CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Siite Remediation, Omaha, NE

EPA

ASW Associates Inc Certification for Property Closeout

BVID 1308 Property Address 4407 Leavenworth Street

Field Work Started 13-Oct-06 Field Work Completed 20-Oct-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 DZ quadrant was excavated to a depth of 10 inch.

• Verification samples confirmed that the cleanup standards were met.

• Verification samples were taken from bottom of excavation.

• 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.

40261749

Comments:

None.

SUPERFUND RECORDS

Jan Prawdzik

Name

ASW Project Manager

Title Date

& >i\cx

Ot&er: <±> 7 2: y
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 1308

Property Address: 4407 Leavenworth Street

Sample ID

1308-DE-F1-06

1308-DE-DZ-10

XRF Results

Avg.

(ppm)

89.3 ± 39

102.8 ±39.6 |

Lab

Results

(ppm)

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Signatunr

Sample Designation

OLSID-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 as follows;

Fl = Front Yard (1* Quadrant)

B1 = Back Yard (1 * Quadrant)

F2 = Front Yard (2nd Quadrant)

B2 = Front Yard (2nd Quadrant)

DZ = Drip Zone

PZ = Play Zone

GA = Garden

EA = Easement

dd describes the depth from which the sample was collected.

NA = Not Applicable
Property #: _

Date/Time:

Quads Excavated:

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property Address:

Owner's Name:

Contractor Group

leaver>WtrM 5t

Excavation General Yes No

1. If necessary, were the correct quadranl(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 (he 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

I/

^

>/

,/

/

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)

•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?

4. Was damage to windows or door screens avoided?

5. Was damage to downspouts or downspout extensions avoided?

/

s

S

/

s

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

S

S
Owners comments:

Inspection notes:

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

EPA Representative &m &^ Date: /o/s//**-.

^ ——
f

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site ®

OLSID

Property Owner

CK*,5,vXA^ ^[fflProperty Address

WV

Lfe/jV^/J^aA-f/iSJ

Is the Resident the Owner D Yes 0 No

Compliance Statement:

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

and conduct environmental restoration sen ices 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

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

I agree that restoration is completed at my property

D I Do Not Agree: Comments:

s (A,

Property Owner's Signature Date

-ct /k

ative Signa

o

EPA Representatiye Signature Date
Oct. O4 06 12:09a Chapman Dieh l Companie s 4026140677 p. 1

U.S. frtvironmentitl Protection Agency Region VII

Omaha Lead Site

Omaha, NK

Residential Yard Soib

Environmental Restoration

Services

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

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

activities upon the following described premises. For further information please conlact EPA at I -800-223-0425.

Property Access Granted By _

(Please Print Name)

(o

(Property Owner Signature) (Dot*)

NOTE: Granting permission DOES NOT naccssarify impty your property will I* remediated at this time.

Residence Address:

Property owned by:

Owners mailing address.

Owner's telephone number—Home:

Ag« of Home? _ 1*130 -^ years How long have you lived here?

Has (he exterior been painted or covered with aiding since 1978

Has the interior been painted or covered since 1978'?

Toial number of occupants: ^- List Ages:

OS

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

Comments:

ADTHORJTY FOR fcNVIORNMENTAL RESPONSE ACTIONS

The activities to he implemented by QPA imder this agnxmcnt aie pmsiuut to Section 104 ofCCRCLA. 41 U.S.C. VMM. EPA't right of vLk-eu lu ih

piupeny for in Section I M(e> of CIMLl J\. 42 U.S.C. 9604 (c). which pmvidct entry (or.

 u

d<unniaing the octtl foi nipuno:. w chinning or uklm

«ny fcsfmnv ucuon under this title. ornthcnviK enforcing the provisions of fhis tide."

Access AUempis:

I- irst: Second: Third:

OCT 03,200 6 11:55A 4026140677

900Z'ZO 100

page 1
Get O3 O6 U?:!Oa Chapman Dieh l Companies 402BI40B77 P- 3

Property Address: ^L\D~1 /- <?ft VV K) l+J O

Owner: OLSIO# :

Descriptjon:

n a/

C

 V

-

A

- «~ r "
,..

C

1308

Owner Name: •jpfxTr-.UL.LQ. r'^r'~f^~Pic:T^'°'j

Address: 4407 LEAVENWORTH ST

Phone: H ^-/ B-P+VCO w-.CRl -°«f

r

Omaha Lead Site

Site Sketch

Exterior Paint North Arrow

Q Good xTTN.

Q Not paint >*JX

Sample Number

RYASCPXA-1308

RYBSCPXA-1308

RYCSCPXA-1308

RYDSCPXA-1308

RDZSCPXA-1308

RGZSCPXA-1308

RPZSCPXA-1308

Lead

Concentration

YA 221

YB 121.8

YC 342.2

YD 901.6

DZ 1300

GZ

PZ

Sample

Collected

 LAd

ppm 0 Q

ppm 0 Q

ppm 0 Q

ppm 0 0

ppm 0 Q

ppm Q D

Ppm D D

Number of Samples = I 5 i i 1

Samples Collected

Firm: Sverdrup

Date:

Time:

Samples Analyzed

XRF Unit: Book:

Date: 12/18/1999

Time: 03:14

Staff:

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play

LEAWNW0RTH

UEAVENWORTM

5T.

 :

: Yt?

I22

YC :

M2:

5HEt?n

*< H: HAC€A

046141.0123