TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28228 DATE: 12/15/2010 

ADDRESS: 2309 N 27 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[Ti PRE AND POST VIDEO OF PORPERTY (DVD) 

Ef EXECUTIVE SUMMARY 

EPA-PROVIDED PROPERTY SKETCH 

SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

SETTLEMENT DOCUMENTS (I.E., FOR DAMAGE OR TO REPLACE PLANTS, ETC.) 

oi CONFIRMATION DATA 

PHOTOGRAPHS 

AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

a DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

i UTILITY CLEARANCES 

PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

^\xM CV y y 

SIGNATURE DATE 

30218613 mil 

Superfund 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 28228 ­ 2309 N 27 ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: 

JOTY OF OMAHA 

Owner Name: Resident Name: 

P-OT 

Owner Addressl: 

Ic/O CTTY RNANCE 

Owner AddressZ: 

11819 FARNAM ST 

City: 

JOMAHA 

Owner Piione 

]C402) 441-5150 

State: ZipCode: 

JNE J68183-

Alternate Phone: 

1(402) 444-5180 

Owner Address: 

City: 

1 • 

Owner Phone: 

State: Zip Code: 

Alternate Phone: 

r—^— " 

Property Address: 

J2309N27ST 

ZipCode: 

168111-

Resident Phone 

\ " ' 

Contract: Assessment: 

Contractor: PRUDENT2010 S i Qualifying Group |400 

Contract Option jOPTlON 2 Assessment Max XRF Value f 494 
PROPERTY SUMMARY 

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

Property Address; 2309 N 27 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 = 284 PPM @ 3"; EA = 124 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 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, 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. 
'^!tLhjui 

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 25 " >^ ^ Property Address ^ 5^'*1 ^ ^ ^ ^ ^ 

Date/Time: Owner's Name: Csi-H\ c-^L^yyuxi^t^ 

Quads Excavated: ^ / Contractor Group: PrudeniTechnologies, Inc., 

Excavation General Yes No 

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

2 If necessary, were the correct areas of dnp zone excavated and restored'^ ^ 

Grading Sod and Vegetation 

1 

2 

3 

4 

5 

6 

Does the grading around the penmeter ofthe house m excavated areas generally slope away 

from the house'^ 

Has sod been laid in all areas that were excavated? 

Does tlie sod appear to be generally healthy and growing'? (Only evaluate if inspected at a 30 

day time penod) 

Are sodded areas generally fimi and evenly graded'? 

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

time penod) 

Was lhe property graded such tliat water will not pool on the property*? 

Yes

y 

y 

y 

y 

y 

y 

 No 

7 Was damage to landscaping or plant materials avoided'? y 

Gates, Fences and Retaining Walls 

1 Do gates open and close freely•? (If apphcable) 

Yes

y 

 No 

2 Were all gates or fences taken down dunng restoration activities reinstalled? (Ifapplicable) y 

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

4 Was damage to retaining walls avoided"? (Ifapplicable) y 

Foundation, Siding and Gutters 

1 

2 

Was damage to the siding or trim avoided? 

Was damage to die foundation avoided'? 

Yes

^ 

^ 

 No 

1 

4 

Was damage to windows avoided? 

Was damage to windows or door screens avoided? 

y 

5 Was damage to downspouts or downspout extensions avoided"? i ^ 

Sidewalks and Driveways (Concrete) 

I Was damage lo driveway surfaces avoided'? 

Yes No 

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 /9c^ J&, Date: lofnlio 
m 

CHNOLOGIES, INC 

AS - BUILT DRAWING 

OLS # 28228 

Date Excavated: 10/08/2010 

USEPA Signed-OffDate: 

OMAHA LEAD SUPERFUND SITE 

Name; C^V+A <rrO*'»v<3Ka Omatia Lead Site Date; North Arrow 

Address; 7 ^c ^ /<i 2.r ^ S t Site Sicetch Time; 

Phone; 

Team 5('k3.-C^ /) ItuJll^a ^ BVID # ;2-S^2-Z-S XRF Code .35^5 " 

Sample Number 

Lead Concentration Confirmation Sample 

m^ f^Yes a No B? 1% W^M 

ppm ' i Yes n No Kl 

ppm 

ppm A Yes • No g . 1 

i I Xft M^ ^ ,^^ ^ 

ppm SiYes n No KL 

ppm Yes n No n 

ppm Yes Q No a 

ppm Yes • No • 

-/^-TJ 

:.fr°^.tL"k__4G<g;&... - ^ ^ Bl = 284 PPM (® 3 m 

A. 

-2=^-'^ 

KJti 14­ /T 

"i 5~e mie^/ -j^"^ ! 

A/ ZT^ PH f 

A)oi>^ 

Omaha Lead Site 

EA=124PPM® 46130 I" 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
ffSfCjTjHi 

Property Completion Agreement 

This agreement documents the completion of removal activities perfonned 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; ^y^^K> ,f/„„>. j ; J i' <./.,. / 

Owner: yyj-yy K 

Phone: ^ /'/' / '/J'/} " 

Restoration Items In Question: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

lSf\ agree restoration Is completed. 

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

..^\ (I >Ll.l r/jy O 

Owner' tvner'ss Signa Sienatur t e y Date 
¥ 

Prudent Technologies, tnc (Prudent) is under conlraci wilh (he U S Environmenial Proleciion Agency (EPA) lo clean up leadconlaminaled soils at a nuniber ofproperties located in Omaha. Nebraska, including the property located al 

1^,10'^ AJ pl- ^ Kyrv-'t The EPA requests your pcmiission lo allow Prudent to perform a soil cleanup al Ihis 

property lo remove lead-conlaminated soil By signing Ihis form, lhe properly owner grants permission lo Prudent lo perform 

activiiies related lo Ihe cleanup including soil sampling, removal of lead-coniammated soil, and resloralion ofthe referenced property. 

Ifyou have any questions about lhe soil cleanup planned for your property, please conlaci Prudeni soulh office .for Ihc Omaha Lead 

Sue cleanup-al (402) 733-1188. General queslions about Ihe Om.^a Lead Sue cleanup can be directed lo the EPA Public Informalion 

Centers al (402) 731-3045 (Soulh Omaha ofTice) or (402) 991-9383 (North Omaha ofHcc) 

Property Access Granted By; A^/ //'/ »^ / ^ Lvt4r\ J ^ 

(Please PrinI Name) 

Property 0>vner Signature yi/M. iJyL 5-Ocl -Po/v 

(Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by resideni and/or properly owner - please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

2.^0 ^ /\/ 5L7 e ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

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 19787 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 aclivmes lo be implemented by EPA under ihis agreement 

are pursuant to Seclion 104 ofCERCLA, 42 U S.C 9604 EPA's righl of access lo Ihe property is provided for in Section 104(e) of 

CERCLA, 42 U S C 9605(e), which provides enlr>' for "delermming Ihe need for response, or choosing or taking any response action 

under this title, or otherwise enforcing ihe provisions ofthe mle " 

8080 Ward Parkway, Suite 40S seoosiost 4242 Medical Drive, Suits 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 
Name: ^^'^<^^**^ ^ ^ Omaha Lead Site Date: ^/n/b^- j North Arrow 

Address: 2--^ q A/ 2.y ^ ^ Site Sicetch Time: 'y^O ^ 

Phone 

Team 5^kxX^> > l\i.t\\\=.^<i BVID # ;:?_ S'Z-Z ^ XRF Code .35^S " 

Sample Number Lead Concentration Confirmation Sample 

ppm /^Yes C] No Sf 

# ppm 5- Yes n No C31 

ppm iT Yes n No g . 3 S ^ ppm ^lYes D No KL 

ppm Yes CD No D 

ppm Yes n No a 

ppm Yes • No a 

A)ci>^ 

Omaha Lead Site 46130 
N 30x100 

A ^ Printed: Oct 25, 2010 

www.dcgis.org/dogis 

2301 Kl ^7 SL" 
Page 1 of 1 

"> 

Create Back to Irth Internet Send Email Another Jicket 

YOUR TICKET NUMBER IS 2609462. 

Original Call Date: 10/05/10 Time: 4:34 pm Op: SIVA18967 


Work to Begin Date: 10/07/10 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2309 Street: N 27TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-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 Nuniber 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 RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 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... 10/5/2010 
TEDHNOUieni CONSTKUCnCW , mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

2 7 ^ Address: -^21iJl—U. Excavation Date: Jii-t/JiSJi, 

Crew: Backfill Date: —C^jL/jiauiL. 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leecli 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

CP/ ^ ^ s •" /P "^y> 

e^ 

(h^' \p 

O/ca r ^ 

* — 

(PC ^ 

CP'Sier^ 

o*— 

-

Site Safety Office 

Date: 

SSao WanHRarlony. Sute 405 seoosiost 4242 Medical Drive, Suits 7250 

KjmaKGQy; IK>«4114 OiitiAa, Nataoska «St07 San Afitsnio, TX 78229 

Ptiaiw:(81«)36»3703 1>liefW: (402)733-1108 Phone: (2t0) 822.-0S88 

Ftf : {S16) 363>47D7 i=aK: (402)733^1083 Fax:(210)«r«-<577 
'^/ \fzz/zoio 

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