TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 27070 DATE: 12/15/2010 

ADDRESS: 1910 N 25 ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B I PRE AN D POST VIDE O OF PORPERTY (DVD) 

n( EXECUTIVE SUMMARY 

a EPA-PROVIDED PROPERTY SKETCH 

a SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

H RESTORATION AGREEMENT 

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

0 CONFIRMATION DATA 

a PHOTOGRAPHS 

0 AS-BUILT SKETCH 

U SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

0 PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

d UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

<y ^ qV^^'' 

SIGNATURE DATE 

30260762 

Superfunci 
Find Record 

Backfill: 

Sample Area: 27070 -1910 N 25 ST 

Owner: 

n Owner Occupied 

Owner Name: 

JCFTY OF OMAHA 

Owner Addressi: 

C/O FINANCE DEPT 

Owner Address2: 

fl819 FARNAM ST 

City: State: ZipCode: 

OMAHA NE ; 68183-

Owner Phone Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option jOPTION 2 

Remediation Query Lead Remaining Query Property Damage Query 

User Provided Owner Inforniation 

Owner Name: 

Owner Address: 

i 

City: State: Zip Code: 

1 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value 471 

Resident: 

Resident Name: 

I 

Property Address: 

11910 N 25 ST 

Zip Code: 

168111-

Resident Phone 

r 
PROPERTY SUMMARY 

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

Property Address: 1910 N 25 ST 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 266 PPM @ 6"; B2 = 294 PPM @ 6"; NO EASEMENT 

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 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) E.xcavation 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. 
TECHNOLOGIIES. INC. 

EPA Property Close Oot 

Property #: JT/CT/O Property .-^ddrcs-r. (1(0 p- T-"^ 

Date/Time: Owmer's Name: (^" vA-^.,^ ^^-^1 (^ Vv^A.Ucv 

Quads ExcavatctJ: v3>(. ^ S ^ Contractor Group: Pr«.((fent Technologies, Inc., 

Excavation Genera! Yes No 

1 If neccssarv. were the correcl quadrant(s) e.xcavated and restored? y 

j 2. If necessan... were the correct areas of drip zone e.xcavated and restored? y 

Grading Sod iind Vegetation Yes No 

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

from lhe liouse? / 

2. Has sod been laid in all areas ihat were excavaled? / 

3 Does die .sod appear to be generaJly healthy aid growing? (Only evaluate if inspected ata 30 / day lime period) 

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

5. Arc die joinls belween the sod strips generally tight? (Only evaluate if inspected al a 30 day 

time period) y 

6. Was llie property graded such diat water will not pool on die property? y 

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

Gates, Fences and Retaining WalJ.s res 1^0 

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

2. Were all gales or fences lalcen down during restoration activities reinstalled? (If applicable) / 

3. Was d.Tmage to gates or fences avoided? (If applicable) y 

4. Was dam;ige lo relaining walls avoided? (Ifapplicable) y 

Foundation, Siding iind Gutters 

1 Was damage to die siding or trim avoided? 

2 Was damage to the foundation avoided? 

3. Was damage to vvindovvs avoided? 

4. Was damage lo windows or door screens avoided? 

.-i. Was damage to downspouts or downspout extensions avoided? 

Yes 

y 

y 

/ 

y 

X 

No 

Siiilewalks and Driveways (Concrete) Yes No 

Was damage (o diivewav surfaces avoided? y 

Was damage to walkway surfaces avoided? 

x\ 
Owners comments: 

Inspection 0Otes: 

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

EPA Representative ,0,.. ^ Date: „i„/,G 
ECHS.OU.JU:ES. rwc. 

AS - BUILT DRAWING 

OLS n 27C70 

OMAHA LEAD SUPERFUND SITE l'SEP.4 S:2.-;i-i-0/r IJats: 

t 

27070 

Extericv Paint ^!crt>lA^o<r Omaha Lead Site 

Samplin • Good g Addms : 1910 N 25 ST_ SiteSfcatch 

D P'»f 1 PhOfW: H (402)342-2820 ALT 0 ^ Notpatnt 

Sampfe Number Lead 

Concentratior* 

Sampte 

Conected LAB 

Firm; 

Samples CoOet^ed 

RYASCP\A-27070

RVBSCPXA-27070

 Fl 

 F2 

Z'^O 

^2 5 Pl ^ 

D 

D 

Date:

Time;

 _ 

2 

g ­ 12-07­ 40 ^ RYCSCPXA-27070

RYDSCPXA-27070

 Bl 

 B2 

41 1 

HOft 

ppn) 

ppm 

D 

D Samples Analyzed 

r^DZDCrXA 27070 B£ - ppm n D XRF Unit. ioSt-l. Book; Iftf 

riOZCCPXA 27070 63 -

npgscpxA j7o?e—az 

— 

-

ppm 

ppm D 

D 

D 

D 

Dale: g-lS-0 7 

Time: /4 M 

Number of Samples = ^ Staff. JilsW -

Legend: F1 = Front Left. F2 = Front Rigtit. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, P l - Piay 

All qusdranrs are »s viewed (rani the sueet, fadng property 

ENTERED 

JUL 2 7 2007 

g) ffi Q. g) 

Ai. ?e-.Sh • 

Ciened 6.'r2/20tl? I<M7 10 NO E.'VSEMENT 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
^ 1 

Property Completion Agreement 

Tiiis agreement documents lhe completion of removai activities performed on. the below listed property. 

The properly owners signature indicates tItat tlie property owner is satisfied with the restoration ofthe 

subject propert)', and that no items are in question, now, or at any time in the future, excluding any 

remaining warrant)' (30 days totai) cscept those items listed below, ifany. 

Property ID; 

Properly Address: /9/0 yyy-k 35 ^ S-j^ y 

Owner: y77l-!A^. y C7-,-,'>, i./\-. 1 Phone: ^^^v/v- V/^(f 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 1 

agree restoration is completed, 

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

. / • • * / 

y. -y zy/zy- y7yyzy-yy\ / I -/Pjiy:>y'Z/- yO^O 

Owner's Signati/r^ Date 
Pnident Teclinologies, Inc. (Prudent) is under conti-act witli the U. S. Envirorunental Protection .A.gency fEP.A.) to clean tip leadcontaininated soils s ^ mimbcr of properties located in Omaha, Nebraska, including the property located at 

IHI O ^ Cy ^ Q l The EPA requests your permission to allow Prudeni to perform .T soil cleanup at thit; 

properfy to remove lead-contaminated soil. By signing this form, the propeny owner grants permission to Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-conlaminated soil and restoration ofthe referenced property. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent.south office for the Omaha Lead 

Sile cleanup-al (402) 733-11S8. General questions about tlie Omaha Lead Site cleanup can be directed to the EPA Public Information 

Centers at (402) 731-3045 (South Omalia office) or (402') 99I-.95S3 (Nortii Omalia office). 

Property .Access Granantet d ^rl^^^l r/l D Pi^~'REULy > 

(Please print Name) 

Property Owner Signamre:! lolujio 

(Date) 

(To bc completed

PROPERTY INFORMATION 

by resident anil/or property owner — pieasfijmjit) 

RESIDENT NAIVIE: \)/\rCA. ^ T * ^ ^ Renter 

RESIDENT ADDRESS, 

/?M /)o.<7lSSf. 

IF RENTAL, PROPERTY OWNED

A^A 

BY: 

OWNER'S HiAILiNG ADDRESS; 

'(1^13 hHci7 7ifLi/ i$o 3yi^Ah/A,/oe i^^)W 

OWNER'S TELEPHONE NUMBER - HOME: (7*^^ ) 3 // - ' 2" ^ 2^D WORK: 

J L 

AGE OF HOWIE? : /U/A YEARS. HOW LONG HAVE YOU LIVED HERE? /^/A YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? 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.) 

/Jlk 

ALITHORITY FOR ENX-TRONMENTAL RESPONSE .-\CT10NS, The activities to be i.mplemented by EPA under this agreemeni 

;ire pursuant 10 Section 104 of CERCLA, 42 U.S.C. 9604. EPA'sright of access to the property is provided for in Section 104(e)of 

CERCLA, 42 U.S. C i'605(e), which provides entry for "determining the need for response, or choosing or laXing any response aclion 

under litis title, or otherwise enforcing the provisions ofthe tille." 

8080 Ward Parkway, Suite 4G£ 5600 S "C- St 4242 Medical Drive. Suite 4250 

Kansas City,'MO 64114 C'.rna.'-ja, Niebrastta 6£l07 San Antonio. TX 78229 

Phone: (81S) 363-3703 Phone: (4G2) 73S-1188 Phone: f210) 822-9588 

F.ix: (8iej 36S-3707 Fse: 14025 73.3-18E3 Fax: (210! 579-6577 
• 1iiniiiiiii ^ II 27070 

Omah Exterior Paint North Arrow a Lead Site 

Samplinq Addrew: 1910 N 25 ST Site Sketch • Good 

• Poor 

Phone: »• (402)342-2820 ALT: 

0 " Not paint 

Sampl Lead •Sample Samples Collected e Number LAB Concentration Collected Firm 

RYASCPXA-27070 F1 Z^ 0 PP'm D Date; 

RYBSCPXA-27070 F2 Time; 40 A / • n ^

RYCSCPXA-27070 Bl fi n _ ppm 1/ D Samples Analyzed RYDSCPXA-27070 B2 HOQ ppm D

RDZQCPXA-27070 BZ 

ppm n XRF Unit: iaSHl. Book: Ifttf 

nGZGCnXA^27070 GZ- D

ppm D Date: 8-i5-0 7 

RPZCCnXA 2707O 9Z D

ppm n D Time: Ai^. Staff: H5W Number of Samples = /J Q 

Legend: Fl ^ Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadfants are as viewed from the street, facing property 

ENTERED \ 

JUL272O07 

6B- -a- ®' S -f 

/ 

. / 

"Hil .:•..,.HoQ..:-c. 

Rev Crtaed: fel2.200" Iti.4*49 i.Mt>|.fl,0l:?3 
itBir? 

30x66 

A ^1 S15_ Printed: Nov 16.2010 

www.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2618632. 

Original Call Date: 10/15/10 Time: 4:03 pm Op: SIVA18967 


Work to Begin Date: 10/19/10 Time: 4:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1910 Street: N 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,16-NE 


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 LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRJCT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/15/2010 
Page 2 of 2 

. . .. Alt; 4062071494 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Eiiierg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT..:. 10/15/2010 
TEOHNOUMISS, INC. CONSTRUCTION 

SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: .y^-J^L.->JL.J±:. Excavation Date: -U2y..£.y^o 

Crew: BackfiU Date: JTip^u^iUO 

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 Hasutrds Corrective Action 

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Site Safety Office 

Date: 

8080 Waid'RariBMay. Suite 405 iSSOOSIOSt 4242 Btedical Drive, Suite 7250 

Kansas Gify, iaO«4114 Omaha, Nduaska €8107 San Antonio, TX 78229 

Phone: (8T6)363';37a3 PtKMW: (402)733-1188 Phone: (210)822,9588 

Fax: (8tfi) 363-3707 Fax: (402)733-^1883 Fax: (210) 579-6577 
1910 /^^eS ^