TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Hbl^ l Date: lO/jt/z^tO 

Address: I ^Cs ^ 7 <^ t 

Remediation Contractor: Ppt-, rypr>rf l^r.\k N^icpg '<^*V /Ai<r.y Year: '3-010^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

CQ/ Video of property (DVD) IjVe, / fios.^ 

s / JExecutive Summary 

EPA-provided property sketch 

ESy Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

S/ Restoration Agreement 

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

•'B^ ConjBrmation data 

IS/ Photographs 3o-4^ ^ *=^^^ 

5/^ As-built sketch 

IS/^ Satisfectory restoration signed by Property Owner 

Sl / Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

"SK Utility clearances 

5/ Property infonnation from Douglas County Assessor's Office 

D ^ 

D 

30262408 

iiHnniiii 

Superfund 
PROPERTY SUMMARY 

Date: 10/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: October 

Property Address; 1509 Z 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 = 347 PPM @ 9"; DZ = 77 PPM @ 13"; Bl = 255 PPM @ 9"; B2 = 310 PPM @ 9"; EA = 183 PPM @ 

SCRAPE (~1") 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreenient including access agreements required for crossing other properties 

3) Pre-Excayation 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 of areas not meeting hiterim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
Find Record 

Backfill: 

Sample Area: 46134 -1509 Z ST 

Owner: 

d Owner Occupied 

Owner Name: 

JRODRIGUEZ ERIKA C 

Owner Addressl: 

r 

Owner Address2: 

11509 Z ST 

City: State: Zip Code: 

lOMAHA " [NE 168107-

Owner Phone Aiternate Phone: 

r 

Contract: 

Contractor: |PRUDENT_2010. .S 

Contract Option iBASE 

Remediation Query J Lead Remaining Query J Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: Alternate Phone: 

1 " 1 

Assessment: 

Qualifying Group 1400/CHILD 

Assessment Max XRF Value j 650 

Resident: 

Resident Name: 

JMEYER ROLAND P 

Property Address: 

|1509ZST 

Zip Code: 

168107-

Resident Phone 
!R 

TBCHNOLCXilBS, INC S^drfA 

EPA Property Close Out 

Property #: ^6>i 5 f Property Address: ^'^^^ " ^ ^ " 

Date/Time: Owner's Name: ^yr\ I'cu. Y-o d \ i Oi.^ ZQuads Excavated: p 2 i O'Z., €.1, ft2- Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

I. Does the grading around the perimeter of the house in excavated areas generally slope away / from the house? 

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

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

day time period) / 

4. Are sodded areas generally firm and evenly grad.ed? / 

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

time period) • 

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

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

Gates, Fences and Retaining Wails Yes No 

1. Do gates open and close fireely? (Ifapplicable) / 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 7 

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

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / 

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

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

Sidewalks and Driveways (Concrete) Yes , No 

1. Was damage to driveway surfaces avoided? / 

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

Inspection notes: 

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

EPA Representative B"^-fi^ ^Date: 5^ il [

nii6 
m. CHNOLCXJIES, INC 

AS - BUILT DRAWING 

OLS #46134 

Date Excavated: 08/28/2010 

USEPA Signed-Ofr Date: OMAHA LEAD SUPERFUND SITE 

Name: fc . 1 f. h : ^ Oinaha Lead Site 

Address; •SF7 Site Sketch 

Phone: 

Team /i) /ii/'/i.' ( C^i.) BVID* ^//-./i y 

Sample Numtier Lead Concentration 

1 ppm So 

ppm ^ ^ 1 

^ 3 ^ ppm 

ppm 

.iiiL. 

ppm 

ppm 

ppm 

==ife= sr Bl = 2.S5 PPM a<r- p 

^si hi ?-^.' 

'^^tl 0 

\/ JS0J? J— 

^i 

k. PrDate: I L ''1 w North Arrow 

Time: 1 -.('J I 

'v 

XRF Code S^*^! 

Confirmation Sample 

^'Yes n No a 

•'^Yes a No El 

^;Ye s

^uYes

/?oYes

Yes

Yes

 CD 

a 

O 

a 

a 

No

No

No

No

No

 Cl 

 E] 

Q 

Q 

D 

5. 

uy...i| 

B2 = 3I0PPM a 9" 

-

•••'•lirvf:.-: 

1)7 = 77 PPM a 13" 

*H"5-i<f 

^ ^<i fc n 

r P2 = 347 PPM a 9" i^^ . f l 

zn i65o 

'fr..-; 

"Z se 

Omaha Lead Site 

46130 FA = 183PPMfa'SCR.APK 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
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 of the 

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 those items listed below, ifany. 

Property ID: 

Property Address: ( ^ & <) - ^ S^— 

Owner: ^^ « ^ ^ ^^fH^^ i ^ V -

Phone: " 0 

Restoration Items in Question: 

Item: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^ ^ ^ 

/t u I agree restoration is completed, except as noted above. 

L J I do not agree restoration is. completed 

Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminateiLspils at a number of properties located in Omaha, Nebraska, including the property located at 

|9P ^ ^ ^ K ' . The EPA requests yqur 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 planned for your property, please contact Prudent .South Omaha Ofl'ice for the Omaha 

Lead Site cleanup,.at (402) 733-1188; 733-14SS. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-304S (South 0mp|;a oflice). 

Propeity Access Granted 

Property Owner Signature: pk /if) "(Date) 

^MATION 

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

RESIDENT NAME: ^"^ W t_ ^ Owner Renter 

RESIDENT ADDRESS: 

\Se> q 7? Q » Ovs.^..JL. v^ ^ C^-\c^n 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

JWNER'S TELEPHONE NUMBER - HOME: J L 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 

_3_ NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD F0R.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 of CERCLA, 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 960S(e), which provides entry for "determining 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 8.10'" Street 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1455 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form . . Address: 1*5 <^^ <S>ih Date: ^M | | 0 

Phone: qp^­- ^ H ~ S3» ^ BVID: 

Kin p ( ^ ufc . ^Jb L^wJl Sc o p >r 

^Z, . p- n ^'U . S^. ^ J^ ^ Q-^vx..^ jg f,^(i~ 

S\n ­ 5-3^7 . ^ 

rWf g u -^-ix>- Xk . Ai^ ^ -k^^^ i P ^ C^^-^^-—<. • 

Qyjtg1^^.>^ ^ '^y.^<u? Lgt-">-a-e­ Or-^uUa_y\ aJFQl. ^ t:>y> w<L «^ ^ . 

Prudent Employee 

Signature: 

8080 Ward Parkway, Suite 405 2505 N. 24"* Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio. TX 78229 
Name: P.-. . I A K Omaha Lead Site Date: //-'V-fo North Arrow r Address: /^P7 ^ ^(- Site Sketch Time: 1^(9 & 

Phone: 

Team f\\ /kJ.llie. C (Jt~) BVID# ^/^7 / ^ V XRF Code ^"^^ l 

Sample Number 

1 

2 

3 

4 

5 

6 

7 

0 

r 

v/ 

e 

t ^ 

- ^ ­

• hwimt* 

Lead Concentration Confirmation Sample 

i 50" ^ ^ ( 

.37 ^ 

^ 1 ^ 

•m'\ 

'M^\ 

i ""'^Li- i^ 

rlr.l^lc . 

i.s.0i. 

?i 5f I 

/^firc-h i 

i,c^f u/'--^'/~ 

7 s^ 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

I 

^'Yes

^•CYes

Ay Yes

'Ji Yes

/?^Yes

Yes

Yes

 a 

n 

n 

 1^ 

n 

• 

• 

No

No

No

No

No

No

No

 Q 

S 

S 

0 

H 

 CD 

• 

5. 

.vA <-•­ _ - U ' 

k.. 

^q ­

-i(fUJcfl 

^<­ ^( ^ 

656 

//c..­

,.-i c; 46130 
Page 1 of I 

160^ -2- Sl 

http://douglasne.mapping-online.com/assessdoc/Photos/38/R05078600000001.jpg 6/14/2010 
Print Preview Page 1 of2 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

0507860000 

RODRIGUEZ 

ERIKA C 

1509ZST 

OMAHA 

68107 

1509ZST 

OMAHA 

NE 

68107 

10-14-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

ALBRIGHT CHOICE 

32 

3 

50X130 

0.15 

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

parc=0507860000 

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

accountno=R0507860000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/15/2010 
8/9/2010 ,ttp://www.dhon.org/irthinternet/DHO... 

Create Another Ticket Back to Irth Intemet 

• YOUR TICKET NUMBER IS « 2563770. 

Original C all Date: 8/09/10 Time: 3:06 

Work to Be gin Date: 8/11/10 Time: 3:30 

State: NE County: DOUGLAS 

Address: 1509 Street: Z ST 

Twp: 14N Rng: 13E Sect-Qtr: 10-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Soil Remediation Project 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: 


Involves Tunneling or Horizontal Boring : 


CXCATV LEVEL3 MUD02 OMAHACOF 


Service Area 

CXCATV COX COMMUNICATIONS, INC

LEVELS COMMUNICATIONS, LEVELS LLC 

METROPOLITAN UTILITLES MUD02 DISTRICT 

:^end Email,, 

pm Op: SIVA18967 

pm 

Place: OMAHA 

-

Phone: (402)733-1188 


N Front: Y Rear; 


N Explosives: N 


0PPDGPR6 QLNNEIF 


Utility Contact 

Phone Number Type 

Day: 4029S40469 

 HEIDI 

Alt: 4029S40469 

Emerg: 4029S29757 

Day: 877S668S44 

NA Alt: 

Emerg: 877S668S44 


Day: 402504782S 


SANDY 

Ak: 


Emerg: 4025047970 

Day: 4024447197 


CITY OF OMAHA- OMAHACOF 

RICH/TRAFFIC Alt: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

dhon.org/irthinternet/.../MessageTextas... 1/2 
8/9/2010 ttp://www.dhon.org/irthinternet/DHO..

OMAHA PUBLIC POWER 0PPDGPR6 DISTRICT 

QLNNEIF QWEST LOCAL NETWORK 

ELM 

LOCATING 

ELM 

LOCATING 

Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 4067289343 


Ak: 4062071494 


Emerg: 8887289343 


dhon.org/irthinternet/.../MessageText.as... 2/2 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFfcTY HAZARD ANALYSIS 

s4 Address: l^u^^^J ^ ._^JLJ^1 ^ Excavation Date: 

Crew: fcLiW^-. Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines ^ooA J ^ ^vNNjt yo W 

Gas Line ^ o ^ v^o 

Water Line ^iQi^A, *\ 0 

Sewer Line ^VlftJl V^T> 

Septic/Leech 

Field Kl/ft 

Propane/Bntane ^JV f 

Sidewalk ^ao ^ jjki L *?\v wJ-aa<^ 

Foundation fa^A. -v\ 0 

Retaining Walls w*^ v > C 

Fences Y \ 0 

Trees G^Bd A JSaA. a-. y «3'"o y ^ -V"'* »\«^ ^*i 

Structures fa<><?4- ~«rvO 

Driveway (siar> ^ VA O 

Sprinkler System j j i ^ 

Other 

Crew Foreman Site Safety Office 

Date: 

/9/>^ ^^ -oe^ h^£_j:o_ 

OSOOSIOSt 4242 Madical Drna. Suite 72S0 

iCMy;MO«4114 ibMlMWia ? SanAntonio,TX 78229 

: (816) 30^3703 PhofiK (402)733-i m Phone: (2t0).822!«588 

toe (MS) 36347V7 ftc fMQTSS^IttS Fax: (210)679-6577 
* , ,=51*'•'«**'•' 

..* - 150 ^ • t