TRANSMITTAL OF OIVIAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#; 33396 DATE: 12/15/2010 

ADDRESS: 3910 N 22 ST 

REMEDIATION CONTRAaOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

G ( PRE AND POST VIDEO O F PORPERTY (DVD) 

[^ EXECUTIVE SUMMARY 

Cfl EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

[ J RESTORATION AGREEMENT 

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

d CONFIRMATION DATA 

Cj( PHOTOGRAPHS 

a AS-BUILT SKETCH 

13 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

\h PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

of UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

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SIGNATURE ~ DATE 

30218319 

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PROPERTY SUMMARY 

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

Property Address: 3910 N 22 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 = 360 PPM @ 6"; EA = 153 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/phojographs 

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 (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. 
TECHNOLCXJIES, INC. 

EPA Property Close Out 

Property #::-^33^ > ^ Property Address:"^^ 10 ^ " ^^?"^ -

Date/Time: Owner's Name: CK^O ^ o^Or^aW a 

Quads Excavated: g>2 Contractor Group: Prudent Technologie,s, Inc., 

Excavation General Yes No 

1. If necessary, were the correcl quadrant(s) excavated and restored? / 

2. If necesscui', 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 that were excavated? y 

3. 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 finn and evenly graded? y 

5. Are the jomls between tlie sod stnps generally light? (Only evaluate if inspected at a 30 day 

time period) / 

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

7. Was dainage (o landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls 

Yes No 

1. Do gates open and close freely'^ (If applicable) y 

I. Were all gates or fences talcen down during restoration activities reinstalled? (If apphcable) / ' 

3. Was damage to gates or fences avoided? (If apphcable) / ' 

Was damage lo retaining walls avoided? (If applicable) / 

Foundation, Siding and Gutters Yes, yso 

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

2 Was damage to the foundation avoided? / 

3. Was damage (o windows avoided? / ^ 

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

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

Sidewalks and Driveways (Concrete) Yes, No 

1 Was damage lo diivewav surfaces avoided? y 

Was damage to walkway surfaces avoided? 

y^ 
Owners comments: 

Inspection notes: 

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

EPA Representative '^ ^ Date: •A'''' " 
^rTTNDtXJClES. INC, 

AS - BUILT DRAWING 

OLS n 3i3'i6 

Dale Kxcavated: 10/07/2010 OMAHA LEAD SUPERFUND SITE rSF.PA Signed-r)^ Date: 

3.^_a ^ 

Omah Extenor Paint a Lead Site • Good Site Sketch 

• Poor 

Sampling Address: 3 3 I d N £.£.^t . 0'^Not paint 

Sampl Lead Sample Samples Collected e Number U\B Concentration Collected Fimi: feXtic P&T A 

RYASCPXA- 3S33Q^' ^ Ca I ppm D Date: \\jS'lo8 

RYBSCPXA-3335C'^2 23 0 ppm Time: 't-DOAM n 

RYCSCPXA-5335C B1 2^ 2 ppm D Samples Analyzed RYDSCPXA-J335^ B2 ^f'i S ppm \y D RDZOOPXA- B2 - ppm D XRF Unit: fo<t40 Book: 2ZiJ _

noZOGPXA- D — ppm D Date: lh05-O & 

RPgOOPXA- -PZ- ~ ppm D D 

Time £. D r r t 

Staff: m.^L J Number of Samples = 

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

All quadrants are as viewed ft'om the street, racing proj 

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NOVO 5 2008 Q: 

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Fl 

B2 = 360 PPM a 6" 

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.N-.22..ST; 

Rcv2it(«BL rrcatoJ I6.\ia\J))i EA = l.y PPM a S( RAPE (-1") 

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

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 fiiture, excluding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address; g.^/ ^ ^^^^; , ^^6'/^ / 

Owner: ^/•^ \ ol O'^v^ty^-

Phone: 

^vv - yjtHt 

Restoration items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required con'ections to complete the property: 

1 ^ I agree restoration is completed. 

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

/(^ yVowcyy^^iy -yo i 0 

Date 
Prudent Technologies. Inc. (Prudent) is under contracl with Ihc U. S. Environmental Protection Agency (EPA) to clean np leadconinminaicd soils at a number of properties located in Omaha. Nebraska, including the propeny located at 

i?yU l A/, y?,).AiJ Sr/ce'-/ ~ The EPA requests )'0ur permission to allow Prudent to pcrromi a soil cleanup at (his 

property to remove lead-contaminated soil. By signing this roim, llie property owner grants permission to Prudent to perfonn 

Bclivitics related to the cleanup including soil sampling, removal oriead-coniaminated soil, and restoration of the referenced property. 

If you have any questions about Ihe soil cleanup planned for your property, please contact Prudent soulh ofTicc .for the Omaha l.ead 

Site cleanup-at (402) 733-1188. General questions about Ihe Omalia Lead Site cleanup can be directed lo Ihe EPA Public Information' 

Centers at (402) 731-304S (South Omaha office) or (402) 991 -9583 (North Omalia office). 

Property Access Granted By: /w///«3/v \ // • L^lfCAjt ^ 

(Please Print Name) 

Property Owner Signature: 

PROPERTY INFORMATION 

(To be completed by resideni nnd/or property owner -- please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

T^^lo A/ 2X ^ ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

/U"! /^fi, n C/^ S.JIL 11// Oy>^(<y\ Ayf ^.h/SB 

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

K^0>^\ hHH - ^f/^ t 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 _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 ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreement 

are pursuant lo Section 104 ofCERCLA. 42 U.S.C. 9604. EPA's right ofaccess to Ihe property is provided for in Section 104(e) of 

CERCLA. 42 U.S. C 9605(e), which provides entry for "detemiining the need for response, or choosing or taking any response action 

under lliis lillc, ur otherwise enforcing the provisions of Ihe title." 

8080 Ward Parkway, Suite 405 seoosiost 4242^edical Drive, Suite 4260 

Kansas City, MO 64114 Omaha, Nebraska 68107 . San Antonio. TX 78229 

Phone: (816) 363-3703 Phona: (402)733-1188 Phone: (210)822-9688 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6S77 
Number of Samples -\i \ 

^ ^^^ 

333.9a 

Omah Exterior Paint North Arrow a Lead Site • Good Site SIcetcti • Poor 

Sampi'inq Address: 33I Q N 2 £ S t 0^Not paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Finn: feTMC PR TA 

RYASCPXA- 3335CF1 

ppm D Date: \\\^\o ^ 

RYBSCPXA-3335C F2 

2 3 Q ppm Time: ^'DDAM 

RYCSCPXA-3333C Bl 2*f ^ ppm ^y D 

n 

Samples Analyzed RYDSCPXA-3335C B2 Jil2. ppm D 

RDZOOPXA- BE ppm D D XRF Unit: to<^ 0 Booii: 22Z> 

RG20GPXA GZ- .1:: ppm D D Date: // QS-Q Q 

RPZCOPXA -P2- _Z ppm D D 

Time: flm 

Staff: mSL: > 

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

All quadrants are as viewed from the street, fatan 5propert)^ 

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A Printed

: Nov 16,2010 

www.dcgis.org/dogis 
Page 1 of2 

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Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2609470. 

Original Call Date: 10/05/10 Time: 4:36 pm Op: SIVA18967 


Work to Begin Date: 10/07/10 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3910 Street: N 22ND ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-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 


: 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 


ALT872 CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Number Utility Type 

Day: 4067289343 


ALT872 WINDSTREAM COMMUNICATION ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 


Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 4025047823 


MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 


Day: 4067289343 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/5/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon. org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULTS... 10/5/2010 
1<:NU1JNE£RING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAl^TY HAZARD ANALYSIS 

Address: :^5Miyoyz2.. Excavation Date: 

Crew: Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines ^y^ - r.tu ^ lyr\~^i—, 6JB(« _ y^ycyyo 

Ga u s Line r^ 

Water Line yO , . . ^ ^^ ^ 

Sewer Line {P^ 

Septic/Leecli 

Field 

Propane/Butane 

Sidewalk •t-t^h* -

Foundation 7^ ^ 

Retaining Walls 

Fences 

Trees «^/c _ 

Structures 

Driveway £> / i~~ 

Sprinkler System 

Othe ^ . ,. r 

Crew Foreman Site Safety Ofiice 

Date: 

M80 WmfVartany . Suito405 seoosiost 4242 Medical Drive. Sufte 7260 

OmtJOL, Mibriilrn S81C7 San Antonio, TX 78229 

Phone: fsi o 3n>3703 nwne : f4aa)733-11S8 Phone: (2tO) 8224588 

faoc fSIS) SSS-STOr F a c (4eZ)73»4883 Fax: (210) 6r9-«577 
ACAAJT i ::^'}ii.^y y 

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