TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#; '^^lyS ' Date: I1H5-I0 

Address: .-^^^ir. Flor&)Ce . PrO 

Remediation Contractor: Ppc nPfMTf Wr^l^ Nfldoc, \^ q.^ i(^^>i Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d Video of property (DVD) 

Executive Summary 

d 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaipent property 

/ Restoration Agreement 

D 

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

Confirmation data 

d Photographs 

As-built sketch 

d 

Satisfectory restoration signed by Property Owner 

Property close-out check hst signed by EPA 

D 

d 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

D 

D 

D 

3y^y\ Signature Date 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 3936 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 = 165 PPM @ 6"; DZ = 251 PPM @ 13"; EA = 268 PPM @ 2" 

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 (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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Find Record Remediation Query Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 33635 ­ 3936 FLORENCE BD 

Owner: User Provided Owner Information Resident: 

D Owner Ocriipled 

Owner Name: Owner Name: Resident Name: 

|N AND L PROPERTY MANAGEMEm" L 1 |TENA?fTS 

Owner Addressl: Owner Address: Property Address: 

1 |3936 FLORENCE BD 

Owner Address2: Zip Code: 

|10016S13ST |68110-

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

IBELLEVUE |NE |68123­ 1 1 1 I 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

"1 1 " 1 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |4o6 

contract Opti( an jOPnON 1 Assessment Max XRF Value | 447 
INCSLpGnS, BMC. 

EPA .Property Close Out 

Property Address: p%'^(oP\(nt^~cji.^^'^^^ 

Pate/Time: Owner's Name: yj ^tVv. XXaSjot.. ^ &/\ J 

Qinadl.* Excavated: S^7 (51 Contiractoir Group: Prudent TwfcuMttogJes, Jnc, 

Esciivation General Ye* No 

J. If necessar>-. 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 Vegetatiom Yes No 

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

y ^ from the house? 

y 

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

day time period) y 

4 Are sodded areas generally firm and evenly graded? y 

2. Has sod been laid in all areas that were e.Kcavated? 

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

time period) 

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

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

Gates, Fences amd Metainima WaJ5s Yes No 

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

2. Were all gates or fences taken down during restoration activities reinstalled? (If aj^licable) y 

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

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

FoMwdalion, Siding and Gutters Yes No 

!. Was damage to the siding or trim avoided? «<^ 

2. Was damage to tlie foundation avoided? 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

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

Sidewallks and Drivewayg (Concrete) Yes No 

y ^ 1. Was damage lo driveway surfaces avoided? 

2. Was damaige to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative ^s ^ ^Date: /a/^t/to 
ffiun 

CHNOLOGIES. INC 

AS - BUILT DRAWING 

OLS # iihiS 

Dale Excavated: 09/21/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-OffDate: 

Name:

Address;

 liu-jc.' iJi,.- ^ t^. 

 J-?nt. ///=//,w, .^-'^. 

Omaha Lead Site 

Site Sketch 

Date: / 3-c V 

Time: //• / */ 

North Arrow

_--^ 

[-

Team3t//r>//4y.>«>^ /".^^PS) BV1D# '??(^.?5" XRF Code f/^<^^-

Sample Number Lead Concentration Confirmation Sample 

3 

4 

5 

6

f^Y^^Sci-PXA­ ^"^^ ^ 

 Lab RYASCPLA-33635 

Resul 292 ppm t 

TfiyT~ PP"^ 

—y^'^^ ^ pp'" 

1^^<^ ppm 

ppm 

ppm 

^ Yes

-t'iYes

5' Yes

56 Yes

*.Yes

Yes

Yes

 S -

• 

• 

O 

n 

• 

• 

No C3. 

No CZ 

No IS" 

No S 

No ca" 

No CD 

No O 

£.4= 268 PP\I a 2" 

Oinaha L.ead Site 46130 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Property Completion Agreement 

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

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 warrant^' (30 days total) except those items listed below, if any. 

Property JH): 

Property Address: 3^3 ^ P lo re ^ c_i5- B O 

Owner: U^ jyy^ fef fs.)/y<^c^y^ 

Phone: rts- Restoratson Items in Qoestioin: 

hyi i agree restoration is completed, except as noted above 

L J I do not agree restoration is completed 

Owner's Siguature 
y'-'-'-'-^'y 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontamiimted soils at a number of Kpp^ties located in Omaha, Nebraska, including the property located at 

^°13 o TiO'C^Y^tJL-- ^5C3l. Tlie 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 property. 

Ifyou have any questions about the soil cleanup plaimed for your property, 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 Infonnation 

Centers at (402) 731-3045 a office) or h a office). 5 (Sout (Southh Omah Omaha ottice) or (402 (402)

)

 991-958 991-95833 (Nort (North Omah Omaha ottice) 

Property Access Granted 

/^ ^ " ^ (Please Print Nanje) 

Property Owner Signatun 

(Date) 

>PERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

K.D ^K^g ^ h)-e. Q z 1-2) 

IF RENTAL, PROPERTY OWNED BY: 

W^-^^—QAyq^-^v 

OWNER'S MAILING ADDRESS; 

p e G'^i^ ^ 

OWNER'S TELEPHONE NUMBER - HOME: _ 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.] 

ALHTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSi The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for in 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 title." 

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)822-9588 

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

Phone: 

(,^ fr<.:(l-r

MIL 

y 

Property Owner 

Signature: 

8080 Ward Parkway. Suite 405 

Kansas City, MO 64114 

Phone: (816) 363-3703 

TECHNOLOGIES, INC. 

Property Status Form 

Date: 

BVID: 

ENVtRONMENTALA 

CONSTRUCTIOIN 

SERVICES 

.j^i ^ (2jy^ ^ ^ 

Jl—OLPf'^7] 'iUL \i^..:^4 

^ 

Pnident Employee 

Signature: 

5600 S 10 St 4242 Medical Drive, Suite 4250 

Omaha, Nebraska 6S107 San Antonio, TX 78229 

Phone: (402)733-1188 Phone: (210)822-9588 

i4AOV Ti l 'ieO-1 
Name: Cytc. lL,x.ly . Oniaha Lead Site Date: North Arrow 

Address: J-^»?C Ay//... J/y' . Site SIcetch Time: LL M: 

Phone: 

Team&//r>^//^r/M.^ /^-^^S) BVID#JI2^l5 l XRF Code (t^^4 

Sample Number Lead Concentration Confirmation Sample 

p pm -/'Yes No O 

ppm -fives a No ^ 

ppm ijlYes tn No ET U^S. e^Yes CD No 13 gj:»;gggpyA--33/^<^ jt-Yes D No t^' 

ppm Yes n No n Lab RYASCPLA-33635 

ppm Yes • No • Result 292 ppm 

Oniaha Lead Site 46130 
Page 1 of 1 

399t ft 

http://douglasne.mapping-online.com/assessdoc/Photos/03/R20130300000001.jpg 9/15/2010 
A Printed: Nov 16,2010 

www.dcgis.org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet I . Send Email 

YOUR TICKET NUMBER IS 2592095. 

Original Call Date: 9/14/10 Time: 5:33 pm Op: SIVA18967 


Work to Begin Date: 9/16/10 Time: 6:00 pm 


State: NE County: DOUGLAS Place: OM 


Address: 3936 Street: FLORENCE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 03-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 


: 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 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICHA-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 406207149 4 

Emerg: 8887289343 

QLNNE IC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

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

ENGINEERING AND 

CONSTRUCTION ISOHNOUKMSB, mc . SOLUTIONS 

SITE SAFtiTY HAZARD ANALYSIS 

Address: —J?^J^—tUfXfnr dQ Excavation Date: 

Crew: Backfill Date: 

Item Conditioii Hazards Corrective Action 

Overhead Lines \ySe /^^/ ^ 

Gas Line 

Water Line ySewer Line M 

Septic/Leech 

Field 

Propane/Bntane 

Sidewalk lySc^ y>fuA.e^^'7 7 ^ Foundation y 9 ^ 

Retaining Walls 

Fences 

Trees 

Stmctures 

Driveway ^PiS ^ Jt^ - joU^Atyx^t-y 

Sprinkler System 

Other 

Crew Foreman Site Safety Oflice 

Date: 

80M WmfBartDway. SiBto4<B 9800 8108 1 4242 Medical Drive, Suite 7260 

Kansas ia)ly;llO«4114 BbiaMa 48107 San Antonio, TX 78229 

Pbone: (8f6) 3^^3703 nwne : (402)733-1188 Phone: (2t0) 822.8588 

Faoc |8ffi) 383>4707 Faoc (4Q2)73»'1«83 Fax: (210) ers-esn 
BUZ.