TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 1333 1 Date: li ^ I 5 " 1 0 

Address: /p ? / 0 f)\yA.LAJL^ ^f " 

Remediation Contractor: PPf-yn^T^-f 7»/"4iN<X0C|i?-<?.^/fNi("-'^ Year: A U i i j 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

gf Video ofproperty (DVD) IIIIII iiiiiii2?mTMSii 

\^ Executive Summary Superfund 

ffl EPA-provided property sketch 

[A Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja<?ent property 

a Restoration Agreement 

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

• Confirmation data 

3 Photographs 

H As-built sketch 

[ / Satisfactory restoration signed by Property Owner 

0 Property close-out check Ust signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

\j Utility clearances 

[J Property information from Douglas County Assessor's Office 

D 

D 

n 

Signature Date 
PROPERTY SUMMARY 

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

Property Address: 1210 BLAINE ST 

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: 

F2 = 366 PPM @ 9"; DZ = 149 PPM @ 13"; EA = 113 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-E.\cavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) 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. 

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

Backfill: 

Sample Area: 12327 - 1210 BLAINE ST 

Owner: 

n Owner Occupied 

Owner Name: 

JVALENTIN-CALDCTO MARIA I 

Owner Addressl: 

f " 

Owner Address2: 

I12IO BLAINE ST 

City: State: Zip Code: 

JOMAHA JNE 68107-

Owner Phone Alternate Phone: 

f 1 

Contract: 

Contractor: ]PRUDENT2010_S 

Contract Option JOPTION 1 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Code: 

p — r 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group 400/CHILD 

Assessment Max XRF Value | 456.8 

Resident: 

Resident Name: 

JALVARADO ANTONIO 

Property Address: 

J1210 BLAINE ST 

Zip Code: 

168107-

Resident Phone 

r~—" 
6F% r=^ " 

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 12-32- 7 Property Address: \5_lt 5 T3>l-'^"^E^ "^f 

Date/Time: /o/| / Owner's Name:apsftP>€-^ l/ALeiNTlH£ -

Quads Evcavated: riO "T) "^ ^ Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

) If necessar). were llie correct quadrant(s) e.xcavated and restored? y 

2 If necessar)'. v\'ere ilie correct areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

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

from the house'' / 

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

3 Does tlie sod appear to be generally healtliy and growing? (Oni) e\-aluate if inspected at a 30 

/ day time period) 

4 .^re sodded areas generally firm and evenly graded'? J 

.S Are Llie joints between tlie sod strips generally tight'? (Only evaluate if inspected at a 3(^ day 

lime period) 

/ 

6. Was the property graded such tliat water will noi pool on the propeny'? / 

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

Gates, Fences and Retaining Walls Yes No 

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

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

3 Was d;unage to gates or fences avoided'? (If applicable) / 

4 Was damage to reUnmng walls a\oided? (If applicable) / 

Foundation, Siding and Gutters Yes No 

1 Was damage lo ihe sidmg or trim avoided'.? / 

2 Was dajnage to die foundaUon avoided? / 

3. Was damage to ^vlndows a^•oided? / 

4 Was damage io windows or door screens avoided'? / 

:^ Was damage lo dow nspouts or downspout extensions avoided'' / 

Sidewalks and Diiveway s (Concrete) Yes No 

Was damage to drivi.-wa\ surfa(.:es avoided'? 

Was dainase lo waIk^^'a) surfaces avoided? 

r 
Owners comments: 

Inspection notes: 

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

EPA Representative .^r,^ >^^ Date: ____jf(2yt5j/^^ 
ill CHNOLOCIIES, INC. 

AS - BUILT DRAWING 

OLS# 12327 

Date Excavated: 09/22/2010 OMAHA LEAD SUPERFUND SITE I SEPA Signed-Off Date: 

Name: Omaha Lead Site Date: "^ North Arrow —i 

Address. I^ W SCh^ ^ Site Sketch Time: 'r-zyn 

Phone; f" f 

TeamW;te/j.'''/ftl/P.> BVID# W .?'2 7 XRF Code /go4 

Sample Number Lead Concentration Confinnation Sample 

)^^,6ae(A_iR3R3—fl 3551 ay „„^ (=^iYes a No S ^ 

S f*7.Yes a No 01 ^ ?yr' cc.fjxn. ja.^ai A. dyes n No IS ' 

res a^ }t)2.<^PXA mS7~Di: **''^. No '>-' 

es 

CONTRACT tt: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
'"••i'o^j2:rtf iy^-'\<r):^(?''iion i:=\Q7!:r:'^m'mi 

r\::i. 'dgretmi-.r.). ;i:.>;;Li;ver.i;.i; ::..r cc^:,^z:z..i}:. :': ••^LVC\C! .•:;::.v''::ei' riertonriec c . ;;":e rte';-", ..i-T:' .:v-:j-;er\ 

I'hs oroceirN i^wr^i--' '.^ ;ifiJii;"CJ.-.r i;;;:iiCa;es ::..ca :nt i;.:-:,p^m o'^'^ior ii iai:silf:d A;rl: ftio !es:;:r:i:ii-'. ::iT :':.:• 

t;ubjec'( proper^\:. anil ^hai DI; ur/'i': arr iti quest:e>Ti. av.-'A u;" at ary time m (Le tu^L.re, i.f:;;;d]:.i; hiv, 

remaini;:?, H-arrai'.n' (J^O aass tol"ai;- e:'ic.;pi' i;-,o.-:'=: .'.emi !r>i.ed ;")e!u\\', !f airy 

Profjertv ffi-; 

1 L__ J yL Q ^_LQW^K_<^ h y 

Owns

"^^ '^.Sc< t^<^ 1 V-^^^"^^^-^—'^'•^-^ 

Resf:a:-atootii Hems ift QiiKu^i-fiJoiri: 

it&mH 

k-...--. 

Item • 

Bte;^:,: 

11 tli'iSIT:; 

•Jtem: 

'«%eq'ij;i:if"«Oj cciTStCticoinis t^; comipllete •ihe ipiropai-iiir 

! I : aqriiO 'os:;r3tiG.'^ ic cj7.o:erec. eA:;3i:): J:.S -^'aor,; accvK 

I I i do :v.-A aqree •"esto^'aiion is ::.;:r'D!ete^^ 

f^-^rA-jM. [JJ^A^' A, to - vv^- ve 

O W ?li e »•" i § i« E -Jl\! 'ij t'i? Baie 
rttvry 

-C!f^:"l i .•.*;;;?.' 

rrudtiiil 1 ucliM'jIi.igiij:.. Inu (I'liidcni.) is uniler conlraci wiih Ihc LI S Cnvironrnciilal Proiecrion AL'ency (t-FA: d- clean up lead 

cunlanunalcd Sui\'-. al a niimhci of properlip»i'located in Omaha. Nebraska, including ihe properly localcd at 

t'y^l(y_ _ ii-i l . fSrA/..^ "S*V' The liP.'^ requesis your perinis.sion In allow Piudent to perlorm a sial cleanup al ihi-. 

imipcrly lo icinovc Icid-conlaminalcd soil By signing this form, the propeity owner grants permission lo PiiiJeiil lo pcronii 

activities related lo ihc cleanup including soil s.impling, removal of lead-contammated soil, and icstoraiion o l he lercrciiccd piopcr'v 

It'you have any qucslions about Ihe soil cleanup planned for your propeny, please contad Prudent loi llic limaha 

Lead Sue cleanup, al (402) 733--1 188, 733-1455 General questions about the Omaha Lead Site cleanup can b; dneclcd lo ihc PPA 

Public Informalion Ceniers at {•'•102) 73 i-3045 (South Omaha office) 

Properly Acciv-,'^ ( Iranlcd Ply 

Properly Owner Signature ^^ ^ 

(L'alc) 

PROPERTY INFORMATION 

( [ o be compleled by resident and/or property owner — please priiii) 

RESIDENT NAIVIE: -—j — -SW^Q ^ jy/^[JT/1/7 J/y Owner Renter 

RESIB^NT ADDRESS: \ / 

( ^^6(^A^'Ao .) A^A:) I/A'^y^ ST 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS 

OWNER'S TELEPHON E NUMBER - HOME: ( ) WORK: 

AGE OF HOME? : . /. O 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 CHILIIRIJN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEKCOMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

yiyd 

AUTHOr<lTY fC.iK PN VlRi.jNMLNlAL RESPONSE .AUCTIONS. The activities to be implemented by PPA mdei thiv agieenient 

are pursuant to Section 104 of CERi'JLA, 42 U S C 9604 EPA's right of access to the property is piovuicd fo in Seciion l(i4(c) ol 

('JCR(-:LA, 42 U S C '-)605(e), which provides entry for ''deiemiining the need for response, oi choosing oi laking any ic.-.poii-.e acnon 

under ihis lille. or oihcrwise enforcing the provisions of the mle "' 
l^vlRO.^•\lKM•\L ^ 

t ONSTRi;CTI0> 

TECHNOLOGIES, INC. Sl-R\ K FS 

Property Status Form / / 

Address: I C ' ^ 

Phone: BVID: / 2 3 Z -7 

A^A-^iAL Anyiy^ ^ A r^ ^ Z r D ^ 

Z) ^ / ^ C / ^/ ^ /2^ /^ ^ yg ^ X ^. ^ \y ^ r ^A / /y i ULCff /A> ^' ^ 

/ / ^ f/to^T ' CyA^rc H ou r f^n iAo<^ y.u^u'^ 

F^2 ^"T££e 52o/^^ ^ ^ 'T/2^€s <3/^ ro 

A:: rxc^AUAi'f A/lc>u.^ ^ 1/2^:^' ^ 

t 

roperty Owner Prudent Empli 

ignature: Signature: iJ Aply''^ 

8080 Ward Parkway. Suite 405 5600 S 10 St 4242 Medica! Drive. Suite 4250 

Kansas City. MO 64114 Otiiaha. Nebraska 6810" San Antonio, TX 7822S 

Phone: (316) 363-3703 ^hon e i402) 73:^-1188 Phone: (210)822-9588 
Name: Omaha Lead Site Date: njujoi North Arrow 

Address: I^W Site Sketch Time: 

Phone: f 

1 

Team \iMJJ:>^j(^\jP'i' BviD# n:n 7 XRF Code I'304 

Sample Number Lead Concentration Confirmation Sample 

3551 a: (^•Yes n No ffl-' j - ppm 

(^2.Yes n No S ­ ^ ppm i /t.Yes n No IS ' ppm 

'ye s n ^ No ^ ^ 

gs [J^ . No ippm ?es ' No CH 6 RDZSCPLA-12327 

ppm Yes • No • 7 Lab 11800ppm 

C^^Ot 

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: Oct 11.2010 www

. dcgis. org/dogis 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TECHNOLOGIES, INC. 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: 

Crew ..:3 : 

Item 

Overhead Lines 

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 

\r.->:} 

'-^:>.:>.'.P 

:^SiryP 

.A>,o/u . Ua<jj 

|>^or r.rc.'.le| 

T)-^ ^ 

' I^OM 

Pr^rX. 

oV-

TU^/ 

/Jo/Ti> 

A^o^j 

Excavation Date: --t-l^-'Il 

Backfill Date: 

Hazards Corrective Action 

Site Safety Office 

Date: 

8080 VWaid ParkMay, Suite 405 5600 S 10 St 4242 Medical Drive, Suite 7250 

Kansas Giiy. MO 64114 Omatia, Nebraska 68107 San Antonio, TX 78229 

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

Fax:(816)363-3707 Fax: (402)733-1883 Fax:(210)579-6577 
.Page 1 of 2 

'> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2590956. 

Original Call Date: 9/13/10 Time: 4:16 pm Op: SIVA18967 

Work to Begin Date: 9/1.5/10 Time: 4:45 pm 

State: NE County: DOUGLAS Place: 0^4AHA 

Address: 1210 Street: BLAINE ST 

Twp: 14N Rng: 13E Sect-Qtr: 03-NE 

Twp: 15H Rng: 13E Sect-Qtr: 34-SE 

Legal Given: C 

Type of Work: lead soil remediation project 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FA;K ALL CLEARS TO: (402)733-18 8 3 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOiSIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-118 8 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N E.xplosi ves: N 


ATTNEBRl C;<CATV LEVEL3 MCINEB MUD02 OMAHACOF 0PPDGPR6 


PAETEC QLNNEIF 


Service Area Contact Phone Number 

Utility 

Type 

ATTNEBRl ATTT 

Day:

Alt: 

 80024136249 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Ah: 

Emerg: 8773668344 

MCINEB MCI NO CALL PER MEMO 

Day: 8002893427 

Ah: 

Emerg: 8002893427 

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MliD()2 

OMAHACOF 

OPPDGPR6 

PAETEC 

QLNNEIF

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

PAETEC COMMUNICATIONS 

 QWEST LOCAL NETWORK

SANDY 

RICH/TRAFFIC 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

 ELM LOCATING 

Day: 4025047823 


Ah: 


Emerg: 4025047970 


Day: 4024447197 


Ah: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Ah: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Ah: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

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