TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 33335 DATE: 12/15/2010 

ADDRESS: 3919 N 25 AV 

REMEDIATION CONTRAaOR: PRUDENTTECHNOLOGIES. INC YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

• EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

0 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D 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 

0 PHOTOGRAPHS 

0 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 

d UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D , 

D 

D 

SIGNATURE DATE 

30218323 niii 

Superfund 
Find Record iJ

Backfill: 

Sample Area: 33335 - 3919 N 25 AV 

Owner: 

• Owner Occupied 

Owner Name: 

jWHUNER DORETHA W 

Owner Addressl: 

1 

Owner Address2: 

J3915 N 25 AVE 

City: 

JOMAHA 

State:

|NE

 Zip Code: 

 |68111-

Owner Phone 

|(402) 455-2167 1 

Alternate Phone: 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option (OPTION 1 

Remediation Query j Lead Remaining Query y Property Damage Query !zJ 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Code: 

r 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value [ 522.46 

Resident: 

Resident Name: 

I 

Property Address: 

|3919N25AV 

Zip Code: 

J68111-

Resident Phone 
PROPERTY SUMMARY 

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

Property Address: 3919 N 25 AV 

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: 

Bl = 108 PPM @ 6"; EA = 77 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-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/oiphotographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
TECHNOUXJIES, INC. 

Property #: 3a,*i.'?>$ 

Date/Time: /o/i.2^/2^, o 

Quads Excavated: ^ (^ 

EPA Property Close Out 

Property Address: "BPW^ N I S /^v 

Owner's Name: l^oV <. ^ O. U3 h (\ti ejT 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

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

2. Has sod been laid in all areas that were e.xcavated? ^ 

3. Does tlie sod appear to be generally healtliy 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 y time period) 

6. Was the property graded such that water will Oot 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 and close freely? (If applicable) ^y 

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

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

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

Foundation, Siding and Gutters Yes No 

1. Was damage lo the siding or U-iin avoided? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? ^ y 

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? y 

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

Inspection notes: 

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

EPA Representative <^ ^ ^Date: n/s-f/u, 
rHNDCDGIES, INC. AS - BUILT DRAWING 

OLS # 33335 

Date Excavated: 10/4/2010 OMAHA LEAD SUPERFUND SITE USEPA SigBcd-Off Date: 

33335 

North Arrow Omaha Lead Site Exterior Paint Owner Name: DORETHA W WHITNER 

Site Sketch Address • Good y \ : 3919 N 25 AV • Poor Phone: «: 402.455-2167 W: [g^Not paint 

Sample Number Lead Sample „ ^Samples Collected 

Concentration Collected ^'^*^ 

Firm: HE. fX X \ L t 

RYASCPXA-33335 Fl 2-1 I ppm W n Date: I Q -0 5 - Cp T 

" ppm n D Time: B^JSO A.T^ 

RYCSCPXA-33335 Bl 5Z2 . ppm \3r n 

Samples Analyzed 

RYDSCPXA-33335 B2 3 s o ppm 

RDZSCPXA-33aa5 BUr " ppm 

D D XRF Unit: /£>3 7 Book: /g 3 

RGZSCPXA-33335 GZ g<?^ ppm "M " e-"' n Date: / ^ - Z-g -^f T 

•RP2SGPXA-3-33-35 -PZ Time: ~ ppm D D MA. Staff: L A 

Number of Samples = M 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Ali quadrants are as viewed from the street, facing property 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Property C©mp8etlon Agreement 

This agreement documents the completion of removal activities perfonned on the below listed property 

The propert> owner's signature indicates that the property owner is satisfied with the restoration ot 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: -y(( ^ |\ ^ cj^f ^ A\i- t ^ 

Owner: j" ^ \)c^(ethci \hllnU)e'L 

Phone•• Uoi u<;t;-'0^'^?' 

Restoration lltenis io Questioini: 

Required corrections to complete tihe property: 

O^M^i} ^ ^^ ^^)>/ f due/ 4fn^c cM<?ci 

ly] I agree restoration is completed, except as noted above. 

I 1 do not agree restoration is completed 

"^^muM, -'IvJA^.-.. Owmer' Date s Sigiuature 

I
Prudent Techjiologies, Inc. (Prudent) is utider contract with the U. S. Environmental Protection Agency (EPA) to clean up leadCjyitaminated soils at^a number of properties located in Omaha, Nebraska, including the property located at 

y ( / I 'M ' o\ 7^ ^ y • nie EPAreque.st,s your permis.sion to allow Prudent to perform a soil cleanup at this 

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

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

If you 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 By: D^P/ftfi^ \lhtU f r 

(Please Print Name) 

Property Owner Signature: i!}MLth*t} ^.kU i 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME : Dordh^ \^/^lif/^/-/^ ^g^nec^ Renter 

RESIDENT ADDRESESSS : , ,Ly j 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: {HOjL\ ^5^'^IL l WORK: 

jHOO-S ^^ ^ 110 0 

AGE OF HOME?: M YEARS. HOW LONG HAVE YOU LIVED HERE? tS ' YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: N A 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 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 9605(e), which provides enti^y for "detennining the need for response, or choosing or taking any response action 

undei- this title, or otherwise enforcing the provisions of the title." 

8080 Ward Parkv/ay, Suite 405 5603 S %v St 4242 Metftcal Drive, Suite 4260 

Kansas City. MO 64114 Omatia. ?«e*waska SS107 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: ifiOl- 72S-t1S« Phone: (210) 822-&SS8 

Fax; (816) 363-3707 Fax: {492) TZS-tSSB Fax; (210) 579-6677 
mum ENVlROiNMEiMALA 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVFCES 

Property Status Form 

Address: 1>'?/^ hJS-C^' ^^if Date: ^'.^^/ ^ 

Phone: %^ ' HS^'^ll^ 7 BVID: 

7^-^.^^&u^ . Av-c^^ P^ I 

Property Owner Prudent Employee 

Signature; ^mH^-Ap^^Ltyi^ Signature: ' ^^oBadi^­ r ^ 8080 Ward Parkway, Suite 405 S600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City. MO 64114 Omaha, Nebraska 68107 San lirAonU>, TX 78239 

Phone: (816) 363-3703 Phone; (402)733-1188 Phone: (210)822-9588 
•. :^-u.*C;-^ . •"-i^.ii-:.I . 

33335 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: DORETHA W WHiTNER • Good Address Site Sketch y\ : 3919 N 25 AV • Poor Phone: H; 402-455-2167 W: 

0^ 1 paint 

Sample Number Lead Sample „ /Samples Collected 

Concentration Collected ^ ^ Firm: JlL__miiM . RYASCPXA.33335 F1 Z l i ppm uy O Date: / O ~ 03> - OCT 

RYDOCPXAOOOOO Tg "• ppm Time: Q:^^C> A/V^ 

RYCSCPXA-33335 B1 SZ2 . ppm lay u 

Samples Analyzed 

RYDSCPXA-33335 B2 3g g ppm [&^ D 

nOZCGPXA 33335 B2- ppm D D XRF Unit: /^3 7 Book: 133 

RG2SCPXA-33335 GZ 30*4 ppm "M' c y n Date: /a - Z8 -as­ nPZOCPXA 33335 PZ- Time: -" ppm D D JJA, Staff: L A 

Number of Samples = M 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

Ilev4- M6141.0I23 
K 3919N25AV 

A Printed

: Dec 02, 2010 

www.dcgis.org/dogis 
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Create Another Ticket | PBack to Irth Internet Send Email 

YOUR TICKET NUMBER IS  2605489. 

Original Call Date: 9/30/10 Time: 12:39 pm Op: SIVA18967 


Work to Begin Date: 10/04/10 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3919 Street: N 25TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 04-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 SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

lof 2 9/30/2010 12:39 PM 
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OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:39 PM 
ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFifcTY HAZARD ANALYSIS 

?9/ ^ yV'aSyhA:> Address: Excavation Date: 

Crew: BackfiU Date: 

Item Condition Hazards Corrective Action 

Overhead Lines <^J^^/^^'g/0 - ^ " ^ Gras Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk OJ ^ 

Foundation ciC ^ 

Retaining Walls 

Fences <=i/<^ 

Tree tS>^* s 

Structures 

Driveway ayy. 

Sprinkler System 

Other 

Crew Foreman Site Safety Office 

Date: 

M80¥fvd«artaMay, Suite 405 9MOS108 t 4242 Medical Drive, Stdte 7250 

tGilr<'K>«4114 iliij«luitt1C7 San Antonio, TX 78229 

: (819) 36S>3703 Pfwno: (402) 733-11*8 Phone: (2t0) 82Z-4588 

FacfStS) 363.3707 Fax: f402) 733^1883 Fax: (210) 579-8577 
39/9 H Z¥ ^ 

Bl 

Bl 

'/^^/i^' ^