. B2 = Back Right DZ = Dilp Zone, GZ » Garden. PZ - Play 

All quadnmt tra n wawid flDm Via •MM. Ikeing papefty 

ENTERED 

I .:3.iv >^y^.....;f . B2 = 265 PPM (O 4" 

8(:...!.. . ^ 

.. 2a>7I^IAMISr. 

i 

-1-65 

i 

EA = 326 PPM (S> 3" 

^ . 8 i 0 

-PI: F2. 

I n = 283 PPM @ 4" 

. Af/4A1/ 3T : .. Hn 4 i^M«ad »A^>i7li,4^37 

Prudent Technoiogles, Inc | 2505 N. 24TH Street, Suite 308 fOmaha, NE 68110 USA | Tel. 402.504.10041 Fax: 402.504.1005 

Environmental Engineering & Services | Remediation | Construction 
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Remedistion Querv I I LeddRernarmgQuerv | Pfoprtv Damage Query | LBWEJ 

PWparty Wfo I Cl«ian-m» M b Sample Info cuaWiiier CaMs | SiJimMit Hepaw 

Sample Area: 5564 2 200 7 MIAMI ST 

sairois uate . Uuadrant .t Paramete . XRF K<. ^ XRP n»t . Exc . Marker Place . Lead Remainin • in; . sampled B .t UA uonfirmec . La&_Res 

9|^ H B2 LEAO 2i'j mg'kg 4 ISSAC N/A 

6-29-2unE1 LEAD j2b-nrxq ISSAC II'A 

8/23«)11iF2 LEAO 283:m9fkB 4 D B ISSAC M/A 

1 LEAD imgrkg 

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SEPA 

Property Completion Agreement 

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

The property owner's signalure indicates that the property owner is satisfied with the restoration of the 

subject property, and. that no items are in question, now, or at aiiy lime in the fulure, exclusJiing any 

remainrrig warranty (30 days lotal) except those items listed below, ifany. 

JOd M\anv(cSt- Owner jvrexCiC^ Srft»Lv3g:-i-^ (J^^kj\w.\X^ 

'Jq /-^Q^8l 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Requiried corrections to complete the property: 

\z\ I agree restoration is completed. 

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

h ^:^I ^yy 10 isdlL 

Owiier's Signnturc Date 

I

http://www.dhon.orp''-^hintemet/DHONNoticeCreation/MessageText.. 

Create Another Ticket Back to Irth Intemet SendEmai 

• YOUR TICKET NUMBER IS 2813849. 

Original Call Date: 8/04/11 Time: 12:26 pm Op: ASHLEIGH18967 


Work to Begin Date: 8/08/11 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2007 Street: MIAMI ST 


Twp: 15N Rng; 13E Sect-Qtr: 10-SW 


Twp: Rng; Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: ASHLEIGH ANIKPUTA Phone: (402)733-11^ 


Work Being Done For: EPA 


Depth of Excavation: 6FT Corner Lot: N Front: Y Rear; 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

COX Day: 4029340469 

HEIDI COX CXCATV COMMUNICATIONS, Alt: 4029340469 

COMMUNICATIONS INC Emerg: 4029329757 

Day: 4025047823 

MUDOl 

METROPOLITAN 

UTILITIES DISTRICT 

SANDY MUD Alt: 

Emerg 

Day: 4024447197 

OMAHACOF CITY OF OMAHATRAFFICSEWER 

RICH/TRAFFIC 

OMAHA 

Alt: 4024446725 

Emerg 4024445160 

Day: 4067289343 

0PPDGPR5 

OMAHA PUBLIC 

POWER DISTRICT 

ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL 

NETWORK ELM LOCATING 

Day:

Alt:

 4067289343 

 4062071494 

of 2 8/4/2011 12:27 PM 
http://www.dhon.orr'^hintemet/DHONNoticeCreation/MessageText.. 

Ernerg: 8887289343 

2 of 2 8/4/2011 12:27 PM 
IRTH One Call Page I of 1 

Dig9»rs Hctiine 

Of irt Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2831593. 

Original Call Date: 8/25/11 Time: 11:13 am Op: ASHLEIGH18967 


Work to Begin Date: 8/29/11 Time: 11:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2007 Street: MIAMI ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: SOIL REMEDIATION WORK 


Location of Work: ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: EMAIL ALL CLEARS TO: AANIKPUTA@PRUDENTWEB.COM 


: UNSURE CORNER 


Company PRUDENT TECHNOLOGIES 


Contact Name ASHLEIGH ANIKPUTA Phone: (402)733-1188 


Alt. Contact NONE 


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 


http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=803933 8/25/2011 
1 

Al 1/ir.i 5 r 

HNJIH/T 
N 200

7 Miami St 

A Printed

: Jul 07, 2011 

www.dcgis.org/dogis 
Address_._.,^_2„.l^C^/_^__5zr. Date (_ 1//%7l^\t 

P Analysis Completed By i\ f ^><- K.fc- R A >°?' Prudent Technologies Health and Safety Officer 

Item 

Overhead Power Lines 

Gas Lines' 

Water Lines 

Sewer Line 

Septic Tank 

Propane/Butane 

Foundation (DZ) 

Driveway 

Side walk 

Trees 

Plants/Garden GZ 

Access to Property 

Bu.^y Street (need to close 

off Lane) 

Hand Dig 

Pets /bees/wasps/ticks/red 

ants/spiders 

Poison Ivy/Poison OaJ< 

Miscellaneous 

Location 

FJ F2 

Bl B2 Condition 

Aif- Underground 

Utilities 

./l^'A 

/I7fy 

Cji^aCS 

Z^JTlSc TfyOfe-^ 

I/? y5 ( L-jeeAS 

7" 

j^kLjyjy 

dJ^ 

.^I'O 

yA-yy^iy. :LL 

Cj^f^r fi C L 

'isyAci ^y mHazards 

Ele<Jrocution 

Gas, water 

leaks 

> 

rf^ 

il-&i£>i^' 

Corrective Action 

Call Digger Hotline Prior to perfonn locates prior to 

beginning work on property 

Jf utilities are not located contact Supervisor, Safety 

Personnel to notify them of issue 

Go to another property to work as du-ected 

-

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