CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Siite Remediation, Omaha, NE

EPA

ASW Associates Inc Certification for Property Closeout

BVIO

Field Work Started

1562

16-Oct-06

Property Address

Field Work Completed

711 Pine Street

27-Oct-06

Summary:

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

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

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

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

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

The drip zone was not excavated.

Verification samples confirmed that the cleanup standards were met.

Verification samples were collected from the 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.

40261748

Comments:

None. SUPERFUND RECORDS

Jan Prawdzik

Name

ASW Project Manager

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

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

Analytical Result Summary

OLS ID: 1562

Property Address: 711 Pine Street

Sample ID

1562-DE-YC-12

1 562-DE-YD-06

1562-DE-GZ-12

1562-DE-EZ-06

XRF Results

Avg.

(ppm)

119.3 ±45.3

11 7.3 ±45.3

182 ±49.6

78.9 ±35.6

Lab

Results

(ppm)

125

NA

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Dafe Signature

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;

F1 = Front Yard (1" Quadrant)

B1 = Back Yard (1" Quadrant)

F2 = Front Yard (2nd Quadrant)

B2 = Front Yard (2TM1 Quadrant)

DZ = Drip Zone

PZ = Play Zone

GA = Garden

EA = Easement

dd describes the depth from which the sample was collected.

NA = Not Applicable
Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property #: _

Date/Time:

Quads Excavated:

0156 2 Property Address: /''

Owner's Name: /n •' c fe Q f- /

Contractor Group xl £

. _____

Jfl/v,<? s

f ASW

.->> -er c

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 weie 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

s

/

./

'^

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

s

y

s

/

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

/

i/
Owners comments:

Inspection notes:

*" 3o

«i?? of j t

I,,£ re sco 77>/5 /y/?^ /?-r /9 Xrnfo*

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

EPA Representative £)^0/n •&^ Date: //
^r)

Contract: No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site ®

OLSID

fTflfcKA6' ' 3frW-&*

Property Owner • i . <-

Property Address

'\,e stIs 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 Signature

Property Owner Section

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

fesH agree that restoration is completed at my property

D I Do Not Agree: Comments:

^.-^^

•ass^^^ JJ^Jpefl ^^^^^ y Owner's Signatur ^e

JeylAxo. ^iW^at^ ,

jEFA Representativgjtignaturc

Il/6t>f66

1

 l

1

 Date

/./ /O &/6(

/

o

*• / 1

1 Date
fcy Page I of

U.S. Environmental Protection Agency Region VII

U\ ACCESS do

Omaha Lead Site

Omaha, NE

Residential Yard Soils

Environmental Restoration

Services

ipertv Owner)

1-800-2:3-0425

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)

IP- £ Ob

(Date)

NOTE: Granting permission DOES NOT necessarily imply your proper!)' will be remediated at this time.

Residence Address: 1)\ ft *£

(CITY) (STATE) (ZIP)

Property owned by:

Owners mailing address:

tt(i&(o Work: ^96'

-^

years

D NO

D NO

Owner's telephone number—Home:

Age of Home? I ( "I years How long have you lived here?

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

Has the interior been painted or covered since 1978? O'YES

•""? x9<? U C~ t-JTotal number of occupants: ^_> List Ages: Of 7 / ^Q \ /

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

Comments:

AUTHORITY FOR ENV1ORNMENTAL 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 104(e) of CERCLA, 42 U.S.C. 9604 (t:), which provides entry' for, "determining the need for response, or choosing or taking

any response action under this title, or otherwise enforcing th<: provisions of this title."

Access Attempts:

First: Second: Third:
List of existing Conditions pg-

 of

-

Property Address: /// \\Y\ t

Owner':

- x Date: - OLS #

Description:

//Ac ^cyA-.

jexw^-l-e

Owner Sign
1562

Owner Name: v. C H \ M

Address: 711 FINEST

Phone: H: pp^.

Omaha Lead Site

Slte

 Sketch

Exterior Paint

Q] Good

Q Poor

Q Not paint

North Arrow

A

Sample Number

RYASCPXA-1562 YA

RYBSCPXA-1562 YB

RYCSCPXA-1562 YC

RYDSCPXA-1562 YD

RDZSCPXA-1562 DZ

RGZSCPXA-1562 GZ

RPZSCPXA-1562 PZ

Lead

Concentration

302.6

925.6

440

525.2

ppm

ppm

ppm

ppm

ppm

ppm

Sample

Collected

D

0

0

a

a

LAB

a

a

a

a

a

Number of Samples = ! 4

Samples Collected

Firm: Sverdrup

Date:

Time:

Samples Analyzed

XRFUnit:

Date: 6/19/1999

Time: 10:05

Staff:

Book:

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

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