TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: r?fc^ ^ Date: M^I5-) 0 

Address: Q OC ^ f^/Hf]Nin A f 

Remediation Contractor: Pi?,, nPr^-f itr ^ NO<IOC| \^<.^ irsjy.,i Year: /( J I ( j 

SOIL REMEDL\TION 

PROPERTY FILE FOLDER DOCUMENTS 

\ / Video of property (DVD) 

0 Executive Summary 

H EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja^nt property 

y Restoration Agreement 

n Settlement documents (i.e., for damage or to replace plants, etc.) 

Q Confirmation data 

'Z Photographs 

0 As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

0 Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature Date 

30218353 

Mil 

Superfund 
PROPERTY SUMMARY 

Date: 11/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Monthi of: November 

Property Address; 4002 FRANKLIN 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: 

F2 = 157 PPM @ 9"; EA = 158 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 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. 
Find Record Remediation Query j Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 26294 - 4002 FRANKLIN ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

IKELLY MARY C I 

Owner Addressl: Owner Address: Property Address: 

|4002 FRANKLIN ST 

Owner Address2: Zip Code: 

|3717 N 114 QR |68111-

City: State: Zip Code: City: State: Zip Code: Resident Phone 

JOMAHA |NE |68114- I 

Owner Phone Alternate Phone: Owner Phone: Altemate Phone: 

"1 

Contract: Assessment: 

contractor: PRUDEWT2010 S Qualifying Group |46o 

Contract Option JOPTION 1 Assessment Max XRF Value j 522.79 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property tf:,^^*^! Property Address: ^CX>t F^'f^ ' "^ 

Date/Time: Owner's Name: P-»"cW)>jrtA, \^t\(i \ 

Quads Excavated: p2 ^ Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

I. If necessary, were tlie correct quadrant(s) excavated and restored? 

y 

2. If necessary. were the correct areas of drip zone excavated and restored? y 

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? y 

2. Has sod been laid in all areas diat were excavated? y 

3. Does tJie sod appear to be generally healdiy and growing? (Only evaluate if inspected at a 30 

y ^ day time period) 

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

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

time period) y

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 Walls 

Yes No 

1. Do gates open cind close freely? (If applicable) 

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

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

Was dainage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

y 

2. Was damage to tlie foundation avoided? 

y 

3. Was damage lo windows avoided? 

y 

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 driveway surfaces avoided? y 

2. Was dainage to walkway surfaces avoided?. y 
Owners comments: 

Inspection notes: 

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

EPA Representative fL„y^^ Date: lojislio 
26294 

1THNOL(XJIES. INC. 

AS - BUILT DRAWING 

OLS U 26294 

Date Excavated: 09/20/2010 

I'SEP.A Signed-OfT Date: ^ OMAHA LEAD SUPERFUND SITE 

Omaha Exterior Paint North Arrow Lead Site Owner Name: RICHARD I KELLY 

Site Sketch 

• Good 

Address: 4002 FRANKLIN ST • Poor t Phone: H; w: Q Not paint 

Lead Sample Samples Collected 

Concentration Collected 

Sannple Number LAB 

Firm ri)A tcjdfA 

RYASCPXA-26294 Fl ppm D Date '=1-1- oH 

RYBSCPXA-26294 F2 ppm D Time 

RYCSCPXA-26294 B1 ppm i D 

id Samples Analyzed RYDSCPXA-26294 B2 ppm D 

^np^r;^r^(fl^l rnm—DZ ~ ppm 

n XRF Unit: 

RG.?SCPYft,?fi?':iii GZ­ ppm n Date: O^-^LA,.^ ^ 

RPZSCP.YA.262'a4 BZ- D

ppm D 

Number of Samples = i 7 - J 

ENiTERED 

SEP 1 02004 

.3.2 

1 ^ 

2 5 ' * - — : 

HOi^ 

P2 = 157PPVI fl 9" 

...n n 

Sa-b; 

WdtK 

^Tht^l^Ul^ 7>^-

Omaha Lead Site 46130 

E.\ = 158 PPM fdi SCR.\PE 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
This agreement documents the completion of removal activities performed on the below hsted propertv' 

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: LI^ Q ^ FroLr>\C ^(- \ S't r - Owner: Kco-u r VI^^CJU. 

Phone: Q 

Restoration Items in Qyestiom: 

Keni: 

item: 

Dtem 

Stem: 

Item 

Item 

Required corrections to complete the propeirty: 

f agree restoration is completed, except as noted above 

do not agree restoration is completed 

Id)y3-yy)y 

Date 
^ \ 

. I 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcoptaminated soikat a number ofproperties located in Omaha, Nebraska, including the property located at 

KX>C^ 2-— f'^y^Qjry fc-l I Vl The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

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

activities related to the cleanup including soil sampling, removal of Iead-contaminaled 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 

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

Centers at (402) 731 -3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted ^.tkryjiyji 

Print Name) jyTj '' (Pfeay: 

Property Owner Signature: / . ±yfyM^^ 

(Signature) (Date) 

PROPERTY INFORMATION 

o be completed by resident and/or property owner — please print) 

RESIDENT NAME: I. Owner Renter 

^"^^y^fi^.yy.^j/y.. y 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS •j'/n 7^ //y,uy^ 

OWNER'S TELEPHONE NUMBER - HOME: y^i v-y^-/^^^^ WORK: 

t > 

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


ALrrHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) of 

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

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

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City,'MO 64114 Onnaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 383-3703 Phone: (402) 733-1188 Phone: (210)822-9588 

Fax:(816)363-3707 Fait: (402) 733-1883 Fax:(210)579-6577 
ENVfRONMENT.AL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

y. rrope Propert i y Status Form 

Date: 

Address: V^^. Z ^7^ytfiyt/^^Tyiy 

BVID: 

Phone: ^.^ ^ ­ ^f/-^^^/ / 

Property Owner Prudent Employee 

Signature: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

^ , Signature: 

5600 S 10 St 

Omaha, Nebraska 68107 

Phone: (402)733-1188 c.. . i»n'\\ ti t <oo^ 

fledical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Ci v I'HtW S70J:KT 7 
26294 

Omaha Lead Site Exterior Paint North Arrow Owner Name: RICHARD L KELLY 

Site Sketch • Good Address: 4002 FRANKLIN ST 

Phone: H: yv: • Poor t • Not paint 

Sample Number Lead Sample Samples Collected 

i 

LAB Concentration Collected Fimi: PM bCJ^r^ 

RYASePXA-26294 Fl ppm n Date: 'J -'J • 0*4 

RYBSCPXA-26294 F2 ppm n Time: l^.'S O 

RYCSCPXA-26294 B1 ppm D Samples Analyzed RYDSCPXA-26294 82 ppm 

nnrnrr¥A ?n?ni—oz^ n ppm n XRF Unit: ^A: L Book: ^ 

RG.7fiCPYA ?fi?n(1 GZ— ppm n D Date: (^-\^.f^^-| 

RP^SCPYA.?6'Z04 RZ - ppm D D 

n Number of Samples = */ 

ENTERED 

SEP 1 02004 

% \ . 

\t)X 

2i' 

mnicLifosr 

o 

...0 a

59.-^ •I • 'I M V . J L ^•^^^^ ^ 

.^imL 

H^KU/o.sr. 

Omaha Lead Site 46130 
N 400

2 Franklin St 

A fe^ Printed: Nov 16,2010 

www.dcgis.org/dogis 
Page 1 of 1 

Create Another Ticket Back to Irth Intemet Send Email 

. YOUR TICKET NUMBER IS 2594301. 

Original Call Date: 9/16/10 Time: 3:01 pm Op: SIVA18967 


Work to Begin Date: 9/20/10 Time: 3:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4002 Street: FRANKLIN ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-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 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 SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHA-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/16/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION ISDMNmoeffiB, I 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: ^OO ^ fM\^) U "M Excavation Date: -UM. 

Crew: /^/^/l / VamkfJ Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines 

Gas Line C,£y0Ji • ^ 

Water Line (yiy)cyil 

Sewer Line ^ 

Septic/Leech 

Field yy/yf 

Propane/Bntane 

Sidewalk 

Foundation 


Retaining Walls yty^L. 

Fences 

Trees 

Stmctures 

Driveway 

Sprinkler System 

Other 

Crew Foreman Site Safety Office 

Date: 

y^y / < Ca j2^ i^rsJ iT^i^ltL 

8080 Wanfeariony. auitBr405 seoosiost 4242 Medical Drive, Stlits 7250 

KanasGi|y.HO«4114 Ontirfia, NateiMa <8t07 San Antonio, TX 78229 

Phone: (81<)36S'3703 PHens: (402)733-1108 Phone: (2t0) 82Z-i9588 

Fax: {81S) 363-3707 Fax: (402)733^1883 Fax: (210)67»-6577