CONTRAC T # EP-R7-06-04 

### AS W Associate s Inc . Omah a Lead Site Remediation , Omaha , N E EPA 

### AS W Associate s In c Certificatio n fo rPropert y Closeou t BVI D 2198 7 

### Propert yAddres s 291 2 Maso n Stree t Fiel d Wor k Starte d 12-Jun-0 6 

### Fiel d Wor k Complete d 29-Jul-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 1 quadran t was excavate d to 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 of 1 2 inch . Th e B 2 quadrant 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 8 inch . Verificatio n sample s confirme d tha t th e cleanu p standard s wer e met . Th e site was backfilled 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 placements an d sit e restoration s wer e conducte d i n compliance 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 o f th e excavatio n fo rconfirmatio n purpose s Comments : None . 

# .tfd e ^—/g) y Ja n Prawdzi k AS W Projec t Manage r Nam e Titl e Dat e ^- ^

SidKatur e ^

4026200 6

SUPERFUN D RECORD SCONTRAC T n EP-R7-06-04 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

### EPA 

### Analytica l Resul t Summar y OL S ID : 21987 Propert y Address : 291 2 Maso n Stree t XR FResult s Lab Sampl e I D Avg . Result s (ppm ) (ppm ) 21987-DE-F1-1 2 165. 6 ±5 2 

### N A 21987-DE-F2-0 6 205. 3 ± 52. 3 

### N A 21987-DE-B1-1 2 34 6 ± 6 0 

### 43 2 21987-DE-B2-1 2 119, 6 ±4 7 

### N A 21987-DE-DZ-1 8 34 1 ± 10 9 

### 52 6

Ja n Prawdzi k AS W Project Manage r

Nam e Titl e 

### Date 

### Signatured Sampl e Designatio n OLSID-DE-Lowrlon-d d OLS1 D i s aparticular residentia l property 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 Yard(I " Quadrant ) B 1 = Back Yar d(1 * Quadrant ) F2 - Front Yar d(2* * Quadrant ) B 2 = Fron t Yard(2 " Quadrant ) D Z= Dri p Zone PZ= Pla y Zon e GA » Garden E A= Easement d ddescribe s th e dept hfro mwhic hth e sampl e wa s collected . N A= No t App l icablc

# &EP A

Propert y # : Date/Time : Quad s Excava t 

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Property Address : /V)»QOl O (5t . Owner' s Name : 

### g . Contractoe.Grou p Excavatio n Genera l ^ 1 / / Ye s N o 

## •" ' 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

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

## ,»- L Gradin g So dan dVegetatio n Ye s N o 

## i . 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 ? 2 . Ha s so dbeen lai di n al l area s that wer e excavated ? 

## LS 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 * * day tim e period ) 

# u / £^> * 

### ' " 4 . Ar e sodde darea s generall y fir man devenl y graded ? 5 . Ar e th e joint s betwee n th e so dstrip s genera l ly^teb£fl(Onl y evaluat e i f inspecte da t a3 0 da y |l\1 r tim e period ) & dCtCe M /^-/^^WZtf l C 

# to^ \ j / 6 . Wa s th e propert y grade dsuc htha t wate r wil l no t poo l o n th e property ? 

### \ / 

# s 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

### \_ ^ Gates , Fence s an dRetainin g Wall s / ) Q i 

### t*tM>/{^ ^ Ye s N o 7 1 . D o gate s ope n an dclos e freely ? (I f applicable ) ^ / 2 . Wer e al l pte s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? O 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 dGutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 

### ^ 

# U ­ 2 . Wa s damag e t o th e foundatio n avoided ? 

### L^ ^ 

## L - *r ~ 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 ? 

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

# y L

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

### Owner s comments :

Inspectio n notes : Gap* ' O F t. ,



### Removal an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EPA Representativ e *£ U j^L - Date :

# g Contract No : E P - R 7 - 0 6 - 0 4 Property Closeou t Agreemen t 

### (y& | Omah a Lea d Superfun d Sit e OLSI D Property Addres s toi l 

### *«« . ^ Propert y Owne r I s th e Residen t th e Owne r D Ye s D N o «JOH* ) «Sfi^Oi5T > 1 Complianc e Statement : U.S . Environmental Protection Agenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , t o enter an dconduc t environmenta l restoratio n service s fo r th e Omah aLeadSite . You r cooperatio n i n givin g EPA/A S Wpermissio n t 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 that al l wor k

performe dat thi s property wa s complete di n accordanc e withth e contac t specification s an dEPA requirements . I f

yo u hav e question s o r nee dadditional informatio n pleas e contac t th e EP A Publi c Informatio n Center s at (402 ) 7 3 1-304 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 agreement document s th e completio n o f remedial/restoratio n effort s at th e property t o my satisfactio n P . I agre e tha t restoratio n i s complete da t m y property D I D o No t Agree : Comments :



### (

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## — X» V IRA 

# (^T i ^ ^ ^vJLJ.^i . I ) Propert y Owner' s Signatur e Dat e 0-lfa/0t > 

### ' 1 J^^cXMi^Tfe ^ (JEPA . Representativ e Signatur e Dat e 

### 0 7 '/Olf aPag e 1 o f Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio nAgenc 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 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 farthe r informatio npleas e contac t EP A a t 1-800-223-0425 . Propert y Acces s Grante dB y (Pleas e Prin t Name ) 

# 5* - 

# ii (PropffryfUwne r Signature ) (Date ) NOTE : Grantin g permissio n DOE S NO T necessaril y impl y you r properl y wil l b e remediate dat thi s time . Residen t Name : D Rente r Residenc e Address : 1 1 

## ST . (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : Owner' s telephon e number—Home : j ( O " " f Work : Ag e o f Home ? fO year s Ho w lon g hav e yo u live dhere ? year s Ha s th e exterio r bee npainte do r covere dwit hsidin g sinc e 197 8 D N O 

### Ha s th e interio r bee npainte do r covere dsinc e 1978 ? D N O

^3 > Tota l numbe r o f

occupants : .~ y Lis t Ages : Lis t age s o f occupant s unde r 6 year s ol dwh o pla y i nth e yardfo r 5 o r mor e hour s pe r week : Comments : AUTHORIT Y FO RENV1ORNMENTA 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! 0 4 o f CERCLA , 4 2 U.S.C . 960 4 EPA' s righ t o f

acces s t o th e property fo r i nSectio n104(e ) o f CERCLA , 4 2 U.S.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 Attempt^ ; First : Second : Third :

# Lis t o f existin g Condition s 

# pg - Property Address : 2-^)0 - Owner : Date : ^ "//^j > OLS# : * Z ] Description :

Owne r Signature : AS WAssociate s Inc . Prin t & Sig n Prin t

# 2198 7 Exterio rPain t 

### Omah a Lead Site Owne rName : JOH N E SKARDSK L Goo d 

### Sit e Sketc h Addrax ; 291 2 MASO N S T [JJ'foo r Phone : H : 402-333-292 8 W : 402-731-613 6 No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collect ) Sample s Collecte d RYASCPXA-2198 7 RYBSCPXA-2198 7 RYCSCPXA-2198 7 RYDSCPXA-2198 7 Sample s Analyze d RDZSCPXA-2198 7 Numbe ro f Sample s = ; 

# ENTERE D

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