TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^7/| 4 Date: rQ I k ^ . 

Address: ^STf O T?lon/i o <^jRemediation Contractor. fiUAf\li^Jr k \ W Year: (9^0 f Q 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

rf Video of property (DVD) 

a Execudve Stiinmaiy 

ffl EPA-provided propeity sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreenient(s) for adja^«nt property 

^ Restoration Agreement 

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

ffl Confirmation data 

Pliotograplis 

d As-built sketch 

i Satisfectory restoration signed by Property Owner 

Property close-oirt check list signed by EPA 

i 

D Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's OfBce 

D 

D 

D 

Signature " Date 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 27114 - 3510 BLONDO ST 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: |NUNN RENA PRUDENT2009 S I 

|NUNN RENA { Property Address: Contract Option 

Owner Addressl: )3510 BLONDO ST 

|OFnON 2 

Zip Code: 

Owner AddressZ: |68111 

Assessment: 

|3510 BLONDO ST Resident Phone 

City: State: Zip Code: Qualifying Group 

I 

|OMAHA :|NE , |68111 „ poo ' 

Owner Phone: Alternate Phone: Assessment Max XRF Value: 

|(402) 453-6199 "1 795.231 
PROPERTY SUMMARY 

Date:^/15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 | Month of: ^' ^ 

Property Address: 3510 BLONDO ST 

A EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATAVRESULTS: 

Bl = 74 PPM @ 12"; DZ = 88 PPM @ 12"; EA = 116 PPM @ SCRAPE (~1") 

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 sketch ­

i) Shall include fmal 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. 

TECHNOLOCIES, INC. 
TECHNOLOGIES, INC. 

Property #: l~7lt'fDate/Timc: r : • V/-L 41 . 

Quads Excavated: g| , D2-

EPA Property Close Out 

Property .Address: 3S»0 (3r6»/vjLo 'ki' 

Owner'sName: ^'y^cK jOtc\M^ 

CoHJraclor Croup: Pn,iden> Technologies, Inc., 

F.xcavation General Yes No 

1. 1 f iieccss;-m. were lhe correct quadrani(s) excavaied and resiored? / 

2. If necessar>'. were the correct areas of drip zone excavaied ajid restored? / 

Grading Sod and Vegetation Yes No 

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

from lhe house? y

2. Has sod been laid m all areas that were e.xcavaled? / 

.1. Does the sod appear lo be generally healtliy ajid growing? (Only evaluaie if inspecled al a 30 

day time period) y 

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

5. Are the joinis between the sod strips generally tight? (Only evaluate ifinspecled at a .30 day y lime period) 

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

7. Was damage to landscaping or phmt materials avoided? / 

Gates, Fences and Retaining Walls Yes No 

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

2. Were all gates or fences laken down during restoration activiiies reinstalled? (If applicabie) y 

.3. Was daniiige lo gales or fences avoided? (Ifapplicable) y 

4. Was damage lo reiaining walls avoided? (Ifapplicable) J 

Fouindation, Siding and Gutters Yes No 

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

2. Was daniage lo lhe foundation avoided? y 

3. Was damage lo windows avoided' / 

4. Was damage lo windows or door screens avoided? 7 

-•i. Was daniage to downspouts or downspout extensions avoided? 7 

Sidewalks .ind Driveways (Concrete) Yes No 

W:i> (i;iin.ii>c U> drivewav surfaces avoided? / 

2. Was damage lo walkway suriaces avoided? / 
3^10 glonio S ^ 

Owners comineiiits: 

Inspection notes: 

^' ^y 

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

i 

EPA Representative Jdi>^4j Date: //is/o'ji 
SHVK 

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 fijture, excluding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property ID: 

PropertyAddress: 3 5 •, o B \f. ,^ j ^

Sl-­

0^""= ck?NJ?< ^OJn^^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

L J I agree restoration Is completed, except as noted above. 

L J I do not agree restoration is completed 

^2?U^/^ >^DO^ 

oWner's Signature 
TECHNOLOGIES, INC. 

Pmdent Technologies, Inc. (Prudenl) is under contiact with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Oinaha, Nebraska, including the property located at 

. Tbe EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead<;ontaminated soU. By signing this form, tlie 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 propeity. 

[f you have any questions about the soil cleanup planned for your property, please contact Prudent's Administraiivc Clerk for the 

Omaha Lead Site cleanup. Ms. Sivu S. Jamaina-at (402) 7.^.?-l 188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Pubhcjaftmyanon Centers at (402) 731 -3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

ftoperty Access GrantediVl^vi By » M>//tJLr/V 

(Please Print Name) 

Property Owner Signature: ^ I "^ I 7^fi~^ 9 

Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — pleaM£nat) 

RESIDENT NAME: ^ •€-y\jex. Renter 

RESIDENT ADDRESS: .* _ i . 

iN-ijv-r<-gV ^11 < J 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S^^ILING ADDRESS; 

OWNER'S TELEPHONE NUMBER-HOME: ( T^ ^ ' ^ ^ ^ ^ ' 7 OvORK: 

AGE OF HOME?: I ^ Zx YEARS. HOW LONG HAVE YOU LIVED HERE? 0'2—YEARS . 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDING SINCE 1978? _ YES" NO <P^'d^' q

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's right of access 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*^ Street 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) 579-6577 
>KUl)EN ENVIRONMENTAL & ' CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 3 S \ O Date: <^ / C> ^ / Z-creP ^ 

Phone: "T^ ^ "^ BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

I ^ 

b 

Wo CLuJPre-Existing Condition of Structures 

Does your Basement have a Jiistory of leaking? No 

JT Vp-<^ 

Item NO Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: 

^ . 

AuLA*' ^ 

3080 Ward Parkway, Suite 405 5600 S 10"" Street 4242 Medical Drive, Suite 4250 

<ansasCity, MO 64114 Omaha, Nebraska 68107 San Antonio. TX 78229 

'hone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

-a%-. (815) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
IRII 

UHNO I (XilE.S. I\X'. 

AS - BUILT DRAWING 

()l,S3:27n4 

Date IvM-uattd: i>9.'19/2«ft9 OMAHA LEAD SUPERFUND SITE I .>Sl'.I'.\ .Sipncd-OIT Date: 

Name: ^.. ^ i^jf.^*^ Omaha Load Site Date: ^^IQ ^ North Arrow 

Address: :^<S"jo AlotJad Site Sketch Time: /3:«a 

Phone: Q^j-j ^f.,/9^) f 

T«m ferr,.., )[U>^. '^'""g»» "' W mrcM_£S£L 

Sample Number Lead Concentration Confirmation Sample 

O Yes a 

FZ Yes • f^e^PY A " -CT I |<f­ iSl Yes • 

^ ' ^ • i* ^ ppm (3ZYes • gp'^ScPX'A - g7ll ^ /i^^- ^ -gy ppm p i Yes n 

ppm Yes • 

ppm Yes • 

^smpli 5£S_ 

^)oyicfo $ y 

i;.V =116 PP.M a SCR.VPK (~1-) 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
Omaha Laad Site Daln 

Address Site Sketeh 

PhDHB: ; r 

Tesm M^^njo-i ) irfiJ'-' f ' "^ BVID # 'i?^-^ XRF Codfi ^So f 

LK;JrtCt;r(eefitfaliert Confr^raatot- Sarr-pte 

i^i YES t J 

gpgiScyyA - -zii Iff 

finite 

ppm: 

1-^^ Ygs

jPt- Y«s

 i ^ 

a 
-r^^i^?^ 

ARCH 2004 - DOUGLAS COUNTY ASSESSO 
Print Preview Page 1 of2 

Douglas Coimillj^^maha, NE 

Parcel ID 

Owner 

IName 

Property 

Address 

City 

\zip 

Owner 

\ Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

\zip 

Sec-Twn­

\Rng 

1639350000 

NUNN RENA 

3510 

BLONDO ST 

OMAHA 

68111 

3510 

BLONDO ST 

OMAHA 

NE 

68111 

16-15-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

LOWES ADD 1 

C 

2 

60X114.5 

0.16 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=1639350000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 1 

accountno=R1639350000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/3/2009 
Page 1 of2 

[ Create Another Ticket ] [ Back to Irth Internet ] Send Email 

• YOUR TICKET NUMBER IS 2361718. 

Original Call Date: 9/11/09 Time: 8:40 am Op: SIVA18967 


Work to Begin Date: 9/15/09 Time: 9:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3510 Street: BLONDO ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-SE,09-SW,16-NW,17-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 


: 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 LEVELS 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 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
Page 2 of 2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/11/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: 3S/ 0 B^c^ a 

Crew: _ ^ /a^./-^^^<- roc^,o^ Bf.f-^^'^^ 

Date: ^- n-o' j 

Corrective 

Item Condition Hazards Action 

Overhead Lines S^=^^ ^u/^r^/e.^ /at<j J>a-o«^ -/2rs3aGas Line ^trne j M * ^ ^st/H-f 

Water Line 

-/-

Sewer Line I i(/n£ti lArfTtci le^ejerjo 

Septic / Leech 

field AJ/i 

Propane/Butane j /i/> 

Sidewalk ^><uyt. LJStf- ^/yo^o^>.P 

Foundation •A '>-f^ 

Retaining Walls ycf y /%afr/t. g<9//<=vS^ j i>t» /tu/^<i r 

Fences 'Cc^ - ^ 

Trees y>iiL 

Structures y ^ 

Driveway <f>^ ^ ui s J^lye^acJ^ 

Sprinkler System /vV» 

Other 

QT^\S' Foreman Site S:-?fet\ Officer 

^y^/yi -^ , n>-<^^/ yy ^ ^^ S / c>\^ ^s^^ 

8080 Ward Parkway. Suite 4Co 2505 N. 24"" Street. Suite 308 4242 Medical Drive. Suite 7250 

KansasCity. MO S4114 Omaha.iNebraska 68110 San Antonio. TX 7S22S 

Phone; (816) 363-3703 Phone:; (402) 604-1004 Phone: (210) 822-9588 

Fax: (316) 363-3707 Fax: (402) 504-1005 


1. ^^ 'JWtliBa;y,^l 
X, 

*

• * > 

•r-:'l'jm^ ^