### 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 WAssociate s In cCertificatio n fo rPropert yCloseou t BVI O 4839 6 PropertyAddres s 503 0 S 20 t h 

### Stree t Fiel d Wor k Starte d 23-Oct-0 6 Fiel d Wor k Complete d 2-Nov-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 f1 2 inch . Th e 8 1 quadran t wa s excavate d t o a dept h o f6 inch . Th e dri p zon e wa s excavate d t o a dept h o f1 2 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 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 wor k plan s an d specifications . Analytica l dat a provide d i s pos t excavatio n a t th e botto m o fth e excavatio n fo rconfirmatio n purposes . 4025859 1 

### Comments : SDPEKFUNI ) RECORD S 

### None . Ja n Prawdzi k AS WProject Manage r

Nam e Titl e 

### Dat e Signarore q L 

### Jj . jf r f

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# A TCONTRAC 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 : 4839 6 Propert y Address : 503 0 S 20" t h 1 

### Stree t XR FResult s Lab 

### Sampl e I D Avg . 

### Result s (ppm ) (ppm ) 

### 48396-DE-B1-0 6 67.4154. 3 N A 

### 48396-DE-DZ-1 2 164.7165. 3 N A 

### 48396-DE-F2-I 2 

### 55 9 ±9 3 N A



### Ja n Prawdzi k AS WProject Manage r

Nam e Titl e Dat e "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 th e sampl e i s collected . D E = Durin g an d Pos t Excavatio n Locatio n o f th e sampl e a s follows , F l = Fron t Yar d (I " Quadrant ) B l = Bac k Yar d (I * Quadrant ) F 2 = Fron t Yar d (2 n d Quadrant ) B 2 = Fron t Yard (2 n d Quadrant ) D Z = Dri p Zon e P Z = PlayZon 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

# &EP A Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y# : PropertyAddress : 

### " >?- O $ t Date/Time : J l Owner' s Name : peh>b>'€ - Quad s Excavated : fT~T$ , 6 I - / P Z Contracto rCrou p Excavatio n Genera l Ye s N o 1 . I f necessary , wer e 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 nYe s N o 1 . 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 ? i / 2 .Ha s so d bee n lai d i n al l area s that wer e excavated ? \S 3 .

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

ytim e period ) 

# s 4 .Are sodde d areas generall yfir m an d evenl ygraded ? 

# y 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 propertygrade d suc h tha i wate rwil l no t poo l o n th e property ? 

# • / 7 . Wa s damag e t o landscapin g o rplan 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 d clos e freely ? (I f applicable ) 

# y 2 .Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) 

# s 3 . Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

# / 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 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 ? S 2 . Wa s damag e t o th e foundatio n avoided ? S 3 . Wa s damag e t o window s avoided ? 

# s 4 .Wa s damag e t o window s o rdoo rscreen s avoided ? 

# s 5 .Wa s damag e t o downspout s o rdownspou t extension s avoided ? 

### • s Sidewalk s an dDriveway 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 ? t /

### Owner s comments :

Inspectio nnotes :

Removal an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EPARepresentativ e ,6L , j&. , Date : , ,

### Contract No : E P - R 7 - 0 6 - 0 4 VST ) 

### PropertyCloseou t Agreemen t @ ) 

### Omah a Lea d Superfun d Sit e OLSI D Propert y Addres s 

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# *' Propert y Owne r / I s th e Residen t th e Owne r fQ , Ye s D 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 property durin g th e removal/restoratio n phas e i s sincerel y appreciated . Thi s documen t certifie s tha tal 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 ) 731-304 5 o r (402 ) 991-958 3 o r th e EP AOffic e o f Externa l Program s a t 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 $ 3 I agre e tha t restoratio ni s complete dat my propert y D I D o No t Agree : Comments :

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# // / OpfoC , Propert y Owner' s Signatur e ' Dat e 

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# r>( o EP ARepresentativ e Signatur e ' Dat e•\ 

# l c Pag 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 est aform aespart o Ipu r lav e -223-042 : 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 I V 

# ) (Propert y Owne r Signature ) / \(Date ) I NOTE : Grantin g permissio nDOES NO T necessarily impl y you r property wil l b e remediate dat thi s time . PROPERT YINFORMATIO N (1 0 b e complete d b vresiden t ami/o rproperl vow n Residen t Name : KLOwne r D Rente r Residenc e Address : 5b 3 O S . (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address: _ 

# S . Owner' s telephon e numbe r —Home : *JO'2 . -2(2. - tf- j * f ( Work : Ag e o f Home ? _p Q

_ year s Ho w lon g hav e yo u live dhere ? / Q year s Ha s th e exterio r bee npainte do r covere dwit hsidin g sinc e 197 8 ErYE S D N O Ha s th e interio r bee npainte do r covere dsinc e 1 978 ? BYE S D N O Tota l numbe r o f occupants : ^*

—_ Lis t Ages : r « fl\* ~ V"T~_S 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 ) 

### f 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 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 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 :

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