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

20580

9-Aug-06

Property Address

Field Work Completed

3502 Poppleton Avenue

13-Sep-06

Summary:

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

The F1 quadrant was excavated to a depth of 8 inch.

The drip zone 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.

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

purposes

40261510

Comments:

None.

SUPERFUND RECORDS

Jan Prawdzik

Name

ASW Project Manager

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

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 20580

Property Address: 3502 Poppletori Street

Sample ID

20580-DE-DZ-06

20580-DE-F1-08

(Could not excavate further due to

tree roots)

XRF Results

Avg.

(ppm)

151.3±47

422 ± 64.5

Lab

Results

(ppm)

NA

MA

Jan Prawdzik

Name

ASW Project Manager

Title Dale 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;

Fl = Front Yard (la 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
SEPA

Remediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property #:

Date/Time: _

Quads Excavated:

Property Address:

Owner's Name:

Contractor Group

-IT

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 light? (Only evaluate if inspected at a 30 day

time period)

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

7. Was damage to landscaping or plant materials avoided?

/

/

y

y

y

y

</

Gates, Fences and Retaining Walls Yes No

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

2. Were all gates or fences taken down during restoration activities reinstalled? .(If applicable)

3. Was damage to gales or fences avoided? (If applicable)

4. Was damage to retaining walls avoided? (If applicable)

y

y

y

y

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?

y

y

y

y

y

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

*/

V/
Owners comments:

Inspection notes:

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

EPA Representative tf^jfa**, _ Date:
VB)

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site ®

OLSID

Property Owner

fi-0^ K*IH?

Property Address

>JT^2 fc,,}^

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 ILPA 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

0"i agree that restoration is completed at my property

D I Do Not Agree: Comments:

t

^^ ^/:^Sy^_

Property Owner's Signature

rT^/T ^ P / /

EPA Representative Signature

<3- I6>-O(~

Date

Date
Page 1 of

• //

U.S. Environmental Protection Agency Region VII

Omaha Lead Site

Omaha. NE

Residential Yard Soils

Environmental Restoration

Services

PROPERTY ACCESS (to lie completed by Property Owner)

ira recibir esta forma csoariol nor favor ilamc al N800-223-042:

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 conjact EjPA at 1-800-223-0425.

Property Access Grunted By

(Pleaxe Print frame)

(Propertf okrufr Signature)

NOTE: Granting permission DOES .\'OT necessarily imply vour property wilFbti remediated at this time

Resident Name:

PROPERTY INFORMATIO N

:>y resident and'or property owntT-J— P

Owner

Residence Address: ?662 PkppW.4r/\ Av/G,

r

>

D Renter

ME,

(CITY) (STATE) (ZIP)

Property owned by: X^

Owners mailing address:

Owner's telephone number — Home: T02.- b8t>"5T&?OL- \ Work: __

(<&0

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

Has the exterior been painted or covered with siding since 1978 D^YES D NO

Has the interior been painted or covered since 1978? 0 YES D NO

Total number ofoccupants: 'y List Ages: 5~\ 1 L3 )

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

Comments:

AUTHORITY FOR ENV10RNMENTAL RESPONSE ACTIONS

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA. 42 U.S C. %04. EPA's right of access to the

property for in Section 104(el of CliRCLA. 42 U.S.C. %04 (e), which provides enlr\' for. "determining the need for response, or choosing or taking

any response action under this title, or otherwise enforcing the provisions of this titl e "

Access Attempts:

First: Second: Third:
List of existing Conditions pg. _ of

Property Address: 35^)2.

Owner: fC o (4e s Date:Q7//0 :Q7//f/0 £ _ OLSID #

Description:

Pija

CG Q \ O ^x>V^Ki jyUL

iO ^^

D2.

f~ ~ 2-. ^t-y-dr

I) AW?

\

1Q&-

ua .

j

ASW Associates Inc.

Prin/ Sign
Omaha Lead Site

Site Sketch

ppm

ppm

ppm

Ppm

ppm

ppm

ppm

Omaha Lead Site 46130