TRANSMrrXAL of OMAHA LEAD SrTE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ??CC ;^n Date: 1 1 ' I 5 " I 0 

Remediation Contractor: Ppt-. nPrM^ l^rA^ N/TCOC, ift <\. //VK^. ? Year: cAjX (j 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

/ Executive Summary 

^ EPA-provided property sketch 

Ef Signed Access Agreement for subject property 

n Signed Access Agreement(s) for adja^nt property 

^ Restoration Agreement 

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

^ Confirmation data 

d Photographs 

y As-btiilt sketch 

y Satisfectory restoration signed by Property Owner 

^ . Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

^ Utility clearances 

Property information from Douglas County Assessor's Office 

D 

D 

D 

Qo^J^ ilifclw , 

Signature Date 

30218347 

•HHHIM 

Superfund 
PROPERTY SUMMARY 

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

Property Address; 3116 FONTENELLE BLVD 

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: 

Bl = 87 PPM @ 2"; EA= 113 PPM @ 2" 

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 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. 
Find Record Remediation Query j Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 85030 - 3116 FONTENELLE BD 

Owner: User Provided Owner Information 

n Owner Occupied 

Owner Name: Owner Name: 

INEI^O N DONALD V 1 

Owner Addressl: Owner Address: 

1 ! 

Owner Address2: 

|3116 FONTENELLE BLVD 

City: State: Zip Code: City: State: Zip Code: 

(OMAHA |NE J68104- j 1 r • 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1(402) 457-4007 )(402) 312-1988 1 1 

Contract: Assessment: 

Contractor: JPRUDENT2010_S I Qualifying Group 400 

Contract Option OPTION 1 Assessment Max XRF Value 490 

Resident: 

Resident Name: 

Property Address: 

)3116 FONTENELLE BD 

Zip Code: 

)68104-

Resident Phone 

I 
.))jg]ji-!")ikj\.1: 

TKMNOLOGDES, EMC. •:<-y ? '' ''..-•-jv.^ju U 

EPA Property Close Out 

Property #: ^'70 $ <^ Property AddressL ^51 '(^ ?*'^+<^-^le Uv A 

Date/Time: Owner's Name: %^oru>t.\ck ^^Sov \ 

Quads Excavated:' Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

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 ail areas that were e.\cavated? y 3.

 Does tl^e sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) y 

4. Are sodded areas generally finti and evenly graded? y^ 

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

time period) y 

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

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

Gates, Fences and Retaining Walls 

Yes No 

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

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

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

Was damage to retaining walls avoided? (If applicable) y 

Foundation, Siding and Gutters 

Yes No 

I. Was dainage to the siding or trim avoided? 

2. Was damage to the foundation avoided? "7 

3. Was damage to windows avoided? y^ 

4. Was damage to windows or door screens avoided? 

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

Sidewalks and Driveways (Concrete) 

Yes y. No 

1. Was damage lo driveway swrfaces avoided? fr 

-y 2.

 Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative ^'^ ^ ^ ^Date: io\(s\\o 
rRNDEDCIES. INC 

AS - BUILT DRAWING 

OLS #85030 

Dale Excavated: 09/28/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signcd-OfT Date: 

85030 

Omati Extenor Paint a Lead Site • Good Site Sketch 

Q^Poof 

Sampling Address: 3116 FONTENELLE BD [ ] Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Firm: pE Tuf . DP.T.\ 

RYASCPXA-85030 Fl ppm D Date; 7/01/o ^ 

RYBSCPXA-85030 F2 115 ppm • Time: l7-2f?PN\ 

RYCSCPXA-«5030 B1 Jlio ppm D Samples Analyzed RYDSCPXA-85030 B2 IQ? ppm D 

RDZSCPXA-85030 DZ AH2^ ppm D XRF Unit; IQSfr'Z- Book; ZMfi> 

nGgOCPXA-05030 -ez ppm D D Date 1 IS -o'=t 

nPZOCPXA-B5030 PZ- ppm D D Time: 

nn. Staff: Numt>er of Samples = 5 nsw 

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

All quadrants are as viewed from ttie street, facing propeity A. . e v 

R<\- :JK« rre^tfj: 'iri-SovJ« w^w^ 

Toivn-EMEH_E tip . 

EA = 1I3PPM aj2" 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 
x^ 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below hsted propert^/ 

The property owner's signature indicates that the property owner is satisfied vvith 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, if any. 

Property ID: 

Property Address: Mit t P-of^^ey\-p.(llp B n 

Owner: """^ 

1 Phone: 

Restoration Items imi Qyestion: 

ItetB: 

ttem: 

ttem: 

item: 

Item: 

Required correctiioirss to complete the property: 

\n\ I agree restoration is completed, except as noted above 

L J I do not agree restoration is completed 

-W;) ' Aj^ ^ 1o\\:> 

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

dj l U p K()ftff£Al^Ll.f. Qt-V^ • Tlie EPA requests your permission to allow Prudent to perform a soil cleanup at this 

propertyto 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 of the referenced property. 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent south 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: ^Uikio 

(Signature) (Date) "'^.Vs^^*- . 

PROPERTY INFORMATION 

J, (To be complet^ by resident and/or pproperty owner — please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

3 // ^ Fo /V TlAJtLL €^ 3^ / & 

IF RENXAL, PRQP55TY GOWNED BY: 

OWNER'S MAILIN .ING ADDRESS ADDRESS; ^ v,^^ .

3\( U v^^YN>u> ^ \ VJ (^ 

OWNER'S TELEPHONE NUMBER - HOME: f^? ^ Y ^ f " 2-^7^ ^ WORK: 

J L 

AGE OF HOME?5^ YEARS. HOW LONG HAVE YOU LIVED HERE? 2x YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? ^_2\_YE ^ S NO

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: I NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER
 <V. ^

ISTS 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 


±2_ 
 COMMENTS OR SPECIAL INSTRUCTIONS^I.E. DOGS, ENTRY GATES, ETC.) 

tr 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSi The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 9605(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 of the title." 

8080 Ward Parkway, Suite 405 5800 S 10 St 4242 Medical Drive, Suite 4260 

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

Phone: (816) 363-3703 Photie: (402)733-1168 Phone: (210)822-9888 

Fax: (816)363-3707 Fan: <402i 733-1883 Fax: (210) 579-6677 
ENV[ROiNMEi\T.\L& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 3// ^ foNTl^N€LLi S^*/T> Date: ^/^ijOiO IO 

Phone: ^^_^^_2f ^ BVID: J5c ? 3 0 

/<r^^7>//?<: A OCA 6 h 

u l YLAA/? ^ KtMoO l Oi^'O f^ca ^ O^y^ C^xYtoU-^ 

^ ^ K J lic^vuivei Fsy^^i ^ S^yf^(>/^(^ ^KcAvitrT ^ ((1'5 ^ ^ 

\)o ^ i^^^l l?e /jyy f^Sri)^. "yc? /Uoin7='y 

OuJiyK€ir ^t^/j^uen^^ (Zs^,yv*^v^ {x^y-WkKyJ 3-'^ ht^ r J 

Property Ownei Pnident Employee 

"^^.U^ ^ Signature: Signature: 

8080 Ward Parkway. Suite 405 5600 S 10 St 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) 822-9688 C-.W. /O'IC t ie- * '»TAT C.»v. tAt\t \ Ti l '400 1 i:..v. tt^rw e70JS«77 
^'. ^ 85030 

Omaha Lead Site Exterior Paint Nortn Arrow 

Site Sketch • Good 

G/Poor 

Sampling Address: 3116 FONTENELLE BD Q Not paint 

Sample Number Lead 

Concentration 

Sampte 

Coitected LAB 

Firm: 

Samples Collected 

RYASCPXA-85030

RYBSCPXA-8503C

RYCSCPXA-85030

RYDSCPXA-85030

 Fl 

 F2 

 Bl 

 B2 

103 

;i5 

H'^O 

105 

ppm 

ppm 

ppm 

ppm 

c/ 

D

• 

D 

D 

Date:

Time:

 7/C>ili:>'^ 

 12,-25? h 

Samples Analyzed 

RDZSCPXA-85030 DZ IH Z ppm D XRF Unit: I08 R Book: ZHie. RGZGCPXA-eSOOO

RPZCCPXA-8.5Q30

 82 

 PZ­ — ppm 

ppm • 

D 

n 

Date: _ 

Time: 

1 -fS -o ^ 

Number of Samples = I 3^ j Q Staff: <nsw 

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

All quadrants are as viewed from the street, facing property A ; t c V 

Crtiittd' orMNnvJ:'S W»>v- 0447ni ui ;3 K 

TGWTENJEI_I.£ 'b'D. 
^ ^ Page 1 of 1 

3M^ mh-hdJe Slvd, 

K. %^ 

http://douglasne.mapping-online.com/assessdoc/Photos/04/R24144900000001 .jpg 9/14/2010 
H 

A Printed

: Nov 16,2010 

www.dcgis.org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet Send Emails 

YOUR TICKET NUMBER IS 2597347. 

Original Call Date: 9/21/10 Time: 11:04 am Op: SIVA18967 

Work to Begin Date: 9/23/10 Time: 11:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3116 Street: FONTENELLE BLVD 

Twp: 15N Rng: 13E Sect-Qtr: 08-NW 

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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 


QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/21/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION tBOHNOLoenp, mc. SOLUTIONS 

SITE SAl^TY HAZARD ANALYSIS 

Address: --3llJji--^LJ2i2£siL£U£.. Excavation Date: 

Crew: BackfiU Date: — 

Item Condition Hazards Corrective Action 

Overhead Lines ^ ! ^ u>Jgr pnuf^ Gas Line 

Water Line y

Sewer Line -fr £1 

Septic/Leech 

Field 

Propane/Bntane 

Sidewalk irr. ^ ^fiAyjSs>^Bt^ 

Foundation c^€^ 

Retaining Walls 4yr^ 

Fences j^: i 

Trees G 6 ^ 

Structures 

Driveway f^ftf-Zt^gt^g/--^ 

Sprinkler System 

Other 

Crew Foreman Site Safety Office 

Date: 

m o WaitfBMlMwiy. Suite 405 seoosiost 4242 Medical Drive, Sufte 7260 

KaMwGi|y;iK>«4114 Oinatiaif Nctaaifca 08107 San Antonto, TX 78229 

Pfione: (8ft) 3tt|3?Q3 PlMiw: (402)733-1108 Phone: (210)8224588 

Fax: |8ffi)363«3707 Fax: (402)733^1083 l=ax: (210) 679-6577 
3116 

61 

W'OZ-^o/n