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TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 33309 DATE: 1/15 

ADDRESS: 3918 N 25 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201(( 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 ^ PRE AND POST VIDEO OF PORPERTY (DVD) 

Q EXECUTIVE SUMMARY 

 EPA-PROVIDED PROPERTY SKETCH 

[fl SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

Ca^RESTORATION AGREEMENT 

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

^ CONFIRMATION DATA 

E ^ PHOTOGRAPHS 

0 ^ AS-BUILT SKETCH 

H SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

a PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

n UTILITY CLEARANCES 

^ PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30218859 

mm 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 3918 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 Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 = 380PPM(g6";EA = 318 -Q S 

PPM @ SCRAPE H" ) '^ P|t» r "Sao fP"^ ^6 ^ 

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, 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 | 

Backfill: 

Sample Area: 33309 - 3918 N 25 ST 

Owner: 

n Owner Occupied 

Owner Name: 

JFUERTES JOSE 

Owner Addressl: 

jC/O RAUL CHAIDEZ 

Owner Address2: 

|4306 S 21 ST 

City: state: Zip Code: 

[OMAHA ^ JNY 168107-

Owner Phone Aiternate Phone: 

r 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option JOPTTON T 

Remediation Query ] Lead Remaining Query j Property Damage Query 

User Provided Owner Information 

Owner Name: 

r 

Owner Address: 

1 

City State: Zip Code: : 

Owner Phone: Alternate Phone: 

I 

Assessment: 

Qualifying Group J400 

Assessment Max XRF Value \ 498.76 

Resident: 

Resident Name: 

I — 

Property Address: 

|3918 N 25 ST 

ZipCode: 

168111-

Resident Phone 

I 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property#: '^'3>^C>\ Property Address: ^"^ ^ ^ ' ^ ^ '^^-

Date/Time: Owner's Name: ^«Uc\ 0\aXA-^~l-^ 

Quads Excavated: <^ Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes 

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

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

Grading Sod and Vegetation Yes 

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

from Ihe house? y 

2. Has sod been laid in all areas Uiai were excavated? / 

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? y 5.

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

time period) y

6. Was the property graded such tliat water will not pool on die property? y 

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

Gates, Fences and Retaining Walls Yes 

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

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

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

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

Foundation, Siding and Gutters 

Yes

1. Was damage to the stdmg or trim avoided? / 

2. Was damage to tlie foundation avoided? / 

3. Was damage to windows avoided? ^ 

4. Was damage to windows or door screens avoided? 

/ 

5. Was damage lo downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) 

Yes

I Was damage to diivewav surfaces avoided? 

2 Was damage to walkway surfaces avoided? 

No 

No 

No 

 No 

 No 
Owners comments: 

Inspection notes: 

/ . 

cT , ,\o< 

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

EPA Representative ^' ^ ^ . ^Date: i|»|» 
1^ (.'HNOLOUIES, FNC, 

AS - BUILT DRAWLING 

OLS#33309 

Date Excavated: 11/03/2010 OMAHA LEAD SUPERFUND SITE liSEPA Signed-Off Date: 

3.3309 

Omah a Exterior Paint Lea d Sit e Owner Name: RAUL CHAIDE2 

Site • Good Sketc h Address: 3918_N 25 ST -£:i> . • Poor Phone: H: W: ^ ' Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 P ET /VVv -^ U ^ 

RYASCPXA-33309 Fl \ 7 ? ppm D Date: C A •Xk-n5 ' 

RYBSCPXA-33309 F2 "2-3 1 ppm D Time: / OC O •^•-'V 

RYCSCPXA-33309

RYDSCPXA-33309

 Bl 

 82 ^2-£ , ppr" B"" 

D 

D Samples Analyzed 

RDZSCPXA 33300 BZ " ppm D D XRF Unit: /05 1 Book: /g 2 

RCg&GPXA •33300 -G2­ ~ ppm D D Date: /a -Zff-a^ 

RPZSCPXA-33309 PZ V^' ? ppm D Time: P m 

Number of Samples = C Staff: L - A 

ENTBEED 

7 L.*^-r.^ 

Omaha Lead Site •tfil.^O EA = 318 PPM ff S( RAPt: {~\"\ 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
%1S^ 

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 ofthe 

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; 'P^C\ \ g tO P,S^ ^ ^j^UPhnne; 0 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

1/3 I agree restoration is completed. 

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

Owner's Signature Date 

• & S 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontainina(ed'toils at a numbef of properties located in Omaha, Nebraska, including the propetty located at 

^ n 1 5 "^ '2^~> \ . -T" The 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 propeity. 

Ifyou have any questions about the soil cleanup planned for your propetty, 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: 

(Please Print Name) 

Property Owner Signature: 

r - ^ C (Signatures ^ ^ | (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: :9iLFcri I Auur\c9o : , /* c 11 ~L 

IF RENTAL, PROPERTY OWU^D BY: 

^ 

OWNER'S MAILING ADDRESS; , ^ 

OWNER'S TELEPHONE NUMBER - HOME: _£ L WORK: 

J 1 

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 activities to be implemented by EPA under this agreement 

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 takmg any response action 

under this title, or otherwise enforcing the provisions ofthe title." 

8080 Ward Paricway, Suite 405 5600 S 10 St 4242 Medical 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. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Address: 3 ^ ^g M

Property Status Form 

 %<^K-% ^ ''''''• ^^|^^f ^ 

Phone: BVID: 

Prudent Employe 

Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 4250 

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

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9688 
Owner Name: RAUL CHAIDEZ 

Address: 3918 N 25 ST 

Phone: H: 

Sample Number 

RYASCPXA-33309 Fl 

RYBSCPXA-33309 F2 

RYCSCPXA-33309 Bl 

RYDSCPXA-33309 B2 

RDgeCPXA 33300 BZ 

nOilSGPXA 33300 62-

RPZSCPXA-33309 PZ 

Omaha Lead Site 

Site Sitetch 

W: 

Lead Sample LAB 

Concentration Collected 

LZ2_Ppm ^ D 

^ 3 7 ppm D 

ZHS" ppm or D 

^2- 5 ppm n 

ppm D 

_!___ _ ppm D D 

^ 9 9 pom D

D 

Number of Samples = ^ ^ i 

" •»"^/H<^" • ^ 

% 

i/«?^ ^ 

o^l% /vi;i:r>r" 

^ 

f\ f% 

179 2 3 7 

^ 

33309 

Exterior Paint NorthArrow 

• Good 

• Poor 

0No t paint 

^amples Collected 

Firm: ^ E /VCT ^ U d 

Date: Cf\ ' XL*n ^ 

Time: I Oi^iCi A/v\ 

Samples Analyzed 

XRF Unit: Mil - Book: JJZ- Date: _ 

Time: ^53 

Staff: 

ENTERED 

SEP ii%m 

my— V ' y—jif—) f 

Omaha Lead Site 46130 
3919N2

5 AV:40X 100 

A Printed

: Dec 10.2010 

www.dcgis.org/dogis 
Page 1 of2 

"> 

Create iS^nother Ticket, • . Backjo JEthJnternet Send Email 

• YOUR TICKET NUMBER IS 2632417. 

Original Call Date: 11/02/10 Time: 12:33 pm Op: SIVA18967 


Work to Begin Date: 11/04/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3918 Street: N 25TH ST 


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 


ALT872 CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

ALT872 WINDSTREAM COMMUNICATION ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF 0MAHA-TRAFF1C,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
wmi SAFETY HAZARD ANALYS t 

SOLUTIONS 

Address: — * 

Crew: 

Excavation Date: 

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 Office 

Date: 

1080 VtfanfItarioRny. 8n»BMl& SSOOSIOSt 4242 Medical Drive, Sutte 7260 

CflmMCI|y;«0'M114 Onrtfaaf Ntihf Mfcii fl8i^# Sen Antonio, TX 78229 

i|iane:(816)36»3703 Plwie : (402)733-11fl8 Phone: (2t0y82Z-«688 

•aic f>1S) 363>^3707 F^ax: (402)733^1483 Fax: f210)«T»-65r7 
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