CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

ASW Associates Inc Certification for Property Closeout

BVID

Field Work Sitarted

13271

14-Aug-06

Property Address

Field Work Completed

3621 Valley Street

7-Sep-06

Summary:

The excavation was performed in compliance with the work plans and specifications.

The F1 quadrant was excavated to a depth of 6 inch.

The F2 quadrant was excavated to a depth of 6 inch.

The B1 quadrant was excavated to a depth of 6 inch.

The B2 quadrant was excavated to a depth of 6 inch.

The drip zone was excavated to a depth of 12 inch.

Verification samples confirmed that the cleanup standards were met.

The site was backfilled with materials which meets contract specifications.

The backfill was compacted to acceptable standards.

Sod placements and site restorations were conducted in compliance with work plans and

specifications.

Analytical data provided is post excavation at the bottom of the excavation for confirmation

purposes

40261517

Comments:

None.

SUPERFUND RECORDS

i— p, f\ A

Jan Prawdzik

Name

ASW Project Manager //

Title 'Date

s^-^

Signature
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 13271

Property Address: 3621 Valley Street

Sample ID

1 327 1-DE-F 1-06

1327I-DE-F2-06

1 327 1-DE-B 1-06

1327I-DE-B2-06

13271-DE-DZ-12

XRF Results

Avg.

(ppm)

86.7 ±53

225.6 ±52.3

124 ±46.7

39.6 ±43.7

239 ±58.3

Lab

Results

(ppm)

NA

NA

NA

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Date

Sample Designation

OLSID-DE- Location-dd

OLS1D is a particular residential property ID from which the sample is collected.

DE = During and Post Excavation

Location of the sample as follows;

Fl = Front Yard (1s Quadrant)

Bl = Back Yard (la Quadrant)

F2 = Front Yard (2nd Quadrant)

B2 = Front Yard (2nd Quadrant)

DZ = Drip Zone

PZ = Plt.yZone

GA = Garden

EA = Easement

dd describes the depth from which the sample was collected.

NA = Not Applicable
&EPA

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property#: /32/V

Date/Time:

Quads Excavated:

Property Address: 362 I Vfl

Owner's Name: /I

Contractor Group

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 of the 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)

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

7. Was damage to landscaping or plant materials avoided?

/

</

/

/

/

/

J

Gates, Fences and Retaining Walls 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? (If applicable)

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

J

/

/

/

Foundation, Siding and Cutters Yes No

1 . Was damage to the siding or trim avoided?

2. Was damage to the 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) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

/

V/
Owners comments:

Inspection notes:

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

EPA Representative £L, & Date:
(^)

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site

fsSzJ

OLSID

Property Owner 5KL

Property Address

1M v. (ley Si

/

Is the Residen t the Owner Bf Yes D No

Compliance Statement:

U.S. Environmental Protection Agency (EPA) or its authorized representatives, (or its contractors), to enter

and conduct environmental restoration services for the Omaha Lead Site.

Your cooperation im giving EPA/ASW permission to access your property during the removal/restoration

phase is sincerely appreciated. This document certifies that all work performed at this property was

completed in accordance with the contact specifications and EPA requirements.

If you have questions or need additional information please contact the EPA Public Information Centers at

(402) 731-3045 or (402) 991-9583 or the EPA Office of External Programs at 1-800-223-0425.

Additional Comments by EPA and/or ASW:

CONTRACTOR CERTIFICATION

Jan Prawdzik

Name

ASW Project Manager

Title Date Signature

Property Owner Section

This agreement documents the completion of remedial/restoration efforts at the property to my satisfaction

Sj. I agree that restoration is completed at my property

D I Do Not Agree: Comments:

s Signa«i«L__J

3,0/o6

Date

Representativ^ S/gnatu re

/ Date
Page 1 of

U.S. Environmental Protection Agency Region VII

Omaha Lead Site

Omaha, NE

Residential Yard Soils

Environmental Restoration

Services

PROPERTY ACCESS (to be completed by Property Owner)

ira recibir estn forma esp;mol por favor ikini e al 1-800-223-0425

Grantor (the property ov/ner), consents to and authorizes the United Sates Environmental Protection Agency (USEPA)

or its authorized representatives (or its contractors), the Grantee, to enter and perform certain environmental response

activities upon the following described premises. For further informatiop please contact EPA at 1-800-223-0425.

Property Access Granted By

(Property Owner Signature) ^

NOTE: Granting permission DOES NOT necessarily imply your property wiir&e remediated at this time.

PROPERTY INFORMATIO N

dieted bv resident and.'or propertv ownei

Resident Name: A >OrHo 10/4^106140^ Owner D Renter

Residence Address: 3 k 2-t \//l(i£S -Si

l

£§ / &5~

Property owned by:

(CITY) (STATE) (ZIP)

Owners mailing address:_

Owner's telephone number — Home:

Age of Home?

~ S 7 3 ( Work:

years How long have you lived here? years

Has the exterior been painted or covered with siding since 1978

Has the interior been painted or covered since 1978?

Total number of occupants: / List Ages: r* J&C^V\

& YES

Cf YES

D NO

D NO

List ages of occupants under 6 years old who play in the yard for 5 or more hours per week:

7

Comments:

AUTHORITY FOR ENVIORNMENTAL RESPONSE ACTIONS

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the

property for in Section I04(e) of CERCLA, 42 U.S.C. 9604 (e), which provides entry for, "determining the need for response, or choosing or taking

any response action under this title, or otherwise enforcing the provisions of this title."

Access Attempts:

First. Second: Third:
List of existing Conditions pg. _ of

Property Address:

Owner:

l//)((e\l vSf~

Date: 67/3-27 OLSID #

Description:

~ O~QJi

?(/C

Owner Signatu

Print & Sign

ASW Associates Inc.
Omaha Lead Site

Site Sketch

Name:

Address:

Phone:

Sample Number Lead Concentration Confirmation Sample

+-7B f\ Yes

fZYes

ppm

ppm

ppm

ppm

ppm

ppm

ppm