TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAJD#: Ami^" ^ Date: H ^ I 5 ^ I 0 

Address: ^<^<:JS f^lOddO SJ " 

Remediation Contractor: Pbf-> r?PrM-7 Jo-rM N<^OC, \'?-<.. /ror-.^i Year: /> U 1 ( J 

SOIL REMEDDinON 

PROPERTY FILE FOLDER DOCUMENTS 

Zf Video of property (DVD) 

H Executive Summary 

0 EPA-provided property sketch 

a Signed Access Agreement for subj ect property 

D Signed Access Ag?reement(s) for adjacent property 

I Restoration Agreement 

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

B Confiimation data 

a Photographs 

a As-built sketch 

a Satisfactory restoration signed by Property Owner 

IJ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

[II Utility clearances 

12 Property information from Douglas County Assessor's Office 

D 

D ] 

D 

< ^ . V ^ 

Signature Date 

30261060 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2525 BLONDO ST 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 300 PPM @ 3"; EA = 143 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-E.xcavation 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. 

TECHNOLOCIES. INC. 
Find Record Remediation Query Lead Remaining Query j Property Damage Query 

Backfill: 

Sample Area: 27139 - 2525 BLONDO ST 

Owner: 

• Owner Occupied 

Owner Name: 

iCmr OF OMAHA 

Owner Addressl: 

JC/O PLANNING DEPARTMENT 

Owner Address2: 

J1819FARNAMST#1111 

City: State: Zip Code: 

OMAHA |NE J68183-

Owner Phone Alternate Phone: 

Contract: 

Contractor: )PRUDENT2010_S 

Contract Option |0FTON T 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

City: State: Zip Code: 

j 

Owner Phone: Alternate Phone: 

1 1 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value 1 505 

Resident: 

Resident Name: 

I 

Property Address: 

)2525 BLONDO ST 

Zip Code: 

J68111-

Resident Phone 

1 ~~ " 
TECHNOLOGIES. EMC. !&cPA 

EPA Property Close Out 

Property*: 2-"7'^ ^ PropertyAddress: Z^^ ^ Bb-JlO 

Date/Time: Owner's Name: G-.i~ix^ cr^ci^w^vW tfc 

Quad Contractor Group: Prudent Technologies, Inc., s Excavated: 2>\ 

Excavation (Jeneral 

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

2. If necessary', were the correct areas of drip zone excavated and restored? 

Grading Sod and Vegetation 

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

from lhe house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected at a 30 

day time period) 

4. Are sodded areas generally fimi and evenly graded? 

5. Are Uie joints between the 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? 

7, Was dainage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

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? (If applicable) 

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

Foundation, Siding and Gutters 

1. Was dainage to tlie siding or ttim avoided? 

2. Was damage to the foundation avoided? 

3. Was dainage to windows aA'oided? 

4. Was damage to windows or door screens avoided? 

5. Was daniage to downspouts or downspout extensions avoided? 

Sidewalk.s and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

y 

^ 

Yes No 

y 

y 

y 

^ 

y 

^ 

^ 

Yes No 

y 

y ^ 

y 

y 

Yes No 

y 

. / 

y 

y 

y 

Yes No 

y 

^ 
Owners commemts: 

Inspection notes: 

1 

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

EPA Representative B^- ^ ^Date: |0 
ECHNOLOUIES, INC. 

AS - BUILT DRAWING 

OLS #27139 

Date Excavatefl: 9/24/2010 

USEPA OMAHA LEAD SUPERFUND SITE Signed-Ofr Date: 

27139 

Exterior Paint North Arrow Omaha Lead Site • Good Site Sketch • Poor 1 

SamDiinq Address: 2525 BLONDO ST Q4jo t paint 1 

Sample Number Lead 

Concenlration 

Sample 

Collected LAB Samples Coliecied 

Firm: VE T^r . OR TC. 

RYASCPXA-27139 

RYBSCPXA-27139 

F1

F2

 2.Q5 "

 13 1

 ppm 

 ppm 

D 

D 

Dale: l[n/of t 

Time: (:Y , FH 

RYCSCPXA-27139 

RYDSCPXA-27139 

B1

82

 'iZ° l

 6>H

 ppm 

 ppm 

\ ^ 

D Samples Analyzed 

RO20CrXA-27139 -B2 — ppm D D XRF Unit: 0)51 0 Book: 2J3 

RQZOCrXA"27109 -e ? — ppm D D Date: 1-2S"-O S 

RPZSCPXA'g7139 -PZ­ — ppm D D Time: Ar ^ 

gUb RYCSCPLA-27139 

-« Result 505 ppm 

Number of Samples • 

=

/ Staff: M3L J 

Front Right, B1 Back Left, B2 = Back Righl DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

.HEAVY.. 

GWWTH JUL 2 4 2008 

Ml'^ GH 

.^1. m-. ' ^ 

BI=3C0P?^] -§,3" 

- 4 ­ ^ 

gl 

ZO^ in 

.fl ...n 

M3 *SiC*:WAU>i: ' 

WAL >-ENt)S.' ' K 

&L0NDO: S<-. Rev 2008 Cn. 

£.•4 - '.iS PPR] (f 2-

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

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: •i') j^c j 

PropertyAddress: ^c^2- ^ ^^, ^ ^ ^ 

^^"^'•^ CITY GF o^An ^ 

Phone: M^H^'IZ ^ 

Restoration Items in Question: 

Item: 

Item: 

Hem: 

Item: 

Hem: 

Hem: 

O I agree restoration is completed. 

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

,^/©wner's S^nature 
¥ RUDEN 

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

A-^J'*~ i fr>)oVVdiO ^V " . Tlie EPA requests your permission to allow Prudent 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 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 Infonnation 

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

Property Access Granted By: yi/l)Cit^ // , U^yiyAjl) 

(Please Print Name) 

Property Owner Signaiure: /h^F^^o 

V (y " ' (Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property OHTier — please_grint) 

RESIDENT NAME: FFi-F\ --r/* F)yy)aln Owner> Renter 

RESIDENT ADDRESS: 

F:I^^ S 8 \Ti f^A g^ ^JFIF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

///^ Pkr^Ary, Fl. . F/.'l L //ff O^ U MF 6 Fj[ ^ 

y / 

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

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.) 


AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS. The activities lo be implemented by EPA under this agreemeni 

are pursuant lo Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's righl of access lo the property is provided forin Section 104(e) of 

CERCLA, 42 U.S. C 9605(e). which provides entry for ""detemiining the need for response, or choosing or taking any response action 

under tliis title, or otherwise enforcing ihe provisions ofthe title." 

8080 Ward Parkway. Suite 405 Sl BOO S 10 St 4242 Medical Drive, Suite 4250 

Kansas City. 'MO 64114 Omaha. Nebraska 62107 San Antonio. TX 73229 

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

Fax: (816) 363-3707 Fax: (402) ;•33-1883 Fax:(210)579-6577 
ENVfROiV!MEi\T.AL& 

CONSTRUCTION 

TECHNOLOGIES, INC. S£RVICE.S 

Property Status Form 

Address: 

Phone: BVID: 

u JL Al 

U4 rir^Cp ^ ^ ^ 

UUrxi Ai3^g 6uU 0^-^^-^ =S=^ ^ = 

t) G9^|-5 OA^nCJc^ C..^ 1-;M 0 c- ^. ^ i 

( y iMih M 1 n ^ si^ /l/acc^^vA [i 

^ Q^oa • fiio^J..-. 

g^ _^ \SJ^ V-Uc^c^ 

y 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St edical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78228 

Phone: (816) 363-3703 Phone: (402) 733-1188 Phone: (210)822-9588 
Hiiiiiiiiuimiiiiii 27139 

• Omaha Lead Site ^ P Exterior Paint ,Mc-rin .^now 

Site Sketch 

Sampitng Address: 2525 BLONDO ST j Q-^Vot patnt 1 h 

r Sample Number 

RYASCPXA-27139

RYBSCPXA-27139

RYCSCPXA-271.39

RYC-SCPXA-27139

RDZGCPXA'27139

 F1 

 F2 

 81 

 B2 

 9 ? 

KrZ3CP.XA'-2"M39 P^-

Lab RYCSCPU-27139

— i^'Result 505 ppm 

Lead 

Concentration 

Sampie 

Coltected LA i R Samples Coliecteci 

-iJLl 

ppm 

ppm 

Date 

Time 

JiniQ&­ .xI3il.-Pt^ 

*13^'V._ pprn 

• pprn Samples Anal;/zeci 

XRF Unit: 0)5^ 0 Book: 2-?3 

.... ,. — PPITI Date: 1 -ZST'O S 

Time 

 .Number of Samples = i M i Staff: jtamy 

Front Right, 81 - Back Left. B2 = B ack Right C'Z = Dnp Zone, GZ = Garden, PZ = Play 

AM quadrants 3re as '/Iewed from the treet, facing property 

04470! or; i 
H 

A Printed

: Nov 15.2010 ww

w .dcgis,org/dogis 
Page 1 of2 

"> 

Create Another Ticket Bacl< to Irth Internet I Send Email 

YOUR TICKET NUMBER IS 2592074. 

Original Call Date: 9/14/10 Time: 5:20 pm Op: SIVA18967 


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


State: NE County: DOUGLAS Place: OMAHA 


Address: 2525 Street: BLONDO ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,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-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

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

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

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

ENGINEEREVG AND 

CONSTRUCTION TEeHNOUKWs, mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: jSl^^MlltL ^ Excavation Date: f-^V^/ P 

Crew: }^rny^\

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 

 O/^^y^^—-^- Backfill Date: 

Condition Hazards Corrective Action 

•X 

r\ 0 

Y\ ^ 

n ^ 

no 

<Y\V • 

f\D •r\n 

n o 

n o 

<^Yy\^ 

'r\o 

no 

it/9 

——^-

Site Safety Office 

Date: 

•^/u /CX^ 

8080 Wanfiaaftany. Suite405 5600 S 10 St 4242 Medical Drive, Suite 7250 

Kansas Gay;ilO«4114 etaaska 68107 San Antonio, TX 78229 

Phone: 1(816) 363-3703 Piwne: (402)733-1188 Phone: (2T0) 822-.9588 

FtefSte) 3634707 T^K (402)733-1883 Fax: (210)679-6577