SAID#: 49203 

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

DATE: 1/15 

ADDRESS: 4615 N 34 AV 

REMEDIATION CONTRAaOR : PRUDENT TECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ri PRE AND POST VIDEO OF PORPERTY (DVD) 30237503 

a EXECUTIVE SUMMARY unm 

Q EPA-PROVIDED PROPERTY SKETCH Superfund 

U SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

Ei RESTORATION AGREEMENT 

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

of CONFIRMATION DATA 

a PHOTOGRAPHS 

H AS-BUILT SKETCH 

m SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

CJ UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

" »\^* 1

»^A^ 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address; 4615 N 34 AV 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: CONTAMINATION LEFT BEHIND PER P.O. REQUEST: F1/FLOWERS 

(2'X40') = 406 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 367 PPM @ 10"; DZ = 643 PPM @ 13"; EA = 187 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 (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 of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record Remediation Query ] ijead Remaining Query | Property Damage Query 

Backfill: 

Sample Area: 49203 - 4615 N 34 AV 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

fCLUB INCORPORATED [ "^•TM" jCLUBINCORPORATED 

Owner Addressl: Owner Address: Property Address: 

1 J4615 N 34 AV 

Owner Address2: Zip Code: 

14615 N 34 AVE J68111-

City: state: Zip Code: City: State: Zip Code: Resldent Phone 

[oMAHA JNE^ J68111­ 1 ••'• 1 ' 1 •"" " ! 

Owner Phone 

j(402) 451-9815 

Altemate Phone: " r 

Owner Phone: Alternate Phone: 

Contract: Assessment: 

•

! Contractor:

 , 

 |PRUDENT2010_S Qualifying Group |400 

I Contract Option (BASE" Assessment Max XRF Value J 480.13 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ^'^^ ^ Property Address: '4<o\'^_ M "^ 4 A\re -

Date/Time: Owner's Name: Okt \r€ *~ C) ov>-a>~ 

Quads Excavaterf: p( ^ Q 2 Contractor Group: PrucSent Technologies, Inc. 

Excavation General Yes No 

I If necessarv. were the correct qLiadrant(s) excavated aiid restored'^ / 

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

Grading Sod and Vegetation 

1 Does Llie grading around tlie perimeter ofthe house in e.xcavated areas generally slope away 

from the house'' 

Yes 

/ 

No 

2

3

 Has sod been laid m all areas tliat were excavated? 

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

day time period) 

/ 

/ 

4 Are sodded areas generally firm ai\d evenly graded? / 

5 Arc Uie joints between the sod stnps generally light? (Only evaluate if inspected at a 30 day 

time penod) 

/ 

6 Was (he property graded such tliat water will not pool on llie property? / 

7 Was damage lo landscaping or plant materials avoided'' / 

1 

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and close freely'' (If applicable) / 

2 Were all gates or fences taken down during restoration activities reinstalled? (If applicable) '71 

Was damage to gates or fences avoided? (If applicable) 7 

Was damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters Yes No 

1 Was damage lo the siding or trim avoided? / 

2 Was damage lo tlie foundation avoided? / 

Was damage to windows avoided'' / 

4 Was damage lo windows or door screens avoided? / 

5 Was damage lo downspouts or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

Was damage lo dnvewav surfaces avoided'' 7 

Was damage to walkway surfaces avoided'' 7 
Owners comments: 

Inspection notes: 

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

EPA Representative '^^ ^ ^Date; \t\i\[0 
RnTNOL(X;iF,S. INCAS - BUILT DRAWING 

OLS # 49203 

Date Excavated: 10/28/2010 OMAHA LEAD SUPERFUND SITE I SEPA Signed-OIT Date: 

49203 

Omah Exterior Paint H a Lead Site Owner Name: CLUB INCORPORATED 

Sit ^ Good e Sketch Address: ••615 N 34 /VV _ • Poor Phone: " W: n Not paint 

Sample Number 

RYASCPXA-49203 F1 

RYBSCPXA-49203 F2 

RYCSCPXA-49203 Bl 

RVDOCrXA''49203 —BSRDZSCPXA-49203 D2 

-nogocr'XA4oro3—s£­

RPZOGr)(A-<9g03 -P2-

Lab RYBSCPLA-49203 

Result 258 ppm 

Lead 

Concentration 

±" ^ O ppm 

l_pp m 

_!4_2>—PP"TM 

ppm 

%?i' ^ ppm 

ppm 

ppm 

Number of Samples

Sample 

Collected 

GT 

D 

0 

n 

a 

= "^ 

LAB 

Firm 

D Date 

0' Time 

n 

D 

XRF Unit: D 

D Date:

Time: 

n Staff 

1 

Samples Collected 

r=DR. - • . ^ .• ~ : • . 

 ^ • ' ^ . 

iX -,. ^ 

Samples Analyzed 

^ 1 \ Book: \t^l ^ 

 \7S^ ' ^ ^ •(i:>^, 

-#v C^,e» ^ ^ 

r:s.i Pr.o Ci-slAK 

O r -.aLc^Vj V 

C O M AMINATION I.KKI BEHIND '•J?zi%^1 PER P.O. REQI E.S!: EI/KEOW ERS .•f\ .H'^.i'T.K.. (2'\40') = 406 PPM a S( RAPE (-1") .c / . 

r 

l)Z = 643PPM a 13" 

^ 

:2i ^ 

El =367 PPM a 10" 

' K: \ r \S

Omaha Ixad Site 461 .'ill 

EA = 1S7 PPM a S( RAPE (I" ) 

CONTRAa #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
«EnV 

Property Completion Agreement 

This agreement documents the completion of removal activities performed 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: l^^f t ; f^^ 2 ^ ^V E 

Owner: Oi^ium cfnajss Cf/i^^j)^j[yr) 

Phone: f^nx\ ^D/-ir^ ^ 

Restoration Items In Question: 

Item: /(j€T=f) iPf^^U^^ J)/fCr t^/faui^ ftoiuDffni/^^ 

Item: 

Lia^,irfii.t^t^ i^\J^n( \ ptf f a OOO. 

Item: r\.myQjL^ i^yyiAuED /imr cUi^emjfii^iPi^/^m^ lAWf^nJCt^A^^di^ gg ^Oit^c ^ 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

J 

L J I agree restoration is completed. 

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

//-3.<?-/<g 

Date 
TFC-H^OiiK^iFs. ivr: 

Prudent [echnologies. Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) tn clean up lead­ contaminated soils ata number of properties located in Omaha, Nebraska, including the property located at 

Vi^^S^ A / 3""/*^ /WJt. The EPA requests your permission to allow Prudent to perform a soil cleanup at this properly to remove lead-contaminated soil By signing this form, tlie property owner grants permission to Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration of :he referenced property 

If you have any questions about the soil cleanup planned for your property, please contact Prudent •• • '• ' r i ,: <..' .i,\- for the Omaha 

Lead Site cleanup, at (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can b : directed lo the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office). 

Property Access Granted By (ll_\{Jfl L '0[79feV ^ i*^ ^ ' 

•• (Please Print Name) 

Property Owner .Signature £z^=B'/o 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Itl ^ ^Od B Owner Renter 

RESIDENT ADDRESS: -^L/S A J 3Vt2> A^€ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS 

'^ hi- J¥ ^f^^ ' 

OWNER'S TELEPHONE NUMBER - HOME: (TIM > Hit) / "000 ^ WORK: 

J \ 

\ 

AGE OF HOME?: ^72L YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

^ 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? C—^ S NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: Mf ^ 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.) 

AUT»miTY FOR ENVIRONMENTAL RESPONSE ACTIONS, The activities to be implemented by EPA .inder this agreement 

are pursuant to Section 104 of CERCLA. 42 U S.C. 9604. EPA's right of access to the property is provided fo- 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 Parkw/ay, Si' 

Kansas City. MO 641"-: :s.:ii. (^iMo-'Mo '•)< '"Ai2\-

Dhone: («16! 353-:-"'"' 

•••• • '•'• .T'l " r';;:Ais?; > 
E^vTROl^^vrE^TAL& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

/// ^ / /yP^^P^^'ty Status Form 

Address:-^e'/^ A 2>^th. /^Vt Date: g/^'^/^^lO 

Phone: j? ^ / ^ 5 W ^ BVID: y9^ ^ 3 

^^.g^/^ L /to:A5 A&JE /^/ f 7^ 

r V - f^^AJ f YATL-^ /Ve^rtTH S/73£^ L^j^^jf AL U PL^^T I i 

7)2 - ^Ht p Zo^ i 5o ' f^/idy\ fo(A OATlo/^ Oui*^^fi ^ 

4' i^lJ^Cfi U/xTH ^^/nc^Lch f 

^"^JCA^A H f/^M T i /^/oA< ^ UJin i yHjo^cc^ 

Prudent Employee •p/cy^^^s^ 

Signature: 

8080 Ward ParttWay. Suite 4f 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)822-9688 
49203 

Omah Exterior Paint North Arrow/ Owne a Lead Site r Name: CLUB INCORPORATED 0 Good Site Sketch Address:46l5N34AV • Poor <r 

Phone W: : ^ [~] Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: \=^0(\ ^^<^ / Ox/ 

RYASCPXA-49203 F1 

ppm 0" D Date: i:x/ S^/ry '^ 

RYBSCPXA-49203 F2 

i %0 

ifx ppm D 0' Time: \7k'.^.'< 

RYCSCPXA-49203 Bl A ^ ppm 0 D 

Samples Analyzed RYDOCP)(A-40203 —BS- ppm D D

RDZSCPXA-49203 DZ "^T^ l ppm 0- D XRF Unit Book: ibO, ROZOCPXA 40200 GZ- ppm D D Date \7^-7^.;^,-(D^, RPZOCPXA-49203 -PZ- ppm D Time 

Lab RYBSCPLA-49203 n Staff: Number of Samples = 3 a ^ & 

f^^su" 258 ppm _ 

e 

E.N.T.EEED 

DEC 1 5 imh 

&.I. . Pr.'ii/; euAJoy. 

m 

IT D f'^'Je.A^a.y 

a'H -t^ 

Awe_ 

PL hV^Y. 

^ %0 

F ^ 2\^ 

:^^)Au\^ 

V^ ^ H ^ h^^ 

Omaha Lead Site /lAnn 
4615N34AV 

^

A Printed

: Nov 30. 2010 

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Create Another Ticket Back to Irth Intemet Send. E maik 

• YOUR TICKET NUMBER IS 2627913. 

Original Call Date: 10/27/10 Time: 2:50 pm Op: SIVA18967 


Work to Begin Date: 10/29/10 Time: 3:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4615 Street: N 34TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 04-NW 


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: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


ALT872 CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber 

Utility 

Type 

ALT872 WINDSTREAM 

COMMUNICATION 

ELM 

LOCATING 

Day: 4067289343 

Mt: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

AH: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILITIES 

DISTRICT S/ySTDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

dhon.org/irthinternet/.../MessageText.as., 1/2 
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OMAHACOF CITY OF OMAHATRAFFICSEWER RICHTRAFFIC

Day: 4024447197 

 Al: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER 

DISTRICT 

ELM 

LOCATING 

Day: 4067289343 

AH: 4062071494 

Emerg: 8887289343 

QLNNEl C QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
ENVIRONMENTAL 

ENGINEERBVG AND 

CONSTRUCTION lEeMNoukoes, mc. SOLUTIONS 

SITE SAFt:TY HAZARD ANALYSIS 

Address: .i{4l5._^ . Jf Z Mj/„^. 

Crew: J^l^i f JJ-lilj.QJC^——. 

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 

PaOcA 

(^LurveA 

'^uuTi-e^A. 

\\uu^^•ui 

U/A 

N/A 

Pcc\r 

C-^006 

>oA 

Y(k.\r 

fiDhX 

(^oi> dMA 

A/A 

. lohiLo.. Excavation Date: 

Backfill Date: 

Hazards Corrective Action 

Site Safety Office 

Date: 

fe^\N\i Ui\V\aro 

8080 WMtffiariany, SuitB 405 5600S10St 4242 Medical Drive, Suite 7250 

Kansas OHv. IIO«4114 OmAfia, Netaaska 68107 San Antonio, TX 78229 

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

f^x: (816)3634707 Pax: (402) 733-1883 Fax: (210)579-6577 

\ " 

• ' ^