CONTRAC T# EP-R7-06-0 4 

### AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E Inc . EP A 

### AS W Associate s In cCertificatio n fo rPropert yCloseou t

BVI D 2133 8 Propert yAddres s 103 3 Sout h 31 s tStree t Fiel d Wor k Starte d 6-Jun-0 6 Fiel d Wor k Complete d 26-Jun-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 8 2 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 . Th e sit e wa s 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 wer e conducte d i n complianc e wit h work plan s an d specifications . Analytica l dat a provide d i s pos t excavatio n a t th e botto m o f th e excavatio n fo rconfirmatio n purpose s Comments : 

### None . 

### B^ak: . Other: .

Ja n Prawdzi k AS W Projec t Manage r



### Nam e Titl e 

## Dat e

4026073 8

SUPERFUN D RECORD SCONTRAC T # EP-R7-06-0 4 

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

. EP A 

### Analytica l Resul t Summary OL S ID : 2133 8 Propert y Address : 103 3 Sout h31 s t 

### Stree t XR FResult s La b Result s Sampl e II ) 

### AVR . (ppm ) (ppm ) 2I338-DE-B2-0 6 273. 6 ±87. 3 N A 

### 2I338-DE-F2-0 6 110.5184. 6 18 9



### Ja n Prawdzi k AS W Projec t Manage r

Nam e Titl e 

### Signature Sampl e Designatio n OI.SII)-nK-Locntion-d d OI.SI D i s a particula rresidentia l propert yI D fro m whic h th e sampl e i s collected . D K- Durin g an d Pos t Excavatio n I.ocatio n nl'ili e sampl e a s follows ; F l ~ Fron t Yar d (I M Quadrant ) U l =Qac k Yar d (I * Quadrant ) F 2 - Fron t Yar d (I" 1 Quadrant ) H 2 = Fron t Yar d (2'" 1 Quadrant ) W . - Dri p 7,on e I V " Playiiun c CI A= Garde n F; A= Kasemcn l d d describe s th e dept h fro m whic h th e sampl e wa s collecte d N A- No t Applicabl e

# &EP A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : _ Propert y Address : 

# /03 3 s . 3\ * Date/Time : /6 Owner' s Name : Quad s Excavated : ' ' f £ .g>< £ Contracto r Grou p Excavatio nGenera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? U- " *• 

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

### LS Gradin g So dan dVegetatio n Ye s N o 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 mth e house ? 

# u s 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 t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0

* r da y tim e period ) 

# u * 

# U * * > 4 .Ar e sodde darea s generall y firman devenl y graded ? 5 .Ar e th e joint s betwee n th e so dstrip s generall y right ? (Onl y evaluat e i f inspecte da t a3 0 da y ^ tim e period ) 

# IS

^- F 6 . Wa s th e propert y grade dsuc htha i wate r wil l no t poo l o nth e property ? 

### f 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 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 ) 

### ( ^ 

## L^ 1 r 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 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 ? 

### ' C ^ < _ 2 .Wa s damag e t o th e foundatio navoided ? 3 .Wa s damag e t o window s avoided ? ^ 

### <—

• 4 . Wa s damag e t o window s o r doo r screen s avoided ? 

### t^ - *• 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

### U ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? t_* ­ 

### ^ / 2 . Wa s damag e t o walkwa y surface s avoided ? 

### tx '

### Owner s comments :

Inspectio n notes :

Removal an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e JL)ff\ . \Jcd*J L Date :

# ? Contract No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t 

### © Omah a Lea d Superfun d Sit e OLSI D Property Addres s 

## „ #s 

## y * Propert y Owne r , / I s th e Residen t th e Owne r Q^e s D N o Complianc e Statement : 

### /T '^ ^ tfyd'ti U.S . Environmental Protectio nAgenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , to enter an dconduc t environmenta l restoratio nservice s fo r th e Omah aLeadSite . Your cooperationin giving EPA/AS Wpermissio n to acces s your propert y durin g the removal/restoratio n phas e i s sincerel y appreciated . Thi s documen t certifie s that al l wor k

performe dat thi s property wa s complete di naccordanc e wit hth e contac t specification s an dEPA requirements . I f

yo u hav e question s o r nee dadditiona l informatio npleas e contac t th e EP A Publi c Informatio nCenter s at (402 ) 731-304 5 o r (402 ) 991-958 3 o r th e EPA Offic e o f External 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 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 at th e propert y to my satisfactio n m/ 1 agre e that restoratio ni s complete da t m y property D I D o No t Agree : Comments :



### } * • • 

# VW6 6 <r

r " & •*-"-' Property Owner' s Signatur e Dat e 

# C7~7? ^ ^ r^c_ - £ ~ lo-c>£ * EP A Representativ e Signatur e Dat ePage 1 o f Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc y Regio n VI I 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 npleas e contac t EP A a t 1-800-223-0425 . Property Acces s i 

# A- let (Pleas e Pr'mt~Nume ) 

# APR , ^Propert y Cfine t Signature ) {/ (Date ) NOTE : Grantin g permissio n DOE S NO T necessarily impl y you r propert y wil l b e remediate dat thi s time . Residen t Name : D Rente r Residenc e Address : (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address: _ 

## S . Owner' s telephon e number—Home : Work : Ag e o f Home ? j Q O 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 hsidin g sinc e 197 8 STYE S D N O Ha s th e interio r bee n painte do r covere dsinc e 1978 ? fi/YES D N O Tota l numbe r o f

occupants : * O Lis t Ages : 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 RENVIORNMENTA 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 US C . %0 4 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 US.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. " Acces s Attempts : First : Second : Third :

### 4^04.783-0 1 OmahnLea dSit e