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 W Associate s In cCertificatio n fo rPropert yCloseou t

BVI D Fiel d Wor k

Starte d 1745 2

25-Aug-0 6 PropertyAddres s

Fiel d Wor k

Complete d 241 1 S 14 t h Stree t 7-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 1 quadran t wa s excavate d t o a dept h o f6 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 o f 6 inch . Th e B 2 quadran t wa s excavate d t o a dept h o f 6 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 . 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 contract 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 post excavatio n a t th e botto m o f th e excavatio n fo rconfirmatio n purposes . 4025859 5 

### Comments : None . SUPERFUM ) RECORD S Ja n Prawdzi k Nam e AS W Project Manage r Titl e 

## Date ' Signatur e



## I D fcfi g 

## s P i * _&& , h. - 7 . 

## I Jtat CONTRAC 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 : 1745 2 Property Address : 241 1 S 14 t h

### Stree t Sampl e I D 

### 17452-DE-B1-0 6 17452-DE-B2-0 6 17452-DE-F1-0 6 17452-DE-F2-0 6 1 7452-DE-DZ-0 6 XR FResult s Avg . (ppm ) 

### 194. 6 ±48. 6 95. 5 ±4 3 

### 19 4 ±50. 6 103. 6 ±4 5 

### 63. 8 ± 4 1. 3 La b



### Result s (ppm ) N A N A N A N A N A



### Ja n Prawdzi k Nam e AS WProject Manage r Titl e 

### bat e Signatitf e

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 1 = Bac k

Yar d (I " Quadrant ) F 2 = Fron t Yar d (2 n d Quadrant) B 2 = Fron t Yar d (2 n d Quadrant) D Z = Dri p Zon e P Z = Pla

yZon e G A= Garde n E A= Easemen t d ddescribe s th e depthfro mwhic hth 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 Property# : f

? ' Date/Time : Quad s Eicavated : f I ] fj , P) > , R? , O Z

Hl2c/0 £ PropertyAddress : ^ ^ / / Owner' s Name : f/ir'^i/ e J Contracto rGrou p /4 Excavatio n Genera l Ye s N o ] . 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 dan dVegetatio nYe s N o 1 . Does th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 2 . Ha s so dbee

nlai di nal l area s tha t

were 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 da t

a3 0 da y tim e period ) 4 . Ar e sodde darea s generall y firman devenl y graded ? 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t

a3 0 da y tim e period ) 6 . Wa s th e propert y grade dsuc htha t wate r wil l no t poo l o nth e property ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

# s I / 

# ^ 

# s i / 

# I / 

# s 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 ) 2 . Wer e al l gate s o rfence 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 rfence s avoided ? (I f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) ^ S 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 ? 2 . Wa s damag e t o th e foundatio n avoided ? 3 . Wa s damag e t o window s avoided ? 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 ? / i / S S i / Sidewalks an d Driveway s (Concrete ) Ye s No . 1 . Wa s damag e t o drivewa ysurface s avoided ? 2 . Wa s damag e t o walkwa ysurface s avoided ? \S i /

### Owner s comments :

Inspectio nnotes :

Removal an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EPA Representativ e £><^ ^- ^ Date : // 

### /z_e/o £

# C~ ) Contract No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t 

### Omah a Lea d Superfun d Sit e 

### © OLSI D P/0&1 5 Le t Propert y Owne r

' / Propert y Addres s 

# jillS.l1* X I s th e Residen t

th e Owne r

£ ] 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) , to 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 property durin g th e removal/restoratio n phas e i s sincerel y appreciated . Thi s documen t certifie s tha t

al 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 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



### Propert y Owne r

Sectio n Signatur e 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 ( 2 I agre e tha t

restoratio ni s complete dat my propert y D I Do Not

Agree : Comments :

, 

# e»r/f* A- ^ /

*f t t Propert y Owner' s Signatur e 

# AA^ \J&^KJJ! ^ T^/v , OEP V Representativ e Signanir e 

# [l/

o c , / o t i / Dat e 

# tllOb/ o & , i ( Dat ePag e 1 o f

U.S . Environmenta l Protectio nAgenc y Regio nVI I

PROPERT YACCES S (lo b Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s oen y 0\\ner ) 1-800-223-042 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 (Please Print Name ) (Propert y Owne r Signature ) (Date) NOTE : Grantin g permissio nDOE S NO T necessarily imply 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 owner—Pler i Residen t Name : Residenc e Address : a4 I I So . 1 ^ Sf V jfl . Owner^ D Rente r V hJC - (CITY ) (STATE ) (ZIP ) Propert y owne dby : Cr\r \0)l_ ) ( L O n £ Owner s mailin g address : Work : Owner' s telephon e number

—Home : 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 Ha s th e interio r

bee npainte do r

covere dsinc e 1978 ? Tota l numbe r

o f occupants : S Lis t Ages : 3>^\ . D YE S

% YE S



# . n D N O

D N O 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 : 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 . 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 :

# Lis t o f existin g Condition s pg . _

# o f Propert y Address : Z H I i S . Owner : Date : Description : OLSID#:nM5Z .

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

# 1745 2 Omah a Lea d Sit e Sit e Sketc h Exterio rPain t Goo d 

# n ^ Not pain t Owne rName : BERNIC E ALAUGHLI N Address : 2411 S 1 4 S T Lea d Concentratio n Sampl e

Collecte d Sample s Collecte d Sampl e Numbe r RYASCPXA-1745 2 RYBSCPXA-1745 2 RYCSCPXA-1745 2 RYDSCPXA-1745 2 RDZSCPXA-1745 2 RCZOCrXA174G 2 Sample s Analyze d pp m \J ) o D pp m RPZSCPXA1745 2 Numbe ro fSample s = ; 

# ENTERE D AU G ; 

## 1 0 200 4

Omah aLeadSit e 

# 5 . H 5)- . 4613 0