0

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28018 DATE: 12/15/2010 

ADDRESS: 2625 Grant St 

REMEDIATION CONTRAaOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ PRE AND POST VIDEO OF PORPERTY (DVD) 

Ef EXECUTIVE SUMMARY 

 EPA-PROVIDED PROPERTY SKETCH 

[ ^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

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

H CONFIRMATION DATA 

Q 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 

cf UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

»^w «^\^^^^' 

SIGNATURE DATE 

30260753 

• ill 

Superfund 
Find Record 

Backfill: 

Remediation Query 1 Lead Remaining Query Property Damage Query J 

Sample Area: 28018 ­ 2625 GRANT ST 

Owner: User Provided Owner Information Resident: 

n OwnerOccupledOwner Name: 

MATLOCK RICHETTA R 

Owner Addi-essl: 

1 

Owner Address2: 

Owner Name: 

1 

Owner Address: 

r 

Resident Name: 

r^ " • 

Property Address: 

|2625 GRANT ST 

Zip Code: 

|3242 BEDFORD AVE |68111-

City: 

lOMAHA 

Owner Phone 

1(402) 346-8483 

Al 

r 

state: Zip Code: 

|N E J68111­

ternate Phone: 

City: 

1 

Owner Phone: 

1 

State: ZipCode: 

1 1 

Alternate Phone: 

1 

Resident Phone 

1 

Contract: Assessment: 

Contractor: ]PRUDENT2010_S Qualifying, Group '[400 

Contract Option lOPTTON 1 Assessment Max XRF Value 1 540.89 
PROPERTY SUMMARY 

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

Property Address; 2625 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: 

B2 = 367 PPM @ 10"; EA = 310 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 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, 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
TECHNOLOGIES, INC. 

Propertv #: 2^0 1 S 

Date/Time: 10/2-^/^^l ^ 

Quads Excavated: 

Excavation General 

l.-^"3. ff 

EPA Property Close Owt 

Property Address: 2-^"^ ^ S P-"^^"^ "^ 

Owner'sName: Richc-Hrc x /\AcM~locbContractor CBroup: Piruident Technologies, Irac, 

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

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

Grading Sod and Vegetation 

1. 

2. 

3. 

4 

5. 

6. 

7. 

Gates, 

1.

2. 

.1 

4. 

Does tlie grading around the perimeter of the house in excavated areas generally slope away 

from the house'.' 

Has sod been hiid in all areas tliat vvere excavated? 

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

day time period) 

Are sodded areas generally finn and evenly graded? 

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

time period) 

Was the property graded such titat water will not pool on tlte property? 

Was damage to landscaping or plant materials avoided? 

Fences and Retaining Wails 

 Do gates open mid close freely? (If applicable) 

Were all gates or fences tal-cen down during restoration activities reinstalled? (If applicable) 

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

Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, Siding and Gutters 

1. Was (iajiiagc to the siding or trim avoided? 

2. Was damage lo the foundation avoided? 

?i. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Yes No 

y 

/ 

Yes No 

y 

y 

y 

y 

/ 

y 

y 

Yes No 

y 

y 

y 

y 

• Yes No 

' 

y ' 

y 

y 

y 

y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided'' y 

2. Was damage to walkway surfaces avoided? y 
Owners commeinits: 

Inspection notes: 

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

EPA Representative 7/,..^ J/L.. Date; /^/^a//^ 
28018 

rtCHNULOGIES. FNC. 

AS - BUILT DRAWING 

OLS U 28018 

Date Excavated: 10/5/2010 

USEPA OMAHA LEAD SUPERFUND SITE Signed-OfTDate: 

lili 

Omaha Exterior Paint North Arrow Lead Site Owner Name: RICHETTA R MATLOCK 

Site Sketch 

• Good 

Address: 2625 GRANT ST • Poor Phone: H: W: Q Not paint i

Lead Sample 1 AP Samples Collected 

Concentration Collected Firm: Flaf t \ R s yTci j 

RYASCPXA-28018 F1 ppm I T n Date: Ot - 3 o - o M 

RYBSCPXA-28018 ppm 

Sample Number 

 F2 \3r D Time: a .3 0 

RYCSCPXA-28018 Bl —355 ppm [ T D 

Samples Analyzed RYDSCPXA-28018 82 ppm IT D 

nOZSCr'XA 28018 B^ ppm D D 

XRF Unit: ^ \ \ Book: & D 

nczscpxA-280ie—es - ppm D D Date:. 

riPgGCP)(A"20010 P2- ppm D D Time:. PW 

staff: Numtier of Samples = 

.E;NTIIREJ). .. V*^ 

:AUG n 'I z m :^<»< ^":)k \y- y ^ 

-0 

82 = 367 PPM @ 10" 

2fct5^ 

^ ^ 

\ 

V 

• ^ 

q; 

c:; 

37^..;. mi 

i-A' 

^ 

- :—I . V 

<< tZZ] y 1 <^ " tie. LJOOLU.; 

Cjran * SiV 

L 

Oinaha Lead Site 

46130 

EA= 310 PPM @ SCRAPE 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
Property Completion Agreement 

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

The propert)' owner's signature indicates that the propertj- owner is satisfied vnth the restoration of the 

subject property, and that no items are in question, uow, or at any time in the future, exchading any 

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

Property' 

Property Address: ,j(p^f ^ Oimr\ f "^iJ^ O J t ' 

Owner: 

p^o--yf07j-<y^^L\^nn\ 

Restoratoon litems imi Qyestiora: 

Item: 

Itere: 

Item: 

ReqiLsired correcteoins to complete the piropertjn 

i agree restoration is completed, except as noted above 

[_] I do not agree restoration is completed 

lD-2i'/o 

Owner s Sigmatere 
''^^-

Pnidcnt Technologies, Inc. (Prudent) is under contract witii the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated^ojk; at a number of properties located in Omaha, Nebraslia, including the property located at ..I. A *\ . ^ C n ..^..m. .*. ' Tl.. . n' o A . „ , :~~: ._ _11 n_ , j * * - j :- . The EPA reque,>:t.s your permission to allow Prudent to perform a soil cleanup a1 Ihi.s i^__ propeity / to remove lead-contamuialed soil. By signing this form, the property owner grants permission to Prudeni to perform 

activities related lo 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 Prudeni south office for the Omaha Lead 

Site cleanup-al (402) 733-1188. General questions about Uie Omaha Lead Site cleanup can be directed to the EPA. Public Information 

Centers ai (402) 73 1-3043 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property .Access Granted By:( 

' ^ ' ^ (flease Print Name) 

Property Owner %\?p2.v.iriJ/y.fyl^.zyyZ/'- ^ / W /^/F^^^^JjCr a 1/ 7 ' ^ 

(Date) 

PROPERTY INFORMATION 

(To be completed by resident andi'or property OAvner — please piint) 

RESIDENT NAME: (/.l^JjyT^nkediot : f - T y y Renter 

RESIDENT ADDRESS 

^.(^X^ l^^gy/U^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: (f/2^ ) PLII J ~ l o ^ ^ WORK:--. _ 

J L 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YES NO ^ 

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

|jl|lMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

MniENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

ALITHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be Implemented by EPA under this agreemait 

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

CERCLA, 42 U.S. C &605(e). which provides entry for "detennining the need for response, or choo.sing or taking any response action 

under tliis title, or otherwise enforcing the provisions ofthe title." 

8080 Warrf Part.vray. Suite 405 560S s •;-:- s t 4242 Wectical Drive, Suite 4250 

Kansas City, 'M O 64tf 4 OrriEna. ?igDi2.sfea 53107 San Antonio. TX 7822S 

Photie: ^SIS) 363-3703 Phone: ;432i. 7i3-'it£t Phorie: /210) 322-S588 

Fax; (S1S> 363-3707 Fax: {432; '-^^AfS^ -Pax; i213) 57S«577 
ENVTRO.NMEiMALJi 

COiNSTRLiCTIOiS 

TECHNOLOGIES SERVrCE.S , INC. 

Property Status Form ^ , . Address: ^^ 5 f/^^/J-^T ^ Date: ^ ^^^ T " / ^ 

Phonef /( BVID: yg^/^?f)-/^y? 

Property Owner Prudent Employee 

Signat ure: yfy^^^J^ ^ '^^^ ^ r y A= 

3080 Ward Pai 5600 S 10 St 4242 S/ledrca! Drive. Suite 4250 

Kansas Ciiy, MO S4114 

Phone: (816) 363-3703 

r-.. . /o.«ei nen ^TA T 

Ortsaha. Nebraska S8157 

Phone: (40Z)733-11SS 

c..»­ ttnix -Jin icon 

San Antonio, TX 73229 

Phorte; (210)322-9583 

C..V­ ntl\ \ B7a.J!ST7 
28018 

Omaha Exteriair Paint North Arrow Lead Site Owner Name: RICHETTA R MATLOCK 

Site Q Good Sketch Address: 2625 GRANT ST • Poor 

Phone: H: W: Q Notpaimt i

Sampl Lead Sannpte Samples Coiiected e Number LAB Concentration Collected Firm: FJS'ft \ R s VTC J 

RYASCPXA-28018 F1 OiiL ppm n Date: Ot- ^ 3 o -O M 

RYBSCPXA-28018 F2 l ^ ppm n Time: 2>' 3 P

RYCSCPXA-28018 Bl 0" n 

Samjgtes Anatyzed RYDSCPXA-28018 B2 ^^ \ PP"' n

RDZOCrXA'20010 ppm D n 

RCZGCPXA2801B 62 ­ ppm D D 

RPZOCr)(A"20010 P2- ppm D n 

Number of Samples = M 

®WT.£EE;D. ..\^. 

e^' ^ •AUG n 4 z m :^i'>« ' \ y * - y •O 

y 

<^y 

^ / .V 

c ^ - %

SI'H r o 

L A ^ 

A 

K : •' * y V? 

li-i--- —? ^ • > 

.V 

V < < 

\U7i-: XS7 

I t : 

^ T ale uatsuJU.; "T"'—•" • ' >' 

Qifart' ^ Sih 

Omaha Lead Site 46130 
N 33x105 

A Printed

: Oct 21. 2010 

-A'".'.^v.(JcEfe 'WS* de"f^ 
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. 

create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS  2605487. 

Original Call Date: 9/30/10 Time: 12:37 pm Op: SIVA18967 


Work to Begin Date: 10/04/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2625 Street: GRANT ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg; 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT S/iNDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

I of 2 9/30/2010 12:38 PM 
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT E LM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:38 PM 
SOtUTIONS 

SITE SAFETY HAZARD ANALYSIS 

. ^^X 5 ^VQLnh ^ ^ Address Excavation Date: -MsUZ L : 

Crew: BackfiU Date: 'jdMlSL. 

Item Condition Hazards Corrective Action 

Overhead Lines <^ ' /^' ^ k^-^i i ^Si - pf'- p 

Gas Line 

Water Line 7^ 

i^ 

^ 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk o/<^ 

Foundation 
 ar^ 

Retaining Walls 

Fences (pc^^ 

Trees cy^ 

Stmctures ^^^— 

Driveway 

Sprinkler System 

Other 

Crew Foreman Site Safety Office 

Date: 

\ Waid ParioMay, Sule 405 SSOOSIOSt 4242 Medical Drive, Suite 7250 

;Cify;Ma^li 4 Omataa, Webraska 68107 San Antonio, TX 78229 

Tone: (ffW) 3CT<mi3 Plwna: (402)733-1188 Phone: (2t0) 822:^588 

nc (8t6) 363-3707 Fax: (402)733^1883 Fax; (210)«T9-6577 
Z62blUGif^tfr 5 r 

I '^Izoio 
iili5!zoio