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

20206

23-Jun-06

Property Address

Field Work Completed

1408 South 11m Street

th ,

17-jui-oe

Summary:

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

The F2 quadrant was excavated to a depth of 6 inch.

The B1 quadrant was excavated to a depth of 6 inch.

The B2 quadrant was excavated to a depth of 12 inch.

The drip zone was not excavated.

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:

Gardeni zone^asjxcavatejd toa degthjrf jjjncjr

"r

Jan Prawd7ik

Name

ASW Project Manaflei

Title

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Signature

40261961
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 20206

Property Address: 1408 South 11th Street

Sam pie ID

20206-DE-F2-06

20206-DE-B1-06

20206-DE-B2-12

20206-DE-GZ-12

XRF Results

Avg.

(ppm)

162 ±53.3

185.3 ±53.6

211 ±55.3

148 ±49 |

Lab Results

(Ppm)

NA

NA

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title Date

Sample Designation

OLSlD-DE-Location-dd

OI.S1D is a particular residential property ID from which the sample is collected.

DE - During and Post Excavation

Location of the sample as follows;

FI - Front Yard (Ia Quadrant)

Bl - Back Yard (lu Quadrant)

F2 = Front Yard (2nd Quadrant)

B2 - Front Yard (2nd Quadrant)

D7, - Drip /one

P/ - Play Zone

GA = Garden

EA = Easement

dd describes the depth from which the sample was collected.

NA -NotApplicable
EPA

Property #: £

Date/Time:

Quads Excavated:

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property Address: //JQft «3.

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?

/

s

Grading Sod and Vegetation

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?

Gates, Fences and Retaining Walls

Foundation, Siding and Gutters

Yes No

Yes No

1. Do gates open and close freely? (If applicable)

2. Were all gales 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

Yes No

I . 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 No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

i/

«/
Owners comments:

Inspection notes:

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

EPA Representative x&«^? Date:
1

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site ®

OLSID

j-i/J/lJflOUlP'fl £fl\}ftftA

Property Owner -M» c L,

Compliance Statement:

U.S. Environmental Protection Agency (EPA) or its au

and conduct environmental restoration services for the

Your cooperation in giving EPA/ASW permission to a

phase is sincerely appreciated, This document certifies

completed in accordance with the contact specification

If you have questions or need additional information pi

(402) 73 1-3045 or (402) 991-9583 or the EPA Office c

Property Address

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t^/v-/^/ ^^>. l| *"" *^ •

Is the Resident the Owner D Yes J*J No

thorized representatives, (or its contractors), to enter

Omaha Lead Site.

:cess your property during the removal/restoration

that all work performed at this property was

s and EPA requirements.

ease contact the EPA Public Information Centers at

f 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

G3- 1 agree that restoration is completed at my property

D I Do Not Agree: Comments:

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Property Owner's Signature

^ 8A&A-A .CXf^MA^ 'S\&j iffvyv.

/ PPA Representative Signature

fiJ^/^-ob

 Date

6*y //y 04>

I' * Date
Page 1 of.

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:

Residence Address: /A Q 0 % // f»'

D Owner

O FlA HA

D Renter

(CITY) (STATE) (ZIP)

Property owned by:

Owners mailing address.: v

Owner's telephone number—Home: /3 5 '" * ^ * ^— Work:

Age of Home? /Q years How long have you lived here? __

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:

_ years

rYES

ffl^YES

D NO

D NO

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

Comments:

AUTHORITY FOR ENVIORNMRNTAL 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 CFRCLA, 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. 1 of

Property Address: . °$ S //

Owner: Date: 6 '£"04 QLS#

Description:

A

Owner Signature'

Print & Sign

ASW Assocites Inc

Print <S S
Name: C

Address: j

Phone:

Omaha Lead Site

Site Sketch

Date: "

Time: la

North Arrow

X

Team BVID # XRF Code

Sample Number Lead Concentration

3SB +

5 re i

ppm

ppm

ppm

Confirmation Sample

Yes

OcYes d

Yes O

Yes d

No

No

No

No

No ET

No d

No D

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Omaha Lead Site 46130