TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 27531 DATE: 12/15/2010 

ADDRESS: 4327 GRANT ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

\h PRE AND POST VIDEO OF PORPERTY (DVD) 

ID EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

m SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

di RESTORATION AGREEMENT 

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

m CONFIRMATION DATA 

m PHOTOGRAPHS 

6 AS-BUILT SKETCH 

• SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

dl PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^^ ^ 3\llV^ 

SIGNATURE DATE 

30218593 

Superfund 
Find Record 

Backfill: 

Sample Area: 27531 - 4327 GRANT ST 

Owner: 

n Owner Occupied 

Owner Name: 

I HABITAT FOR HUMANriY OF OMAHA^ 

Owner Addressl: 

Owner Address2: 

|2204 AMES AVE 

City: State: Zip Code: 

JOMAHA " |NE )68110-

Owner Phone Alternate Phone 

I r 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option JOPTION 2 

Remediation Query i Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: 

1 

Alternate Phone: 

Assessment: 

= ~ Qualifying Group [400 

Assessment Max XRF Value 1 549.89 

Resident: 

Resident Name: 

Property Address: 

|4327 GRANT ST 

Zip Code: 

J68111-

Resident Phone 

I 
PROPERTY SUMMARY 

Date: 12/15/2010 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: December 

Property Address; 4327 GRANT 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: 

Bl = 366 PPM @ 6"; EA = 274 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 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 (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. 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 2 7 6^ ' Property Address: H 3>27 &r<Ui-v9^. 

Date/Time: Owner's Name: 1Vv>^W\ ^ r t^tvrv&nrv «^ 

Quads ExcaA'ated: ^ ( Contractor Group: Prudent Technologies,Inc., 

Excavation GeneraJ Yes No 

I. If necessary, were the correct quaclrant(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 perimeter of the house in excavated areas generally slope away / from the house? 

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

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

day lime period) y 

4. Are sodded areas generally finn and evenly graded? y 

5. Arc the jontts between the sod strips generally tight? (Only evaluate if mspected at a 30 day / time penod) 

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

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

Gates, Fences and Retaining WaUs Yes No 

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

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

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

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

Foundation, Siding and Gutters Yes No 

]. Was damage to the stding or trim avoided? y 

2. Was damage lo the foundation avoided? / 

3. Was damage lo windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes, No 

I Was daniaiJe to diivcwav surfaces avoided'? 

2. Was damage lo walkway surfaces avoided? y 
Owners comments: 

Inspection notes: 

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

EPA Representative Bt>.„ -JOo^ Date : fill's/IP 
BrTTNDCDGlES. INC 

AS - BUILT DRAWING 

OLS #27531 

Date Excavated: 10/21/2010 

USEPA Signcd-Off Date: OMAHA LEAD SUPERFUND SITE 

27531 

Exterior Paint North An-ow Owner Name: CHARLES^H LINDHORST Omaha Lead Site • Good 

Address Site Sketch : 4327 GRANT ST • Poor 

Phone: H W: g'No t paint i 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 rv\fc.-b A^rv^O 

RYASCPXA-27531

RYBSCPXA-27531

 Fl 

 F2 

AZ. i^ o 

. ppm 

. ppm r 

n 

D 

Date:

Time:

 i I / 0 ' /0<o 

 10 - t.*S a.fy \ 

RYCSCPXA-27531

RYDSCPXA-27531

 Bl 

 82 

550 35 1 

ppm 

. ppm 

a 

D Samples Analyzed 

-ROZSCPXA-37.W4 B2­ ppm D D XRF Unit ino- 7 Book: U' J 

RGZSCPXA.37531

RPZSCP,XA.27531

 SZ 

PZppm 

ppm 

Number of Samples =

D 

n 

 '­

n 

D 

Date ll-7J^d(s> 

Time: P m 

Staff: yi^LJ 

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

All quadrants are as viewed trom the street, facing property , 

Bl =366 I'PM « 6' 

(j)W(L 

SSO 

e>\ 

r E NTB.HED 

%\a<~. 0% 

+'*Nt house. 

432-7 C C(MJ T 6 T 

(p- ^ 

?> 

IUO, 

:Fz. 

lev 4' 

\;)aoy,y. 

C^rotK^

KA = 274 I'PM a

 Kt -

 S(RAPi:(~l") 

CONTRACT tt: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
SEm 

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 ofthe 

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; 432 7 6r^tnV5l. 

Q^'""'- toiU fc. \^mjLM\^ 4 (huL\x(L 

Phone: ^t)Z-H?l-'?b^l 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^3^ 1 agree restoration is completed. 

L J I do not agree restoration Is completed at (noted deficiencies above) 

H \<fjzoio 

dwaef^s Signature Date 
RX Date/Time 10/08/201 ^20100 12:30 402 457 4012 P.002 

Oct. 8. 2010 12:28PM Hafta t for Humanity No, 1414 P. 2 a0al 

Prudent Technolofiu, Inc. (Prudeni) ii under c«n(i«ct wilh the U. S. Envjronincntil Protection Agency (EPA) to cleen up leadctulaminMcd soil! at a number of prapeniet located in Omiht, Nebraiki^ including IIK propeny located at 

^^2- 7 q»7iVl'rar i . The EPA requests your penniMion lo allow Pnidoit lo perfonn a soil clcaniv at this 

property to itmove lesd-MnUminatcd soil. By sigDine thit fomi, the property ovnter grants permission to Pnident to pcrfbnn 

activities related to the cleanup Including toil sampling, removal of lead-contaminated soil, and restoration ofthe refirtoeed property. 

Ifyou have any questiom about the toil cleanup planned fbr your property, pleate contact Prudent soulh ofBce io r the Omaha Lead 

Site cleanup-at (402) 733-118S. General questions about the Omaha Lead Site cleanup can be directed to ihe EPA Public Inibrmalion 

Centers al (402) 731-3045 (Soulh Omalia office) oi (402) 991-9S83 (Nonh Omaha office). 

Property Access Crantcd By: y^eis t Print Nafie) 

Property Owner Sigoatui MIIJMO 

lignaluie) ^ (Date) 

PROPERTYINFORIMATION 

(To be coapletcd by t-eiidtat and/or properiy owner ­ please print) 

RESIDENT NARAE: •—^^^——.^^_^^_____^^.^^ ^ /owne r J Renlsr 

RESIDENITT ADDRESS A[)DRESS : _ A^ ^ 

irneNTy, PROPERW OWNED BV: 

OWNER'S MAILING ADDRESS: 

OWNER'S TELEPHONE NUMBER-HOME: l^Sfl-\ i{T~ l ^ ^^*5~ l WORK: 

J 1 

AGE OF HOME?: h/<l YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1076? ^YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OP CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DCQ8, ENTRY GATES, ETC.) 

AiriHORlTY FOR ENVIRONMENTAL RBSPONSB ACTIONS; The activities to be implemenled by EPA under this agreement 

are pursuant to Seclion 104 ofCERCLA, 42 U.S.C. 9504. EPA's right of access to the propeity is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 960S(c), which provides entry fbr "deteiminiog the need fbr retponte, or choosing or taking any response aciion 

under this title, oi otherwise enforcing Ihc ptoWsions of the title." 

8080 Ward Parkway, Suite 40S 6600 SIO St 4242 Madical Driva. Suite 4250 

Kansas City, MO 64114 Omaha, Nebnicka 68107 San Antonio, TX 78229 

Phone:(816)363-3703 Phona: (402) 733-1188 Phone: (210) 822-0688 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax:(210)679-6577 
ENVraONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^ ^^- | (l(fo^vsj ^ %\ ^ Date: l0((^ f , 

Phone: BVID: 

. ^ 

)f 15 ClC_ 

Property Owner 

Signature: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

5600 S 10 St 

Omaha, Nebraska 68107 

Phone: (402)733-1188 

Fax: (402)733-1883 

4242 Medical DriveTSuite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
27531 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: CHARLES H LINDHORST 

Sit • Good e Sketch Address: 4327 GRANT ST • Poor Phone: H: W: 

g^Not paint 

Number of Samples = ; ^ 

Sample Number 

RYASCPXA-27531 Fl 

Lead 

Concentration 

ppm 

Sample 

Collected LAB 

D 

Finn:

Date:

Samples Collected 

 Wtfct) ftWmO 

 H/Ot/o( o 

RYBSCPXA-27531 F2 1<PO ppm D Time: tO - l ^ a-rv \ 

RYCSCPXA-27531

RYDSCPXA-27531

RDZSCPXA 27631

RGZSCPXA-27531

RPZSCPXA 27531

 Bl 

 B2 

 DZ^ 

 6Z 

 PZS?Q., 351 

ppm 

ppm 

ppm 

ppm 

ppm 

mr 

u 

D 

n 

n 

D 

D 

n 

n 

Samples Analyzed 

XRF Unit JQQX. Book: i32_ 

Date: J l K'CXp 

Time: QT> 

Staff: /%i ^ 

Legend: F1 = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Dnp Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property , 

(ipiJC ENTERED 

SSO 3i57 

e>v 

+v^e house. 

C e^i-^r 6T ^ibzn 

6^: IUO 

f' ;f2L 

>j;idk.viVt. 

(s'TQ \ ^-X' 

Rev 4' 0461410121 
5

0 X 120 

A •'

. *i*, « Printed: Nov 16,2010 

www.dcgis.org/dogis 
_____ _ 

TEOHMOtaiMa. mc. CONSTRUCTION 

SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: —M^^-jS^tocL^ L Excavation Date: f<^l^^\^— 

Crew: BackfiU Date: iMAiJJA 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leecli 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

c ^ ^ 

e^ 

h^' 

v^ 

ore 

or­ . — 

pcc ^ 

CP^< ^ 

a^ 

o^— 

Hazards Corrective Action 

Site Safety Office 

Date: 

laao WwdlMitaMy. Si«e405 seoosiost 4242 Itodical Drive, Suite 7260 

(ansa* caiy; »044114 OnrtiHL-M<bi3SfcB San Antenk), TX 78229 B8T07 •bona: fgW) 38»gWP VUanr Phone: (2tO) 822-0688 . (402)733-1108 

te: fSliS) 363.3707 Fax: (210)«7M«77 
— -»»»%•• /f_