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TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAK>#: pro22 . Date: gyj- K ^ r>^rAi 

Address: 3>2-ZO GvyJlx^JIo 11^ 

Remediation Contractor: r>\jQt^ %^ . 2Vif.^ Year: ^0O*=^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video ofOTOoertv (DVD) 

y Executive Summary 

y EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration A^eement 

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

y Confirmation data 

y Photographs 

y As-built sketch 

y Satisfectory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

y Property infomiation from Douglas County Assessor's Office 

D 

D 

D 

Signature 

s/asjio 

Date 

30054217 

III Illllil 

Superfund 
Find Record Remediation Query j Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 85022 - 3220 FONTENELLE BD 

Owner:

n Owner Occupied 

Owner Name: 

[•miRTY LLC 

Owner Addressl: 

r 

Owner AddressZ: 

|3510 DODGE ST 

City: State: Zip Code: 

|OMAHA [N E |6813 1 

Owner Phone: Alternate Phone: 

j(816) 322-6365 I 

 Resident: 

Resident Name: 

I ~ — 

Property Address: 

|322 0 l=OhrrENELLE BD 

Zip Code: 

|68104 

Resident Phone 

I 

Contract: 

Conlractor: 

jPRUDEr^n2009_S 

Contract Option 

BASE 

Assessment: 

Qualifying Group 

|800/CHILD 

Assessment Max XRF Value: 

r 1002 
PROPERTY SUMMARY 

Date: 9/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: August . .. . „ . „ __ . _ „. , . . _ ^ . . . .. . 

Property Address: 3220 FONTENELLE BD 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A4 other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 168 PPM @ 6"; B2 = 177 PPM @ 6"; DZ = 374 PPM @ 13"; EA = 93 @ 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 clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Docxmientation - Completed Close-out Checklist 

6) As-Built sketchi) Shall includefinal 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) fonnat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

liillill 

TECHNOLOGIES. INC. 
TECHNOLOGIES. INC 

Property*: *?Sb i2. 

Date/Time: 

Quads Excavated: /S'; Q^, D2 

^EPA 

EPA Property Close Out 

Property Address: 32-2-0 Q^t.JU- ^ 

Owner's Name: ^A^-et\ Sfewevt^ 

Contractor Group Pnident Technologies 

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? / 

Grading Sod and Vegetation 

Yes No 

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

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 inspected at a 30 

day / time period) 

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

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

time period) i / 

6. Was the property graded such that water will not pool on the property? / 

7. Was damage to landscaping or plant materials avoided? 

/ 

Gates, Fences and Retaining Walk 

Yes No 

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

v/ 

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

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

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

y 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

/ 

2. Was damage to the foundation avoided? 

/ 

3. Was damage to windows avoided? y 

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

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

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative Sc^ J0 ^ Date: s/s>/oy 
Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below hsted 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 fiiture, excluding any 

remaining warranty (30 days total) except those items listed below, if any. 

Property ID: 

Property Address: 32-2J O "^^ O ^ f eyv «1LG . R^ 

Owner: 4|^^^e ^ ^_ ^U^.^. ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

MJ I agree restoration is completed. 

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

??-/<?- ^ 

Owner's Signature Date 
Prudent Technologies, Inc. (Pnident) is under contrsct with the U. S. Enviranmental Protection Agency (EPA) to clean up leadcantaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permissian to allow Rudent to perform a soil cleaniq) at this 

property to remove lead-contaminated soil. By signing this form, die property owner grants pencnission to Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-cantaminated soil, and restoratioo ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Administrative Cleik for the 

Omaha Lead Site cleanup. Ms. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA PubUc Information CeqtO^at (402) 731-3045 (South Omaha ofifioe) or (402) 991-9383 (North Omaha oflice). 

Property Access Granted By: ;<5e/^r ^W^/^ ^ 

(Please Print Name) 

Property Owner Signature: hd6rO ^ 

(Signature) (EJate) 

PROPERTY INFORMATION 

(To be compkted by resident and/or property owner — pleaiM print) 

RESIDENT NAME: OlQ u ^T* TLlMliA^ JTs Owner Renter 

RESIDENT ADDRESS: 

/N^l ^ NX^- £)S^ ^ 

IF RENTAL, PROPERTY GOMNED BY: 

OWNER'S MAILING ADDRESS; 

?>S IO J^^^fl-» -SfcL 

* 

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

AOE OF HOME?: \<SO^ YEARS. HOW LONQ HAVE YOU LIVED HERE? " ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WfTH SIDINO SINCE 1978? YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: . NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDEI 


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 to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 960S(e), which provides entry for "determining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provision ofthe title." 

Qi«M.| ), 1 ^ 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Oinaha, 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-«577 
i^NVTRONMEiVTAL. 

CONSTRUCnO 

SERVICE 

Property Status Form 

Address: -^J. 2.o r^^-^AV-Cj^tiLt ^ O Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

)0o«^€­

Pre-Existing Condition of Structures 

Doe O ^ ' V-fc*» s your Basement have a history of leaking? Yes No 

Item NO Description & Location 

On Map 

Ks 6ir\ ^ 

Property Owner Prudent Employee 

Signature: Signature: 

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.gs8« FAY ; IMK \ '\R'\.V7n-7 
HNULUOES, INC. 

AS - BWLT DRAWING 

OLS#:8S022 

Date Excavated: 06/29/2009 OMAHA LEAD SUPERFUND SITE USEPA Signed-OiTDate: 

85022 

Exterio North AfTWf r Paint 

Site Sketch 

Omaha Lead Site 

• Good 

l g Poor Sampling Address: 3220 FONTENELLE BD • Not paint 

Sample Number 

RYASCPXA-85022 F l 

Uaa 

Concentration Sample 

Collected LAB 

D 

Samples Collected 

Fimfi:_EaA PR , A- T 

Date: // ' T­ Ot 

RYBSCPXA-8S022

RYC8CPXA-e5022

RYDSCPXA-S5022

RDZSCPXA-85022

noiiooPKA-asoec

 F2 

 Bl 

 B2 

 OZ 

 og 

22 ^ pom 

H'i Q ppm 

.1002 . ppm 

l3B 0 ppm - Pom 

or 

a 

D 

D 

D 

D 

D 

Time: l/:lO Am 

Samples Analyzed 

XRF UnH: /V<*/Q Book: 22i L 

Data: I Z -l l • 6 0 

npzsGPXA 860aa—M­ ~ ppm D D Time: r m 

Number of Samples g I S I | Q | Staff: ..ilJi y 

Legend: Fl = Front Left, F2 " Front Right, B1 = Back Left, B2 - Back Right DZ " Drip Zone, GZ " Garden, PZ - Pla; 

MlquadnnKamaavtaMdltamtlMilnel, hdngpnparty Al|£> / 

Rn-moi Cwaut. l8-,Si«<ll 044701 X1I.23 

EA = 93 PPM @ SCRAPE (-1") 

CONTRAa #: EP - R7-07-06 TO#l PRUDENTTECHNOLOGIES, INC. 
85022 

Omaiha Lead Site 

Site Sketch 

Sampling Addfass: ^22fl FQfrEUELJL BD 

Sai^plff NunOrr Leaa 

CcncsnL-alon 

Sanple 

Collected LAB 

RYASCPXA-SS022 Fl PCXT a 

RYBSCPXA-eEa22 F2 1^5 D 

RYCSCf'XA-85:'22 Bt a 

B2 

RDZSCPX>V-«M22 t)2 

fioaccrxA-BJOgi—GSRYOSCFXA-fl5022 ..J-CSlZ^ COT g^ 

a 

n 

D 

o 

»^PgOGPXA-<IS0Ca PS» a p 

bxtcficr P*nt SoithAnrs* 

Q OoGd 

Q MB! catrt 

Sainpiita Cnlkirtcd 

f'^nr F2>ft PB,, A.T,, Date //'S'-Ot 

T»'Tie //;iO SkiTJ 

Samples Ar.aiyz»d 

XRF Unit ^(fiHQ. Book.22i L 

Date / Z '/ / -o S 

Time. yrf t 

Ntmbcr cf Sarrr^s=j g j | Q | 

L6<3drid: PI = Frl;^lt Leil. F2 " FronI RIglK, Bt••» aacK Ltd, B3 "= Back RighJ DZ » Oiip Zonif, GZ = Garden PZ = Pla; 

Al i^r^A^jrcz ar» *&/MAMd lr^«r th* >lim4 (•rrgjwpM ^ AlUv u 

-TVJPrV^ lU u r-" r— 1 ^^^y 

3a»JLo FOAVCACJI Qi3 

INECp9 20O$ 

2»S\b Ooa^^V ­

"3 lo o 

^^> - (^\At 

f^MTSjoe^^ Sp i;*.- :>».s • *tK« a •t-'.j^ - < .HI : i 
± Cl.£^W 1 \JX Ji 

i «*•«"•, • 

^M- yf y 

"v^ *t.^'i<-v^ ' -,•'"'- ;'*^-." 

MAY 2005 - DOUGLAS COUNTY ASSESSO 

3220 (y-jc^y^' <^ 

http://douglasne.mapping-online.com/assessdoc/Photos/04/R24144000000001.jpg 6/12/2009 
Print Preview http://www.dogis.org/dogis_alias/dogis/printPreview.aspx7PrintOpt.. 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2414400000 

THIRTY LLC 

3220 

FONTENELLE 

BD 

OMAHA 

68104 

3510 DODGE ST 

OMAHA 

NE 

68131 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

08-15-13 

WAVERLY PARK 

2 

3 

40X127 

http://webapps.dotcomnn.org:8080/TreasTax/faces/pages 

/taxinfo.jsp?parc=2414400000 

http://douglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R2414400000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale 
Page 1 of 1 

"> 

• YOUR TICKET NUMBER IS 2298580. 

Original Call Date: 6/19/09 Time: 9:32 am Op: SIVA18967 

Work to Begin Date: 6/23/09 Time: 10:00 am 

State: NE C ount y: DOUGLAS Place: OMAHA 

Address: 3220 Street: FONTENELLE BLVD 

Twp: 15N Rng: 13E Sect-Qtr:. 08-NW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: SOIL LEAD REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX TUiL CLEARS TO: (402)733-1883 


: FAX ALL CLEARS TO (402)733 1883 


: UNSURE COMMENTS 


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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emeig: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt 

Emeig: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFnC,SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emeig: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emeig: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emeig: 8887289343 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: S^Z-c> ?4»«-/«g>»g//g 

Crew: rJ^M' ^

Date: ^ - J(f>- o*\ 

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 

 yu^^^ks^ 

Condition 

-fccA 

lyu fieni 

hijttai ^ 

k.r. ^ 

/\^A 

/V/> 

fircf^ 

TAtit' 

j y A 

•^AiA 

^flu * 

AA M 

^ A 

Bf. 

Corrective 

Hazards Action 

MJ* - y-*W«9^ 

A >«>««/ /oc^A ^ 

U^ J /oc.4+r 

AI^MJ /oe^f-f^ 

Site Safety Officer 

...yiyi-Uj-

^Ar^ i 

8080 Ward Parkway, Suite 405 

KansasCity, MO 64114 

Phone: (816) 363-3703 

ra y /Btfi\ 'Ktn.XJKl 

2S05 N. 24''' Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

4242 Medical Drive, Suite 7250 

San Antonio, TX 78229 

Phone: (210) 822-9588 

Fax:(210)579-6577