TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID# Xllf!b Date. 11-15-1 0 

Address ;74AC ^lonflrN 9r 

Remediation Contractor Pp,-, ryPiM-J itrA^ N/XLOC, ly g.. \c^.,i Year <^ 0 I ( J 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Cf Video of property (DVD) IIIIUIIIIIIMHUIM 

a Executive Summary Superfund 

E EPA-provided property sketch 

H Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

[^ Restoration A^eement 

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

Sl Confinnation data 

IZ Photographs 

17 As-built sketch •'

a Satisfectory restoration signed by Property Owner 

ffl Property close-out check hst signed by EPA 

D Description of areas not meetmg ROD cleanup cntena 

B( Utility clearances 

Property mfonnation from Douglas County Assessor's Office 

D 

D 

D 

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 2435 BLONDO 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 

Bl = 386 PPM @ 3"; B2 = 319 PPM @ 3"; 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 sketch ­

i) Shall include final lead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

111) 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 

111) 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: 27180

Owner: 

­ 2435 BLONDO ST 

User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

ICnY OF OMAHA 

Owner Addressl: 

lC/0 FINANCE DEPT 

Owner Address2: 

11819 FARNAM ST 

City: 

(OKAHA ~~ ~ 

Owner Phone 

State: Zip Code: 

|NE 168183-

Alternate Phone: 

Owner Address: 

City: 

Owner Phone: 

State: Zip Code: 

Alternate Phone: 

Property Address: 

12435 BLONDO ST 

Zip Code: 

Resident Phone 

Contract: Assessment: 

Contractor: |PRUDENT2010. .S Qualifying Group |400 

Contract Option OPTION 1 Assessment Max XRF Value 527 
£5^ 

TECHNOLOGIES, INC 

^m 

EPA Property Close Out 

Property # ^"7 1^^ Property Address 2^45 ^ ^^^^^^c ^"^ 

Date/Time: Owner's Name <^rv^/-/S c^''>~»^ 

Quads £\ca\ated. oV Contractor Group: Pi udent Technologies, Inc, 

Excavation General Yes No 

1 If necessary were the correct quadrant(s) excavated and restored'^ / 

2 If necessaiy were the correct areas of dnp zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

1 Does the grading around the penmeter of the house m excavated areas generallv slope away y

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 mspected at a 30 

y day tune penod) 

4 Are sodded areas generally firm and evenly graded? y 

5 Are tlie )oints between the sod stnps generally tight? (Only evaluate if inspected at a 30 day 

time penod) y

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

7 Was damage to landscaping or plant matenals avoided? y 

Gates, Fences and Retaining Walls Yes No 

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

2 Were all gales or fences taken down dunng restoration activities reinstalled? (If apphcable) y 

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

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

Foundation, Siding and Gutters Yes No 

1 Was damage to the siding or tnm avoided? y 

2 Was damage to tlie foundation avoided? X 

3 Was damage to windows avoided? / 

/ 4 Was damage to windows or door screens avoided? 

5 Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Dnvewa>s (Concrete) Yes ^ No 

1 Was damage to dnvcwav surfaces avoided? 

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

Inspection notes: 

t.ftRO'^ fctCM 

Removal and restoration activates complete including the 30-day sod wajranty t 

I 

EPA Representative ^an_A«, ^Date iA)'u]ia 
iCHNULOUIES. INC 

AS - BUILT DRAWING 

OLS# 27180 

Date Excavated 9/24/2010 OMAHA LEAD SUPERFUND SITE USEPA Signed-OIT Date 

27180 

Extenor Paint North Arrow Owner Name NFAi L REYNOLDS Omaha Lead Site • Good Address 2435 BLONDO ST

 Site Sketch • Poor Phone H w Q Not paint I

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm 

RYASCPXA-27ieO F1 D Date FDA {^/m 

RYBSCPXA-27180 F2 5qcy ppm n Time 

ppm 

RYCSCPXA-27180 B1 ppm D 

1(6 o r Samples Analyzed RYDSCPXA-27180 B2 ppm n 

pnzsrpxA ?7ioo -ez­ ppm D D XRF Unit —rf- Bock 33 . RezacpxA-2/ iBO~ js i ppm D D Date •1 e^ " 

-nPirOCPXA-27TBg ^ z ppm D D 

Time _3 

Number of Samples = y Staff _ fe

Omaha Lcdd Site 46 no 

NO EASEMENT 

CONTRACT #• EP-S7-10-05 PRUDENT TECHNOLOGIES, INC 
&EPA 

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, if any 

Property ID; yj \ ^Q 

Property Addnas: f^^ ^ J^^r^ o 5T . 

Owner. (^^^ ^^ ^^^ ^ 

Phone- {y ^ ^^ ^ ^g ^ 

Restoration Items in Question 

Item: 

Item. 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property 

L J I agree restoration is completed 

| 2 I do not agree restoration is completed at (noted deficiencies above) 

^Owner's Signature W^ 
D)RUDE! .' Ms^ , ^ j 

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

^/• ? ^ rilt^afti Hie CPA requests your permission to allow Prudent to perform a soil cleanup at this 

property lo i emove 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 

II you 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 Geneial questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

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

Property Access Granted By Chill i A/ ^ l—yyUAJi h 

(Pi 'lease Pnnt Name) 

Property Owner Signature IJz5c4Ly^ 

(Sigjiature) (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner ~ please pnnt) 

RESIDENT NAME Renter 

^ 

RESIDENT ADDRESS 

o ^ M ?>.sr 8\^'^^fc. 

IF RENTAL, PROPERTY OWNED BY 

OWNER'S MAILING ADDRESS, 

OWNER'S TELEPHONE NUMBER - HOME J L WORK 

it^(\^ J^Jj^-Hji^ y 

AGE OF HOME' 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 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 ] 


AUTHORIl Y ^OR ENVIRONMENTAL RESPONSE ACTIONS. The activities to be implemented by EPA under this agreomeni 

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 provideb enti y for detennming the need for response, oi choosing or taking any response action 

under this title or otherwise enforcing the provisions of the title " 

8080 Ward Parkway Suite 405 5600 S 10 St 4242 Medical Drive Suite 4250 

Kansas City 'MO 64114 Omaha Mebraska 68107 San Antonio TX 78229 

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

Fax (816)363-3707 F?x i402) 733-1883 Pax (210)579-6577 
EN\rRO\'MEi\TAL& 

CONSTRUCTION 

TECHNOLOGIES, S£RVICES 

Property Status Form 

Address: Olda^ U ^ Dale: ^|\3\\ 0 

Phone: BVID: 

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Property Owner Prudent Employee 

Signature: Signature: / 

8080 Ward Parkway Suite 406 5600 S 10 St ^^^iSiedical Drive, Suite 4250 

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

Phone (816)363-3703 Phone (402)733-1188 Phone (210)822-9588 
n 27180 

Omaha Lead Site Owner Name NEAL L REYNOLDS 

Site Sketch Address- 2435 BLONDO ST 

Phone H w 

Sampl Lead e Number 

Concentration 

RYASCPXA-27180 

RYBSCPXA-27180 

RYCSCPXA-27180 

RYDSCPXA-27180 

Rl 

ReZ3CPXA-2/ ItiU 

• KJiiLljCDJ'k^.'HJO 

Number of Samples = 

ENTBBBB 

Extenor Paiht Ncrth Arrow 

• Good 

• Foor 

Q Notpamt i

Samples Collected. 

Firm FC^ 6c^/DH 

Date g Z ^ OH 

TTme Kg^oS ' 

Samples Analysed 

XRF Unit ' ^ i,D Book. S 3 

Date- q'.l.g>(LP ~ 

Trme-. r 0 

Staff fe 

zs s r 

EtO^OO S'T 

Omaha Lead Site 4613a 
N 243

5 Blonde st 

A ^ Printed: Nov 16,2010 

wvvw.dcgis org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2592077. 

Original Call Date: 9/14/10 Time: 5:22 pm Op: SIVA18967 


Work to Begin Date: 9/16/10 Time: 5:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2435 Street: BLONDO ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-SW,15-NW,16-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 


: 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 LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFlC,SEWER RICHA-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/14/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION TEftHMomcmi, mc . SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

._^W<^ Address: 

Excavation Date: 

^der, • ^ 

Crew: 

Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines \jj^'^ f*^^' 

Gas Line fljMT: 

Water Line ^/P^ 

Sewer Line M 

Septic^Leech 

Field 

^ 

Propane/Butane L ^ 

Sidewalk /)exrr 

tiXrJZ^k'tol /fjf,}t(?/^ 

Foundation r 

Retaining Walls ir ^ 

Fences 

lio 

Trees \/M 

/*^> 

Structures ^f^ 

^r-,^ . M.lf<J<-' 

Driveway 

1/7/0 

Sprinkler System r ^ 

Other 

Crew Foreman 

Site Safety Office 

U ^ ^ T 

aoaowi 

iRfBi(taM|y.Suito405 SGOOI siost 4242 Medical DrivB. Stdts 7250 

C«y.llff«4114 ORnta,Nili San Antonio, TX7«229 

[8W) 36X^3103. Ptam : ( « l2)73S-11fl8 Phone: (2t0) 822.-J9588 

ftnc(81 t6K363'4?ll7 Faoc (402 )73»<1tt3 

Fax: (210) «7»4577 
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