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

15724

15-Aug-06

Property Address

Field Work Completed

3857 Gold Street

7-Sep-06

Summary:

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

The B1 quadrant was excavated to a depth of 12 inch.

The B2 quadrant 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 were conducted in compliance with work plans and

specifications.

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

purposes

40261499

Comments:

None.

SUPERFUND RECORDS

1-

Jan Prawdzik

Name

ASW Project Manager

Title g nature
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 15724

Property Address: 3857 Gold Street

Sample ID

15724-DE-B1-12

15724-DE-B2-12

XRF Results

Avg.

(ppm)

240 ± 58.3

104.7 ±50.6

Lab

Results

(ppm)

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Date Tgnatufe'

Sample Designation

OLSID-DE-Location-dd

OLS1D 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 (2TM1 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
&EPA

Property #:

Date/Time:

Quads Excavated:

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

[ Property Address: 3g5*? 4tf//

Owner's Name: C7</Vi / F*r

Contractor Group

Excavation General Yes No

\ . If necessary, were the correct quadrant(s) excavated and restored?

2. If necessary, were the correct areas of drip zone excavated and restored?

S

S

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.

2.

4.

5.

6.

7.

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 properly?

Was damage to landscaping or plant materials avoided?

/

/

/

/

/

/

/

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?

/

/

/

/

/

Sidewalks and Driveways (Concrete) Yes No

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 ^. XZy _ Date: 9/Jtf/af
f

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site ®

OLS ID

J-gVJ^i-ft/*-

Property Owner SclvRoeOe^

Property Address

3#57 Gc>/<£st

Is the Resident the Owner JS 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 ASVV:

CONTRACTOR CERTIFICATION

Jan Prawdzik ASW Project Manager

Name Title Date

Property Owner Section

Signature

This agreement documents the completion of remedial/restoration effort:; at the property to my satisfaction

03- 1 agree that restoration is completed at my property

D I Do Not Agree: Comments:

S~\

( 1 J !

V^x^^l^^^tiJ^^v

v ^/Property Owner's Signature

I/I v^£MM ^L aAAc^vjacoVx^

\J EPA Representative Signature

olfn /<>&

' V Date

o?/nl&(* i i

Date
Page 1 of

Omaha Lead Site

Omaha, NE

Residential Yard Soils

Environmental Restoration

Services

U.S. Environmental Protection Agency Region VII

PROPERTY ACCESS (to be coinpleled by Property O

ira recibir esi;i forma espanol por favor ikune al 1-SOOGrantor (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 ^-^£LT\PsyrVfA

<: // l\ /? (Please Print Name)

'ropertlpwner'sTgnaiure)

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

Resident Name:

PROPERTY INFORMATION

eied by resident and/or properly o\\ner

IB Owner D Renter

Residence Address: 3 &5 1 Go(<Q.

(CITY) (STATE) (ZIP)

Property owned by:

Owners mailing address:

Owner's telephone number—Home: Tr"2.~x

13

~ ? 7 C? Work:

Age of Home?

QOP1I

years How long have you lived here? _

E^YES

E'TES

years

Has the exterior been painted or covered with siding since 1978

Has the interior been painted or covered since 1978?

Total number of occupants: ^-^ List Ages: to y/C o\oL

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

Comments:

D NO

D NO

AUTHORITY FOR ENVIORNMENTAL 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 (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 pgProperty Address: 3&£~I (jLO

Owner: Date: Oil 2. «//O (p OLSID # : /572V"

Description:

5-1

/^&^l -

"tfl/UL> ) ^\^JL

Xvvner j>igna|ure

'rint/fe Sign

ASW Associates Inc.

2H**** jaO^Coc

Prilit & SignJ
15724

Owner Name: JENNIFER scHROEDER Omaha Lead Site

Address: 3857 GOLD ST

Phone: H: 402-20&-9706

Site Sketch

W: 402-351-7922

Exterior Paint

fj Poor

fj Not paint

North Arrow

J

Sample Number

RYASCPXA-15724 F1

RYBSCPXA-15724 F2

RYCSCPXA-15724 B1

RYDSCPXA-15724 B2

RDZSCPXA-15724 DZ

RPZSCPXA- 15724 PZ

Lead Sample

Concentration Collected

\%(& ppm [y

5*7 / ppm f*i

0Hfy ppm \vf

<4 I # ppm fvT

2.^ ppm ra'

pcm [~l

- ppm PI

-/=— ; Number of Samples - .*j i

LAB

D

D

n

D

D

D

D

-

Samples Collected

Firm: fyjf-TZ/stfltJ

Date: g-So-Gf

Time: l/?<&^

Samples Analyzed

XRFUnit: 1037 Book: /jq

Date: "7 - H-OS"

Time. P /v\

Staff: LA

Legend: F1 = Front Lett, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play

All quadrants are as viewed from the street, facing property

Rev 4 0-1614). 0123