TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: hlf^lb Date: gj}^/n ^ 

Address: ol9/4 fnJLy^iUU U 

Remediation Contractor: ryv^d^'h Te,J\ . i-vic^ Year: 2-^n<9 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

IET Video of proDcrtv (DVD) 

eT Executive Summary 

\y EPA-provided property sketch 

\y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

y Confiimation data 

y Photographs 

y As-bmlt sketch 

y SaHsfiactory restoration signed by Property Owner 

[y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanitp criteria 

^ Utility clearances 

y Property infonnationfirom Douglas County Assessor's Office 

u 

D 

D 

S<^- ^ Ziiilio 

Signatiu* Date 

30054212 nimii 

Superfund 
PROPERTY SUMMARY 

Date; 08/13/2009 I Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: June/July, 

Property Address; 2912 FONTENELLE BLVD 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCATED PER P.O. REQUEST AT 

Bl/LS (12'X5% 8'X5', AND 25'X5') = 203 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 164 PPM @ 13"; EA=173 PPM @ SCRAPE O^ " ) 

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/photogr^hs 

4) Post-Excavation digital video cUp/photogr^hs 

5) Documentation - Completed Close-out Checklist 

6) As-BuUt sketch ­

i) Shall includefinal 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) fonnat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria 

TECHNOLOGIES, INC. 
Rnd Record Remediation Query Lead Remaining Query Property Damage Query 

Backfill: 

Sample Area: 84716 - 2912 FONTENELLE BD 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: PRUDENT2009_S 

QUINN KEVIN R Property Address: Contract Option 

Owner Addressl: 2912 FONTENELLE BD BASE .. .. . 

Zip Code: 

Owner AddressZ: 68104 Assessment: 

2912 FONTENELLE BLVD Resident Phone 

City: State: Zip Code: Qualifying Group 

OMAHA NE 68104 800/CHILD 

Owner Phone Alternate Phone: Assessment Max XRF Value 

(402) 933-8337 (402) 995-2419 919 
TBCHNOLOGIBS, IN C »EPA 

EPA Property Close Out 

Property #: 5*7/6 Property Address: 29/Z fonieaieuc BlJi. DateATime: 0 7/3olo>i Owner's Name: Ki^!» a*no 

Quads Excavated: QJ_ Contractor Group Prudent Technologies 

Excavation General Yes No 

1. If necessary, were the corrert quadrant(s) excavated and restored? / 

2. If necessary, were the corrert areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

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

from the house? y

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

3! Does the sod appear to be generally healthy and groAving? (Only evaliiate if insperted at a 30 / day time period) 

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

5. Are the joints between the sod strips generally tight? (Only evaluate if insperted at a 30 day 

time period) y 

6. • Was the property graded such that water will not pool on the property? " 

y 

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

Gates, Fences and Retaining Walls Yes No 

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

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

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

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

y 

Foundation, Siding and Gutters 

Yes No 

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? / 

i 
^V; L ^IttyeJd^ Blvt/ 

Owners comments: 

Iiiisipec'tidn notes': 

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

EPA Representative ^9ct^jA^ Date: 7/30/of 
Jul . 23. 2009 3:47PM Jo, 0358 P. 2 

&EP^ 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The property owner's signature tndioates 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 diose items listed below, if any. 

1 Property ID: 

Property Address: 2.^\^ ^ T e>r^> «.n «. Lie S O 

Owner: ^^ ^ ^ ^ CC^sA r.^ 1 

[Phone: ^^ T . *i| *^«; , 9'^^. i. 

RMtoratlon Items In Question: 

Item: 

Item; 1 

Kem: 

Item: 

Item: ' 

Item: 1 

Required corrections to complete the property: 

I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

Date ^ 
Jun. 19. 2009 12;33PM No. 0343 P. 

6>V"^ 

Pnuleni TadMologi«t. Inc. (Pnidoti) ii undtf eonuuet with the V. S. Eovlnnmental Prawciion AsooBy (EPA) lg clean up luad' 

e(inUimiiwl«d <oil« m o itumber cf properiia* located tn Omalu. Nebnika, Includuig the property leeatod al 

. 'fhe EPA requnis your pantiiaion to allow Pru(init u> perTonn a ioil clsuiup ax ihis 

prtpoly to KRWvo lusd-conlaminBlGd «e>l. By stgnins this fonn, ifae prapetty owiar Giants pemioien to Prud«ni lo pcrfoini 

ealivi(i«i nilDied to thu cleanup including loit tampling, removal orieud-contaminttted Mil, and nnomtioa ot'lhe rafiircnoed propeityIfyou have any question* aboiu the Mil etoanup planned ibr yotv property, ptww eoniaci Prudent') Adj2iH]ijt]iuu%iLCli!Ck.fer the 

Oinalia Lead Situ cleanup. .Vis. siv;i s Jmn|iuiq-ni (402) ".V^-l IXx. Gewral ijaealioffi about the Omaha Lend Silo cleanup can be 

diroeiwl to tho EPA Publie IntbrmBtie^eenter MiopCenter*a * t (402)731-304 (402) 731-304S (SouthOmBhaofliee (South OmBhaofliee} er(402)99)-9 er (402) 99) -95SJ 3 (North Omaha oniee).

l^ropony Aiceeaa Orantod By; 

(Pteaac Print Name) 

I'roperiy Ovrntr Signuiure; (• Vf-1^? 

( ^ ^ Mill 

PROkGfilXlMreRMATION 

(To be eoiDptaisd b / iMidoBt and/or propel^ owiur - plewe print) 

RESIDENT NAME: \C^U< *\ <L ^.jJ.s ^ /OwneM Ranter 

RESIDENT ADDRESS: 

t^^:sV... K.V^ ^^1 0 H 

IP RENTAL, PROPERTV OWNED BY: 

OWNER'S MAILING ADDRESS; 

z.qi-^ v^a^^^^^tli^ Qj^ r,m^U la ^ <b*?iow 

OWNER'S TELEPHONE NUMBER-HOME: t "ja a ^33 ' ^33 1 WORK: 

AOE OF HOME?!

,85- YEARS. HOW LONO HAVE YOU LIVED HERE? ?:/- YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDINO SINCE 1976? JL. .YES .NO 

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


NUMBER OF CHILDREN UNDER 7 YEARS OLDWHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: 


o 

COMMENTS OR SPECIAL INSTRUCTIONS: (l£. DOCS, ENTRY OATES, ETCJ 

T)66r \^ U^^^\^^ . \ 

AU'rj-IOKlTY I'X>R UNVUIONMHNTAL KliSI'ONSU AC'I'IONS; 'I'lu acliviiii!) (o be implemented by [-PA tmdiir ihii agreemeni 

an: punuani lo Section 104 ot'CRRCLA, 42 U.S.C. 9^ . SPA'< right oraceeii to the proparty U provided fbr in Section 104(a) oT 

CERCLA, ^3 U.S. C 960J(G), which provide* cntiy ror"det«ntiii\irtg the need for rceponae, or vhootins or Uikins uny reipDnBe action 

undv Ihia title, or othenvite onforung the proviiionx ofthe title." 

SOSO Ward Parltway, Suite 405 260S N. 24'" StrsBt, Suite 306 4242 Mrdicni Drive, Suite 4260 

Kansas City, MO 84114 Omaha, Nttbrdska 68110 Ssn Antonio. TX 78226 

Phon*: (816) 363-3703 Phone: (402) $04-1004 Phona: (210)622-8566 

Fax: (616) 3S3-3707 Fax: (402)504-1009 Fax: (210) 4794677 

»nnn/cnonBi YVil 0S:8T fi00Z/8T/90 
Jun . 19. .200 9 12:33P M Jo, 0343 P. 2 

EWTRONMENTAL 

CONSTRUCTK 

TECHNOLOGIES, INC. SER>1C 

Property Status Form 

Address: 2.c{\*i ^ T=orNVeyNeUe Q> D Date: 

Phone: Mo2.- c\^ s - '^Ht q BVID: 

Plants & Permanent Landscaping To Remain In Place 

Description & Location 

Pre-Existing Condition of Structures 

Does your Basement have a history of lealdng? Yes _j \ No 

Itera NO Descnption & Location 

On Map 

rudent Employee 

Signature: 

8060 Ward Parkway, Suits 40S 2505 N. 24" Streec, Suite 306 4242 Medical Drive, Sulta 42! 

Kansas City, MO S4114 Omaha, Nebraska esil0 San Antonio, TX 782: 

Ph(\n»t IM7\ fiM-AaOi Phone: (210)622-951 

yva nc:AT nnnx/fn/a n 
m 

HNULlXilES, INC. 

OLS<>:84716 

Date Excavated: 07/09/2009 

USEPA OJMUiHii I^kto $^^^ SITE Slgned-OfTDate: 

M716 

Omah Exterior Paint ' NoffiAiraw a Lead Site n Sood Site Sketch 

(g^Poor 

Sampling Addraas: 2912 FONTENELtf BD • Not paint 

Sample Number lead Sample Samples Collected 

Concentration Collected Firm: Pg. CC . c-K- RYASC»>XA^716 F l 3.HS com D Date: lo->4-oa r RYBSCPXA-847ie F2 2.1$ PPno D Time: I2.'.^g- p.n^. RYCSCPXA-64716 B l .ai.9_ppm D Samples Analyzed RYDSCPXA-84716 B2 D 

RDZSCPXA44716 DZ -JS£2_PPm D XRF Unit: &6HO Boot 7.7.li 

ncaccpxA g«7i8—oe- .ppm D D Date: / g -.Zg -OB 

RPZ3CPXA-e47ie PZ ISS. .PP"" D Time: flrO 

Staff: ms\ ^ Number of Samples = | (g \ | | 

Legend: F1 ° Front LeR, F2 >: Front Rlgm, Bl » Bsd^^n. B2 a Back Right DZ > Drip Zone. GZ ° Garden, PZ » Pis; 

AJl quadrerls are as Mtowd lion nn Easal, faokig propeity J l If 

UC(I5'X4') = 2)I PPM 

AREA NOT EXCAVATED; 'a SCRAPE (-l") h, 

Bl/LS (2.'^'X5', 8'X5', 12'X5') ^ • , „, , . 1 ^ • 

= 203 PPM a, SCRAPE (~ n OCT 2 b 268a 

<W 

BI = 164 PPM a 13" 

WIMK 

lwrf4«.iJ*il«. ttO KovlOOl Onant OMq»(« 

EA = 173 PPM a SCRAPE (-1") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
Jo, 0343 P. 3 Jun. 19, 2009 12;33PM 

84716 

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httD://douslasne.maDDine-online.com/assessdoc/Photos/04/R24020800000001.iDe 6/12/2009 
Print Preview http: //www. dogis. org/dogisalias/dogis/printPreview .aspx?PrititOpt.. 

Douglas County-Omalia, NE 

J9II5 KJNTENELLE'SD 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2402080000 

QUINN KEVIN R 

2912 

FONTENELLE BD 

OMAHA 

68104 

• 

2912 

FONTENELLE 

BLVD 

OMAHA 

NE 

68104 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Unk 

Assessor 

Website Link 

08-15-13 

VINELAND 

1 "'^ 

13 

40X125 

http://webapps.clotcoinm.org:8080/TreasTax/faces/pages 

/taxinfo.jsp?parc=2402080000 

http://clouglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R2402080000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale 
Page 1 of 1 

"> 

• YOUR TICKET NUMBER IS 2303584. 

Original Call Date: 6/25/09 Time: 2:07 pm Op: SIVA18967 


Work to Begin Date: 6/29/09 Time: 2:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2912 Street: FONTENELLE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 08-NW-SW 


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 


: 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emeig: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFnC,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emeig: 8887289343 

QLNNEl C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 
L^S 

E.NVIRONMEIMTAL & 

CGIMSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

CD Site Safety Hazard Analysis 

Address: Ji'i/'Z V^/^^^// ^ 

Date: ^-JlS - <yq 

Item 

Overhead Lines 

1 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 

c,<u>d 

^/->^c i 

1 

hyu^ec 

-^a . 

yt/ ^ 

A.^ 

A^^ 

/K^ 

Al^ 

/af^^ytA. 

^ s ^ 

A.^ 

/7-^>*-

Corrective 

Hazards Action 

Wx^)hp/ e US ^ A^'^i' ^ 

* 

I 

( 

K.t^y /«,>'^«-

Site Safety Officer 

.Jk llLLLLl. fi^^g 

/C^ Co'^jz)^ 

8080 Ward Parkway, Suite 405 

KansasCity, MO 64114 

Phone: (816) 363-3703 

2505 N. 24"' Street. Suite 308 

Omaha, Nebraska 68110 

Phone: (402) 504-1004 

4242 Medical Drive, Sufte 7250 

San Antonio, TX 78229 

Phone: (210) 822-9588 

Pay /mft\ r^K.-s-iTn? Fax: (402)504-1005 Fax: (210)579-6577 
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