SAID#: 21573

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE; 1/15 

ADDRESS: 815 PACIFIC ST 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

13 PRE AND POST VIDEO OF PORPERTY (DVD) 

m EXECUTIVE SUMMARY 

I EPA-PROVIDED PROPERTY SKETCH 

J SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

H RESTORATION AGREEMENT 

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

d CONFIRMATION DATA 

a PHOTOGRAPHS 

m AS-BUILT SKETCH 

El SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

d PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

III UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

n 

n 

< ^ ^s ^ t\^\^^ 

SIGNATURE DATE 

302374 inil hll 

Superfu nd 
PROPERTY SUMMARY 

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

Property Address: 815 PACIFIC 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: 

F2 = 139 PPM @ 4"; Bl = 380 PPM @ 4"; 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-Buih 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. 

TECHNOLOGIES, INC. 
Find Record 

Backfill: 

Sample Area: 21573 - 815 PACIFIC ST 

Owner: 

n Owner Occupied 

Owner Name: 

jCANIGLIA Lrrn i ITALY LLC^ 

Owner Addressi: 

jc/0 BLUESTONE^EVELOPTIENT 

Owner Address2: 

1 S 15 ST #100 

City: State: Zip Code: 

lOMAHA INE |68102-

Owner Phone Alternate Phone: 

r 

Contract: 

Contractor: JPRUDENT2010_S 

Contract Option jOPTION 2 

Remediation Query Lead Remaining Query - Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: state: Zip Code: 

] •"••• r r 

Owner Phone: Alternate Phone: 

r ^ 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value j " 484.75 

Resident: 

Resident Nanrie: 

i • 

Property Address: 

|815 PAQRC ST 

Zip Code: 

968108-

Resident Phone 

1 
TECHNOLOGIES, INC. 

Propertv #:' 'Z l 5 7 3> Property Address; ^l* ^ P^C^-Cvc ^•^-

Date/Time: Owiiier''§Kame: ([^(^ K\ t^^l i''V L LC _ 

Quads Exca>'ated: ^ \ p '2__ Contractor Croup: FnMk'int Teelhumologics, .Inc., 

Excavation General Yes 

1 If necessarv. were tlie correcl quadji"ant(s) excavated and restored? / 

2 If nccessiiiy, were the correct areas of drip zone excavated and restored'^ 

/ 

Grading Sod and Vegetation Yes 

J Does tJie grading aroimd tlie penmeter of the house in excavated areas generally slope away 

from the liouse'^ / 

2 Has sod been lajd m all areas that were excavated? / 

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

day dme period) / 

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

5. Arc iJie joints between the sod stnps generally tight? (Only evaluate if inspected al a 30 day 

lime penod) y 

b. Was tiie ])roperty graded such tliat water will not pool on tlie property'^ / 

7 Was daiu;sge lo landscaping or plant materials avoided? / 

Gates, Fences and Relaining Walis Yes

! Do gates open and close freely? (If apphcable) i/ 

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

3 Was danijige 10 gates or fences avoided? (If applicable) / 

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

Foundation, Siding, and Gutters Yes 

1 Was damage to the siding or trim avoided? / 

2 Was damage lo the foundation avoided? / 

3 Was damage to windows avoided? / 

4 Was damage to windows or door screens avoided? / 

5 Was damage to downspouts or downspout extensions avoided? / 

Sifllewalkft and Privcwrtys (Concrete) Ves

1 Was damage to diivewav surfaces avoided'? / 

Was damage to walkway surfaces avoided? 

No 

No 

 No 

No 

 Wo 
Owners comments: 

Inspection notes: 

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

EPA Representative fj,.^ y ^ Date: ///s/// 
21573 

ra 

CHNOLOGIES. INC. 

AS - BUILT DRAWING 

OLS #21573 

Dale Excavated: 12/03/2010 

IISEPA Signed-OfTDate: OMAHA LEAD SUPERFUND SITE 

Omaha Exterior Paint Lead Site Owner Name: JM[LIA LLC 

Site Sketch • Good 

Address: 815 PACIFIC ST • Poor Phone: H^ W: 

ig^Not paint i 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: t23l^jM-:^jL- RYASCPXA-21573 Fl D Date: G-/7- cV 

RYBSCPXA-21573 F2 _ ppm D Time: f'^^ S 

RYCSCPXA-21573 B1 _ ppm D Samples Analyzed RYDSCPXA-21573 B2 _ ppm I D

RDZSCPXA-21573 DZ _ppm D XRF Unit; _3LL\ _ Book:Vf. ^

RGZSCPXA-21573 GZ _ ppm D D Date: W " gl k 

RPZSCPXA-21573 PZ _ppm D D Time: P M D staff: Numtier of Samples = /^ 

TORE] 

y'^f^f^J.Cf^.i'. 

-H­ I

t>v -^'= > o ,p^ ^ >^ 

BI =380PPM a 4" 

C ^j^lT' "f 

^ : 

•flyj ^ 

Omaha Lead Site 46130 

NO EASEMENT 

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

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, ifany. 

Property ID: 

Property Address 

Owner: *H^ jt'^^H^ 

Phone: 

Restoration Items in Question 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Required corrections to complete the property: 

CB4.agree restoration is completed. 

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

/I'ir'Toto 

^Signature Date 
Prudent Technologies, Inc. (Pmdenl) is under contraci wilh the U. S. Environmental Proleclion Agency (EPA) lo dean up leadconlaniinated^aib at^umber of properties located in Omaha, Nebraska, including Ihe property localed al ^815 Pacific 

Sireel ^ j /TA-ti^iy*, The EPA rcquesU >'our pennission lo allow Pnident lo perfonn o soil cleanup at this property 

lo removelc&d-contMninaialsoil. By signing Ihis form, the property owner grants pennission to Prudenl to perfonn activities related 

lo Ihe cleanup includmg soil sampling, removal of lead-contaminated soil, and restoration of Ihe relercnccd property. 

If jxyu have any questions about Ihe soil cteanup planned for }t)ur property, please coniact Prudent south ofTicc .for Ihe Omaha Lead 

Site cleanup-ol (402) 733-1188. General questions about the Omaha Lead Site cleanup can be directed to die EPA Public Information 

Centers at (<t02) 731 -3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted By: .Christian Christendsen_ 

(Please Print Name) 

Property Oivner Signature: /f'/?'tfHC 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: _N/A empty lo t Owner Renter 

RESIDENT ADDRESS: 816 Pacific street Omaha 

NE 

IF RENTAL, PROPERTY OWNED BY: 

N/A 

OWNER'S MAILING ADDRESS; _720 North 13" Strset Omaha Ne 

68102 

OWNER'S TELEPHONE NUMBER - HOME: JL402-346-2408 L WORK: 

J 1 

AGE OF HOME?: N/A YEARS. HOW LONG HAVE YOU LIVED HERE? N/A YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 _YE8 NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: . NUMBER OF OCCUPANTS 7 YEARS OLD ANO OLDER 


NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 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 Ihis agreement 

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

CERCLA, 42 U.S. C 9605(e), wliich provides cnliy for "detennining Ihe need for response, or choosing or taking any response action 

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

8080 Ward Parkway, Suite 405 seoosiost 4242 Medical Drive, Suite 4260 

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

Phone: (816) 363-3703 Phone: (402)733-1188 Phona: (210)822-9988 

Fax:(816)363-3707 Fax: (402)733-1883 Fax: (210) 679-6677 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

8080 Ward Parkvray, Suite 405 seoosiost 4242 Medical Drfre, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107- San Antbnio, TX 78229 

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

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) $79-6577 
21573 IIII 

Omaha Exterior Paint North Arrow Lead Site Owner Name: EMILIA LLC 

Site • Good Sketch Address: 815J'A(;;iFIC ST • Poor 

Phone: H: W: 

[^'^Not paint i

Sample Number 

RYASCPXA-21573

RYBSCPXA-21573

RYCSCPXA-21573

RYDSCPXA-21573

RDZSCPXA-21573

RGZSCPXA-21573

RPZSCPXA-21573

 F1 

 F2 

 Bl 

 B2 

 DZ 

 GZ 

 PZ 

Lead 

Concentration 

Number of Samples = /J 

! i— 

• y 

U^Cc,.yj^Oi^pp 

1 

i ¥ r 

Firm: 

Date 

Time 

Samples Collected 

Samples Analyzed 

XRF Unit: ^ \ \ Book: W 

Date: AZiSS^ljQ ' 

Time: P W \ 

Staff: VXX": 

% 

JUN 2 1 imi, 

^ J 

^ 

% \ 

,.\^^5 W^^'--< 

/I •-.c 

•Q^ (r< 1^ 

f\^ ztL5<^V' f i-^ ^ 

^ItlpalK I

•- 9^.''^ -i^ a 

Omaha Lead Site 461.30 

^ 
iniiiii 21573 

Omaha Lead Site 46130 
N 

50 X 147 

A 

V 6IS ...MT Printed: Nov 18,2010 

WWW.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back tojrth Internet Send Email 

YOUR TICKET NUMBER IS 2644078. 

Original Call Date: 11/17/10 Time: 5:10 pm Op: SIVA18967 


Work to Begin Date: 11/19/10 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 815 Street: PACIFIC ST 


Twp: 15N Rng: 13E Sect-Qtr: 22-SE,23-SW,26-NW,27-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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl MUD02 OMAHACOF 0PPDGPR5 0PPDGPR6 


QLNNEIC QLNNEIF QWESTNE SPRINTNE 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/17/2010 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

QLNNE IF QWEST LOCAL NETWORK ELM LOCATING

QWESTNE QWEST LONG DISTANCE 

SPRINTNE SPRINT COMMUNICATIONS CO 

Day: 4024447197 


 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


 Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 


 Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 


 Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 


 Alt: 4062071494 

Emerg: 8887289343 

Day: 8002834237 


Alt: 


Emerg: 8002834237 


Day: 8005210579 


Alt: 


Emerg: 8005210579 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/17/2010 
'TEOi mc CONSTRUCTION 

SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

^ f /^<N-uj^c ^y ^ Address: Excavation Date: 

Crew: 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 

i^< - L' C 1— f P rcLffi 

e^ 

h^P ' 

ore 

ar^ 

pccyc^ 

a^'^ 

a ^ 

a^— 

^ 

Site Safety Oflice 

Date: 

180 Wntfltaftaray. Sut e 405 seoosiost 4242 Medical Drive, Suite 72S0 

•naMCi|^.aH>«4114 Ontidm, Ncbnrtka 08107 San Antonio, TX 78229 

Mine: (St6) 363*3703 Plione: (402)733-1188 Phone: (210)8224688 

KifSIS) 383.^3707 Fax: (402)733^1883 Fax: (210) 679-6577