CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

ASW Associates Inc Certification for Property Closeout

BVID

Field Work Started

Summary:

18004

22-May-06

Property Address

Field Work Completed

21 14 South 40th Street

31-May-06

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

The F1 quadrant was excavated to a depth of 12 inch.

The F2 quadrant was excavated to a depth of 12 inch.

The B2 quadrant was excavated to a depth of 12 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

specifications.

Commenti:

Punch List: Dead sod was replaced.

were conducted in compliance with work plans and

Jan Prawdzik

Name

ASW Project Manager

Title

40260711

SUPERFUND RECORDS
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 18004

Property Address: 2114 South 40th Street

Sample ID

18004-DE-F1-12

18004-DE-F2-12

18004-DE-B2-12

18004-DE-DZ-12

XRF Results

Avg.

(ppm)

96.2

324 ± 1 10

329

175

Lab Results

(ppm)

NA

302

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Date

Sample Desltaatk»

OLSlD-DE-Location-dd

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

DE = During and Post Excavation

Location of the sample » follows;

Fl • Front Yard (1" Quadrant)

Bt« Back Yard (1* Quadrant)

F2 • Front Yard (2* Quadrant)

B2 - Front Yard (2* Quadrant)

DZ - Drip Zone

PZ -PlayZone

GA-Garden

EA = Easement

dd describes the depth from which the sample was collected.

- NA - Not Applicable
<>EPA

Property #:

Date/Time:

Quads Excavated:

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property Address: 0(1 W i

Owner's Name: /?/r/£

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 property graded such that water will not pool on the property?

7. Was damage to landscaping or plant materials avoided?

s

s

t)

^f

N

s

/

ft

\

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)

s

s

/

/

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?

4. Was damage to windows or door screens avoided?

S. Was damage to downspouts or downspout extensions avoided?

S

s

/

/

/

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

/

J
Mo

Owners comments:

Inspection notes:

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

EPA Representative ^nnt &y Date: f//f/»f
Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site

OLSID _ / o &o y

Property Owner . ,

C Tf/S fa1*'// it

Property Address

i/W 5. fr* j

Is the Resident the Owner ffl'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 in 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 ASW Project Manager

Name Title Date

Property Owner Section

Signature

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

Of I agree that restoration is completed at my property

D I Do Not Agree: Comments: * .

ft < /?/*'£-<*' ^enr $£>&( .

r

Property Own*TM Signature

EPA Representative Signature

/-<?-<?/

Date

Date
trtl

Page 1 of_

t t

U.S. Environmental Protection Agency Region VII

Omaha Lead Site

Omaha, NE

Residential Yard Soils

Environmental Restoration

Services

Grantor (the property owner), 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 information please contact EPA at 1-800-223-0425.

Property Access Granted By C r/j- LJp i\j

'('Please Print Name)

(Property Owner Signature) ^ (Date)

NOTE: Granting permission DOES NO T necessarily imply your property will be remediated at this time.

Residence Address:

Property owned by:

(CITY) (STATE) (ZIP)

tf

Owners mailing address:_

Owncr's telephone number — Home. $~ 7/~~

Age of Home? _ *l _ years How long have you lived here?

Has the exterior been painted or covered with siding since 1 978 BYE S

years

Has the interior been painted or covered since 1978?

Total number of occupants: _ Z- List Ages:

YES

D NO

D NO

)O ,

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

Comments:

AUTHORITY FOR ENVIQRNMENTAL RESPONSE ACTIONS

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA, 42 U S C. %04 EPA's right of access to the

property for in Section 104(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: Z // V $.

/

Owner: ^^/> d*t*,\ Date: */~1Q-e& QLS#

Description:

* Oil

21 r ?/

Owner Signature: ASW Associates Inc.

t

Print & Sign ^rint & Sign
Omah

a Lead Site

Site Sketch

Phone: <-)l- *?oi")