CONTRAC T# EP-R7-06-0 4 

### AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

### AS W Associate s In cCertificatio n fo rPropert yCloseou t

BVI D 

### Fiel d Wor k

Sitarte d 1327 1

14-Aug-0 6 

### Propert yAddres s

Fiel d Wor k

Complete d 362 1 Valle yStree t 7-Sep-0 6 

### Summary : Th e excavatio n wa s performe d i n complianc e wit h th e wor k plan s an d specifications . Th e F 1 quadran t wa s excavate d t o a dept h o f 6 inch . Th e F 2 quadran t wa s excavate d t o a dept h o f 6 inch . Th e B 1 quadran t wa s excavate d t o a dept h o f 6 inch . Th e B 2 quadran t wa s excavate d t o a dept h o f 6 inch . Th e dri p zon e wa s excavate d t o a dept h o f 1 2 inch . Verificatio n sample s confirme d tha t th e cleanu p standard s wer e met . Th e sit e wa s backfille d wit h material s whic h meet s contrac t specifications . Th e backfil l wa s compacte d t o acceptabl e standards . So d placement s an d sit e restoration s wer e conducte d i n complianc e wit h work plan s an d specifications . Analytica l dat a provide d i s pos t excavatio n a t th e botto m o fth e excavatio n fo rconfirmatio n purpose s 4026151 7 

### Comments : None . SUPERFUN D RECORD S 

## i

—p , f \

## A

Ja n Prawdzi k 

### Nam e AS W Projec t Manage r/ / 

### Titl e 'Dat e 

# s^-

^ Signatur e

### CONTRAC T# EP-R7-06-0 4 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E EP A 

### Analytica l Resul t Summar y OL S ID : 

### 1327 1 Property Address : 362 1 Valle y Stree t Sampl e I D 1 32 7 1-DE- F1-0 6 1327I-DE-F2-0 6 1 32 7 1-DE- B 1-0 6 1327I-DE-B2-0 6 13271-DE-DZ-1 2 XR FResult s Avg . (ppm ) 86. 7 ±5 3 

### 225. 6 ±52. 3 12 4 ±46. 7 39. 6 ±43. 7 23 9 ±58. 3 La b



### Result s (ppm ) N A N A N A N A N A



### Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e Date Sampl e Designatio n OLSID-DE - Location-d d OLS1 D i s aparticula r

residentia l property I D fro mwhic hth e sampl e i s collected . D E= Durin g an dPos t

Excavatio n Locatio no f

th e sampl e a s follows ; F l = Fron t

Yar d(1 s Quadrant ) B l = Bac k

Yar d(l aQuadrant ) F 2 = Fron t

Yar d(2 n dQuadrant ) B 2 = Fron t

Yar d(2 n dQuadrant ) D Z= Dri p Zon e P Z= Plt.yZon e G A= Garde n E A= Easemen t d ddescribe s th e depthfro mwhic hth e sampl e wa s collected . N A= No t

Applicabl e

# &EP

A Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m Property# : /32/ V Date/Time : Quad s Excavated : Propert yAddress : 36 2 I Vf l Owner' s Name : / I Contracto rGrou p Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 . If necessary , wer

e the correct

area s o f dri p zone excavatedan drestored ? / / Gradin g So dan dVegetatio n Ye s N o 1 . Does th e gradin g aroun dth e perimeter o f th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? • 2 . Ha s so dbee

nlai di nal l area s tha t

were excavated ? 3 . Doe s th e sod , appea r

t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t

a3 0 da y tim e period ) 4 . Ar e sodde darea s generally fir man devenly graded ? 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t

a3 0 da y tim e period ) 6 . Wa s th e properl y grade dsuc htha t wate r wil l no t poo l o nth e property ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? / </ / / / / J Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely ? (I f applicable ) 2 . Wer e al l gate s o r

fence s take ndow ndurin g restoratio nactivitie s reinstalled ? . (I f applicable ) 3 . Wa s damag e t o gate s o r fence s avoided ? (I f

applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) J / / / Foundation , Sidin g an d Cutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio navoided ? 3 . Wa s damag e t o window s avoided ? 4 . Wa s damag e t o window s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t

extension s avoided ? / / / / / Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa ysurface s avoided ? 2 . Wa s damag e t o walkwa ysurface s avoided ? / V /

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e £L , & Date :

## (^

) Contract No : E P - R 7 - 0 6 - 0 4

PropertyCloseou t Agreemen t Omah a Lea d Superfun d Sit e 

## fsSzJ

OLSI D Propert y Owne r 

# 5K L Propert y Addres s 

# 1 M v . 

# (le y S i / I s th e Reside nt

th e Owne r

B f Ye s D N o Complianc e Statement : U.S . Environmenta l Protectio nAgenc y (EPA ) o r it s authorize drepresentatives , (o r it s contractors) , t o ente r an dconduc t

environmenta l restoratio nservice s fo r th e Omah aLea dSite . You r cooperatio ni mgivin g EPA/AS Wpermissio nt o acces s you r propert y durin g th e removal/restoratio n phas e i s sincerel y appreciated . Thi s documen t certifie s tha t

al l work performe dat

thi s property wa s complete di naccordanc e wit hth e contac t specification s an dEP A requirements . I f yo u hav e question s o r

nee dadditiona l informatio npleas e contac t th e EP APubli c Informatio nCenter s a t (402 ) 731-304 5 o r

(402 ) 991-958 3 o r

th e EP A Offic e o f

Externa l Program s at

1-800-223-0425 . Additiona l Comment s b y EP A and/o r ASW :

CONTRACTO RCERTIFICATIO N Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e Dat e Signatur e 

### Propert y Owne r

Sectio n Thi s agreemen t

document s th e completio no f remedial/restoratio neffort s at th e propert y t o m y satisfactio n Sj . I agre e tha t

restoratio ni s complete dat my property D I D o No t

Agree : Comments :

s Signa«i«L__J 

# 3, 0 

# /o 6 Dat e Representativ ^ S/gnat u r e 

## / Dat ePag e 1 o f

U.S . Environmenta l Protectio nAgenc y Regio nVI I Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s PROPERT Y ACCES S (t o b e complete db y Propert y Owner ) ir arecibi r est nform aesp;mo l po r

favo r ikini ea l 1-800-223-042 5 Granto r (th e property ov/ner) , consent s t o an dauthorize s th e Unite dSate s Environmenta l Protectio nAgenc y (USEPA ) o r it s authorize drepresentative s (o r it s contractors) , th e Grantee , t o ente r an dperfor mcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises . Fo r furthe r informatio p pleas e contac t EP Aa t 1-800-223-0425 . Propert y Acces s Grante dB y 

# ^ (Propert y Owne r Signature ) NOTE : Grantin g permissio nDOES NO T necessarily imply you r property wiir& e remediate dat thi s time . PROPERT Y INFORMATIO N diete db v residen t

and.'o r propert v owne i Residen t Name : A>OrH o 10/4^106140 ^ Owne r D Rente r Residenc e Address : 3 k 2- t \//l(i£ S -S i



### l 

### £ § / &5 ~ Propert y owne dby : (CITY ) (STATE ) (ZIP ) Owner s mailin g address:

_ Owner' s telephon e numbe r —Home : Ag e o f Home ? 

### ~ S 7 3 ( Work : year s Ho w lon g hav e yo u live dhere ? year s Ha s th e exterio r

bee npainte do r

covere dwit hsidin g sinc e 197 8 Ha s th e interio r

bee npainte do r

covere dsinc e 1978 ? Tota l numbe r

o f occupants : /

Lis t

Ages : r * J&C^V \



### & YE S 

### C f YE S D 

### N O

D 

### N O Lis t age s o f occupant s unde r

6 year s ol dwh o pla y i nth e yar dfo r 5 o r mor e hour s pe r

week : 

# 7 Comments : AUTHORIT Y FO RENVIORNMENTA LRESPONS EACTION S Th e activitie s t o b e implemente db y EP Aunde r thi s agreemen t

ar e pursuan t

t o Sectio n10 4 o f

CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s t o th e propert y fo r

i nSectio nI04(e ) o f

CERCLA , 4 2 U.S.C . 960 4 (e) , whic hprovide s entr y for , "determinin g th e nee dfo r response , o r

choosin g o r

takin g an y respons e actio nunde r thi s title , o r

otherwis e enforcin g th e provision s o f thi s title. " Acces s Attempts : 

# First . Second : Third :

# Lis t o f existin g Condition s pg . _

# o f Propert y Address : Owner : l//)((e\ l vSf ~ 

### Date : 6 7/3-2 7 

### OLSI D # Description :

~ O~QJ i



## ?(/ C

Owne r Signat u Prin t & Sig n AS WAssociate s Inc .Omah a Lea d Sit e Sit e Sketc h Name : Address : Phone :

Confirmatio n Sampl e Sampl e Numbe r Lea d Concentratio n 

# +-7 B f \ Ye s fZYe s pp m pp m pp m pp m pp m pp m pp m