TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 19846 DATE: 1/15 

ADDRESS: 1505 S 28 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201p i 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS . 

D /PRBAND POST VIDEO OF PORPERTY (DVD) rVv(£.5i^t., PbeV'OC-O y^^"^ I 

E1 EXECUTIVE SUMMARY 

d EPA-PROVIDED PROPERTY SKETCH 

l i SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

|li SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

m RESTORATION AGREEMENT 

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

in CONFIRMATION DATA 

h PHOTOGRAPHS 

AS-BUILT SKETCH 

SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

m PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

h UTILITY CLEARANCES 

D PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^ ^ ^\xl\^ 

SIGNATURE DATE 

30218584 

Superfund 
PROPERTY SUMMARY 

Date: 12/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: December 

Property Address: 1505 S 28 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 = 67 PPM @ 4"; 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 (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. 

TECHNOLOGIES, INC, 
i

Find Record 

Backfill: 

Sample Area: 19846 -1505 S 28 ST 

Owner: 

n Owner Occupied 

 Owner Name: 

IMORELLO BERNARD J 

Owner Addressl: 

Owner Address2: 

111413 HICKORY RD 

City: State: Zip Code: 

lOMAHA |NE 168144-

Owner Phone Alternate Phone: 

1(402) 342-2820 

Contract: 

Contractor: PRUDENT2010 S 

Contract Option pPTlON 2 

Remediation Query Lead Remaining Query Property Damage Query 

User Provided Owner Information Resident: 

Owner Name: Resident Name: 

Owner Address: Property Address: 

11505 3 28 ST 

Zip Code: 

168105-

City: State: Zip Code: Resident Phone 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group 400 

Assessment Max XRF Value 481 
3

'TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: I<^B4 ^ Property Address: 15^05 "5- 2^^ . 

Date/Time: Owner's Name:'^vftjrd l I'^Tfllo 

Quads Excavated: ^ \ Contractor Group: Prudent Technologies, Imc., 

Excavation General Yes No 

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

i / 

2. If iiecessar>-, were the conect areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

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

from the house'i' / 

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

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

day lime period) / 

4. Are sodde4 areas generally fmn and evenly graded? 

/

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

time period) / 

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

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

Gates, Fences and Retaining WaUs Yes No 

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

/ 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 

/ 

4. Was damage to retaining walls avoided? (Ifapplicable) 

y 

Foundation, Siding and Gutters Yes No 

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

2. Was damage to tlie foundation avoided? / 

3. Was damage to windows avoided? / 

4. Was damage to windows or door screens avoided? / 

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

Sidewalks and Driveways (Concrete) YeYe&& No 

I. Was damage lo drivewav surfaces avoided? 

1. Was damage to walkway surfaces avoided? ~y 
Owners comments: 

Inspection notes: 

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

EPA Representative 9"^-A^ Date: ii\i)\o 
I 

19846 

•CIIN()1.0GIt;S. INC 

AS - BUILT DRAWING 

Ol,S# 19846 

Date Kxcavaled: 10/20/2010 OMAHA LEAD SUPERFUND SITE ISEPASigncd-OffDaU-: 

Samplina Address: 1505 S 26 ST 

Sample Number 

RYASCPXA-19846 

RY8SCPXA-19846 

RYCSCPXA-19846 

RYDSCPXA-19846 

r;DgOOPXA-1004G 

RCZCCPW 10846. 

RPaSCP.XA 198116 

Fl 

F2 

Bl 

B2 

-«Z 

- O i 

J U. 

Omaha Lead Site 

Site Sketch 

Lead Sample LAB Concemration Collected 

SLB^ . ppm n 

- l l . ppm D 

J^RL. . Ppm n 

13^ . ppm I D . ppm D 

ppm D D . ppm D D D 

Number of Samples = I 4 | I Q • 

Extenor Pamt Nortn Aitow 

• Gooa 

• Poo( 

Q/klot paint 

Samples Collected 

Firm: FP/? f& Cfi 

Dale: (\-&-0^ 

Time |2-W^ 

Samples Analyzed 

XRF Unit: (pSH Z Book: 1*^3 

Date lOIO I fO l 

Time: AAI 

Staff: AlSk/ 

Legend: Fl = Front Left. F2 = Front Right. Bl = Back Left. 82 = Back Riglit DZ = Drip Zone. GZ = Garden, PZ = Play 

AH quadr^r^s are as viewed from the street, faang property 

ENTERED 

SEP 1 9 20B7 

i? 

V6f \II S 

\') 

ft> VI 

v ^ 

Bl=67PPMu4 ' 

/ 

'^^i?e^ 

f? 

56 111 

Fl n 

idJ 

jtia^iL . 

5I8SV 

crejwd %n\nmiw«niii 

NO F.ASKMKM 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
oEfV^ 

Property Compietion Agreement 

This agreement documents the completion of removal activities perfonned 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: 

Properly Address: -^ /s^.^ .z ^2r Sf- Owner: 

Phone: 

Restoration Kerns in Question: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Blagre agre( e restoration is completed. 

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

gy ^ LNTJjJ^t^^ 

OWner'^Signature / ^ Date ' 
'w'-

Prudent Techno\ogies, Inc. (Prudent) is under contract with the U. S. Environmental Proiection Agency (EPA) to clean up leadcontaminated soiU at anumbtt (^properties located in Omaha, Nebraska, including the property located at 

f ^ 6 .O ^ (s) fs c/*" The EPA requests your permission to allow Prudeni to perform a soil cleanup at this 

property to 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 ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudeni south office for the Omaha Lead 

Site cleanup-al (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: 0Ofify/^/< D /^Qf^lf/j^ O 

(Please Print Name) 

Property Owner Signatui ^ll,^aA/t-)^/ydl/^ /^//(/fO 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: ^IkCA ^ ^ i^O " ^ Renter 

RESIDENT ADDRESS: 

/5d 5 y^6. Z^ S f 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

//y/ 3 /^' }c/<n(LC^ 1 ^ . Or^AHA^AJa ^27/^ f 

OWNER'S TELEPHONE NUMBER - HOME: Kl^l j 3 H 2 ^ X' j ^ ° WORK: 

J L 

Jj[l_ AGE OF HOME 7:^! ^ 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.) /^[A 

Al.rrHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Seclion 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 litis title, or otherwise enforcing the provisions ofthe title." 

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)822-9588 

Fax: (81S) 363-3707 Fax: (402) 733-1883 Fax: (210)579-6577 
19846 

Sampling Address: 1505 S 28 ST 

Sample Nuiriber 

RYASCPXA-19846 F1 

RYBSCPXA-19846 F2 

RYCSCPXA-19846 Bl 

RYDSCPXA-19846 B2 

RDZOOPXA-1904G BZ 

nczGcrxA io846—ca 

Omaha Lead Site 

Site Sketch 

Lead 

Concentration 

S-8 . pprn 

"11 . ppm 

H^f . ppm 

135 .ppm 

— . ppm 

• — 

. ppm 

— . ppm 

Sample 

Collected 

[^ 

1 

n( 

D 

n 

n 

Number of Samples = I ^ 

L At 

D 

D 

D 

D 

Exterior Painl North Arrow 

[ 3 Good 

• Pooi 

[^No t paint 

Firm: 

Date: 

Time: 

Samples Collected 

^'6'09 ­

\1'.[0 

Samples Analyzed 

D XRF Unit: (fS H Z Book: 1*^3 

D Date: lOlo l j O l 

D Time m. Staff AlSk/ 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back RigM DZ = Dnp Zone, GZ = Gaiden, PZ = Play 

All quadrants are as viei'/ed from the street, facing property 

ENTERED 

1 -.I twu» ( ? 

Mt\ IBS' 

: \ /... . 

6i : B2 

1 

i 

l5o5 „ t 

t 

4 

<-. . . . ; 

5.B...n., , si 

Fl . rz. , 

^SJ 

...., , 'J 

> ' 

\N^\)^ 

SiSsV 

3 C.rei cd inxpymm'^1 y^ 1146141 C 
M^:^/^^^^^ i 

H 1505 s 28 st 28x144 

A Printed: Nov 30. 2010 

www.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2618629. 

Original Call Date: 10/15/10 Time: 4:03 pm Op: SIVA18967 

Work to Begin Date: 10/19/10 Time: 4:30 pm 

State: NE UGLAS Place: OMAHA 

Address: 1505 Street: S 28TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-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-llf 


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 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


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 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RiCHmiAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULT.,. 10/15/2010 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/15/2010 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: J^O^ ^ §:i^^^ ^ U K Ex.. 

Crew: P / o v»vivAr Bf. 

Date:/0-^-^ ^ 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leecii 

field 

Propane/Butane 

Sidewalic 

Foundation 

Retaining Walls 

Fences 

Trees/ Bushes 

Structures 

Driveway 

Sprinkler Systeni 

Other 

Corrective 

Condition Hazards Action 

A\ 

1 

\ X 

c) 

^ 

\' ^ 

^^ ^ \v 

/ 

1 /

ly 

Site Safety Officer 

8OQ0 Ward PaAway, SiiKia 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 Fax: (210) 579-6577 
7)1 

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