TRANSMTTTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: a07;) 0 Date: ^i\L^lt O 

Address: 2.Lt7:7_ gyp{v>4nn ^r f 

RemediationConlractor: Pf\]iAljlW "I^LI A \(\ L Year: ^g/ 6 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

ffl

a

A 

I 

D

i 

i 

a

a

D

ID

D 

D 

D 

 Video of property (DVD) 

 Executive Summary 

EP A-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.) 

 Confixmation data 

 Photographs 

As-bnilt 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 Office 

Signature Date 

30054183 

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

Backfill: 

Sample Area: 20720 - 2422 POPPLETON AV 

Owner: 

D Owner Occupied 

Owner Name: 

{HERNANDEZ ABELARDO 

Owner Addressl: 

r 

Owner AddressZ: 

|2422 POPPLETON AVE 

Qty: State: Zip Code: 

[OMAHA [N E J68105 

Owner Phone: Alternate Phone: 

|(402) 346-3620 

Resident: 

Resident Name: 

[HERNANDEZ ABELARDO 

Property Address: 

|2422 POPPLETON AV 

Zip Code; 

|68105 

Resident Phone 

I 

Contract: 

Contractor: 

|PRUDENT2009_S 

Contract Option 

|OPnON 2 

Assessment: 

Qualifying Group 

)400/CHILD 

Assessment Max XRF Value: 

r 665.37 
PROPERTY SUMMARY 

Date:t>|/15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 | Month of: jy | a\J 

Property Address: 2422 POPPLETON AVE 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED PER P.O. REQUEST; F2/LS (10'X15') = 184 

PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 86 PPM @ 6"; B2 = 254 PPM @ 6"; DZ = 353 PPM @ 12"; 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 

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. 
TlCHNOLOGIES, INC. 

EPA Property Close Out 

Property #: .aOl^ O Property Address: Q^3 i Si, PopP'^+Z^^" ^ 

Date/Time: Owner's Name: /^ V)^-\ftw>l.c) lT<-fYvcL-^M.€-!r^ 

Quads Excavated: Contractor Group: Pruiricnt Technologies, Unc, 

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? y 

Grading Sod and Vegetation Yes No 

1. Docs lhe 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 tliai were excavated? / 

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

day lime period) y 

4. Are sodded areas generally firm and evenly graded? y 

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

time period) y 

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

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (If appUcable) ^ 

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

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

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

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? / 

3 Was damage lo windows avoided? / 

4. Was dainage lo windows or door screens avoided? i / 

."i. Was damage lo downspouts or downspout extensions avoided? / 

Si(ie^valks :ind Driveways (Concrete) Ycs^ No 

I W;is dnmagc lo drivcwuy surfHces avoided'' 

2. Was damage lo walkway surfaces avoided? 

~7 
Owners comments: 

Inspection notes: 

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

EPA Representative S^JSL . Date: /?//»/o^ 
1 

Property Completion Agreement 

This agreement documents the completion of removal activities perfc crniled on the below listed property. ( 

The property owner's signature indicates that the property owner is latisfied with the restoration of the 

subject prroperty, 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 ai y 

Propert;t ^ ID: 

Properly AddrMi: Qj^^ . /^fl/UM/aj * ^l> e 

Owner: /^y^/^f,/ ^ /^/rll^/^Je^ . 

Phone: ^OX- ^Vd-3^Z 0 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I agree restoration is completed. 

I I I do not agree restoration is completed at (noted deficiencies; ab Dve) 

/^^^Jl ^ A^Jl ^ yiCn. ^ //-jy-d>9 

Owner' ^ s Signature Date 
Prudent Technologies, Inc. (Prudent) is unde r contract with the U. S. Environmenta l Protection Agenc y (EPA) to clean u p leadcontaminated soils at a numbe r o f propertie s located in Omaha , Nebraska , including the property located at 

. Th e EP A requests your permission to allow Pruden t t o perform a soil cleanu p at this 

property to remov e lead-contaminated soil. By signing this form, tlie property owne r grants permission to Prudent to perform 

activities related to the cleanup including soil sampling, remova l of lead-contaminated soil, and restoration o f the referenced property. 

If you have any questions about the soil cleanup planned for your property, please contac t Prudent Administrative Clerk for the 

Omah a Lead Site cleanup. Ms. Deborah Johnson -a t (402) 733-1188 . General questions about the Omah a Lead Site cleanup can be 

directed to the EP A Publi c Information Centers al (402) 731-3045 (South Omah a office) or (402) 991-958 3 (North Omah a office). 

Property Access Granted 

(Please Print Name ) 

Property Owne r Signature: 

(signature ) <»V^ (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

2^3? pOppl f ^t4>^ ^ ^^v^uJUt NH. 4gi c 5" 

IF RENTAL, PROPERTY OWNED BY: 

\ V\ ^ f r\,.r>, f^t » /

ihkkirio 

OWNER'S MAILING ADD^E^SS; 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

AGE OF HOME?: I ^ ^ YEARS. HOW LONG HAVE YOU LIVED HERE? J' D 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.) 

AUTHORIT Y FO R ENVIRONMENTA L RESPONS E ACTIONS : Th e activities to be implemented by EPA unde r this agreement 

are pursuant to Section 104 o f CERCLA , 4 2 U.S.C. 9604 . EPA's right of access to the property is provided for in Section 104(e) of 

CERCLA , 4 2 U.S. C 9605(e), whic h provide s entry for "determining the need for response , or choosin g or taking any respons e action 

unde r this title, or otherwis e enforcing the provisions o f the title. " 

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 

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

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
ENVIRONMENTAL «& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^rr L PofpUhvN A^-<. Date: Iblt^o"] 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

I , 

Pre-Existing Condition of Structures 

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

Item N5O 

On Map 

Description & Location 

p 2 y\^eA^ ^ ^ ^^ ' ""~^-^ 

7-

Property Owner Prudent Employee 

Sigi r«ft Signature: 

>>a«?*7*<?' L-~~ ^ 

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 

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

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
rFCHKnTTjniF.s. TNC. 

AS - BUILT DRAWING 

()F,.S#:20720 

Date KxiovaUd: ll/()2/2Ut>9 OMAHA LEAD SUPERFUND SITE ISHPA .Signcd-OIT Date: 

Name: .^Afi'/Wo HsTmnje^ Omaha Lead Site 

Address: 2'iZX fppp/^'f'ot, f\\/ Site Sketch 

Phone:i^«^pa\3^fe^3 <ea.O 

Team^^/w.^/^./1/OoJPf^ BVID# S£y7X D

Sample Number Lead Concentration 

2¥o <- Z7 ppm 

ppm ^ i ppm 

ppm 

ppm 

ppm 

ppm RGZSCPLA-20720 

Date: North Arrow 

Time: k 

 XRF Code ^^^SD 

Confirmation Sample 

No iR 

/=iYes n No S 

No Ql 

Si - Yes CD No O 

52^ Yes ° No a 

& Yes JSL 

Yes • 

No

No

 n 

D 

Omaha Lead Site 46130 

CONTRACT #: EP - R7-07-06 T0# 1 PRUDENT TECHNOLOGIES, INC. 
f-Mns / / - p-^j Ii- i^m /^K^^Y/y/. ^ t 

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Print Preview Page 1 of2 t t 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

\City 

Owner 

State 

Owner 

Zip 

2218100000 

HERNANDEZ 

ABELARDO 

2422 

POPPLETON 

AV 

OMAHA 

68105 

2422 

POPPLETON 

AVE 

OMAHA 

NE 

68105 

Addition 

Blocic 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

SHULLS2NDADD 

7 

17 

60X168 

0.22 

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

parc=2218100000 

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

accountno=R2218100000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/21 /2009 

2 
# t 

Page 1 of2 

"> 

YOUR TICKET NUMBER IS 2388965. 

Original Call Date: 10/19/09 Time: 10:41 am 


Work to Begin Date: 10/21/09 Time: 11:15 am 


State: NE 


Address: 2422 


Twp: 15N Rng: 13E 


Twp: Rng: 


Legal Given: C 


County: DOUGIAS 


Street: POPPLETON AVE 


Sect-Qtr: 27-NW,28-NE 


Sect-Qtr: 


Op: SIVA18967 


Place: OMAHA 


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: 

Involves Tunneling or Horizontal Boring , : 

N

N

 Front: Y

 Explosives: N 

 Rear: Y 

CXCATV LEVEL3 METHODIS MUD02 OMAHACOF OPPDGPR6 QLNNEIF 


Service Area Contact 

CXCATV COX COMMUNICATIONS, INC HEIDI 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

METHODIS METHODIST HEALTH SYSTEMS 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Phone Number Utility Type 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Day: 8888474757 


Alt: 


Emerg: 8888474757 

Day: 4025047823 

Alt: 

Emerg: 4025047970 
% % 

Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHn-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 
t 

TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SOLUTIONS 

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Site Safety Hazard Analysis 

Address: J?v^^ /ly>^/«7fe^ ^^9^^^ Ex. /0'?,0-0'^ 

Crew: fj ^ 

Date: /o.J^uo' i 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees/ Bushes 

Structures 

Driveway 

Sprinkler System 

Other 

Cre>\ Foreman 

Condition Hazards 

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T-e-iA. 

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Site Safety Officer 

Corrective 

Action 

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

Kansas City, MO 64114 Omaha, I\!et)r3ska 68110 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402) 504-1004 

Fax:(816)363-3707