CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

ASW Associates Inc Certification for Property Closeout

BVID

Field Work Started

59

9-Oct-06

Property Address

Field Work Completed

1 117 Kavan Street

27-Oct-06

Summary:

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

The YA (F1) 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.

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.

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

purposes.

40258572

Comments:

None. SlIPERFUM) RECORDS

Jan Prawdzik

Name

ASW Project Manager

Title Date Signature
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 59

Property Address: 1117 Kavan Street

Sample ID

59-DE-YA(Fl)-06

59-DE-DZ-12

XRF Results

Avg.

(ppm)

72.4139.3

129.7 ±46

Lab

Results

(ppm)

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Dale ^ignafure

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)

Bl = 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
&EPA

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property #:

Date/Time:

Quads Eicavated:

OOP 5V

P/S

Property Address: // / 7 AVv

Owner's Name: /^gnj^-e f-h

Contractor Group X?

{ASW

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?

/

y

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?

/

/

/

/

/

y

/

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)

/

^

!/

/

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

/

«/

/

Sidewalks and Driveways (Concrete) Yes Mo

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

<S

</
Owners comments:

Inspection notes:

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

EPA Representative &-^j&~ ^_ r Date:
§

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site

ilsSv/

OLSID

Oj/J/'-y^fc'ttv /£<X»6£f

Property Owner '

Property Address

ii /i KW^/j 'ir

Is the Resident the Owner ^ 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

6B, I agree that restoration is completed at my property

D I Do Not Agree: Comments:

i^t^r a, , /^W<^Jtr

Property Owner's Signature

v_Jo AAM ^d/l/v A A i *& Ifrr^

\ "*wj*

 w v W^ u I

EPAmepresentative Signature

/•d/WoC

pate

/&/.?//**>

Date
List of existing Conditions pg. of

Property Address:: | ) | *7 \*~ 0\ Vft l/\ 6 7

Owner: "M^rV O ( A f\rf /"Date: ^ - 30 OLSID #

Description:

\Atf\de r A

Owner Signature: />| ^x, 7^^ i^yi^O^

 ASW Associates Inc

B^k Br.S

Print & Sign rint Sign
59

Owner Name:

Address: 1117 KAVAN ST

Phone:

 H:

Omaha Lead Site

Site Sketch

w

Exterior Paint

D

 Good

LI Poor

Q] Not paint

North Arrow

Sample Number

RYASCPXA-59 YA

RYBSCPXA-59 YB

RYCSCPXA-59 YC

RYDSCPXA-59 YD

RDZSCPXA-59 DZ

RGZSCPXA-59 GZ

RPZSCPXA-59 PZ

Lead

Concentration

633.6 ppm

196.3 ppm

244.8 ppm

249.8 ppm

1849.6 ppm

ppm

ppm

Sample

Collected

KJ

0

D

D

LAB

D

D

D

Number of Samples = 5

Samples Collected

Firm: Sverdrup

Date:

Time:

Samples Analyzed

XRF Unit:

Date:

Time:

Staff:

11/9/1999

Book:

11:13

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

Rev 4 046I4I.OI23