TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAIP#; 22787 DATE; 1/15 

ADDRESS: 519 S 24 AV 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC YEAR: 20lb 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ni PRE AND POST VIDEO OF PORPERTY (DVD) 

m EXECUTIVE SUMMARY 

a EPA-PROVIDED PROPERTY SKETCH 

/ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

RESTORATION AGREEMENT 

D SETTLEMENT DOCUMENTS (I.E., FOR DAMAGE OR TO REPLACE PLANTS, ETC.) 

E CONFIRMATION DATA 

PHOTOGRAPHS 

I AS-BUILT SKETCH 

Q SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

of PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

• UTILITY CLEARANCES 

• PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

• 

D 

• 

t\^^^^ 

SIGNATURE DATE 

30237443 

'J^ 

niuii IIIIIII 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 519S24AV 

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 = 310 PPM @ 2"; NO EASEMENT 

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 (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 

Backfill: 

Sample Area: 22787 - 519 S 24 AV 

Owner: 

D Owner Occupied 

Owner Name: 

jSERVICE AMUSEMEr^ LLC 

Owner Addressi: 

IC/O JEROME w m 

Owner Address2: 

J522 S 24 ST 

City: State: Zip Code: 

)OMAHA " " [NE 168102-

Owner Phone Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option JOPTION 2 

Remediation Query Lead Remaining Query ] Property Damage Query 

User Provided Owner Information 

Owner Name: 

r 

Owner Address: 

1 

City: State: Zip Code: r^' 1 1 

Owner Phone: Alternate Phone: 

1 ( 

Assessment: 

Qualifying Group ^400 

Assessment Max XRF Value f 501.92 

Resident: 

Resident Name: 

! 

Property Address: 

1519 S 24 AV 

Zip Code: 

168105-

Resident Phone 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: X^^' ^ Property Address: 5( "^ ^7 - ^ f -^^^^^ 

Date/Time: Owner's Name: "^^^OTIA^ ui \-^ 

Quads Excavated: F^— 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 

1 Does the grading around the perimeter ofthe house in excavated areas generally slope away / from the house'' 

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

Tl. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected al a 30 

day time period) / 

4 Are sodded areas generaUy fimi and evenly graded? / 

5. Arc tlie jomts between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

lime period) / 

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

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

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and close freely'.' (If applicabie) / 

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

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

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

Foundation, Siding and Gutters Yes No 

1 Was damage to the siding or trim avoided? 

Was damage lo the foundation avoided? 

- ^ Was damage to windows avoided? 

Was damage to windows or door screens avoided? 

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

Sidewalks and Driveways (Concrete) Yes No 

 Was damage to drivewav surfaces avoided'' 

1. Was damage to walkway surfaces avoided? 

I
Ownn^s comments: 

Inspection notes: 

rfMfi ^ 

c ^ ^..1-' 

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

EPA Representative 0on >j£^ Date: ijisjn 
EOINOLOGIES. INC 

AS - BUILT DRAWING 

OLS # 22787 

Date Excavated: 10/29/2010 OMAHA LEAD SUPERFUND SITE I'SEPASigned-OffDate: 

22787 

Omaha Exterior Paint Owne Lead Site r Nam«; IDA FELLMAN 

Site • Good Sketch Address: 519 S 24 AV • Poor Phone: H 402-342-0400 W: [~) Not painl 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm.

Samples Collected 

 P'&A HJ/'TI. . 

RYASCPXA-22787 Fl ppm B D Date IC--/ C ­ ^ 

RYBSCPXA-22787 F2 ppm 0 D Time: ir'i i 

RYCSCPXA-22787

RYDSCPXA-22787

 Bl 

 B2 ''f ^ 

?5S ppm 

ppm 

0 

0 

D 

D Samples Analyzed 

ppm D D XRF Unit: /<g 3 7 Book: ? 3 5 

_-RaZSCEXA-22?85^ G^ - ppm D D Date: I \-10-O f • •RPZSGr>XA-22?87 Pi ­ ppm D D Time: A M 

Number of Samples = / Staff: A^ 4 

Legend Fl = Front Left, F2 = Front Right. Bl = Back Leff, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ihe street, facing propeity 

ENTEEED 

x>t­ a l t M liivS 

SI'i s -J.4 Av 

3 5 5 j 375­

^'. t.. . 

t^J-r~. 

I 2 = 3I0PP M fl 2" r i F Z -=i 

3:3^ (02. 

WAL-.V: 

|KO.4- 2 4 ,-4v 

NO EASEMKM 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
p KU)IM< ^To^cJ^c/ ^ 

Thii 5.ki;f:eil!r;;:s '.•ivr'--uji;e"('iti tJlc (..i-uipiciiOi; Ol I'dlJO'vai JCiJv'jUrS ye:i'i';'irriei:! uii iliC btii:'v\' Ji.Sit;;d pi'^.tpcjTy. 

The propeity owne:'j. .iignatme indicate,? ihat the propeitv r-vy'tjer is ,=atiyfied with the restora,vj..«ii ol the 

•Siibjecf pioperty a;id that no item:, 'ire )n question, now, or al a:ny iirrie in the future, excluding any 

reini^!nni,g waira/ity' (30 day.s tota) i e.iicept those items !i.sted bel'iw, if any. 

Propsr!.T ffi'-

Proper:!-?- .=;-.i'Jldif';'S.s' ? ^ ] Ci C ^ 

U'WEr'ar­

.PfniiRf, 

Cann-ns^ 

He^slQ-miiiom ii*'5w,iS iirs Qtiiesltiioi' 

ilteim^ 

' ii'tetT'!. 

immItepr-­

im:m co-rirselllionis to comipjlete iihis pi'0!|^®ii*'t.f.-

L*!J i v;..ore^f iestofation is completefl, except as noted abov= 

L ^^ i :>. 0 • jCt £Kit"ee restciration is ccrvipieled 

J^^^lVrkP •Uwfl)* r • s 33 sp. -lieu t'j ' Baie 
^^r^ w t v/ « ^ 


1-875 8 P.O l Oct-25-lO 02i23P MUSI .SERVICE CORP. 4 02 


IVf£A/£WIU i<;ua P.002mi3 

Pntdtni Tccknotogits. h& (PiudcnOB under conma with the U. S. EnvirotMientil Fioieeiion Ageacy (EPA) lo clean op leadtsoils tt«anflitf of pnpcrtittlaaMlia Ootfha, Nitoadi^ mdodinsteprapcrtyloateJ « 

^^<^ * . Ilie KPA nqoMttynirpeniiiuioa to lUow Indent to perfeim a toil elMntiptttliit 

liupifty to rvsfovi loBil^ialuBJiiBCed lofl. BysigriggflwtotD^lhepfcpcitytwOM gyBnopwinriifoiitoPfiidcaltDpBrfbfBi 

icliTitfctittoleJlo(lKdcaa^pincluJmgioilany1iwg.ranDvaloflMd<onfHniiti«W«oi).»»diiil^^ 

lfvoiitoweaB»qQwiHw»«>colUieM<lcleMnippUmitJtoiTOiptopaty.ptet»ecciilKtf>iiilg<S^ 

Lead Sile cteam|i>.at (402) 733-1188; 733-M55. GencialqiiesiuMaakcwtdieOmihaLctdSitccleinapcfnbediRcitdtoiheEPA 

PuWic faifbrnottao CeoMn ai C402) 731 OMS (Sotdk Omibc office^ 

Preparty Asctn Cimttd By: jgRft«t Wirr 

(PteaM Print NOM) 

Piupcfty Ownct Signxm; •VP<M tp-fts-yo 

^ (^tgnaiiBc) (DttB) 

PROPERTY INPORMATICN 

(To te MMBplcud iqr roidwt and/br property owntr - pkMc print) 

RESIDENT Ranter NAME: ^Ct»l.v<j g /9moSgW\g/t r LL C C^O*" ^ 

RESIDENT AOORESS: 

5^*^ -gfc^ ^^t " A-Mg ^></>cAi^r\^T) 

IF RENTAL. PROPERTY OWNED BY: 

OVMWR'S MAIUNQ ADDRESS; 

OWNERSTEL9H0NENUMBER-HOME: fUXL i lann-^^ S WORK: 

AQE OF HOME?; — * YEARS. WOM LONG HAVE YOU LIVED HERCT —•— YEARS. V^C/JK T "^ T 

HAS THE EXTBIIOR BEEN PAINTED OR COVERS} WITH SIDING SINCE 1S78? IBJl " T W 

NUMKR OF OCCUPANTS UNDER 7 YEARS OLO: ^ NUMBER OF OCCUPANTS 7 YEARS OLO AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLO WHO PLAY IN THE YARD FOR 8 HOURS OR MORE PER WEEK: 

-OL 

COMMENTS OR 8PECUU. INSTRUCTIONS: (I.E. DOOS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVtROMMEN fAL RSSPONSE ACHONS I Tbe aclmtiei lo bc iinptemcalcd by EPA under tUj asfcemcnl 

are pummt to Section 104 of CERCLA. 43 USC. 9604. EPA's light ofaecejs to the propetty i i frovided Ibf in Section 104(e) of 

CEKCLA. 42 U.S. C 960S(eX >*4uch pnvldei enliy fbr'dOamiinuiB Ibe iMad (or tesponia. or okoMins Of adcbig 11^ 

under (hi* titiik or otbcrwise enStreiag the pforiatom of dte ttte." 

BOBO W«/ri ParlDMy. Suite 405 . (Sra0 8.10^Sli«at 4242 Madleal Oriv*. Sute 4250 

Kansan CKy, MO 64114 Omaha, Nabraika SBIOT San Antonio. TX 76229 

Phone: (BIO) 363-3703 Phono: (402)733-1465 Phona: (210)6224SBB 

Fax: (816> 363^0 1 Fax: (402)733-1663 Fax: (210) 6704677 
\< .-Jl 

TECHNOLOGIES, INC. 

^ Property Status Form 

Address: "Sl^ ^ ^ ^ /W^ Date: jOU^I(O 

FhoMe; 

^/^^C)/ ^ ^^ ^ f^ 

^p<cj^\//\<rt i: f^SoT ) 

Property Owner 

Signatiuire: 

Pnident EmuJo^e 

 .1 /

Signature: ^..(//"' / \ j 'j-T^-'^^ 

I |V!r;')5r,r;! Diivu. ^jiJiio4'/;il 

i.wih AnirjiiK), 'i".-C Vliilj'.O 

i'h<?Mm: (v-|0) r!'?,-;,')'jt:« 
Iiiniiiii 22787 

Exterior Paint North Arrow 

Owne Omaha Lead Site r Name: iDA FELLMAN • Good Site Sketch Address: 519 S 24 AV • Poor 

Phone: H. 402-342-0400 W: Q Not paint 

Sample Number 

RYASCPXA-22787 

RYBSCPXA-22787 

RYCSCPXA-22787 

RYDSCPXA-22787 

Lead 

Concentration 

3 5-^ 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

0 

B 

0 

0 

LAB 

D 

D 

D 

D 

Firm:

Date:

Time:

Samptes Collected 

 f^t A HJ/'TI . 

 /O-zP- ^ 

 //•*fo 

Samples Analyzed 

ppm 

ppm 

D 

D 

n 

D 

XRF Unit: 

Date: _ 

/^?57 Book: JZ3 3 

\l-W~OS' 

ppm D D Time: Arri 

Number of Samples = / Staff: LPK 

Legend: F1 = Front Left, F2 = Front Right. B1 = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quacfrants are as viewed from the street, facing property 

NT,EEED 

XX- Z ^ r ' -'") OCT H aes 

H„^ ' 

WK s 2-4;/i' 

3 5 5 

•"N 

I 

f

I 

r 

I 

\ 

I : / 

•^"S^- i 

f^ 

\ ^ SPZ. 

VvAtX 

lA. A^ 046141.0123 
iiliii 22787 

Owner Name; IDA FELLMAN Omah a Lea d Sit e Exterior Paint North Arrow 

Address: 519 S 24 AV Site Sketc h 

Phone: H: 402-342-0400 W: ZJ Not paint 

Sample Number 

RYASCPXA-22787 

RYBSCPXA-2278? 

Fl 

F2 

Lead 

Concentration 

ppm 

ppm 

Sample 

Collected 

B 

0 

LAB 

D 

D 

Pimr

Date:

Time:

Samples Collected 

 P'6A Hj/:rj.. _ 

 W~/ G -:£" 

 11^*^6 

RYCSCPXA-22787 

RYDSCPXA-227S7 

S1 

S2' M 

3BS ppm 

ppm 

0 

0 

n 

D Samples Analyzed 

ppm G n XRF Unit 103 1 Book: 13 3 

-—G2­ ppm D D Date: _ W-W-oS' 

RPZSCr^X;'\ 22787­ ppm D D Time: _ A ^ 

Staff: LA Number of Samples • f 

Legend: F1 = Front Left, F2 = Front Right. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from 'tie street, facing property 
N Lega

l Description: 24.32 X 48.64 ^^ ^ 

A Printed

: Oct 25, 2010 •i^ » 

vvww.dcgis.org/dogi.s 
Page 1 of2 

"> 

Create Another Ticket Back,to Jitb .1 nternet Send Email 

YOUR TICKET NUMBER IS 2625964. 

Original Call Date: 10/25/10 Time: 4:11 pm Op: SIVA18967 

Work to Begin Date: 10/27/10 Time: 4:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 519 Street: S 24TH AVE 

Twp: 15N Rng: 13E Sect-Qtr: 21-NE-SE,22-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 


: 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 


ALTS72 CXCATV DOCOINFS ENERGY LEVEL3 MUDOl OMAHACOF 


0PPDGPR5 PAETEC QLNNEIC 


Service Area Contact Phone Nunlber 

Utility 

Type 

ALT872 WINDSTREAM 

COMMUNICATION ELM LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

DOCOINFS DOUGLAS COUNTY 

INFORMATION SERVICES ALLAN 

Day: 4025107242 

Alt: 4024447188 

Emerg: 4025107242 

ENERGY ENERGY SYSTEMS CO DAVE WOODS 

Day:

Alt:

 4023469066 

 4023469128 

Emerg: 4023469128 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/25/2010 
Page 2 of2 

LEVELS 

MUDOl 

OMAHACOF 

0PPDGPR5 

PAETEC

QLNNE1C

LEVEL3 COMMUNICATIONS, 

LLC 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 PAETEC COMMUNICATIONS 

 QWEST LOCAL NETWORK 

NA 

SANDY 

RICH/TRAFFIC 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

ELM LOCATING 

Day: 8773668344 


Alt: 


Emerg: 8773668344 

Day: 4025047823 


Alt: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/25/2010 
TBBHN< . M C CONSTRUCTION 

SOLUTIONS 

SITE SAJ^TY HAZARD ANALYSIS 

Address -SZS. i-Jii-j^ : Excavation Date: 

Crew: — BackfiU Date: — 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Stractures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

OJT*^ 

e^ 

h^' (t7 

- — — 

ore 

a/^ 

. — 

Pc^>*- CXii^ 

a ^ 

c?^— 

-

Site Safety Office 

Date: 

so WwfSvtaiay . St«e 44B seoosiost 4242 Itedical Drive, Suite 7260 

Oiirttaa, MttiratiM OT1g7 San Antonio, TX 78229 

: {Sit) 3SS-37V3 PhOfM: {402)733-1108 Phone: (210)822-0588 

K fMi ) 363>^3707 Ftax: 4402)733d«83 Fax: (210)«79-S577 
^ 

:*5ir»»J. 

« .^ ^ '" ^ 

:ift'?