TRANSMITTAL of OMAHA LEAD STTE 

SOIL REMEDIATION FILE FOLDER 

SAID#: tS^-^^ C Date: ^ A ^ 

Address: .^3 ^ f^ ^r/-/f f^y^f 

RemediatioiiContractor: . K-iirlPAf '~(e rL Year: ^0 1 n 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

D Executive Summary 

D EPA-provided property sketch 

D Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

D Restoration Agreement 

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

D ConfLrmadon data 

D Photographs 

D As-built sketch 

D Satisfactory restoration signed by Property Owner 

• Property close-out check list signed by EPA 

Q Description of areas not meetii^ ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D 

D 

liignature" ' Date 

30261039 iiliiil 

Superfund 
Find Record Remediation Query I Lead Remaining Query I : Property Damage Query 

Backfill: 

Sample Area: 27375 ­ 3370 PATRICK AV 

Owner: Resident: Contract: 

n Owner Occupied 

Owner Name: 

|MCNEILJANYCE 

Owner Addressl: 

1

Owner Address2: 

|3370 PATRICK AVE 

City: 

[OMAHA 

State:

:,|NE

 ^ 

1 

 ZipCbde: 

 |68111 

Resident Name: 

JMOORE TOMMIE L 

Property Address: 

[3370 PATRICK AV 

Zip Code: 

[68111 j 

Resident Phone 

I 

Contractor: 

|PRUDENT2009_S

Contract Option 

[OPTION 1

Assessment: 

Qualifying Group 

[400/CHILD 

 j; 

 |: 

Owner Phone: 

1 

Alternate Phone: 

:|. . • 

Assessment Max XRF Value: 

r 777.12 
PROPERTY SUMMARY 

Date:3/15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: J^QG^ 

Property Address: 3370 PATRICK AVE 

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 = 79 PPM @ 13"; B2 = 104 PPM @ 13"; DZ = 124 PPM @ 13"; EA = 38 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. 
TECHNOLOGIES, INC. 

Property*: 2-737S 

Date/Time: 

Quads Excavated: S^ffyuy ^ 

EPA Property Close Out 

PropertyAddress: 3S7 P fkrr}' ^ P^ 

Owner'sName: -foyyvm«-6 VA^or<f^ 

Contractor Group Prudent Tecnnologies 

Excavation General 

Yes No 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? 

y 

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? y 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected at a 30 

day time period) y 

4. Are sodded areas generally firm 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 that water will not pool on the property? y 

7 (^ . Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) ^ 

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

3. Was damage to gates or fences avoided? (Ifapplicable) y 

4. Was damage to retaining walls avoided? (Ifapplicable) Y 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim 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? / 

2. Was damage to walkway surfaces avoided? y / 
3^70 foHrdL Ave 

Owners comments: 

Inspection notes: 

__/ J * t 

s o Sf(/A/ArV. ^ ^ 

'-/«/o? y y y .y .y «- •'" . .I,<.v° 4 t\ ^ « 

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

EPA Representative J?^ Ay Date: ^//f//fl 
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: 

PropertyAddress: 33-1 0 PgJhr^rt/ ­ v..^- ^ 

Phone: 

Restoration Items in Question: 

item: 

Item: 

item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

\\ agree restoration is completed. 

I do not agree restoration is coinpleted at (noted deficiencies above) 

y^^y ^ y o - J - o<^ 

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

. The EPA requests your permission lo allow PnuJenl to perfonn a soil cleamip at this 

property to remove lead-contaminated soil. By signing this form, the property owner grants peraiission lo Prudent lo 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's Ailmini.'iLniiivc Cle.rk for the 

Omaha Lead Site cleanup. Ms. .Si\,i S. .tMiiiii:iiui-at (402) 73?-! ISS. 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- \ MITN Y C C fl O / IC. [ 

I (Please Print Naine 

Property Owner Signature..: Q-'^^-^.^vo nrysL-J) i-iyo i 

Pate) r y \J (Signature) 

PROPERTY INFORMATION 

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

RESIDENT NAIVIE: Cfc^^' l T <' ^^«•/^P > / Renter 

RESIDENT ADDRESS: 

?y?. TO P CxS-y. r > 1^^- ^ Cb "WiJU^ U-e_ ^ S 11 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: ( uL ^ ^ ^ ^ "^ fs' K 1 \ WORK: 

lHf!P\ QS ^ ' -g S(^C 

' F 

AGE OF HOME? [(fO YEARS. HOW LONG HAVE YOU LIVED HERE? 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIOING SINCE 1978? 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: Y 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 activities to be implemented by EPA under this agreemeni 

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 "determining 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 2505 N. 24'" Street. Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO G4114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402) 504-1005 Fax: (210) 579-6577 
ii>:i\viK<.5i'S!>ai:.i'N«Ai^ vv 

<'<;?NS'ruuc!'50.iN 

TECHNOLOGIES, BMC. SCKVICES 

Property Status Form 

Address:

Phone: kItem NO 

On Map 

P\ 

^•ZItem NO 

On Map 

 -^ B ^D '\>o}rr>c}c^ A v/^-<_ Date: "^ M"^ I ^ 

 M02.- <^'^^ - 2- ^ ^ ^ BVID: 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

(DLP-^ <fclr eo 

Wu<c M-^.-^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No 

Description & Location o C^'cui^'te^ , 

Property Owner Prudent Employe^ 

Signature: Signature: 

8080 Ward Parkway, Suite 405 2505 H. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402) 504-1005 Fax:(210)579-6577 
m 

CHN()L()GIF..S. INC. 

AS - BUILT DRAWING 

OI,.S#:27J75 

Diili; KMiivjited: 08/21/2009 OMAHA LEAD SUPERFUND SITE l>iF.P.\ Signcd-Off Date: 

illiiliil i 27375 

Owner Name: TOMMIE L MOORE Omaha Lead Site Exterior Paint No * Arrow 

• Good 

Address: 3370 PATRICK AV ®'*^ Sketch 

5>f^o r Phone: H: W: • had paint 

Omaha Lead Site 46130 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 

27.^75 

Omdha uxleia r Paint r-Jii-rti Ainirw Lead Site Owner Name: T0r»1MIE L MOORE 

Skte Sketc^ Address : ^370 HATRIC K AV 

Phone: •^ '^ [~] Nol p.nr.'! 

Sample Number 

RYASCPXA-2?37i> =1 

Concentration 

1 2 7 pfj-Ti 

Cotlected 

DLAB 

u 

Firrr

S3n:>p)e& Coiiected 

 I^OA Qf^/G; ' 

RYBSCPXA-27375 r? 1 (<i "-i ?i:>'ri Tme. -.4 . .- M 

RYCSCP>CA-27375 B1 7 "ci 1 :i3in 

KYDSCPXA-2/'376 

RDZSCPXA-?7375 

RPZSePJt«r27375 

92 

&2 

E2 

77 7

.

 BDP 

pprr. 

 ppm 

y 

a 

n 

G 

n 

D 

D 

Sa-np1frs Analyied 

XRf U'nil: € i C Book: 

OiiK; f / 2 r /• c 

f Tor* ^Z/- ; 

Number [rf g.!-ri).ili:!e 

S:aff: -i-Al • . 

v\ 

t)^'-'"'^ 

^ - ^ 

- ^ ,>^ ­

c/'"'-^^ 

t-''=?.^:i V^J^ f &4; 

I'imaha 1 ,R:iii Siii? A-.A' 
PRIL 2004 - DOUGLAS COUNTY ASSESSO 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

 2547000000

MCNEIL 

JANYCE 

3370 

PATRICK AV 

OMAHA

;68111

3370 

PATRICK

AVE 

OMAHA 

NE 

68111 

09-15-13 

 Addition 

Block 

Lot 

 Legal 1 

 Legal 2 

Legal 3 

 Legal 4 

Acres 

1/1/ h -f

Link

Assessor

Website

Link

YALE PLACE 

0 

99 

40X119.5 

0.11 

 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

 parc=2547000000 

 http://douglasne.mapping­

 online.com/DouglasCoNe/static/accountinfo.jsp? 

 accountno=R2547000000 

2 
Page 1 of 2 


"> 

• YOUR TICKET NUMBER IS 2336468. 

Original Call Date: 8/07/09 Time: 3:39 pm Op: SIVA18967 

Work to Begin Date: 8/11/09 Time: 4:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3370 Street: PATRICK AVE 

Twp: 15N Rng: 13E Sect-Qtr: 09-SW,16-NW 

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 


: FAX ALL CLEARS TO (402) 733 1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAI-IA 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 LEVEL3 COMMUNICATIONS, LLC NA

Day: 8773668344 

 Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 
Page 2 of 2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOC/U. NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 
j > 

ENVIRONMENTAL & 

CONSTRUCTION 

SOLUTIONS 

Site Safety Hazard Analysis 

f^ 

Address; 3 3 l O T^jC/^jt: r^c^ 

Crew: ~^ifv\&J L ^ ^ ^^'^ '{^•"--y^^rDate: y-Yi'O'? 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler Systeni 

Condition 

-^^^^ ^ 

^e/ria J 

4­

otyrtOiJ 

A^/1­

-A4 ^ 

f^/f­

•rc^A 

£^ 

A^Yt_ 

< V ^ 

y^^» i lAi^&^Y /^oof ^ 

Hazards 

ntoJh^^ . /etulm'^ ^ 

Corrective 

Action 

ase ^ /Zr>o/Q 

htnJ Jeo*^ 

4­

ly ^ lacj^ ^ 

USt? j/^fhfMJtHSiA 

Site Safety Officer 

y/^i^f'^^yy^i''-^'''^ 

K y 

8080 Wird Parkway, Suite 405 2505 N. 24"^ Street, Suite 308 4242 Medical Drive, Suite 7250 

Kansas Oily. MO 64114 Omatia, Nebrastta 68110 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax. (8ISI 363-3707 Fax: (402)504-1005 Fax; (210J 579-6577 


10-'^7-a 9 

^^* i- sod 
% 

•