TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: cy}ip3S^ Date: 1 1 ' I O "" ' U 

Address: /So? 9 -T/or^.nCO P) 0 

Remediation Contractor: Ppf-, rypryf %-r-\^ fa/^oq i^<i. )r\ic.ij Year: <^U I ( j 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) ^ 

[/ Executive Summary 

a EPA-provided property sketch 

a Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

of Confirmation data 

a Photographs 

i As-built sketch 

Satisfactory restoration signed by Property OAvner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

ffl Utility clearances 

B Property information from Douglas Coimty Assessor's Office 

D 

D 

D 

Signature Date 

30260749 

•11 ' 

Superfund 
PROPERTY SUMMARY 

Date: 11/15/2010 Omaha Lead Site Remedial Actioii Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 1529 FLORENCE BLVD 

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 = 64 PPM @ 6"; 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 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 (ifany 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. 

TEGHNOLOCIES, INC. 
Find Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 26259 - 1529 FLORENCE BD 

Owner: 

D Owner Occupied 

Owner Name: 

ICriY OF OMAHA 

Owner Addressi: 

)C/0 PLANNING DEPT 

Ownel- AddressZ: 

)1819FARNAMST#1111 

City: State: Zip Code: 

loMAHA |N E 368183-

Owner Phone Alternate Phone: 

r 

Contract: 

Contractor: JPRUDENT2010_S 

Conti-ac± Option JOPTION 1 

User Provided Owner Information Resident: 

Owner Name: 

I 

Owner Address: 

1 

City: 

1 

Owner Phone: 

1 

State: ZipCode: 

"1 1 

Alternate Phone: 

r 

Resident Name: 

j 

Property Address: 

!|1529 FLORENCE BD 

Zip Code: 

168110-

Residept Phone 

Assessment: 

Qualifying Group MOO 

Assessment Max XRF Value f 503 
TECHNOIOGIES, INC. aEPA 

EPA Property Close Out 

Property #:'Z.<^2.^'^ Property Address: ( ^ ^ ^ F'c^^-^^^.ci , 

Date/Time: Owner's Name: C ''i-cj «S-OivuaW^ 

Quads Excavated: \^ ( Contractor Group: Prudent Technologies, Inc., 

Excavation General 

Yes No 

1. If necessary, vvere the correct quadrant(s) e\cavaled and restored? 

2. If necessary, were lhe correct areas of drip zone e.xcavated and restored? y 

Grading Sod and Vegetation Yes No 

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

from the house? / 

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

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

day time period) 

/ 4.

 Are sodded areas generally fimi and evenly graded? 

5. Are die joints between tlie sod strips generally tight? (Only evaluate if inspected at a 30 day / time period) 

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

/ 

7. Was damage to landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walls 

Ye Ye^ s No

1. Do gates open aiid close freely? (If apphcable) 

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

Was damage to gates or fences avoided? (Ifapplicable) / 

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

Foundation, Siding and Gutters Yes No 

/ 1.

 Was damage to the siding or trim avoided? 

2. Was damage to Lhe foundation avoided? / ' 

3. Was damage to windows avoided? / 

4. Was damage to windows or door screens avoided? y 

.T. Was damage to downspouts or downispout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? y 
Owffiers comments: 

Inspection notes: 

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

EPA Representative _Date: iof.6Jio - ^ 

^ 
BCHNOLUUIES, INC. 

AS - BUBLT DRAWING 

OLS U 26259 

Date Excavated: 9/22/2010 OMAHA LEAD SUPERFUND SITE USEPA Signed-Off Date: 

26259 

Omah Exterior Paint North Arrow a Lead Site 

Sampling Address: 1529 FLORENCE BD Site Sketch Q Good 

Q Poor Phone: H: (913)829-9929 ALT: [^'Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 A5 w V^A < 

RYASCPXA-26259 F1 ppm lEf D Date: OT~T>- ^c^"^ 

nTDSCPXA-£0£G9 H=2­ ppm D a Time: >: Se f"-^ 

RYCSCPXA-26259 

nYDCiCrXA-20259 

B1 

-B2­

5f?J ppm 

ppm 

aD 

n 

D Samples Analyzed 

f^DgOCPXA-g0259 ppm n D XRF Unit: &5f Z Book: /6V 

•~RI32SCPX?P2e2S9

nPZCCPX/V 26250

 62-

 P2 

ppm 

ppm 

Number of Samples =

D 

D 

1 

n 

D 

Date: ^jHfO I 

Time: 

Staff: 

An 

f^^W 

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

AH quadrants are as viewed from tiie street, facing property 

ENTERED 

JUL 3 1 2007 

Rev! Creaied mj/ZOO? 08.3141 

miuTRArrit-FP-«7-in-n«; PRiinFMTTFrHNninfiiFQ iwr 
oERfV 

Property Completion Agreement 

This agreement documents the compietion of removai 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 ftiture, excluding any 

remaining wananty (30 days total) except those items listed below, ifany. 

Property ID: 7i?25 ^ 

Property Address; / ^ 2^^ f^^^l^^y^ ^ 5 ^ 

?Z!Z:ZZL C^TY t.F OAA^iA 

Phone: /y^) myzi/ i 

Restoration Items in Question: 

Item: / 

Item: 

item: 

Item: 

Item: 

Kem: 

Required corrections to complete the property: 

K l I agree restoration is completed. 

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

J^ner' s Sigliature Date ' 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Proiection Agency (EPA) to clean up leadcontaminated soils at a number of properties locaied in Omaha, Nebraska, including the property locaied at 

/V' ^ J-IO'-cylCC .. • Tlte EPA requests your permission to allow Prudent to perform a soil cleanup at this 

propeny to remove lead-conlaminated soil. By signing Ihis form, the property owner grants permission lo Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-conlaminated soil, and restoration ofthe referenced property. 

Lf you have any questions about the soil cleanup plamied for your propeity, please contaa Prudeni south office for the Omaha Lead 

Sile cleanup-at (402) 733-1188. General questions about the Omaha Lead Sile cleanup can be direaed lo the EPA Public Information 

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

Property Access Granted By: /^l///r^yy i /^i^ly/tiiri 

lease Print Name) 

Property Owner Signature: yyfZyZy.A s-y-^oy

(Date) y / y \ (Signature) '' 

PROPERTY INFORMATION 

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

RESIDENT NAME: yZiU U- O/YT^hyi- ^^wne?]^ Renter

H 

RESIDENT ADDRESS: , 

ergjtvc ^ 

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 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'sright of access to the properly is provided forin Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "detennining the need for response, or choosing or taking any response action 

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

8080 Ward Parkway. Suite 406 5600 S 10 Si 4242 Medical Drive, Suite 4250 

Kansas City,'MO 64114 Omaha. Nebraska 6S107 San Anionic. t X 78229 

Phone: (81S) 363-3703 Phone: (402) 733-1188 Phone: (210) 822-9588 

Fax: (816)363-3707 Fax: (402) 733-1383 Fax: (210)579-6577 
ENV{ROi>f!VIELVTAL<S 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

Property Status Form 

Address: 

Phone: BVID: 

n) r^q^ c u A^ ^ 

g) .^oS-Q K^^ \S ^ ^ ^ 

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g) 14 1 ^ O(A-^'C3 ^ y 

(^ ^,-^iS l^^rc^^U ±:2!^ 

Qyoa 'Mr.^J. £1 

Q^ .p ISj q F-UreMC^ 

( ^ 1 S M 3 F to r e ^

^ 

IL. 

N i ^ q (C gr,'s^<' ^ 

/ 

/ 

Property Owner Prudent Employee / 

Signature: Signature: / 

808D Ward Parkway, Suite 405 5600 S 10 St nedical Drive, Suite 4250 

KansasCity, MO 64114 Onnaha, Nebraska 63107 San Antonio, TX 78229 

Phone: (816) 363-3703 c^« . 'o^c» ne n OTA ? 

PhorJe: (402)733-1188 r:..v. /4f%--i\ 7-^n 4oo n 

Phone: (210)822-9588 

K 

A <>IS 

Printed: Oct 06, 2010 

www.dcgis.org/dogis 
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Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2592086. 

Original Call Date: 

Work to Begin Date.: 

9/14/10 

9/16/10 

Time:

Time:

 5:27 

 6:00 

pm 

pm 

Op: SIVA18967 

State: NE 

Adciress: 1529 

County: 

Street: 

DOUGLAS 

FLORENCE BLVD 

Place: OMAHA 

Twp: 15N Rng-: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 15-NW 

Sect-Qtr: 

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

Involves Tunneling or Horizontal Boring : N

 Front: Y

 Explosives: N 

 Rear: 

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 LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

IVfUDOl 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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0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

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

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

TEPHHOUMWES, mc . 

SITE SAFETY HAZARD ANALYSIS 

Address^ii3-i-£l^ji^£AC f

Crew: ^^ ^ 0 T(A<^^ ^

Item Conditioii 

Overhead Lines /vW 

Gas Line 4 ^ 

Water Line 4Zi 

Sewer Line / ^ 

Septic/Leech 

Field yiz. 

l\ 

Propane/Bntane /}/ y^ 

Sidewalk AA 

Foandation 4 ^ 

Retaining Walls 4^ 

Fences 4^5 

Trees /l/L 

Stmctures A^ 

Driveway 423 

Sprinkler System US. Other 

Crew Foreman 

 > ^ Excavation Date. ^-~- Q ? 

 BackfiU Date: 

Hazards Corrective Actioii 

Site Safety Office 

Date: 

8880 «IEatf«aitany,SutB 405 SGfMSIOSt 4242 Medicar Drive, StiSte 7250 

Kaisa5Glly.eiO:«4114 dHasfcafiStOT San Antonio, TX 78229 

PtMiie: (8tfi)36S4703 Ptane: (402)733-1188 Phone: (2t0) 822-i9588 

Fax: {816) 363-3707 Fax: (4(02)733^1883 Fax: (210) 579-6577 
k,' ^ A ' S""""* 7-A.- "f^'^y-^^^i 

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