Inc . 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 c Certificatio n fo rPropert yCloseou t BVI D Fiel d Wor k

Starte d 16624

9-Oct-0 6 Propert yAddres s Fiel d Wor k

Complete d 235 4 S 33 r d Stree t 27-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 2 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 f 6 inch . Verificatio n sample s confirme d tha t th e cleanu p standard s wer e met . Verificatio n sample s wer e collecte d fro m th e botto m o f excavation . Th e site was 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 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 . 4026172 0 

### Comments : None . SUPERFUN D RECORD S



## Other : ^ 7 Z . y

Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e 

### 'Dat e SignarareCONTRAC T # EP-R7-06-0 4 

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

### Analytica l Resul t Summar y OL S ID : 1662

4 r d 

### Propert y Address : 235 4 S 33 TM Stree t Sampl e I D 16624-DE-DZ-0 6 16624-DE-F2-0 6 16624-DE-B2-0 6 XR FResult s 

### Avg . (ppm ) 164. 3 ±48. 3 6 7 ± 

### 42. 6 22 2 ±

### 54. 3 La b



### Result s 

### (ppm ) N A N A N A



### Ja n Prawdzi k Nam e AS W Project Manage r Titl e 

## bat e SIgnati/fe

Sampl e Designatio n OLSID-DE-Location-d d OLSID i s aparticular

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 n o f

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

Yar d(1 ° Quadrant ) B I = Bac k

Yard(1 " Quadrant ) F 2 = Fron t

Yar d(2 ndQuadrant ) B 2 = Fron t

Yar d(2" 1 Quadrant ) 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 dept

hfro mwhic hth e sampl e wa s collected . N A = No t

Applicabl e

# &EP

A "Tfr 

# Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : Date/Time : Quad s Excavated :

I 6 b 2 t/

/ / 7 2 . £ 2 • / PropertyAddress : Owner' s Name : _ Contracto rGrou p 

### 5 3 3 

### Lc<>o/ € Excavatio n Genera l 

### Ye s 

### N o 

### 1 . I f necessary , wer e th e correc t quadranl(s ) excavate dan drestored ? 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? V 

### ^ / 

### Gradin g So dan dVegetatio nYe s N o 1 . Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 2 . Ha s so dbeenlai di nal l area s tha t wen ; 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 dat

a3 0 da y tim e period ) 4 . Are sodde darea s generall y firman devenl y 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 propert y grade dsuc htha t waie 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 ? (S ( / 

# lX 

# v / 

# \ / /

Gates , Fence s an d Retainin 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 

# fl o Qat a reinslalled?^fl 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 ) V 

### I / I / I/ ' 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 . Was damag e to downspout s o rdownspou t extension s avoided ? } / 

# \ s V \ y ^ / / / ^ /

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 ? J / 

# J

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s EP A Representativ e idin g th e 30-da y so dwarranty :

# f Contrac t No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t Omah a Lea d Superfun d Sit e 

# CsSd i

OLSI D Pr.p.r. y <>„,, „ >^* . J( ? 

### Propert y Addres s 

# s . 3 3 s i I s th e Residen t

th e Owne r

D Ye s 89 - 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 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 work performe da t

thi s property 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 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 nPrawdzi k

AS WProjec t

Manage r Nam e Titl e Dat e



### Propert y Owne r

Sectio n Signatur e Thi s agreemen t

document s th e completio no f remedial/restoratio neffort s a t th e property t o m y satisfactio n B . I agre e that

restoratio ni s complete dat my propert y D I D o No t

Agree : Comments :

x 

# ^'hj/vj^fhJL ? ( Propert y Owner' s Signatur e 

### ^JQM* A xJ^l/AXvV ^ t&\ s I H PARepresentati^e/>ignatur e 

## it/oifa L Dat e 

# n loilo L

Dat ePag e 1 o f

U.S . Environmenta l Protectio nAgenc y Regio nVI I Omah aLea dSite Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s Granto r (th e property 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 contac t EP A a t 1-800-223-0425 . Propert y Acces s Grante dB y ; ft (Pleas e Print

Name ) 

# t (Propert y Owfc r Signature ) ^~ ~ *~~ J I (Date ) NOTE : Grantin g permissio n DOES NO T necessarily impl y you r property wil l b e remediatedat thi s time . PROPERT Y INFORMATIO N etec l b v residen t

un u o r —Plens e Residen t Name : ic£ . 

### Jg , Residenc e Address : 

### 3 > 5 

### * f S . 3 3 JS . Owner Oifrl/I M D Rente r



## At e (CITY ) (STATE ) (ZIP ) Property owne dby : - U c?/d/ Q ( C Y LoSo\ £ Owner s mailin g address : Work : Owner' s telephon e numbe r —Home : j-Qj - Ag e o f Home ? _< D Q _year s Ho w lon g hav e yo u live dhere ? _ 5/YE S 

### ffl^YES 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 : 

### D 

### N O D 

### N O Lis t Ages : " £EffJ A a€f t 5 Lis t age s o f occupant s unde r

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

week : 

### / Comments : AUTHORIT Y FO RENVIORNMENTA LRESPONS EACTION S Th e activitie s t o b e implemente db y EP A unde 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 ) ofCERCLA , 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 : S . 33 ^ 

### Owner : £>a/Od U LoSoj g .J £Date : OL S #: 

### Description : 

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### Owne r Signature : Pri n& Sigr i AS WAssociate s Inc . Prio & Sig nA ] y^l-r ' 1 / "

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