PROPERTY SUMMARY SHEET 

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

Said: 10283 Property Address: 4541 S 18 St. 

Executive Summary: 

• Issues Encountered: None 

• Issues Resolved: None 

• Unique Findings: None 

• Other Relevant Information: None 

o CONFIRMATION SAIVIPLING DATA/RESULTS: Bl = 124 PPM @ 13"; EA = 83 PPM @ SCRAPE 

Attachments : 

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

Property sketch provided by EPA pursuant to contract specifications V 

onto adjacent properties 

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

Pre-excavation agreement details (if any 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 

Other Documents: 

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 

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

Prudent Representative: (U^.-JIUAJUIAA-'^'-*' ^ EPA Acceptance: zJtf^^'^ ' 

Date: Date: 3/"2.1 / I 2_ 

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

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation | Construction 
k iM-'^Kcin^>>:M4Ha']»^!ib;nr2 < •.*-<Mrt'*M'»^i»Visi»e'S'h-iV*'l'Vj-i«i;;4*rfi.'.<.V,;., 

lli in11 10283 

Exterior Painl North Arrow | i Owner Name: JACK MCiMTiRE Omaha Lead Site [vfCood 

1

Acidress: 4541 S 18 ST Site Sketch 

Phone: H: 402-391-2598 W: 

^-^ 1

j • Not paint 

Sample Number Lead Sample LAB Samples Collecte Collected d

Concentration Collected Firm: s RYASCPXA-10283 Fl ZOO ppm D Date: i^h^h s 

RYBSCPXA-10283 F2 iZO ppm D Time: (.'30 

RYCSCPXA-10283 B1 39 6 ppm 

D Samples Analyzed RYDSCPXA-10283 B2 3*?/ ppm 

RDZSCPXA-10283 DZ 33 f ppm 

n 

XRF Unit: /(?57 Book: lH-3 

nCZSGPX.A 10283 & ? ~ ppm D n Date: _ t-lh-0(4> - ppm D D Time: P ^ 

Numbe

D Staff: MA. r of Samples • _a. Legend: Fl = 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 

.6123 
U3LM 

I*ROPERTY ACCESS FORM ^ ^ ^ S'\9)^^ ' io^^2? 

EYttdcpt TMhnologits, lae. (Vrttrfcot) is mMtoreeotJWt wtih Ae 11..S Eiivir«WM«tf»t Protevlion A»eii«y 

(!EPA>teicleapi up kad-contomlnated soil; 8i a number o» proj*rtl« lo«it«J in Onnh« Nebraska, li>cU>i»i»8 «•« 

ptoptny located •: t> g tf l / ^ | ^ H y ^ V • 1"he BFA it«)ue«t» yow pcrmiMion ir rflow Prwteor to 

perform E soil cteaniip%rQiic:pra(J&iy to remove te«<l-oom«rb>»«Bdl u>IL By dftomg this fcim. * • pjofieny ow»i«f 

ErantsipermlsjfojttO'Pnidcm to pcrfbm MliYhiss r«l»te4 w the cleaniiv incltiitiivtoii »ampttii»rtwiovfll of l«adeootttowhrtfd soili;and'fcsiorwion of *ie rttmznccd propefty. 

If yoa have any 4iK^o»3^xnit the toil cleanup^inncd fbi yo«r pipperty, plcMc coatact the Pruiitnt 

Omo* for (hr (liBiibs Lead Stt* c(Mmt|> it^MZ) 733-110. .OenerftI questions aboiK iht Omaha Lftod Site cle«iMp 

can tie dmreleitotb» EPA ?ttWic !nft>ma«oii OntMS «t (402) 731-3043 (South Omsba eflice):or (402) 991-9583 

(North OmabkOiTiCB), 

rf your proptrty l«aft ei'»vel or dift *ive*Bys of pariwjjMtoB* then the removal «n«t rBplacwreni of Aesoil 

wwi/or gtave! during'thti-wrcdiation process does »o« weke youf tBe ^ gjWveVdirt «biveways or parting areai legal. 

I»repeiTyAccc»s.Gr»i«oil By 

T>«piiny Owaer. SipuriUre: ^JfeWrfcj^f^^^^-"^ ^-^^- ^ 

Pnjperty .^cceneJ hy (Pmdcivl EinployGe Nim ) 

PfWJPEirrv INFOItMATION (To b«eomptal«dby racktont «ndAorprop«rty^ owner ­ pte«»e prlni) 

HEWDCWT NAME:: |L|r i-|­' h o> y>yOtA" ^ Owner Renter 

IF REICTAU PROPERTV OVWEO BY I ( O yvNaVfa VAir>Vvv£-^ VAX , 

OWKER'S RWULHUS ACIDIIE88; fT ^ > f S ilj^ ^ < h ^ 

0«MER: $ TElLEPHO»« MUfWBER • HC»IE: j ^^- ? /^<>I<V 't»«»K: < t 

S. TEUAfTC'S TELEt^ONe. NUflBER • NOME: ! ^ .)(W>RK: _ L _L 

8. AOE OF HOMETi __lo2 — YEABS. HOW tOt«0 MAVB VOU LIVED HERE? YEARS. 

7. HAS THE EXTERIOR BEEN PAINTED ORCOVENEO WITH SIDMO SINCE 197r7 YBS . „ WO CJ ^ »%oT y.Ko' ^ 

e. • OF OCCUPAKta UNDE R AG E O F 7: _3:_ „ »OF OCCUPANTS AT OR OVER 7 YEARS OLD ^ 

9. *OFCH(E.DREI»UN0eRA0eOf 7WHOPtJ^YINTK£YAROFOR9HOUR^ORMOnEPERWEEK: 

10. COMMENTS OR SPECIAL INSTRUCTIONS: <I.E. DOGS, EtTTRY GATES, NEIOHBORING PROPERTY 

ETC.) 

AUTHORITY FOR SNVIROlMEllTAL RESPONSE ACnOMS; TNa acUvltlM Iv ba ImplMnvilVd by EPA undw Ihis 

iy»wr)wit ampunwfiHc Section 104 of CERCUI, 4Z U.aC. IfiM. EPA'srigM OTCBOMCIO tPi* p«»(i«(ty <• 

provided tor bt Section tOt<e|ef CERCLA 42 II.S. C BSD9(oK«iMch pfMMa»antiyfcr''d«tmnlnkiftat«iMHltor 

mpOHM, ar chfloalna er tikkr^ aa^ raapons* •ctton uwSnr mi* Wla, er otfionatw mfbixJrts th« provlaien* of cha titla." 

Prudent Tec^aologics Inc. S600 S. 10*^ St. Omaba, NE 68107, 

4ftZ.733.1 t8S (OfBce) 462.733.1 W»3 (Fax) 

3DWd S3nys ojinw E)NI>I 00T1?t'0S2Bt' 9E::0 T 0I0Z/22/t70 

W)Od fr»:oi U02/ZZ/frO 
ENVmONMENTjU..* 

cortSTBucrioN 

TECHNOLOGIES, INC SERVIICK» 

/, . ^ u f^ Propert y SCdtu» For m _ - » 

A4dr«5:^^^ l S 1 «« ^ ^ ^ ' D«e:: C3<^ f^ l |2..« (?/ 

KOTtCE TO BE GIVEN TO: I^OWNER/ TENANT BOTH 

HOWmrCKMOTIGEtSNeEDffD: 24 HOURS 4ff HOURsi 72 HOURS 1 

:}TNER NOtrCE HEEDED (PLEASE SPECIFY): 

iVbUi ^ly A Hot-Voi^^ PHONE « ANO NAME TO U/KDM NOTICE NEE08 TO BE GIVeN: 

lAfitt NSIOHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES NO 

IP NeiOHBORIMO PROPERTV WILL NEtED TO BE ACCESSED WHAT WTHE ADDRESS: 

WAS AN ACCESS fORKOBHAlNEO FROM THeNCtGHBORr YE^ ko l 

nnLU A FENCE NEED TO 5E TAKEN OOWff TO OQTAIN ACCESS? YES (NO 

rF ANSWERED YES TO NUMBER 12 PLEASE PROVtOC LOCATION OF PENCK 

is THERE PRE-eXBTlHG FACIAL DAMAGE TO THE PROPERTY ANO IF SO PLEASE PROVIDED' LOCATION AND DESCRtPTtC^ 

OF SUCH: YES /^O")' SPECIFY: 

IS THERE PRE-EXt37inG CO>*CRCT«l DXMAG B TO THB PROPBWTY AMO IF 8 0 I^LEASE PROVIOEO LOCATION AND 

DESCRIPTION OF 8UCM:: YES /NO/«PECIFY ; 

./• ^ 

PropertyOwner ^(Jv^-^^ ^^Qr^^*^ Prudent Employee / pj) •^-T 

Sigaatur*. 8iiB»atiirer_ -tpi.y'-^^ V^, \Vvvn<si^v 

Jlv i 

DATE: U'AI ^V 

Frndenl TecbnologMs Inc. 5600 S. f O'" St. Omaha, NE 68107, 

402.733.118S (QflBcc) 402.733.lit83 (Fax) 

90 3E)Vdi S3nVS. Oiny^ 9NIX . 00Ift'8SZ0t' 9£:0 I 0.I02/22/f0 

900d ooifrfroszot woi nozfww SUBI/SWQXJJ 

I 
SNVIRONMBNTAL« COVSTRUCTfON 

SERVKES i£CHNOLOr>IK9, IKC. 

Property InspectioB Form 

Phone:: MQ-^ ^ 7^ 0 I Q g> I BVID: [OlK ^ 

Pre-Existing Damage: Flease write ia detail and indoded lo>catioD 

and description of damage: 

CoDcrete Damage: 

Facidt DaznaKc liteladtng Sfafing; 

Does Baseuent: have history of leaking or Hooding? YES {'NO J 

Docs Homeowner want rod replaced in an areas? ^JC^^ NO UNO plea»e provide what 

arca» are not to be sodded and what nceda to b« replaced instead of »od {k*. mukb, rock, 

: leave bare) If wwlcto or rocfc pleaw tpeetfr what type and color; 

ANY OTHER £>AMAGe OR RjEQUESTS: 

.a 

Property Owner w Y^V\ \ ^'^\CKr^<-^ Prudent Employee/ ~ j 

Sigoatuure: "^ \jAi^^^^^^^ ^ Signatnrs: ^ J / 

DATE: H^n-^ ^ I PATE; ^-^(J.^K.. ^ l^-cPh^' ^ "^}\i^J K 

90 3£iWd S31WS' Olintf DNI>I 00Tft'0SS0t? 3E'-0l 0T0Z/ZS/f0. 

SOO'd W-Ol ilOZiZZf^ 
bjlO 

ENViaONMENTALi 

CONSTRUCTION 

TECHNOLOGIES. INt SERVICES 

. XBF CLEARANCE SHEET 

MAF HAS BEEN HEVmWED AND NO MISSED AREAS EMST: tES ) NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE AND DIMENSIONS: Q Q 

CMEW^ V\tDr\^\ 

DATE IJEPTK OUAi;.)K.ANT READING i 

Fl 1 

XEETECH: L Adr> fAS::^^^ 

¥2 

READINGS DOCUMENTED IN U'^ C S " BI 2^. LOGBOOK? YES NO 1 B2 . 

GAl^EN 

PLAYZON E 

EASE?vIE?»fT (J(p < , .-SS 

1 ~ -" 

1 
r 

•ii-);::cH':-iC!ttfv;>.iK;L in". 

Ov'Li:er't> WaniK:;- ii^<:*»\ <^l'i"^; 1} i ^ »;A<^'*'^<S^'ir" 

9...(!!•:• CiiVu::: r:\... ,..|;j .•,..-...ti!{., 

tlE;!^*"- . 

:)f.ci:^.vo"irv' v,''?!"c oi^' jrrec; :p;u:v'?;'an)(:.} ex(::Tviitco .ri.J 'cf^tov-a:;'. I / 1 

/ 

: 

!... Doc:-- On:: K):adj!:g.iJi'oiinci i}:'; n^n/KCter oi i.!i(-- iiousf. .(«• t:xaivat.ed ares':: y,ei'ier'?riy sloy e avv::(v 

fr;.KTi li.ii.:- (iOUS::''' 

2. H:rt :}=:>;•>. ^Ksn (a^d lii alt ;:'ve:iS litai vv:~,i-e excr.vo;i(:.d7 i"7t \ : ?i''^.-. i'^i;. .;o;rf .rr ;.";••.':• i.o b.- j.enei;;:'.!'/ ?ir;a(d::.! anf:; g!r'V'.;:jiS'' (Only ;\'.v;iti!-'i"!t ^lif^^irach^ <•::;' 1 .iT ^

 J 

' •;:. : :. ; • :;(.'.i. O . • ;•^^c:-:;li.•: .ii:-;? ,;-n:. 'r..i-.;;:Iv ;;: ^MI;;-,..!'' 

An'- aie ;>:;:.!'.:'• ::tn 0:t.: iod f:lrip:^ ic'.ti'v-:!.!.!-; ii;^;i;'.' aj'ah' ^v^•:t^p:>'f:• i!';-".|"(.;'"\:!'.^i :HI '~7 .. ..;.. , 1 . 

:•: ; i'^.' ^;^. | • •-\. t 1 

7^1'•':.> v.' ;: r 

•ii.l'"]:-v.:"ipii'.^ ::i " tUaii . 'Vi;>'i;Ti?tl:-.. •.ivoi':t(''!:' ' 

•;V!yf;:;' l;:;?;'!." ::i'!i:.\:_ ':'••:: 

'•:.:•• • r;:.:.:! O.r;...!; :..;•. • c ^i;i;:.),..>h 

:•• ;-s'iiJ(?..^'.^ • ^) •';;';;/i:'i:;:.f;lcl 

.(.•;;. : ..v. 

'•i:;:'.i.:U'n/::.;,f: Xy- !h'-: ::;i.^K>9. rn' I ' ^ I 

M S ': I .' i-:'':::V:: 'iVvvi.i-: 

i.t!=po;n o;':K.'K-:/;i"-'»:;: :;>0)i;^: 

..'b 'i.Mi..;;^': tC 

0!Oi;'i f 

'• y 
O'^^^KCFS- •v:Oi!'3*5n'«^l!l.liS:: 

[ Mspecin-aini s'it-f^K: 

ReiHOOvsl and resloration aci:ivates coinrppkie ntchjctiiig ihe 30-iJa.y" sod warranty 

tJ''A lkep!:s":ienisfi'^-ir _&s*!?..*336rn._ J><i'^ ..^JlJ-^ZlfL 
m !' V l| <.X.ilES, rNt 

AS - BUILT DRAWING 

OUS#l<l2J(3 

l)«tr r.xmvatcd: 5 I<>/20)1 OMAHA LEAD SUPERFUND SITE Sanipltd B>: 1 JOIIBMIB 

i • 

wmm 

&mrmtmmm:.ms^m:imm, 

•-'^.3 

JJ] ;«*a:uB)mi 

£"i3ifera«r; 

XKMSscsnmr-mism IFH O 

Sj«i]rs«:iniuMtsBie 7 3 O TTimB!- A-'yK/ 

o 

^'^ f mr a 

3 Sii !j(}fru o r>«KP"i:;iiii! __ig32 L Bfij*. ^ 

o o C5&»: f.-l'te-d'df ."..-—.. » *.*vh'i . .|h~i^fT.'n _ .*..<.. 

!wriif.^t.:;pTr^"V)7.iii'3i7 (fif. I ppnr. o Time: 

IStu.mberotSamtitas • A ? 

Staff: 

ll*SB3(it:ff-1-lTi»ireiiarf<tir2-rrCT8i5ighf;aai -i«6cfeaaff:,3K'=3feete-Si^^ 

,*l' pvaOtairhjiaB'Sf • .•Bwea'ffoiir.-.mecjt'eet; tso)n<j;,7i''uwnv 

... ., . 3 . 

nif: 1?.?.. -i i -^T^^'-s: -~1i (! J. 

I * £' 

I f i5 I: rt m7 X'^ti'^.i'm^^^ •• 2 • • - - - .. . .S.rr- - , , 

i- : 1 I : !^ 

4^ — f EA = 83 PPMfti SC R.\rE ^ ,x.. 1: f—%-l-t I T 

. IA "7^^,^..,^... -....^^ .r..-.r-;»-.•• .7 i ..'.•.----. iSi'-y'^'' r 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC 

-*^ - --^ - - •'*'^i-* i 
Find Record Remediation Query Lead Remaining Query Property Damage Query dose 

Property Info Clean-up Iirfb !L??r''f*'^J'^ Customer Calls Sidewalk Repair 

Sample Area: 1028 3 454 1 S 18 ST 

Sample Date ­r j Quadrant -t Paramete ­ I XRF Rt ­ J XRF Res ^ [Exc ^ Mar<ef Place •> Lead Remainitv •> Inj -r San^ried B^t QA Confirmee » Lab Res 

T/16/201T B1____J LEAD 124 mg/kg 13 Ljohnson WA 

6/16/2011 E1 LEAD I 83'mg/kg 1 H Ljohnson N/A 

LEAD I i mg/kg j 0 N/A 

^ • I 

-h -i_..­

_..(.._ ­

i 

i 

!

i

 t 

1 

1 

1 

-U 

"I " 

-4 

i

1

 1 

1 

! 

Record: M < > M K Search ^^^^^^^^^ 

i 

" 
Find Record Remediation Query Lead Remaining Query Property Damage Query Close 

Property Info Clean-up Info Sample Info

Sample Area: 10283 - 4541 S 18 ST 

13 Lab.ResuU 1 Lab Result Unit .

Oi mg/kg 

^ 

0 

0 

mg/kg 

mg/kg 

 customer Calls Sidewalk Repair 

 Remarks

.

 j^m ^

 ' ' • " 

i 

i 

T 

1 

1—. -­

t- ­

 .. ­. —

 -- ­

 --_-.. ­ . ­ .-.­ ­ .__ ,._ ­ ­ _ -. .-

• 

i 

1 

1 

- — ­ • 

1 

1 
«n ^HVK 

Property Completion Agreement 

This agFeemeD.t documents the completion of removal actiivities performed on the below Listed'pKoperDy., 

The property owner's signature indicates that the property owiaer is satisfied with, the restoration of t^e 

subject property, and that no items are m questioa, now, or at any time m the future, excluding any 

remairting warranty (30 days total) except those itenis; I'jsted below, if any. 

Property ID: 

Property Address.: ^S¥/ rSoui-ly le^' S T 

Owner: 

Phone: 

Restoration (terns ih Question: 

Item: 

Item: 

item: 

Item: 

Item: 

item: 

Requirect corrections to complete tlie property: 

agree restoratipr> is completed. 

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

1/ A^ /// 

Owners SFgnature Dafe 

I
"Bl 
Page I of 2 

"> 

Cieate Anotfier Tidtet Bacfctohrth litfemet Send Email J] 

YOUR TICKET NUMBER IS 2766036. 

-ry^ 

Original Call Date:: 6/09/11 Time: 8:52 am Op: SIVA18967 


Work to Begin Date:. 6/13/11 Time: 9:15 am 


UGLA •*• :••' .
 S 
 S

Address: 4541 Street: S 18TH ST 


State: NE County: DOUGLA Place: OMAHA 


Twp: 14N Rng: 13E Sect-Qtr: 03-NW-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C '"^ - • ''•' 

Type of Work: lead soil remediation project 


Location o i Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (4021733-1883 


: UNSURE CORNERS •'.•• - *%a 


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 DIGITEL LEVEL3 MUD02 OMAHACOF 0PPDGPR6 PAETEC 

QLNNEIF 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Ah: 4029340469 


Emerg: 4029329757 


Day: 8557426062 


niniTPi LIGHTCORE A CENTURYLINK .. . Alt: 8008509048
 UIOIIbL COMPANY ^ ^ 

Emerg: 8557426062 


Day: 8773668344 


LEVEL3 COMMUNICATIONS, LEVELS NA Alt: LLC ^ ... • .» . Emerg: 8773668344 

Day: 4025047823 


METROPOLITAN UTILITIES MUD02 SANDY Alt: DISTRICT 

Emerg: 4025047970 

http://www.dhon.org/irthinternet/DHONNoticeCreation/Messag,eText.asp?ret-<RESULTS... 6/9/2011 
Page 2 of 2 

CITYOFOMAHA- OMAHACOF TRAFFICSEWER 

OMAHA PUBLIC POWER OPPDGPR6 DISTRICT 

PAETEC PAETEC COMMUNICATIONS 

QLNNE 1F QWEST LOCAL NETWORK

RICH/TRAFFIC 

ELM LOCATING 


NO NEED TO CALL OUT 


EMERGENCY 


 ELM LOCATING 

Day: 4024447197 

Alt: 4024446725 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Einerg: 8887289343 

Day: 8002891901 

Alt: 

Emerg: 8002891901 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


.*; 


':^ ': 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/9/2011 

JA 

:

1

 Apr05.,.2i3

 SI8S

l 

T 

Hi A .riCEif.OI'lJv'Bfflilr. 
Site Job Hazard Anahpis 

Address. Y^^ / $ i l 3 1? ^ Date_,5;/^k6v/^^Z Z 

Analysis Completed By 7\ 7 C^TC Prudent Technologies Health and Seifety Officer 

Location 

F1F2 

Item B1B2 Condition Hazards Corrective Action 

Overhead Power Lines Electrocution /^JA 

Gas Lines Underground Gas, water Call Digger Hotline Prior to perform locates prior to 

Water Lines Utilities leaks beginning work on property 

Sewer Line If utilities are not located contact Supervisor, Safety 

Septic Tank Personnel to notify them of issue 

,Jtri3paiie/B utan e Go to another property to work as directed 

Foundation (DZ) s. 

*.«*f ^liM.^ CttA^4C§ liO ~B£j^*^ o*^ y^A>" v'^'^g^ >^ 

Driveway 

6&ACt^<i 

Side walk ^ QA^^t^^y 

Trees 7^/fi7 

Plants/Garden GZ 

Access to Propert}' 

Busy Street (need to close 

off Lane) 

/ J U 

Hand Dig A^1 U OJ^^ I 1/ n ^0Ci^S .Tljine A^^t ^ 

Pets /bees/wasps/ticks/red 

ants/spiders A/ZA-

Poison Ivy/Poison Oak 

Miscellaneous 3 1 A^A ^^ 7'c>^h^M^ i^yr^ 

Time Print Name of each Signature of each Changes in conditions resulting in additional 

Date Reviewed Reviewed crew member crew member safety assessment ifapplicable 

Audited by_ Date