CONTRAC T n EP-R7-06-04 AS W Associate s Inc . Omah a Lea d Site Remediation , Omaha , N E EP A 

### AS W Associate s In c Certificatio n fo rPropert y Closeou t BVI D 2072 7 Propert y Addres s 121 3 Sout h 27t h Stree t Fiel d Wor k Starte d 22-May-0 6 Fiel d Wor k Complete d 8-Jun-0 6 

### Summary : Th e excavatio n wa s performe d i n compliance 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 of 1 2 inch . Th e dri p zon e wa s excavate d t o a dept h o f 6 inch . Verificatio n samples confirme d tha t th e cleanu p standard s were met . Th e sit e was backfille d wit h material s whic h meet s 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 were 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 a t th e botto m of th e excavatio n fo rconfirmatio n purpose s 

## Comments : Th e pla y zon e wa s excavate d t o a dept h of 1 2 inch . Punc h Lis t Fenc e was pu t bac k i n plac e as pe rth e requiremen t o f propert y owne r

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

4026071 2

SUPERFUN D RECORD SCONTRAC T #EP-R7-06-04 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 : 2072 7 Property Address : 121 3 South 27 t h

### Street XR F Result s La b Result s Sampl e I D 

### Avg . (ppm ) (ppm ) 20727-DE-F2-1 2 

### 12 4 ±8 6 

### N A 20727-DE-DZ-0 6 

### 47 4 ± 

### 8 4 

### N A 20727-DE-DZ-0 6 

### 44 3 ±9 7 

### N A 20727-DE-F2-1 2 

### 25 5 ±4 0 

### N A 20727-DE-PZ-1 2 

### 29 8 ± 

### 3 6 

### N A

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

Sampl e Deaifiiatkr a OLSm-DE-Locatton-d d OLSI D i s aparticula r residentia l propert y ID fro mwhic h the sample i s collected . D E - Durin g an dPost Excavatio n Location o f the sample a s follows ; F l - Fron t Yard(I * Quadrant) B l - Bac k

Yard(1 * Quadrant) F 2 - Front Yard(2 - Quadrant) B 2 - Front Yard(2 " Quadrant) DZ - Drip Zone PZ "PlayZon e QA«Oarde n E A - Easemen t d ddescribe s th e dept h fro mwhic h th e sampl e wa s collected .

- NA-No t Applicabl e

# &ER & Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Property # : Property Address : Date/Time : Owner' s Name : Quad s Excavated: ' 'f-J \J> Z - f Contracto r Grou p Excavatio n Genera ! 1 .I f necessary , were th e correc t quadrant(s ) excavate d an 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 d an d Vegetatio n 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 mthe 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 to b e generall y health y an d growing ? (Onl y evaluat e i f inspecte da t a3 0 day tun e period) 4 .Are sodde d area s generall y firman devenl y graded ? 5 .Are th e joint s between th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte d a t a3 0 da y tim e period) 6 .Wa s th e propert y grade dsuc h that 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 ? Gates , Fence s an d Retainin g Wall s 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 t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an d Gutter s 1 .

Wa s damag e t o di e siding or 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 ? 5 .Wa s damag e to downspout s o r downspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) 1 .Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? Ye s N o

Ye s N o I f

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/ »/ / Ye s N o 

### / i / / / J Ye s N o 

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### Owner s comments :

Inspectio n notes :

Removal an drestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e & * j& , Date :

# s Contrac t No : E P - R 7 - 0 6 - 0 4 Propert y Closeou t Agreemen t W| ) 

### Omah a Lea d Superfun d Sit e 

# OLsr a Property Addres s 

# I2\ 3 S.lTfS l Property Owne r ^t<2A&V- ' 

# ^Tsk i I s th e Residen t th e Owne r .49­ 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 aLea dSite . You r 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 documen t 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 needadditional informatio n pleas e contac t th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 or(402 ) 991-958 3 o r th e EP A 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 Ja n Prawdzi k AS W Projec 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 n o f remedial/restoratio n effort s a t th e propert y to m y satisfactio n x I agree tha t restoratio n i s complete da t m y propert y D I D o No t Agree : Comments :

Propert y Owner' s Signatur e Dat e Representativ e Signatur e Dat e 

### ign

### Pag e 1 of _ Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc y Regio n Vl l 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 drepresentative s (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 I -800-223-0425 . Propert y Acces s Grante dB y (PropertyVwne r Signature ) NOTE : Grantin g permissio n DOE S NO T necessarily impl y you r property wil l b e remediate d at thi s time . 

### Residen t Name : Residenc e Address : 12 * J 3 £ . (CITY ) 

### (STATE ) (ZIP ) Property owne dby : / " 

### Owner s mailin g address : Owner' s telephon e number

—Home : ) V ^ 742. Q Work : 

### Ag e o f Home ? / Q L J

_ year s Ho w lon g hav e yo u live dhere ? .year s Ha s th e exterio r bee n painte do r covere dwit h sidin g sinc e 197 8 OKyE S D N O Ha s th e interio r bee n painte do r covere dsinc e 1 978 ? D^YE S D N O Total numbe r o f occupants : _ ±

_ Lis t Ages : ? / / 

### , f , ° j i 

### f •- / ^ 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 : /C , / Comments : AUTHORIT Y FO RENV1ORNMENTA L RESPONS E ACTION S Theactiviti at 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 propert y fo r i n Sectio n |04(e ) o f CERCLA , 4 2 U.S.C . 960 4 (e) , whic h provide s entr y for , "determinin g th e needfo 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 Property Address : /£/ ; 5 , 2 7 * * 

## Owner : f^vr-e i //& ^ Date : <y~2/-o 6 OL S ft : I £> 7 Description :

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### Owner Signature : AS W Associate s Inc . Prin t & Sig n Prin t & Sig n

## Omah aLea dStt e Sit e Sketch

Omah aLea dSit e 4613 0