TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: cg.TO/9 Date: H ^ I 5 "" I 0 

Address: S^^lf C^qrlf^^ f!f 

Remediation Contractor: Ppt-y^rfPr-iTf 7»/''-|<NodOC|i-{^«^^/rjci-^ Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

i 

Video of property (DVD) 

Executive Sununary 

i 

EPA-provided property sketch 

Signed Access Agreement for subject property 

u Signed Access Agreement(s) for adja<?ent property 

^ Restoration Agreement 

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

Confirmation data 

Photographs 

As-biiilt sketch 

i Satisfactory restoration signed by Property Owner 

Property close-out check hst signed by EPA 

0 Description of areas not meeting ROD cleanup criteria 

i Utility clearances 

i Property information from Douglas County Assessor's Office 

D 

D 

D 

'^<r ^ 4\1V^ 

Signature Date 

30218907 

Miniiiiiiii 

Superfund 
PROPERTY SUMMARY 

Date: 11/15/2010 Oinaha Lead Site Reinedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 2834 CHARLES 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: 

Bl = 227 PPM @ 9"; 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 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, ifavailable, 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. 

TECHNOLOGIES. INC. 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 25819 ­ 2834 CHARLES ST 

Owner: User Provided Owner Information Resident: 

n Owner Ornipied 

Owner Name: 

jCTTY OF OMAHA 

Owner Addressl: 

|C/0 CITY FINANCE 

Owner Address2: 

|1819 FARNAM ST 

City: 

{OMAHA 

Owner Phone 

r 

state: Zip Code: 

(NE (68183-

Alternate Phone: 

1 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

Owner Phone: 

1 "

State: ZipCode: 

1 1 

Alternate Phone: 

1 

Resident Name: 

[LOT 

Property Address: 

(2834 CHARLES ST 

Zip Code: 

(68131-

Resident Phone 

I 

Contract: Assessment: 

Contractor: (PRUDEMT2010_S Qualifying Group |'4o6 

Contract Option (OPTION 1 Assessment Max XRF Value ( 530 
/ S ^ 

'nBCHNOLOGIES, INC. 

EPA Property Close Out 

Property #:'2''7B'^ ^ Property Address: ^^"5 4 CV^iA^ > 

Date/Time: Owner's Name: <2i>C| c.,§^f>v^Wc( 

Quads Excavated: ^ ' Contractor Group: Prudent Technologies, Inc, 

Excavation General Yes No 

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

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

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? / 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 / day time period) 

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

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? (If applicable) / 

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

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

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

y 

Foundation, Siding and Gutters Yes No 

1. Was damage to die siding or trim avoided? y 

2. Was damage to the foundation avoided? 

X 

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? 

^ 

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 wananty: 

EPA Representative jQ^„yk^ Date: /o/fe//^ 
CHNULOGIES, INC. 

AS - BUILT DRAWING J T 

OLS #25819 

Date Excavated: 9/22/2010 

USEP OMAHA LEAD SUPERFUND SITE A S^ned-Off Date: 

Name: _5_ Omaha Lead Site Date: ^////r / . North Arrow 

Address: Site Sketch Time: j '-^i 

Phone: _ 

Team iil'-tw^/- XRF Code ^^^y 

Sample Number Lead Concentration Confirmation Sampie 

J Z l f- Yes n No S ' 

JS;^:^ ppm r.Ye s • No S-"' ^?<p ppm ' Yes CD No B" ' ppm i? -^^o ppm fi.^Yes n No S- ' 

ppm Yes tu No Q 

ppm Yes • No • 

ppm Yes • No • 

ry; 

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:ia3_ 

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^Liwwisi %AL . 

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Sf 

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U^i 

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Omaha Lead Site 46130 

rnNTRArra- FP.^7-in-ni; PRI inFNT TFrHNni rv;iF<; iwr 
Property Coinp(etion Agreement 

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

The property owner's signature indicates that the properfy owner is satisfled with the restoration of the 

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

remaining warranfy (30 days tota!) except those items listed below, if any. 

Property ID: 25fiil 

Property Addraa: ^^-^l / ^H^gLR S ^ . 

Owner: C\vr 6^ M f \ 

Phone: 

(t/oi) ^^^ 'H n 

Restoration Hems In Question: 

Item: 

Kem: 

Item: 

Item: 

Item: 

Required corrections to complete the properfy: 

 I agree restoration Is completed. 

L J I do not agree restoration is completed at (noted deficiencies above) 

^H)wner'»signature 

0
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties locaied in Omaha, Nebraska, including the property located at 

^/).b*-( C^I/yPt^Lz^ • Tlie 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 lead-contaminated 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 Omalm office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: A^/ ll]r>^ Lu'k/ ^ 

(Please Print Name) 

Property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Renter 

RESIDENT ADDRESS: 

^ ^i -

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

im fxxr\r^<^ ^-fj Sy< ^ //// O/^ U x/€ ar^^ 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

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 activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 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 5600 S to St 4242 Medicai Drive, Suite 4250 

Kansas City.'MO 64114 Omaha. Nebraska 68107 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone; (402) 733-1188 Phone: (210) 822-9588 

Fax:(816)363.3707 Fax: (402) 733-1883 Fax:(210)579-6577 
TECHNOLOGIES, INC. 

E^rV'^IRO^MElVTAL & 

CONSTRUCTION 

S£RVICE.S 

Address: 

Property Status Form 

Phone: 

/T^l-M QyJr^ ^ 

Uae. CV.VA_* 

-

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(^ a^oa fiin^.L-. 

© i? '^ f 4 2r-^ir^ 

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3 ) I S Hs F (o r e*^ IL.P 

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Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway. Suite 40S 5600 S 10 St edicat Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio. TX 78228 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

C-... /one * ^C ^ tTrt T C* . filAOl T4 t 400 4 
Name: t , ?^ -ii ^L;;.Wii^.g> Omaha Lead Site Date: m. 

i ! ; V, North Arrow 

Site Sketch Time: | '- 3t' J \ 1 

Phone: ^ 

W: 

Team xTfim^^-y.;r:]^^>-.yyi^9<- s^D*_yjy±A . XRF Code Z^4 ^ 

Sampie Number Lead Concentration Confirmation Sample 

i Yes Cl No S- " 

ppm *• ,^, Yes ^ No S--' 

pprr. ft',' Yes a No S ' •. 

;^^0 ppm i a. Yes ^ No B ' 

ppm " • Yes n No a 

ppm Yes CJ No O 

ppm Yes • No n 

L-Mf-yy-^ 

C. .-..i-s-^A: 

rif'''"'Mf i £iiiiiitHi i >• ii(a'^''''-i. 

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'4 ;/:; ? ^jK^Ii.'/-', 

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,i 'i/V;;, / I i?S 
A Printed: Nov 16,2010 

w\vw.,dcgis. Of g/'dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2592076. 

Original Call Date: 9/14/10 Time: 5:21 pm Op: SIVA18967 


Work to Begin Date: 9/16/10 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2834 Street: CHARLES ST 


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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION icomiaijaanB, mc. SOLUTIONS 

SITE SAFifcTY HAZARD ANALYSIS 

Address: '^^^ ^

Crew: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane^utane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

 <^^^^/<^ 

Condition 

^>fe s 

A 

^ , j ^ ' ^ 

^ ' 

*»<— 

^ ^ 

— 

1 ^ ^ 

. — 

^^L­

_ ^ — 

Excavation Date: 

BackfiU Date: — 

Hazards Corrective Action 

i iLf *s yW,< 3 

*- r r 

U f ^ Ptr u^e^^-^ 

r t 

KJ J^e- iy^£^ie^= ^ 

Site Safety Office 

Date: 

8080 WanHtarkMy, Suito4IS 

Item s emy; II044114 

SSOOSIOSt 

Omidaa, Nctaatta «8ia7 

4242 Medical Drive, Stdts 7260 

San Antonio, TX 78229 

Pfionee f81t)36»-a?03 

faac 1816) 363'37II7 

1>lMnr. i402)73S-1ia8 

Fax: («n)73»<1S83 

Phone: (2t0) 822-«588 

Fax: (210) 6r9-65n