CONTRAC T# EP-R7-06-0 4 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E EEP A 

### AS WAssociate s In cCertificatio n fo rPropertyCloseou t BVI D 2228 5 PropertyAddres s 81 4 Sout h 27 t h Stree t Fiel d Wor k Starte d 30-Aug-0 6 Fiel d Wor k Complete d 30-Sep-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 B 2 quadran t wa s excavate d t o a dept h o f1 2 inch . Th e dri p zon e 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 site 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 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 . 4026155 0

SUPERFUN D RECORD S Ja n Prawdzi k AS W Projec t Manage r 

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Nam e Titl e 

### Dat e 

### Signatur e E D fc 7 *CONTRAC T# EP-R7-06-0 4 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

### Analytica l Resul t Summary OL S ID : 2228 5 t h 

### Propert y Address : 81 4 Sout h27' " Stree t

Sampl e I D XR FResult s Avg . (ppm ) La b Result s (ppm ) 22285-DE-DZ- 6 325. 3 ±57. 6 N A 22285-DE-B2-1 2 222. 3 ±5 1 N A

Ja n Prawdzi k AS WProjec t Manage r

Nam e Titl e 

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# ^ Signature

Sampl e Designatio n OLSID-DE-Location-d d

- OLSI D i s a particula rresidentia l propert yI D fro m whic h (h e sampl e i s collected . D E = Durin g an d Pos t Excavatio n Locatio n o fth e sampl e a s follows ; F l = Fro m Yar d (I s 1 Quadrant ) B 1 = Bac k Yar d (I " Quadrant ) F 2 = Fron t Yar d (2 n d Quadranl ) B 2 = Fron t Yar d (2' " Quadrant ) D Z = Dri p Zon e P Z = P\a yZon e G A= Garde n E A= Easemen t d d describe s th e dept h fro m whic h th e sampl e wa s collected . N A= No t Applicabl e

# Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m 2 Propert yft : -* ' •Propert yAddress : B l ^ Date/Time : Owner' s Name : /^<Jf>' a Quad s Excavated : Contracto rGrou p 

# 4-0 - Excavatio n Genera l Ye s N o



### - 1 .I f necessary , wer e th e correc t quadrant(s ) excavate d an d restored ? 

### 6 ^ ^ 2 . I f necessary. , wer e th e correc t area s o f dri p zon e excavate d an d restored ? 

### 6 ^ Gradin g So d an d Vegetatio n Ye s N o I .Does th e gradin g aroun d th e perimete ro f th e hous e i n excavate d area s generall yslop e awa y ' fro m th e house ? 

# u2 . Ha s so d bee n lai d i n al l areas tha t wer e excavated ? ­ 

## ^ 3 .

Doe s th e so d appea rt o b e generall yhealth yan d growing ? (Onl yevaluat e i f inspecte d a t a 3 0 da

ytim e period ) 4 .Are sodde d area s generall yfir m an d evenl ygraded ? 

# ^ 5 .Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i f inspecte d a t a 3 0 da y tim e period ) 6 .Wa s th e propert ygrade d suc h that wate rwil l no t poo l o n th e property ? 

## <s 7 .Wa s damag e t o landscapin g o rplan t material s avoided ? L-- - Gates , Fence s an d Retainin g Wall s Ye s N o 1 .

D o gate s ope n an d clos e freely ? (I f applicable ) l^ 2 .

Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) L^ ­ 3 .

Wa s damag e t o gate s o rfence s avoided ? (I f applicable ) L- ­ 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) L ^ < 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 .Wa s damag e t o th e foundatio n avoided ? \ S 3 . Wa s damag e t o window s avoided ? \ ^ f 4 . Wa s damag e t o window s o rdoo rscreen s avoided ? \ / 5 . Wa s damag e t o downspout s o rdownspou t extension s avoided ? L / Sidewalks 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 ? A /

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s compjetqjincludin g th e 30-day so dwarranty tivel- > Date : EP A Representative ­

# f Contract No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t vk*S2J y 

### Omah a Lea d Superfun d Sit e 

## OLSI D Propert y Addres s 

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# 2 ? - Propert y Owne r I s th e Residen t th e Owne r D Ye s B

—No ^ fafl// 4 f ait**, * 4 

### 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 aLeadSite . 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 that al l work performe da t thi s property wa s complete di naccordanc e withth e contac t specification s an dEPArequirements . 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 ) 731-304 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 propert y t o m y satisfactio n B^fagre e that restoratio ni s complete dat my propert y D I D o No t Agree : Comments :



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PropertyDwner' s Signatur e Dat e /0-r~& & 

### /^ ^ ^ ^— ^ EP ARepresentativ e Signatur e Dat ePag e 1 o f Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio nAgenc y Regio nVI I Residentia l Yar dSoil s Environmenta l Restoratio n Service s PROPERT YACCES S (t o b e complete db y Properl y Owner ) r; i rccibi r est nt'omn i esnnno l no r f;ivo r ikini eil l1-800-223-042 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 / f

' & '' 2 '/ <^ x (Please Print Name ) 

### _J ­ (Prope#y~&wfiZFSigitart4re ) f \(Date ) J NOTE : Grantin g per missionDOES NO T necessaril y impl y you r property wil l b e remediate dat thi s time . | PROPERT YINFORMATIO N (t o b e complete db y residen t and/o r propert y o w wner—rieas e Residen t Name : W\f\R\A IJ LOwne r D Rente r Residenc e Address : (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : \o& l o!!! > * c* ( ~ Owner' s telephon e number—Home : Work : Ag e o f Home ? 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 YE S 

## P'N O Ha s th e interio r bee npainte do r covere dsinc e 1978 ? D'YE S D N O ^ X) * > Tota l numbe r o f occupants : ___sa 2 Lis t Ages : M 0 t * 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 : C ^ Comments : A/U /^ O S 6 /J /> ^ \ J ' ^ 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 U.S.C . 9604 . 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 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 lakin 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 :

# Lis t o f existin g Condition s Pg - of . 

### Propert y Address : O ( v cQ . Owner : Description : 

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OwnerSi^narure : ^ AS WAssociate s Inc .

# 2228 5 Owne rName : MARI AMIRAND A Address : 8.1 4 S27 ST Phone : H: 402-714-279 9 Sampl e Numbe r RYASCPXA-2228 5F1 RYBSCPXA-2228 5F2 RYCSCPXA-2228 581 RYDSCPXA-2228 5 B2 RDZSCPXA-2228 5DZ • aCgCCPXA'2220 5 -- - 62 - La b RDZSCPLA-22'28 5 Resul t 4210 war n 

### Omah a Lea d Sit e Sit e Sketc h W: 402-612-456 4 Lea d Sampl e / Concentratio n Collected , D D 

### D D D D Numbe r ofSample s = \ Exterio rPain t Nort hArro w L~

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Not pain t

Sample s Collected Firm : /J H Date : Time : Sample s Analyze d XR F Unit : Book :

Date : _ Time : _ Staff :

Omah aLea dSit e 4613 0