### 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 y Closeou t BVI D Fiel d Wor k

Starte d 

## Summary : 1800 4 22-May-0 6 

### Propert

y Addres s Fiel d Wor k Completed 2 1 1 4 Sout h 40t h 

### Street

31-May-0 6

Th e excavatio n was performe d i n compliance wit h th e wor k plan s an d specifications . Th e F 1 quadran t wa s excavate d to a dept h of 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 2 quadran t was excavate d to a dept h o f 1 2 inch . Th e dri p zon e wa s excavate d t o a dept h of 1 2 inch . Verificatio n samples confirme d tha t th e cleanu p standard s wer e met . Th e site was backfille d wit h material s whic h meets contrac t specifications . Th e backfil l was compacte d to acceptabl e standards . Sod placement

s an d sit e restoration s specifications . Commenti : Punc h List : Dea

d so d wa s replaced . were conducte d i n complianc e wit h wor k

plan s an d

Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e 4026071 1

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

d Site Remediation , Omaha , N E 

### EP A 

### Analytica l Resul t Summar y OL S ID : 1800

4 Property Address : 211 4 South 40t h Street Sampl e I D 18004-DE-F1-1 2 18004-DE-F2-1 2 18004-DE-B2-1 2 18004-DE-DZ-1 2 XRF Result s Avg . (ppm ) 96. 2 32 4 ± 1 1 0 

### 32 9 17 5 Lab Result s



### (ppm ) 

### N A 30 2 N A N A

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

### Dat e Sampl e Desltaatk» OLSlD-DE-Location-d

d OLSI D i s aparticula

r residentia l propert y ID fro mwhic h the sampl e i s collected . D E = Durin g an dPost

Excavatio n Location o f the sample » follows ; Fl • Fron t Yard(1 " Quadrant) Bt « Bac k Yard(1 * Quadrant) F2 • Front Yard(2 * Quadrant) B 2 - Fron t Yard(2 * Quadrant) D Z - Drip Zone PZ -PlayZon e GA-Garde n EA = Easemen

t d ddescribe s th e dept

h fro mwhic h th e sampl e wa s collected .

- N A - No t

Applicabl e

# <>EP

A

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 : 0( 1 W i Owner' s Name : /?/r/ £ 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 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimeter o f th e hous e i n excavate darea s generall y slop e away fro mth e house ? 2 . Ha s so dbeen lai di n al l area s tha t wer e excavated ? 3 . Doe s th e so dappea

r to 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 . Are 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 evaluate i f inspecteda

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 ? 

# s s t)

^ f N 

# s 

# / ft \

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 ) 2 . Were 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 to retainin g wall s avoided ? (I f applicable ) 

# s s / / 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 to th e foundatio n avoided ? 3 . Wa s damag e to window s avoided ? 4 . Wa s damag e to window s or doo r screen s avoided ? S . Wa s damag e to downspout s or downspou t

extension s avoided ? 

# S 

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

### / J

## M o

Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g the 30-da y so dwarranty : EP A Representativ e ^nn t & y Date : f//f/» f

### Contrac t No : E P - R 7 - 0 6 - 0 4 

### Propert y Closeou t Agreemen t Omah a Lea

d Superfun d Site 

### OLSI D _ 

# / o 

# & o y Property Owne r

. , 

### C 

### Tf/ S fa 1 

### *'//



### i t Property Addres s 

# i/

W 5 . fr * j I s th e Residen t

th e Owne r

ffl'Ye s D 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 W permissio n to acces s you r propert y durin g th e removal/restoratio n phas e i s sincerely appreciated . Thi s document certifie s that

al l wor k performe da

t thi s propert

y wa s complete di n accordanc e wit h th e contact

specification s an dEPA requirements . I f yo u hav e question s o r

needadditiona

l informatio n pleas e contac t

th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 o r

(402 ) 991-958 3 o r

th e EPA Offic 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 Jan Prawdzi k

AS W Projec t

Manage r Nam e Titl e Dat e



### Propert y Owne r

Sectio n Signatur e Thi s agreement

document s th e completio n o f remedial/restoratio n effort s a t th e propert

y to m y satisfactio n O f I agree tha

t restoratio n i s complete da

t m y propert y D I D o No t

Agree : Comments : * . f t < /?/*'£-<* ' ^en r $£>& ( . r



### Property Own* TM Signatur e EP A Representativ e Signatur e /-<?-<? / Dat e Dat e

# trt l Pag e 1 of

_ 

# t t U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s Granto r (th e propert

y owner) , consent s t o an dauthorize s th e Unite dSate s Environmenta l Protectio n Agenc y (USEPA ) o r it s authorize drepresentatives (o r it s contractors) , th e Grantee , t o ente r an dperfor mcertai n environmenta l respons e activitie s upo n th e followin g describe dpremises . Fo r furthe r informatio n pleas e contac t EP A a t 1-800-223-0425 . Propert y Acces s Grante dB y 

### C r/j - LJ p 

## i\ j '('Pleas e Prin t

Name ) (Propert y Owne r Signature ) ^ (Date ) NOTE : Grantin g permissio n DOE S N O T necessaril y impl y you r propert y wil l b e remediate dat thi s time .

Residenc e Address : Property owne dby : (CITY ) (STATE ) (ZIP ) 

### t f Owner s mailin g address:

_ 

### Owncr' s telephon e numbe r

—Home . $ ~ 7/~ ~ Ag e o f Home ? _* l _year s Ho w lon g hav e yo u live dhere ? Ha s th e exterio r

bee n painte do r

covere dwit h sidin g sinc e 1 97 8 BYE S year s 

### Ha s th e interio r

bee n painte do r

covere dsinc e 1978 ? Total numbe r

o f occupants : _Z - Lis t Ages : YE S D N O D N O ) O , Lis t age s o f occupant s unde r

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

week : 

### Comments : AUTHORIT Y FO RENVIQRNMENTA L RESPONS E ACTION 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 n 10 4 o f

CERCLA , 4 2 U S C . %0 4 EPA' s righ t o f acces s t o th e property fo r i n Sectio n 104(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 n unde r

thi s title , o r otherwis e enforcin g th e provision s o f thi s titl e " Acces s Attempts : First : Second : Third :

# Lis t o f existin g Condition s pg . o f Propert y Address : Z /

/ V $ .

/ 

## Owner : ^^/ > d*t*, \Date : */~1Q-e & QLS # Description :

* Oi l



# 2 1 r

?/

Owner Signature : AS W Associate s Inc . t 

## Prin t & Sig

n ^rin t & Sig nOmah a Lea d Sit e Sit e Sketc h 

### Phone : <-)l - *?oi" )