• m 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAE)#: S^y Date: /0|K)<^' ^ 

Address: 2^ftf ^ T. ^ ^JT. . ^/ L 

Remediadon Contractor: J ^ _ LJ h f^ >>^ -^ ^ r^ Year: ^ ^ ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Bf

0

S

0

D

^ 

n

a

\2

H

0

ill

D

C/

0

D 

D 

D 

 Video of prc^erty (DVD) ^_ _ 

 Execudve Summary 

 EPA-provided property sketch 

 Signed Access Agreement for subject property 

 Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

 Confirmation data 

 Photographs 

 As-built sketch 

 Satisfectory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Description of areas not meeting ROD cleanup criteria 

 Utility clearances 

 Property information from Douglas County Assessor's Ofi&ce 

JSignatiire ' Date 

30054266 

iiiniii 

Superfund 
Rnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 591 - 2448 TEMPLETON ST 

Owner: 

D Owner Occupied 

Owner Name: 

|DELACRUZCUADRA JUAN 

Owner Addressl: 

|C/0 JUAN DE LA CRUZ CUADRAS 

Owner AddressZ: 

)Z448 TEMPLETON ST 

City: state: Zip Code: 

|OMAHA [NE |6811 1 

Owner Phone: Altemate Phone: 

r 

Resident: 

Resident Name: 

Property Address: 

|2448 TEMPLETON ST 

Zip Code: 

|68111 

Resident Phone 

r 

Contract: 

Contractor: 

|PRUDENT2009_S 

Contract Option 

|BASE 

Assessment: 

Qualifying Group 

poo 

Assessment Max XRF Value: 

r 413.2 
iHWiUHiiitiivy *«i mffwtMgy 

Date: 12/15/2009 Omaha Lead Site Remedial Actioii Contract # EP-R7-07-06 TO#l Month of: November 

Property Address: 2448 TEMPLETON 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: 

B2 =190 PPM @ 6"; DZ = 435 PPM @ 13"; EA = 188 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-Buih sketchi) Shall mcludefinal 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 m MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description ofareas not meeting hiterim ROD cleanup criteria. 

iHDiaffiEE^.ir^. 
' TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ^ } Property Address: Slfk^ Tcw<pLiU^ ^ 

Date/Time: Owner's Name: '^^cci^0cU.Cr^^1 (^^^c{^ 

Quads Excavated: ^x . ^-j . Contractor Group: Prudent Technologies,Inc.,

Excavation General Yes 

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

2. If necessar>', were (he correct areas of drip zone excavated and restored? y 

Grading Sod and Vegetation Yes

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

from the house? y 

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

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

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

y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls Yes

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

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

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

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

/ 

Foundation, Siding and Gutters Yes

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? 

y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 

y 

" 

No 

 No 

 No 

 No 

 No 
Owners comments: 

Inspection notes: 

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

EPA Representative Q^^ -j^ ^ Date: /i/iojaf 
Property Completion Agreement 

Tliis 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 fiiture, excluding any 

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

Property ID: 

Property Address: r^i^-M y e^A>^ ^nleh^—D f 

Owner: J ^ ^ -P 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Required corrections to complete the property: 

LJ I agree restoration is completed. 

LJ I do not agree restoration is completed at (noted deficiencies above) 

Date 

10 j'^jo ^ 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Enviroiunental Protection Agency (EPA) to clean up leadCQDtaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

^H'i a fi^JtAfil^Tfyifi ^ T r- ^ * ^^ ^ requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove l&d-contaminated soil. By signing this form, tlie property owner grants permission to Prudent to perform 

activities related to the cleanup including soil sampUng, removal of lead-contaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact the Prudent 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 Information 

Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: 

X^^ 3 (Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: (jUQlA UQ/luCtJ'Z. JyUOd^Q ^wieT^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 5, CA n/l-e 

. OWNER'S TELEPHONE NUMBER - HOME: fl^) I j/" ' /- ^ ^ 7 WORK: 

AGE OF HOME?: 10 YEARS. HOW LONG HAVE YOU LIVED HERE? ( ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? Vv/^ YEv S NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C ? 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 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 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." 

: ...I r\— 
(:f«W«?E«UC!TH6W 

TECHNOLOGIES, INC. S»iERVICB.S 

Property Status Form 

Address: ^V'/ ^ ^ ^ny/e^y i ^^ • Date: f^'^^O^ 

Phone; V/ ^ ::? - a / 7 " VV.5^^/ /f^ <?// 3 BVID: 3S^^^ 9 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes V ^ No 

— Item NO 

On Map 

Description & Location 

Property Owner Prudent Employee 

Signature Signature: 

^«B0WsitFPaMnrafy,3utte'4Q5 '2505: M. '24"'^Strset^uite:308 «.fAf2ii!l&2lttCr6lL)'5iv«.-3iiir;K>;..>.ii:'..' 

iKanssf Cfty;«ae4tf4 'Omaha,! ltet)iaska:6S1 fO 3S2I i«Art tm-iu ,TT .V7C.;i:r:' 

Phone; {WSfSSOi^Slta Phone: (402)504-1004 

FFax: (816r<S63S3707 Fax: 1(402) 504-1005 F?«LME;!I>>'errs =?•?•:•" 
ICHNOLOGIES, INC. 

OLS#:591 

AS - BUIjLT DRAWING 

Date E\cavated: 09/22/2009 

USEPA Signed-OfrDate: OMAHAiiEMSt ^ 

591 

Omah Exterior Paint North Arrow 

Owne a Lead Site r Name: Site • Good Sketch Address: 2448 TEMPLETON ST • Poor Phone: H^ W- (S) Q Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: Sverdrup. 

RYASCPXA-691 YA 413.2 

ppm El D Date: 

RYBSCPXA-591 YB 229.2 ppm 

Time: 

RYCSCPXA-591 YC 34S ppm n El 

D 

Samples Analyzed 

RD2SCPXA-591 DZ 489.2 ppm El D XRF Unit Boole 

RGZSCPXA-591 GZ .ppm D D Date: 10/24/1999 

RPZSCPXA-591 PZ .ppm D D Time: 12:31 

a staff: 

RYDSCPXA-591 YD 255.8 ppm El 

Number of Samples = 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, P2 = Play 

YD VA 

 190 PPM ra 6" ^\S ^ YA = 25^ 

DZ 

m 

DZ=435PP.Mf^l3" Iti 

TEIVIPl£TON 

n 

YC'^ YB y 

3^8/ ZZ9 y 

TEMPLETON 31 . 

EA = 188 PPM @ SC'R.4PE (-1") 

R<rv4 

CONTRACT #: EP - R7-07-O6 T0#1 PRUDENT TECHNOLOGIES, INC. 
.v)i 

Omah y-7«.- tr-tfjv a Load Site ttanwrMame- SiteSketdi AAtf«8S:344aTCMRJuTOK S~ 

PtUtOB. H W

f l 

L£Qd &srr»s6 $amsee Number 

.tm GfldifBcijes; SviM:Jiiifi 

RYASCPXA-&91 YA ??{?rri 

^ U 

PV8SCPXA5B1 YB 2Z6 2 ppr s D Tin e 

RrcscpxAsei YC M& ppiT 2 O 

Samples vi-5 yzcd «fD6CPjgV50l YD 26&6 ppn- m _ j 

RCZSCP3?A59l DZ itss.a fjpit, 51 ZJ 

RGZSt^FXAr^; 2Z 

ppm 13 n -:JI'74,'1S.'?S 

RPZSCPXA-59- PZ 

j^pm D D ; 116.. 

L-!3ff ftjfttbs; al iiarrat«s 

L^end: YA-ysnUHEi VB= VardifSE'l VC = Yatid(3W; v p = ^5.^.(x^,v.i. C7:: Rr:: ?.:••*- Ci7 ti:iiil«P ^V P-l.-y 

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"EJv^.PUTC'N 5 T 

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y-jf - '..••o-AOmaha Load Site OwtMrMm w p i -^ori Site Sfcetcti Address: ^•**" TMC'_C7C'S 5" r ^-^:r 

' L Pho«e. '• •'^' r • s-.-i i.f.'iii 

jiaiiftfe huml3€- Lead 

riLiK;rtriMi-ili( 1! •r/!iU«r;t A;" 

F •••!

3c-nj;;c s CcllfCt"'.-

 Sv : •; :ii M| 1 

HYASCPXA-SOi Yi^ 4".:*: ; ;?P'-i i>l LI J'^lti 

«vgsc=>>:A!Wi Yl> 22fiL " _ Cfiir'" 1 ^ D 

??T^i;c^pxA ba" 

HYDSCPXA-SOl 

VJ 

YH 

345 

;?5F,r. 

_

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 PPr 

 PP" 

i ! 

& 

! : 

S3mp:cs A-svrcd 

RDZ5CPXA 53- DZ 48a.-.(! . Cpif' 3 —; , X 5 P 1^ 

RCirSf:^=XA-sQ' C2 _ CCiT- U 

Hf'ZSCPXjt-S-O­ ' 7 :::x-ii U D •!K­ '!l:..i" 

Mj.^nkiSi .01 i>aKr>«-!, 

Lagena YA = VardCNEi Ve= Viirt1.:3£': VC = Yyi:.l.;5V>, '^D =Viv;.- tWW. V.7 n :: ?.:-.• ti.^ CiimlM • :"/ n.,,-

i^/ViFLrT-N 5T. 

ki 
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Ht;, 244

8 TEMPLETON ST ?A , 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel 

ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

\2 

Owner 

\City 

Owner 

State 

Owner 

\zip 

1644130000 

DELACRUZCUADRA 

JUAN 

2448 TEMPLETON 

ST 

OMAHA 

68111 

2448 TEMPLETON 

ST 

OMAHA 

NE 

68111 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

LUKE&TEMPLETONS 

0 

13 

50X132 

0.15 

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

parc=1644130000 

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

accountno=R1644130000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/2/2009 
Page 1 of2 

"> 

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

YOUR TICKET NUMBER IS 2361235. 

Original Call Date: 9/10/09 Time: 2:12 pm Op: SIVA18967 


Work to Begin Date: 9/14/09 Time: 2:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 24 4 8 Street: TEMPLETON ST 


Twp: 15N Rng: 13E Sect-Qtr: 03-NW,04-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 MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP DEBORAH Alt: 

Emerg: 9185747098 

Day: 4025047823 


MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 


httn*//www Hhnn nro/irtViint*»mf«t/r^HOXr\T/-«fi/»or"i.ao+i«»i/X^.= .0-« * .-DT^CTTT T^n r\ / t rt f^r\/\f\ 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

httD://WWW.dhon.Orp/irfhintPTTlRt/nHn>J>Jr»tir'pPr*»Qfi'rtri/\/focco«oTov+ oo»»9..^+—-OCCT TT T C num'^nnn 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis CD 

Address: j2^<y$- y-ct^^isjc^ Ex._ 

Crew: Bf. 

Date: ?• /f- cr<^ 

Corrective 

Item Condition Hazards Action 

Overhead Lines ^^SKZ . t^Kj/J^^J e I h ^ 

Gas Line ^'^'•aJ l^y j /jg&vAf 

Water Line 4- + 

Sewer Line ^L'lr i g j M "j i iec^/f^ 

Septic / Leech 

field /t/^ 

Propane/Butane /tyA 

Sidewalk /^«g ^ (hi ^ ,^/y^ 

Foundation y^-^ 

Retaining Walls 

Fences /U.^ 

Trees Mu 

Structures ^ ^ 

Driveway /Pc»y<­ t ^ j fp piP^i ^ 

Sprinkler System *^/ i 

Other 

Crew Foreman Site Safet\ Officer 

8080 Ward Parkway. Suite 405 2505 N. 24 Street. Suite 308 4242 Medical Drive, Suite 7250 

Kansas City, MO 64114 Omaha. Nebraska 68110 San Antonio. TX 78229 

Phone: (816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax:' (402) 504-1005 Fa»- (7101 fi7<)-fifi77 


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