TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 20693 DATE: 1/15 

ADDRESS: 1235 S14 ST 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201<) 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

H PRE AND POST VIDEO OF PORPERTY (DVD) 

& EXECUTIVE SUMMARY 

B^EPA-PROVIDED PROPERTY SKETCH 

DESIGNED 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^CONFIRMATION DATA 

B^PHOTOGRAPHS "^-AA^ ^ <n X 

&^-BUIL T SKETCH 

KP^SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

^P^PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

taMJTILITY CLEARANCES 

O^PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

' SIGNATURE \j\ j \ 'DATE 

30262412 

Superfund 
PROPERTV SUMMARY 

Date: II/IS/20I0 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: NjDvember 

Property Addregs: 123SS14St. 

A. EXECUTIVE SUMMARY 

A.I; imlies Encountered: NONE 

A.2 Issues Resolved: NONE 

AJ Unique Findings: NONE 

A.4 Other Relevant Information: None 

CONFIRMATION SAMPLING DATA/RESULTS: 

FI = 146 PPM @ 13"; EA = 213 PPM @ SCRAPE (~1") 

ATTACHMENTS 

1) Property sketch provided try EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavatiori 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) Inscription of areas not meeting Interim ROD cleanup criteria. 

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

Backfill: 

Sample Area: 20693 -1235 S 14 ST 

Owner: User Provided Owner Information Resident: 

• Owner Occupied 

Owner Name: Owner Name: Resident Name: 

JSAMUEL C MARTINEZ LIV TRUST 1 I 

Owner Addressl: Owner Address: Property Address: 

1 11235 S 14 ST 

Owner Address2: Zip Code: 

|l321 JONES ST 168108-

City: State: Zip Code: aty: State: Zip Code: Resident Phone 

jOMAHA NE 68102- 1 1 1 I 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1 1 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |400 

Contract Option jOPTION 1 Assessment Max XRF Value | 507 
QRIJOFM 

TBCHNCHJOGIBSi INC I?' IEPA Property Close Out 

Property #:706^3 » Property Address: V Z^*? 9.f'*'>^-

Date/Time: Owner's Name: Ui V k \Wtk \ i ct»\ 

Quads Excavated: f^ | Contractor Group: Prudent Technologies, Inc., 

Excavation Genera) Yes No 

I. If necessaiy. were the correct quadrant(s) excavated and restored? / 

2. If necessary, were the coirect 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? / 

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

day / lime period) 

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

5., Arc tlie joints between the sod strips generally tiglit? (Only evaluate if inspected al a 30 day 

time period) / 

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

7. Was damage to landscaping or plant niaterials avoided? / 

Gates, Fences and Retaining Walls Ye) No 

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

2. Were all gales or fences taken down diuing restoration activities reinstalled? (If jqjplicable) / 

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

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

Foundation, Siding and Gutters Yes No 

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

2. Was damage to 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? / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo diiveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? / 
OwBcn comments: 

Inspection notes: 

A ' / .

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

EPA Representative ff^ >aL Date; fh/n 
3IES, INC. 

AS - BUILT DRAVWfG 

OLS # 20693 

Date Excavated: 12/7/2010 LEAD 811P£RFUND SITE USEPA Signed-Ofr Date: 

1lllililililiilillll 2069^ 

Omah Exterior Paint North Arrow a Lead Site 

Site • Good Sketch • Poor 

Samolina Address: 1235 8 14 ST 

g^o t paint 

Lead Sample |. „ Samples Collected 

Concentration Collected Sample Number 

Firm: FD A DR/j^ ^ 

RYASCPXA-20693 Fl .5<>7 ppm Q ^ D Date: U//q//5<=? ' 

RYBSCPXA-20693 F2 3M-) oom nr n Time: / /.' <?5 ^ Jv i 

- oom n n Samples Analyzed - Dpm n n 

- oom n n XRF Unit: /O0M - Book: L'\l ^ 

- oom n n Date: ~l • o S • Ofi\ 

nPZSGPXA 30603 4«­ -

 ppm n n Time: ft-»>i 

Staff: KSW* Number of Samples =1 - ^ 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

; ENTE IRED 

1 iUN2 9 2009! 

\ 

I / 

c : : : : 

..i ] \ [ '• 

* : 

[ 

' • • • . : : ' < 

n. 3 5 : 

S. 1^ S^ : 

_ • 5 ^ 

Fl = 146 PPM @ 13" f 

. .' . rr.-7. .. V • / f ; r c 

507 : 311: 

I 

?V 

f 

VlAL k 

^•/VsH ­ 044701 m.li 

EA = 213PPIV1@SCARPE 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
(^dA-^ N--»r 

Property Completion Agreement 

This agreenieiri documents the compietion of removal activities perfonned ou the below listed piopeiTy. 

The property owtier'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 totai) except those items listed beiow, ifany. 

Property DD: 

• Pi-openy^llia ^ \'2_ 1^ S s 1 4 K . <SV 

iowner ^ ^^^y^l ^ \^a^'c ^ (^ ^ 

1 Phone­ ;i _ 

IS ami 

Item; 

item 

agree restoration is completed, a>;ccpl: aa, noted dbnve. 

I I I do not agree restoration is completed 
t:-

y' 

i^<2_ ^ ^ Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmenta] Protection Agency (EPA) to clean up leadI * ' , ccptaminaled soils at a numb^ pf properties located in Omaha, Nebraska, including the property located at 

h^f Cf n \i \ ^KS^^ ^ \ \ S r' Tlie EPA requests your permis.slon to allow Prudent to perform a soil cleanup at this 

'•. 7 ' property to remove lead-contaminated soil. By signingthis form, theproperty owner grants permission to Prudent to perform 

l u ^ jL' activities related to the cleanup incliiding 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 aboAnhe Omalia Lead Site cleanup can be directed to the EPA Public Infomiation 

Centers at (402) 731 -3045 (South Omalia ofBce) or>lflJ)99T=9J83 (North Omaha office). 

Property Access Granted B; 

Property Owner Signature: 

"7^ - ^ ^ ' (Signature) ^ ^ / (Dkte) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS:)?-^ ^ iS | U ^ t r 

-A-N-s«aJ>> iXfiV. ro-gr £38 jog 

IF RENTAL, PROPERTY OWNED BY: 

^ 

OWNER'S MAILING ADDRESS; 

K>^aJl^ M c (^<2 iD-r 

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

AGE OF HOME?: i Q YEARS. HOW LONG HAVE YOU tHVE»HERE? 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: cJ I NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR S 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 rigjit ofaccess 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 aclion 

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

8080 Ward Parkway, Suite 405 S8G0 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 

Fax: (816) 363-3707 Fax: (402) 733-1883 Fax: (210) 579-6677 
ENVIRONMENTAL « 

CONSTRUCTION 

TECHNOLOGIES, S£RVICE.S 

Property Status Form 

Address: J^^' ^ <i\\ ^ l>a»$ S \M^ S ^ Date: O^ /^ 7 | f ^ 

Phone: i{OZ- 6e | _ Mi l H BVID: 

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Prudent Employi 

Signature: v^ 

8080 Ward Parkway, Suite 40S 

Kansas CHy, MO «4114 

Phone: (816) 363-3703 

5600 S 10 St 

Omaha, Nebraska 68107 

Phone: (402) 733-1188 

Ileal Drive, SuKa 4250 

San Antonio, TX 78220 

Phone: (210)822-9588 
'""11 2069:3 

Omah Exterior Paint North Arrow a Lead Site 

Q Good Site Sketch • Poor 

Sampling Address: 1235 S 14 ST g^o t paint 

Sample Number 

RYASCPXA-20693 Fl 

Lead 

Concentration 

ppm 

Sample 

Collected LAB 

D 

Samples Collected 

Firm; FPf^ D^//^ ^ 

Date: (^//^//) ^ 

RYBSCPXA-20693 F2 .liLL ppm D Time; (/.' i^S ^ h o 

RYGGCnXA 20603 &4~ 

nYDScnx;^ 20603—&9­

_Z

J I

 PPn^ 

 ppm 

D 

D 

D 

D Samples Analyzed 

nDZSCP)(A'20003 B2- JZ ppm D D XRF Unit; /Qga>2­ Book: L^j p 

^GZ£G^X;^ 20603—s^ 

nnzsopxA 20603—P2-

H

Z

 ppm 

 ppm 

D 

D 

D 

D 

Date 

Time 

"?'Og-Q ^ 

-a>:x. 

Number of Samples = ^ o Staff MSVxT 

Legend; Fl = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

iUN 2 9 2009 

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Rev :ons lA Created 1'-Mar-08 ^ /vs-f-. 1)44701.(11.23 
Douglas County Page 1 of 1 

W 

http://www.dcgis.org/dogis/ 12/3/2010 
Page 1 of2 

"> 

Create Another Ticket Back to irth Internet Send Email 

YOUR TICKET NUMBER IS 2651917. 

Original Call Date: 12/03/10

Work to Begin Date: 12/07/10

 Time: 10:40 am 

 Time: 11:15 am 

Op: SIVA18967 

State: NE

Address: 1235

 County: DOUGLAS 

 Street: S 14TH ST 

Place: OMAHA 

Twp:

Twp:

 15N Rng: 13E

 Rng:

 Sect-Qtr: 27-NE 

 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 


ATTNEBRl CXCATV LEVEL3 MCINEB MUD02 OMAHACOF 0PPDGPR6 


QLNNEIF QWESTNE 


Service Area Contact Phone Nuniber 

Utility 

Type 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCINEB MCI NO CALL PER 

MEMO 

Day:

Alt: 

 8002893427 

Emerg: 8002893427 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/3/2010 
Page 2 of2 

MUD02 

OMAHACOF 

OPPDGPR6 

QLNNE 1F

QWESTNE

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC.SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK 

 QWEST LONG DISTANCE 

SANDY 

RICH/TRAFFIC 

ELM LOCATING 

ELM LOCATING 

Day: 4025047823 


Alt: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002834237 


Alt: 


Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/3/2010 
CONSTRUCTION 

soLirncKifs 

SITE SA^TY HAZARD ANALYSIS 

Address: /^? ^ ^ i f ^ Excavation Date: 

Crew: BackfiU Date: — 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Bntane 

Sidewalk 

Foundation 

Retaining Wails 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

c ^ ^ 

e^ 

(^^ ' ip 

- — 

OTt. 

ar-

Pcc ^ 

csr<^ 

^ * ^ 

o*-^ • 

. _ -

Hazards Corrective Action 

' 

Site Safety Office 

Date: 

81081. 4242 Itadlcal Drtva^ BtM* 7250 

—irsi.Mmtti Sm^MeBlo.'TXTI2» i 

fiOQTIMIM Phone: (210^a2MBn 

(4«2}7n¥Mn Tte: (2ie)«7»4S77