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 rPropertyCloseou t BVI D 

### Fiel d Wor k

Starte d 1792 0

20-Sep-0 6 

### PropertyAddres s

Fiel d Wor k

Complete d 213 1 S 34 t h 

### Stree t 3-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 dri p zon e 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 o f 6 inch . Th e B 1 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 take n fro m botto m o f excavation . 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 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 . Analytica l dat a provide d i s post excavatio n at th e botto m of th e excavatio n fo rconfirmatio n purposes . 4026178 4 

### Comments : None . SUPERFUN D RECORD S 

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

### Date 

### at u 

### re

0A M a 

# j 

# n

### 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 : 1792 0 t h 

### Propert y Address : 213 1 S 34 f n

### Stree t Sampl e I D 1 7920-DE-F2-0 6 17920-DE-B1-0 6 I7920-DE-DZ-1 2 XR FResult s Avg . (ppm ) 

### 214.7±6 8 93. 9 ±54. 7 323. 3 ±76. 7 La b Result s

(ppm ) N A N A N A



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

## bat e Signature

Sampl e Designatio n OLSro-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 l = Fron t

Yar d(I " Quadrant ) B l =Bac k

Yar d(1 s 1 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 dept hfro mwhic hth e sampl e wa s collected . N A= No t Applicabl e

# &EP

A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Property# : I 7 c

\ 2 0 Date/Time : Quad s Excavated : / ? , /?/ , /> PropertyAddress : 211, ) Owner' s Name : fo ^ Contracto rGrou p ^ Excavatio n Genera l 

### Ye s 

### N o 1 . I f necessary , were 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 ? 

### ./

• / Gradin g So d an d Vegetatio n Ye s N o 

## 1 . 2 . 3 . 4 . 5 . 6 . 7 . 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 ? Ha s so dbee

n lai di nal l area s tha t

were excavated ? 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 ) Ar e sodde darea s generall y firman devenl y graded ? 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 ) Wa s th e property grade dsuc htha t wate r wil l no t poo l o nth e properly ? Wa s damag e t o landscapin g o r plan t material s avoided ? 

### /

• / 

# y / 

# y / s Gates , Fence s an d Retainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely ? (I f applicable ) 2 . Wer e al l gate s o r

fence s take n dow n durin g restoratio nactivitie s reinstalled ? . (I f applicable ) 3 . Wa s damag e t o gale s o r fence s avoided ? (I f

applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### / 

## • S 

# • / 

# ; Foundation , Sidin g an d Gutter s Ye s N o 1 . Wa s damag e t o th e sidin g o rtri m avoided ? 2 . Was damag e to 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 t o downspouts o rdownspou t extension s avoided ? S 

# y / / j 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 : KT £ o n The ,



### Removal an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EPARepresentativ e ,<?. „ >fc ^ Date :

### Owner s comments :

Inspectio n notes : Conc.tacT Eo n The , So^i 1 ^ sip c d F



### nisi 0 6



### Removal an drestoratio n activate s complet e includin g th e 30-da

y so dwarranty : EP A Representativ e ,<?-. „ &. „ Date :

# &EFV

X Remediation/Excavatio n Contrac t (ASW ) EP A Property Clos e Ou t For m Property # : I 7 1 ? 0 Date/Time : Quad s Excavated : r~* , fit , Property Address : Owner' s Name : Contracto r

Grou p " W

Excavatio n Genera l 

### Ye s 

### N o 1 . I f necessary , wer

e th e correct

quadrants ) excavate dan drestored ? 1 . If necessary , wer

e the correc t

area s o f dri p zone excavatedan 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 awa y fro mth e house ? 2 . Ha s so dbee

n lai di n al l area s that

wer e excavated ? 3 . Does 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 day tim e period ) 4 . Are sodde darea s generall y firman devenl y graded ? 5 . Are th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat

a3 0 day tim e period ) 6 . Wa s th e property 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 ? 

### • S 

### S 

# s 

# / y / 

# s 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 . 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 ? (I f applicable ) 

# y s y y 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 to window s avoided ? 4 . Wa s damag e to window s o r door screen s avoided ? 5 . Wa s damag e to downspout s o r downspou t

extension s avoided ? 

### « / 

# y 

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

# y /* » vgjJTW. 4 

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



### OLSI D

_, _\Kc>vv\TA,f ) Propert y Owne r Propert y Addres s

* * * * v^r • C7 \ 

### I s th e Residen t

th e Owne r

D Ye s [JJ . 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 ngivin 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 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 ) 7 3 1-304 5 o r

(402 ) 991-958 3 o r

th e EP AOffic e o f

Externa l Program s at

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

CONTRACTO RCERTIFICATIO N Ja nPrawdzi k

AS WProjec t

Manage r Nam e 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 property t o m y satisfactio n •f B I agre e tha t

restoratio ni s complete da t m y propert y D I D o No t

Agree : Comments :

^/ 

# j^A]/ k Q^^J^ - / Propert y Owner' s Signatur e 

## \JQAAj~ \ruL /

## (!AAA^V«~CA^ZTvvi EP ARepresentativ e Signature d 

### / & /^ - & I /

/ 

## ' O h I Dat e 

# lr > / 

# 2-b>/ b h

' ' 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 d o h e complete db y Propert y Owner ) Par arecibi r

est aform aespano l po r

favo r ilam e a l 1-800-223-042 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 contac t EP Aa t 1-800-223-0425 . Propert y Acces s Grante dB y ~7nOA*AS > (Propert y Owne r Signature ) (Pleas e Prin t Name ) y . 6 ) (Date ) NOTE : Grantin g permissio n DOE S NO T necessaril y impl y you r properl y wil l b e remediate da t thi s time . PROPERT Y INFORMATIO N (t o b e complete db y residen t and'o r propert y owner—Pleas e Print ) Residen t Name : - 1 C'C'i . l- l A f i Residenc e Address : / S 3 4 S T D Owne r



## o n A D Rente r (CITY ) (STATE ) (ZIP ) Propert y owne dby : 

# in o Owner s mailin g address : Owner' s telephon e number—Home : ^ ' I * * ' I Ag e o f Home ? H S Work : O O year s Ho w lon g hav e yo u live dhere ? G o Y E 0 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 : 2 Lis t Ages : GKYE 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 : Comments : AUTHORIT Y FO RENV1ORNMENTA 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 . 960 4 EPA' s righ t

o f acces s t o th e propert y fo r i nSectio 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 nunde 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 . J

_o f 1 Propert y Address : 2 /

g / ' <& W/

/ Owner : ' o*^ . C _Date : L'^V-o(e > OL S #: 4 792. O Description : 

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### AS WAssociate s In c & Sig n

# 1792 0

Owne rName : WILLIA M J Address : 2 1 3 1 S 3 4 Phone : H : CULHAN E

S T W : 

### Omah a Site Lea d Sit e Sketc h Extepo rPain t (3 Good fj Poo r [~ | No t pain t Nortr i Arro w

^ ^ Sampl e Numbe r RYASCPXA-1792 0 RYBSCPXA-1792 0 RYCSCPXA-1792 0 RYDSCPXA- 1 792 0 RDZSCPXA-1792 0 RGZSCPXA- 1 792 0 — RPZ3GPXA-179? 0 — F 1 F 2 B 1 B 2 D Z

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Firm : /2> A/WJ & Date : ^-Z^ /

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# ENTERE D AU G7 6 2005 ;

Omah aLea dSit e 4613 0