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

16860

14-Jun-06

Property Address

Field Work Completed

2341 South 33rd Street

12-Jul-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.

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.

Comments:

None.

Break O'O>

Other:

Jan Prawdzik

Name

ASW Project Manager /£

Title 'Dat6

40261963

SUPERFUND RECORDS
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 16860

Property Address: 2341 South 33rd Street

Sample ID

16860-DE-F1-06

XRF Results

Avg.

(ppm)

90 ±61

Lab

Results

(ppm)

NA

Jan Prawdzik

Name

ASW Project Manager

Title Date Signature'

Sample Designation

OLSID-DE-Locition-dd

OLSIO 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 (2- Quadrant)

B2 - Front Yard (2«l Quadrant)

DZ = Drip Zone

PZ = Play Zone

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: ^3^1 5.33

Owner's Name:

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?

i/

*/

Grading Sod and Vegetation Yes No

1.

2.

3.

4.

5.

6.

1.

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

from the house?

Has sod been laid in all areas that were excavated?

Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30

day time period)

Are sodded areas generally firm and evenly graded?

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

time period)

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

Was damage to landscaping or plant materials avoided?

/

S

*/

S

S

/

/

Gates, Fences and Retaining Walls Yes No

I . 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

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?

5. Was damage to downspouts or downspout extensions avoided?

s

s

s

S

*/

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

«/

J
Owners comments:

Inspection notes:

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

EPA Representative Date:
§

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site @)

OLSID

Property Owner

/*» **,*

Property Address

2.JW S.V

Is the Resident the Owner Q^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:

Jan Prawdzlk

Name

CONTRACTOR CERTIFICATION

ASW Project Manager

Title Date

Property Owner Section

Signature

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

03 I agree that restoration is completed at my property

O I Do Not Agree: Comments:

rltJ\k Jf>jjJ2A

Property Owner's Signature

f^/oJ/, J^ (^—

EPA Representative Signature

-j. (£.06*

Date

7-/A <s£

Date
Page lof 1

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

(Please Print Name)

(Property Owner Signature) (Date)

NOTE: Granting permission DOES NOT necessarily imply your property will be remediated at this time.

Resident Name: /j)/?A DA A/ 8</R

Residence Address: 2-34J $ 33 5Y/W

D Owner

QtfflHA

P Renter

/V£

(CITY) (STATE) (ZIP)

Property owned by:

Owners mailing address: t—^ f\i v[\C—•

Owner's telephone number—Home: 'y*\ [ -"2,OO \ Work:

Age of Home? I O D years How long have you lived here? years

Has the exterior been painted or covered with siding since 1978 D YES

Has the interior been painted or covered since 1978? u YES D NO

Total number of occupants: J List Ages: i 7-( < I ( "7 4 . "?>; Hi . 4 O

List ages of occupants under 6 years old who play in the yard for 5 or more hours per week: ( "2-

Comments:

AUTHORITY FOR ENVIORNMENTAL RESPONSE ACTIONS

The Ktivitiei 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: 2-34) g 32

Owner: Date:

Description:

Owner Si

Print & Sign

ASW Assoeiates Inc

Print
Owner Nam*:.

Addrom:

Omaha Lead Site

Site Sketch

Aorth Arrow

Phone:

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Rev 4

Sample Number

RYASCPXA- /QSGO

 F1

RYCSCPXA- /SdQO

 B1

RYDSCPXA- IG&QQ B2

RDZSCPXA- IQQGQ DZ

Lead

Concentration

//7 t

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1:37 r

133 t

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Sample .

Collected

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Samples Collected

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Time: // '• If

Samples Analyzed

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.egend: F1 » Front Left, F2 « Front Right, B1 = Back Lett. 82 * Back Right DZ = Drip Zone, GZ = Garden. PZ <= Play

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