TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 48975 DATE: 12/15/2010 

ADDRESS: 4755 S 18 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

H^PRE AND POST VIDEO OF PORPERTY (DVD) 

Q/EXECUTIVE SUMMARY 

&^EPA-PROVIDED PROPERTY SKETCH 

-Q^IGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

A SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

13^EST0RATI0 N AGREEMENT 

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

• CONFIRMATION DATA 

Q/'PHOTOGRAPHS "^D-^/OLA-> SO< ^ 

Q^S-B U I LT SKETCH 

B^TISFAAOR Y RESTORATION SIGNED BY PROPERTY OWNER 

•PROPERT Y CLOSE-OUT CHECK LIST SIGNED BY EPA 

• DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

H^TILIT Y CLEARANCES 

n PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

' 30262845 

• 

• Superfund 

DATE 
Find Record Remediation Query Lead Remaining Query ] Property Damage Query 

Backfill: 

Sample Area: 48975 ­ 4755 S 18 ST 

Owner: User Provided Owner Information Resident: 

• Owner Occupied 

Owner Name: Owner Name: Resident Name: 

JiNIESTRA VALENTIN 0 JINIESTRA VALENTINO 

Owner Addressl: Owner Address: Property Address: 

1 14755 S 18 ST 

Owner Address2: Zip Code: 

!4755 S 18 ST J68107-

City: State: Zip Code: City: State: Zip Code: Resident Phone 

[oMAHA |NE J68107­ 1 1 

Owner Phone Al ternate Phone: Owner Phone: Alternate Phone: 

1(402) 991-0578 1 

! ] • ^ 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |PRIORrTY 

Contract Option JOPTION 2 Assessment Max XRF Value | 413 
PROPERTY SUMMARY 

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

Property Address: 4755 S 18 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: /'^mA Ne^EXCAVATCD: yC(35'X50') = 311 PPM @ SCRi\P& G=>r>-(r\t^\t»^\Oti Cef:T BcHlrv O D-Z./t.5. Cl'^^O = 163 5 pV" ^ @ 

rp o IRe^^^-3 , 

CONFIRMATION SAMPLING DATA/RESULTS: \y\t-s. 

Bl = 57 PPM @ 8"; DZ = 431 PPM @ 13"; EA = 74 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 dip/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. 

TECHNOLOCIES. INC. 
• 

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ^9-^ 7 5 Property Address: H*-? ^ 5 f - ^ ^ "J f -

Date/Time: Owner's Name: 5^ ''-e'<^ %'«<^«^ 

Quads Excavated: T)y S ) Contractor Groop: Frwdent Techirnologies, Inc., 

Excavation Genera! Yes 

1. If necesscirv. were the correct qiiadiant(s) e.xcavated and restored? / 

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

Grading Sod and Vegetation Yes 

1. Does tlie grading around the perimeter of the house in excavated areas generally slope away / from iJie house? 

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

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

day lime period) / 

4. Are sodded areas generally finn and evenly graded? / 

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

6. Was the property graded sucli lliat water will not pool on tlie property? 

/ 

7. Was damage (o landscaping or plant materials avoided? 

/ 

Gates, fences and Retaining WaUs Yes 

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

y 

2. Were all gates or fences lal<:en down dining restoration activities reinstalled? (If apphcable) / 

3. Was damage to gales 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 dajnagc to windows avoided? / 

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

5. Was damage lo downspouts or dowiispout extensions avoided? / 

Sidewalks and Driveways (Concre<e) Yes

Was damage lo di'ivcway surfaces avoided? 

No 

No 

No 

 No 

 No 

2. Was damage to walkway surfaces avoided? 
Owners commemts: 

Inspection motes: 

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

EPA Representative jQc^JL^ ^Date: nj^ji^^ 
rFINDECSCIES. INC. 

AS - BUILT DRAWING 

OLS # 48975 

Date Excavated: 10/19/2010 OMAHA LEAD SUPERFUND SITE rSEPASigned-OffDate: 

48975 

Exterior Paint titodft Arrow Omaha Lead Site 

Site Sketch 

Owner NamerVAiENTiNO INIESTRA • Good Addres8:4755Si8ST • Poof Phone: H: 402-991-0578 W: 2 j Not paint 

Sample Number Lead Sample Samples Collected IJVB Concentration Collected Firm: F tbA \ dS \ €v:T 

RYASCPXA-48975 F1 1^6 . ppm D Date: cf- -1 ^ r./-

RY8SCPXA-48975 F2 a" 

ppm 53' Time: -a, : '-!ct^>r»^ /az. RYCSCPXA-48975 B1 W'3 ppm D Ef Samples /Analyzed RYDSCPXA-48975 82 -LUL ppm D 

RDZSCPXA-48975 DZ 7.3^ , ppm D XRF Ur.Jt: '^O Z Book: lO C 

RGilSCPXA 0- 48076 GZ ppm D Date: ft^- \l^O U 

RPZCCPXA 48075 PS- ppm D D Time: A H 

D Staff /MS W Number of Samples = 5~ 

Legend: F1 = Front Lett. F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quaijrants are as viewed Inrr the street, facing property 

ENTEEED 

^ \ H 2S06 

t/y 

CO^TA.MI^ATION LEFT BEHIND 

PER P.O. REQUEST: DZ/LS(rxr) 

= 1635 PPM -g SCRAPE (-1") 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
p RIDEN 

Prox:i(g)rt^7 CompEet8©[!i Aqir©®m®Eri^ 

jj.'ftcf.vts. tjir 'ji'liipictsui'.; Ol rfcl'j'jOVai hO'CiVthc-b yci'iOnVieu Oil i.uf; DciCTv i.'.Sl&d p.ropeirv 

The propern- owaev's .iignatuje f.ri.'jic.ate.s that the property ov..'ner ii ba^isfied with ihe festoration of the 

siibjecf propert}- arid that iio ite'-ni ;ire. in question, now., or al an}' Urne in The fu^ire, excJudling any 

rer/iainnig waiTarit^v (30 days tola?.) s.iicept those items .li.?ted beioi^, if ajiy. 

Property ffi:: AM.i.s:._^ 

Pro pent ^^2^^!:..Jij!SK._.S-/^.^^ 

O'wil l SIT •• ja/nc^li 7! S:'<^< r Q­

^hnm (HOI: 991 • 0^3J^__Jm ^/ ^ -MSB 

Restof-^Hias':! liiemis 'irs Qtaestioni 

Uteincii-; 

Jten:^' 

L_ 

llte,rr!.: 

"H 

f lltemn': 

lltelTTii" 

Rs.qB.c!F&(i:f! CG-rrsctiiojinis tr; comiaileitp; sirtis pTO'fos'rni)/: 

!Jd i .^gree lestoracion is compietefl, except as noted above. 

i ! 1 ao r>ol acii-ae rsstoration is ccmoistec; 

^OI^JLA^.,: ^ ^7ir^. .J1-.U--IGL 

O-^vDeF's Sigsiiiure 
\o/iu 

Pnidem Technologies. Inc. (Prudent) is under contract, with the U. S. EnvironraentaJ Protection Agency (EFA) to clean up leadconumimaled soils ai^anumliett of properties located in Omalia, N ebraskxu including the property located at 

^r7^5 ^ <J 'a'* ' S f The EPA request.*; your permi,>;.'5ion to allow Prudent to perforrn a soU cleanup at thi.s 

propeny to remove lead-oontammated soil. By signing this form, the property owner grants pennission to Prudent to perform 

.activities related lo the cleanup including soil sampling, removal of lead-contaminaled soil, and restoration oflhe referenced propeny. 

U'you have any questions about the soil cleanup planned for your property, please contact Prudent soutli office for the Omaha Lead 

Site cleanup-at (^02) 733-1188. General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

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

Property Access (Jranted By 

' • , (Please Prim Name) 

Property Owner Signature: 

(Signature) 

•<v//A>^ 

(Date) 

PROPERTY INFORMATION 

(To be com pletcd by resident and/or proper1.y owner — please prinf) 

RESIDENT WAME: V Q \^V ^ VO Q - 1V^] ^S:\^(X3^^ « 

RESIDIDEN I T ADDRESS: _ _ _ , 

IF RENTAL, PROPERTY OWNED BY: 

0WNER; S MAILING ADDKESS; ^ c 

OWNER'S TELEPHONE NUMBER - HOII/IE: (40^QQi ~ QS" 1 *£> WORK: 

AGE OF HOfJIE?: YEARS. HOW LONG HAVE YOU LIVED HERE? h. YEARS. 

HAS THE EXTERIOR BEEN PAIfyiTED OR COVERED WITH SIDING SINCE 1978? YES 7x^° 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

ANUMBER 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 EOR ENVIRONMENTAL RESPONSE ACTIONS. The activities to be implemented hy EPA under this agreement 

are pursuant lo 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 9603(e), which provides enU-y for "detennining the need for response, or choosing or taking any response aclion 

mider tliis title, or otherwise enforcing the provisions of the title." 

SOSO ififarcS Pdi kwav. Stfire -v;:: I'K-'^t iY!';(!i--:al Grivi;, Oiiiw 4250 

t< an sa s C ity, M O 6< 11 •( '•j.-rn Aniorijo. TX 7*22.'! 

Pncne: t8t6) 36i-J70? '>'',V:,Vt-: -c-.:!; TVS-'-' i^."iii!;: i2i0) i';22-^>^f;l^ 

j^ax. ;81S; 3S3-:;707 C ' .'• . ': Hi 
'.'ONHTRt.icrroi'^ 

TECHNOLOGIES, INC. 

Property Status Form 

Address: <^_5- ^ 5" /^livj 

Date: /o/> / jZOilJi 

Phone BVID: ^^^y ^: HOZ-^IZ^ ^^5 ? 

^^T)/AL /U2^AS' ^ { k^ ^ 

I) I CL£nA^ TZ) €^cA^j<irT ^ > ^ 5-6 b 

T^^^f ^i-r6^' i TTct^ uc/> ^^^ ^//t-r /^/£^/\ 

E->c^>Ai//Tr^ <- l^^^ ^ 

^xr^^^ri f ^ $"^ 7^ 

A^(; r ^<^ V 

Prudent Em 

Signature: /X^ 

3(!Sfi Ward Par^WBv.rTijrro ^'O.S 2 ;;; IVieriicai Di'ivtv Otittf! 4aEi:) 

,\ansas Citv. MO eill- i tiari». i^leorash.ii lifc'iO'i :-ar, Ariionw, TX 78ii a 

pnone; fS-tfit :5S3-:i70" hr-tife: ;au2, ri::-'- i-sa 

(0.i(;i . ­1 r^-^ T-in ^ 
48975 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: VALENTINO INIESTRA 

Sit n Good e Sketch Address:4755Sl8ST • Poor 

Phone: H: 402-991-0578 W: 2^ Not paint 

Sampl Lead Sampie Samples Collected e Number l-AB Concentration Collected Firm: FCbft \ R5 \ CaiT" 

RYASCPXA-48975 F1 n & ppm n 

Date; C c; -ir.- g^^ 

RYBSCPXA-48975 F2 /8 I ppm Time: "^z, : M c ..p ^^ 

RYCSCPXA-48975 Bl Hi2 ppm 

Ef D 

Samples Analyzed RYDSCPXA-48975 B2 1)3 ppm 0- D 

RD2SCPXA^8975 DZ -1231. ppm 0- D XRF Unit: ^Q Z Book: JO U 

RGZSCrXA 48076 GZ ppm D n Date: Tp" \{^-OC P 

Lab ppm D Time: RYBSCPLA-48975 A J ^ 

"Result 190ppm Staff: 

Number of Samples • PT Msw 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

Rev 4 046141.0123 
Page 1 of 1 

lULY 2003 - DOUGLAS COUNTY ASSESSO 

^7^- ^ S /T ^-h 

http://douglasne.mapping-online.com/assessdoc/Photos/33/Rl 7282100000001 A.jpg 10/5/2010 
K Legal Description

: 45 x 130 

A SI

S * Printed: Oct 12.2010 

vvww.dcgis.org/dogis 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2614390. 

Original Call Date: 10/11/10 Time: 4:27 pm Op: SIVA1B967 


Work to Begin Date: 10/14/10 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4755 Street: S 18TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 03-NW-SW 


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: (4 02)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: Y 


Involves Tunneling or Horizontal Boring : N .Explosives: N 


CXCATV DIGITEL LEVELS MUD02 OMAHACOF 0PPDGPR6 PAETEC 


QLNNEIF 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8665624349 


LIGHTCORE A CENTURYLINK DIGITEL NA Alt: 8008509048 COMPANY 

Emerg: 8665624349 


Day: 8773668344 


LEVELS COMMUNICATIONS, LEVELS NA Alt: LLC 

Emerg: 8773668344 

Day: 4025047823 


METROPOLITAN UTILITIES MUD02 SANDY Alt: DISTRICT 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/11/2010 
Page 2 of2 

CITY OF OMAHA- OMAHACOF TRAFFICSEWER 

OMAHA PUBLIC POWER 0PPDGPR6 DISTRICT 

PAETEC PAETEC COMMUNICATIONS 

QLNNEIF QWEST LOCAL NETWORK

RICH/TRAFFIC 

ELM LOCATING 

NO NEED TO CALL OUT 

EMERGENCY 

 ELM LOCATING 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://'www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/11/2010 
SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: —l^-^^-JA^t . Excavation Date: -Lo]!3\^^:, 

Crew: BackfiU Date: '^11MJ± . 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

< ^ ^ 

e^ 

^ ^ ' Jt7 

— — 

orca/'^ 

. — 

pc£ ^ 

c?f^ 

dp^ ^ 

o*— 

- — 

___ ^ 

Hazards Corrective Action 

U C (=• f p ire^ ^ 

Site Safety Office 

Date: 

> Vtfanf-1?artaBay. Sute 44K 5500 S 10 St 4242 Medical Drive, Suite 7250 

iGay;uafi4ii 4 Oiii^diar Netan^ka 68107 San Antonio, TX 78229 

Hong (816) 3gj.37n3 Fliene: (402) 733-1188 Phone: {2t0) 822-3588 

ax: (SW) 363^3707 Fax: (4ia2) 733^1883 Fax: (210) 579-6577 
H755 5l8'^Sr 

w I ff 

j l i^ IZoio