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

## AS W Associate s In cCertificatio n fo rPropertyCioseou t BVI D Fiel d Wor k

Starte d 1678 5

16-Oct-0 6 PropertyAddres s

Fiel d Wor k

Complete d 372 4 Gordo n Stree t 25-Oct-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 B 2 quadran t wa s excavate d t o a dept h o f 6 inch . Th e D Z quadran t wa s excavate d t o a dept h o f1 2 inch . Verificatio n sample s confirme d tha t th e cleanu p standard s wer e met . Verificatio n sample s wer e take n fro m botto m o f excavation . Th e sit e wa s backfille d wit h material s whic h meet s contract 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 wor k plan s an d specifications . 4026176 3 

## Comments : None . SUPERFUN D RECORD S



### Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e 

## Dat e 

# _ Signatur eCONTRAC 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 : 1678 5 Propert y Address : 372 4 Gordo nStree t Sampl e I D 16785-DE-F1-0 6 16785-DE-B2-0 6 16785-DE-DZ-1 2 XR FResult s Avg . (ppm ) 

### 185. 6 ±44. 6 18 9 ±43. 3 1 3 1. 3 ±42. 6 La b



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



### Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e 7/V < 

## ''SignaWfe

Sampl e Designatio n OLSID-DE-Location-d d OLSI D i s aparticula r

residentia l propert y 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 1 = Fron t

Yard(I aQuadrant ) B 1 = Bac k

Yar d(I " Quadrant ) 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= Pla y 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

A Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m



# . 1672 5 Propert y # : Date/Time : /////£ £ Quad s Excavated : F\.k2 fP2 ~ PropertyAddress : 5 ~ 7 2 V Owner' s Name : U /

.• ' / / / Contracto rGrou p / ^ a /

t ~ Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correct quadranl(s) excavate d an d restored ? 2 . I f necessary , wer e th e correc t areas of dri p zon e excavate d an d restored ? / 

# s Gradin g So d an d Vegetatio n Ye s N o 1 . Doe s th e gradin g aroun d th e perimete ro f th e hous e i n excavate d area s generall yslop e awa y fro m th e house ? 2 . Ha s so d bee n lai d i n al l area s that wer e excavated ? 3 . Does th e so d appea rt o b e generall yhealth yan d growing ? (Onl yevaluat e i f inspecte d a t a 3 0 da ytim e period ) 4 . Are sodde d area s generall yfir m an d evenl ygraded ? 5 . Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i f inspecte d a t a 3 0 da y tim e period ) 6 . Wa s th e propertygrade d suc h tha t wate rwil l no t poo l o n th e property ? 7 . Wa s damag e t o landscapin g o rplan t material s avoided ? / 

# s / / 

# / / 

# / Gates , Fence s an d Retainin g Wall s Ye s N o 1 . D o gate s ope n an d clos e freely ? (I f applicable ) 2 . Wer e al l gate s o rfence 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 rfence s avoided ? (I f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y

. / / 

# y Foundation , Sidin g an d Gutters Ye s N o 1 . Wa s damag e t o th e sidin g o rtri m avoided ? 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 rdoo rscreen s avoided ? 5 . Wa s damag e l o downspouts o rdownspou t extension s avoided ? i / / ; / S S Sidewalks 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 ? 

# / i /

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-day so dwarranty : EPARepresentativ e .<5<L~ >&- , Date : ^/

# § Contract No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t Omah a Lea d Super-fun d Sit e @

OLS1 D PropertyOwne r 

# m'^U^- t Propert yAddres s 

## 37Z f 

## G 6 f^£ ) 

## 6^

.S T I s th e Residen t th e Owne r^- Ye s D N o Complianc e Statement : U.S . Environmental Protectio nAgenc y (EPA ) o r it s authorize drepresentatives , (o r it s contractors) , to ente r an dconduc t

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

al l wor k performe da t

thi s propert y wa s complete di naccordanc e wit hth e contac t specification s an dEP Arequirements . 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 AOffic e o f

Externa l 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 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 a t th e propert y t o m y satisfactio n J& I agre e that

restoratio nis complete dat my propert y O I D o No t

Agree : Comments :

Propert y Owner' s Signanlr e Representative/Snjtiatur e Dat eo . ( „ 

# ,f - / 

### Pag e Iof

_

" M U.S . Environmenta l Protectio nAgenc y Regio nVI I 

### J PROPERT YACCES S (t o b e c o

r; i recibi r est aI'oniK i espnfio lpo r Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s V>pert y O\\ner ) n ll-SOO-223-042 5 Granto r (th e propert y owner) , 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 npleas e contacLEP Aa t 1-800-223-0425 . Propert y Acces s Grante di (Please Print Name ) 

### Q (Propert y Owne r SifenUure ) " " 1 (Date ) ' NOTE : Grantin g permissio nDOE S NO T necessaril y impl y you r property wil l b e remediate dat thi s time . Residen t Name : PROPERT YINFORMATIO N

(1 0 b e complete db y residen t and/o r propert y ow n EOwne r D Rente r Residenc e Address : 3 7 2 T * ^> I 

### (STATE ) (ZIP )

year s (CITY ) Propert y owne dby : Owner s mailin g address : Owner' s telephon e number—Home : ^•Q2'~^l(.> " ^"(p^^ aWork : Ag e o f Home ? /

/ year s Ho w lon g hav e yo u live dhere ? Ha s th e exterio r

bee npainte do r

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

bee npainte do r

covere dsinc e 1978 ? B Y E S 

# 3 0 I 0

Lis t Ages : of

, yi C O \& L—' ' '- > v " - « 

### 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:(j ) 3Ly/ C (\ \ Comments : AUTHORIT Y FO RENV1ORNMENTA 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 n104(e ) o f

CERCLA , 4 2 U.S.C . 9604 (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. " D N O D N O



### Acces s Attempts : First/f t Second : Third :

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

# o f Propert y Address : 3 * S F 

## Owner : M /

/ / A fc/Q Pate : fc S ( p OL S # 

### Description : 

# 4 OJlQ . /KO- C

Owne r S i Prin t & Sig n AS WAssociate s In c \ e 

## *le ; PrirftfeSig nOmah a Lea d Sit e Sit e Sketc h