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

### AS W Associate s In c Certificatio n fo rPropert yCloseou t BVI D Fiel d Wor k

Starte d 2020 4

21-Jun-0 6 Propert yAddres s Fiel d Wor k

Complete d 1 1 1 3 Willia m Stree t 18-Jul-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 1 2 inch . Th e F 2 quadran t wa s excavate d t o a dept h of 1 2 inch . Th e B 1 quadran t was excavate d to a dept h o f 1 2 inch . Th e B 2 quadran t wa s excavate d t o a dept h of 1 2 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 were met . Th e sit e wa s backfille d wit h material s whic h meets contrac t specifications . Th e backfil l wa s compacte d t o acceptabl e standards . So d placements an d sit e restoration s wer e conducte d i n compliance wit h wor k plan s an d specifications . Analytica l dat a provide d i s pos t excavatio n at th e botto m o f th e excavatio n fo rconfirmatio n purpose s 

### Comments : None . 

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### Ja n Prawdzi k Nam e ASW Projec t Manage r Titl e 

## ' ' Da'te dfgnatur e

4026197 3 SUPERFUN D RECORD SCONTRAC T # EP-R7-06-0 4 AS W Associate s Inc . Omah a Lead Sit

e Remediation , Omaha , N E EP A Analytica l Resul t Summar y OL S ID : 2020 4 Propert y Address : 111 3 WilliamStreet Sampl e I D 20204-DE-B1-1 2 20204-DE-B2-I 2 20204-DE-F1-1 2 20204-DE-F2-1 2 20204-DE-DZ-1 2 XR FResult s 

### Avg . (ppm ) 320. 3 ±57. 3 

### 22 3 ± 

### 56. 6 51 0 ±72. 6 

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### 5 5 31 1 ±59. 3 La b Result s



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Ja n Prawdzi k Nam e AS W Project Manage r Titl e 'Dat e Simpl e Deilgnatto n OLSlD-DE-Location-dd OLSI D i s aparticular

residential property I D fro mwhic hth e sampl e i s collected . D E~ Durin g an dPost

Excavatio n Location o f th e sampl e a s follows ; F l = Front Yard(1 * Quadrant ) B l = Back Yard(I " Quadrant ) F2 - Front Yard(2* 1 Quadrant) B 2 • = Fron t Yard(2 * Quadrant ) D Z= Dri p Zon e PZ= Play Zon 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

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Propert y #: . Date/Time : " Quad s Excavated: ' 

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y Address : /t( 3 Owner' s Name : Contracto r

Grou 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 . I f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? 

### L^ 

### L ^ -
Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r 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 n lai di n al l area s tha t wer e excavated ? 3 . Doe s th e so dappea 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 generall y fir man devenl y graded ? 5 . Ar e th e joint s betwee n th 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 propert y grade dsuc h tha t wate r wil l no t poo l o n th e property ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

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# u- ' Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely ? (I f applicable ) fa^f H ' 2 . Wer e al l gate s o r

fence s take n dow n durin g restoratio n activitie 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 ? (F f applicable ) 

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Foundation , Sidin g an dGutter 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 n avoided ? 

### 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 ? 

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Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? 

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Owner s comments : : T• » <•.- *



### Inspectio n notes :



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Removal an drestoratio n activate s complete/jnclijdin g th e 30-day so dwarranty : 

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# s Contract No : E P - R 7 - 0 6 - 0 4 Property Closeou t Agreemen t Omah a Lea d Superfun d Sit e ® OLSI D 

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th e Owne r

D Ye s B N o Complianc e Statement : U.S . Environmental Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , (o r it s contractors) , to ente r an dconduc t

environmenta l restoratio n service s fo r th e Omah aLeadSite . Your cooperation i n givin g EPA/AS Wpermissio n to 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 that

al l wor k performe dat

thi s propert

y wa s complete di n accordanc e withth e contac t specification s an dEP A requirements . I f yo u hav e question s o r

nee dadditional informatio n pleas e contact th e EPA Publi c Informatio nCenter s a t (402 ) 731-304 5 o r

(402 ) 991-958 3 o r

th e EPA Offic e o f

External Program s a

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

CONTRACTO RCERTIFICATIO N 

### Ja n Prawdzi k

AS WProjec t

Manage r Nam e Titl e Date



## Propert y Owne r

Sectio n Signatur e Thi s agreement

document s th e completio n o f remedial/restoratio n effort s at th e propert y to my satisfactio n { & I agree that

restoratio n i s complete da

t m y property D I D o No t

Agree : Comments :



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### Omah a Lea d Sit e Site Sketc h W : 402-292-014

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### Sampl e Numbe r RYASCPXA-2020 4 F 1 RYBSCPXA-2020 4 F2 RYCSCPXA-2020 4 B 1 RYDSCPXA-20204 8 2 RDZSCPXA-2020

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