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TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 27320 DATE: 1/15 

ADDRESS: 2008 N 25 ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 201() 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

 EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

n SETTLEMENT DOCUMENTS (I.E., FOR DAMAGE OR TO REPL^CE PLANTS, ETC.) 

d CONFIRMATION DATA 

H PHOTOGRAPHS 

d AS-BUILT SKETCH 

d SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

d PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

\ y UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

Qy-^'y slih 

SIGNATURE DATE 

30218402 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2008 N 25 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: < 3 i." 

Fl - 33 PPRl @ 6"; Fl • 76 PPM (g) 68; EA = 278 PPM @ SCRAPE (~1") J, Ql - ^^ ^ PPi^ ^ 

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-Buih 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Find Reconj 

Backfill: 

Sample Area: 27320 - 2008 N 25 ST 

Owner: 

n Owner Occupied 

Owner Name: 

ICTTYOFOMAHA 

Owner Addressl: 

|C/0 CITY nNANCE 

Owner Address2: 

|1819 FARNAM ST 

City: State: Zip Code: 

jOMAHA |NE |68183-

Owner Phone Alternate Phone: 

f 

Contract: 

contractor: |PRUDENn010. .S 

Contract Option |OPTION 2 

Remediation Query I Lead Remaining Query j Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

I 

City: State: Zip Code: 

1 1 1 Alternate Phone: Owner Phone: 

1 1

Assessment: 

Qualifying Group [sOO 

Assessment Max XRF Value j 946 

Resident: 

Resident Name: 

I 

Property Address: 

|2008 N 25 ST 

Zip Code: 

|68111-

Resident Phone 

I 
TECtlNOLOGlKS, INC. 

EPA Fropert)'' Close Out 

Pi-opcrty #:'?-. 7 3'^C) Fropemty Address: ZC>6'^ pT-^^J -

Date/Time: Owner's Name: <i"'"^-^ ofOtT^K-^ 

Quads Esca'jated: ^ / Contractor Group: Priuleint TecJmologics, Inc. 

Excavation Genera) Yes No 

I If necessfirv, were the correcl quadrant(s) excavated and restored? y 

2 ir necessjiry. were the correct areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

! 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 tliat were excavated? / 

:i. Does (he aod appear to be generaily healthy and growing? (Only evaluate if inspected at a 30 

day lime period) / 

4. Are sodded areas generally firm and evenly graded? 

/ 

5. Arc tlie joints between the sod strips generally tight? (Only evaluate if inspected al a 30 day 

tune period) / 

(>, Was the property' graded such tliat water will not pool on tlie property? / 

7. Was dajiKige (o landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walls Yes No 

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

2, Were all gales or fences taken down diuing restoration activities reinstalled? (If applicable) / 

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

4. Was damage to retaining walls avoided? (If applicable) / 

Foundation, Siding and Gutterf) Yes No 

1 Was damage to the siding or trim avoided? / 

2 Was damage to the foundation avoided'^ / 

3 Was damage to windows avoided? / 

4 Was damage to windows or door screens avoided? / 

-"j Was damage to downspouts or downspout extensions avoided? / 

Sidewalk.s and Driveways (Concrete) Yes No 

I Was damage to diiveway surfaces avoided? / 

Was damage to walkway surfaces avoided? / 
Owners comments: 

Inspection notes: 

r^ y ^ y 

cyli y 

Removal and restoration activates complete including the 30-day sod w^airanty: 

EPA Representative A^ J^ , ^Date: ///g/// 
THNOIOtilFS. INC 

AS - BUILT DRAWING 

OLS # 27320 

Date Excavated: 10/07/2010 OMAHA LEAD SUPERFUND SITE rSF.PA Signed-OfTDate: 

^T5Z O 

Omaha Exterior Paint Lead Site 

• Good Site Sl<etch 

• Poor 

Sampling Address: -Z-OC 

S+ g'Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: Pg T^iC. r>ft %.k 

RYASCPXA-Z7a20 Fl H S ppm [ y D Date: nll'^llQ 

RYBSCPXA-Z7320 F2 3H ppm o r D Time: q-OOA>A 

RYCSCPXA-Z7320 B1 -f«8 ppm \ 2' n Samples Analyzed RYDSCPXA--17320 B2 ?03 ppm a 

RDgOOnXA t73a o D2 _ = ppm n a XRF Unit: Book: 2JCC& 

RGZCOPXA a7aao ez . n ppm a a Date: 

RPZGOPXA *7»^0 PZ _ = ppm • n 

Time: I t L 

Staff: A75tx/ Number of Samples = 

Legend; F1 = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Rigfit DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from thw street, facing property 

I : tJSTJD > jpjvT^ * 

NQ V19 2 O10 

1 ; S 

&l 

1 : 

H86 .303 . 

Bl = 385 PPM a 2" p-^ 

^ 

_. . \-y^­

\H5 [..i-i 

1 1 P. If) 

^1 

•I ijT 

WfcLK. 

E.A= 278 PPM a SC R.\PF. M,l LS Sn-l. .. Re\- tX*,HL Ore ttcd: 16-Ma> .(!» (>VM\ 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
SEPA 

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 future, excluding any 

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

Property ID: 

Property Address; ^^^J ^^^^^^ ^^^^tb ^4^4. 

Owner: ytk M /^/>^/ig3-

Phone: L,L/L(-L,^Hy 

Restoration items in Question: 

item: 

Item: 

item: 

item: 

item: 

Item: 

[X I agree restoration is completed. 

[ H I do not agree restoration is completed at (noted deficiencies above) 

^^-Ociv^cr ~^0/d 

Date 
Pnideni Technologies, Inc. (Prudent) is under contract with the U. S. Environmemal Proteciion Agency (EPA) to clean up Icadconiantinated soils al a number ofproperties located in Omaha, Nebraska, including ihc propeny located at 

t/OOj AJ. iS'^ 6T". . The EPA requests your permission to allow Prudenl lo perrorm a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, the property ow-ner grants peimission lo Prudent to perfonn 

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

Ifyou have any questions about Ihe soil clcmup planned for )'our property, please contact Prudenl south ofTice .for the Omaha Lead 

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

Centers at (402) 731'3045 (South Omaha olTice) or (402) 991-9583 (North Omaha ofTicc). 

Property Access Granted By: A/.'///^? tvi // • /-uiyAi ^ 

(Please Print Name) 

Property 0\vner Signamree: /yyCW'/\ £y^t/yLyL j yx/^y^/ A y S-Oc-f'c/OJil 

' IA ' (Signature) (Date) 

PROPERTY INFORMATION 

('fo be completed by resident and/or property owner - plcise print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: j l 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

li/') J^^Yit^ ^^^CC/.SL;U//I f Ot^ U Aje 6^(i \ 

OWNER'S TELEPHONE NUMBER - HOME: ( ) WORK: 

yi(i}.\ WV-vjt^r;^ 

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.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The aciiviiies lo be implemented by EPA under this agreement 

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

CERCLA, 42 U.S. C 9605(e), which provides entiy for "detemiining Ihe need for response, or choosing or taking anyresponse action 

under this title, oi otherwise enforcing the provisions ofthe tiile." 

8080 Ward Parkway, Suite 405 SSOOSIOSt 4242 Medical Drive, Suite 4250 

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

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

Fax:(816)363-3707 Fax:(402)733-1883 Fax:(210)579-6577 
27320 

Omah Exterior Paint North AiTOW a Lead Site 

Site • Good Sketch 

Q^Poor 

Samolina Address: 2008 N 25 ST • Not paint 

Sample Number Lead Concentration XRF LAB Samples Collected 

RYASCPXA-27320 F1 U2t2lL-.PP"\ D Fimi:Pgli/g. IE)M\A / 

RYBSCPXA-27320 F2 <^ML ? ppm Date. Illzt^ltfl 

n RYCSCPXA-27320 Bl .?ID 1 ppm Time: ft-MgMA D RYDeOPXA 27320 BS- ' - ppm D Samples Analyzed 

RDZSCPXA-27320 DZ \l^ Q ppm 

RCZSGPXA D XRF Unit: IQftfia. Book: ZSCit 27320 62- • ~ ppm D 

RPZCX}nXA-2702 D Date: 11/23/ ^ 0 PZ " " ppm D D Time Baa 

Number of Samples = | ^ | [ (^ \ Staff: MSW 

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

AB quacCrants are as viewed fr9m the street, fadng property 

r-^ ) 1t — « K it 1 cE"VTmi. - l^*** ! . . -"Cl i r \ • • 

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N 2008 N 25 ST: 37 X 120 

A Printed: Dec 10.201(3 

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Page 1 of2 

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Create Another ticlcet Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2609474. 

Original Call Date: 10/05/10 Time: 4:38 pm Op: SIVA18 967 


Work to Begin Date: 10/07/10 Time: 5:15 pm 


State: NE County: DO.UGLAS Place: OMAHA 


Address: 2008 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 Nuniber 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 DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

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Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

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TEDHMOLOUM, mc CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address : ._..^i_._^.--2.C.£?r- Excavation Date: 

Crew: BackfiU Date: 

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 Hazards Corrective Action 

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Site Safety Oflice 

Date: 

080 Wai»«arfeany. Sul»40S 5600S10 8 t 4242 Medical Drive, Suita 7260 

:ansa0Gi|y;«IO«4114 ihijK Ira 00107 San Antonio, TX 78229 

tKMiK (StO) 3O|3703 Viiaaer. {402)733-1180 Photw: (2t0) 822-0688 

ax: (9ffi) Ses-^STDZ Fax: (402)733^1883 Fax: (210)««.6577 

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