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

### AS W Associate s In cCertificatio n fo rPropert yCioseou t BVI D 2279 0 PropertyAddres s 391 0 Dewe yAv e Fiel d Wor k Starte d 19-Oct-0 6 Fiel d Wor k Complete d 28-Oct-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 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 1 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 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 at th e botto m o f th e excavatio n fo rconfirmatio n purposes . 4026172 6 

### Comments : None . SUPERFUN D RECORD S Ja n Prawdzi k AS W Projec t Manage r Nam e Titl e 

### Dat e

K D feftdi S f Y\n~l o 

### V

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

### Analytica l Resul t Summar y OL S ID : 2279 0 Propert y Address : 391 0 Dewe y Av e XR FResult s La b 

### Sampl e I D Avg . 

### Result s (ppm ) (ppm ) 

### 22790-DE-F1-0 6 47. 2 ±45. 6 N A 

### 22790-DE-B2-0 6 198. 3 ±43. 6 N A 

### 22790-DE-DZ-1 2 

### 12 3 ±3 8 N A



### Ja n Prawdzi k AS WProject Manage r

Nam e Titl e Dat e Signatur 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 Yard (1 " Quadrant ) B l = 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 = 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= Not Applicabl e

# &EPA Remediation/Excavatio n Contrac t (ASW ) EP A Property Clos e Ou t For m Propert y # : 7 2 7 Propert y Address : 1 0 Date/Time : Owner' s Name : Quad s Excavated : Contracto r Grou p Excavatio nGenera l Ye s N o ] . I f necessary , wer e th e correc t quadranl(s ) excavate dan drestored ? 2 . I f necessary , were th e correct area s o f dri p zon e excavate dan drestored ? Gradin g So d an d Vegetatio nYe s N o 1 .Doe s th e gradin g aroun d th e perimete rof th e hous e i n excavate d area s generall yslop e awa y ./ fro m th e house ? 2 . Ha s so d bee n lai d i n al l areas tha t 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 S da

ytim e period ) 4 . Are sodde d areas generall yfir m an d evenl ygraded ? S 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 i / lim e period ) 6 . Wa s (h e propertygrade d suc h tha t wate rwil l no t poo l o n th e property ? < / 7 . Wa s damag e to landscapin g o rplan t material s avoided ? iSGates , Fence s an dRetainin 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 ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) S 3 . Wa s damag e t o gate s o r fence s avoide:d ? (I f applicable ) L^ 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### * x Foundation , Sidin g an d Gutter sYe s N o 1 .

Wa s damag e to th e sidin g o rtri m avoided ? ^ 2 . Wa s damag e t o th e foundatio n avoided ? c / 3 . Wa s damag e t o window s avoided ? 

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

### IS5 . Wa s damag e t o downspouts o rdownspou t extension s avoided ? 

### ^ 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 ? ^

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-day so dwarranty : EP A Representativ e £^j$J-~ , Date : ///>y/i? 60002/00 3 12/07/200 6 TH U13:2 6 FA X 71 2 79 2 589 3 Communit yOi l Co .

Contrac t No : E P - R 7 - 0 6 - 0 4 

### Propert yCloseou t Agreemen t Omah a Lea d Superfun d Site OLSI D Propert y AJdrcai Properl yOwne r 1 s th e Residen t th e Owne r D Ye s D N o ToO O Complianc e Statement : U-S . Environmental ProtectionAgenc y (EJ*A J o r it s authorize drepresentatives , (o r it s contractors) , to ontcr an dconduc t environmental restoratio nservice s fo r th e Omah aLea dSite . You r cooperatio ni ngivin g EPA/A S Wpermission to acces s your 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 wor k

performe da t 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 tfo eEP A Public : Informatio nCenter s al (402 ) 731-3045 or (402 ) 991-958 3 or ihc 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 A.'SW :

CONTRACTO RCERTIFICATIO N Je n Prawxlzi k AS WProjec t Manage r Nam e Titl e Dat e Signature 

### Property Owne r Section Thi s agreement document s th e completio no f remedial/restoratio neffort s at th e property t o my satisfactio n O I agre e that restoratio ni s complete dat my property D I D o No t Agree : Comments : 

# \ PropertyOwner' s Signatur e Dat e Signatur e Dat e

•ou | 'ee)B(ooeevMS V 9 0 9 0 "° N

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

# o f Propert y Address : Owner : Description : 7 7/ 0 P Date : /p - OLSI D #: Z2 - 7



# 74

Owne r Signature : AS WAssociate s Inc . Prin t & Sig n -"Prin t & Sig nName : Omah a Lead Sit e Date : Nort h Arro w Address : g * t i f i Oewc- V Site Sketc h Time : Phone : ~7i7_-Ti 7 ^-ilc 1 Tea m BV1 D # T.t/?**' ? XR F Cod e Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e pp m pp m 

### /^/Ye s No E l N

o E l N o 

### 0 pp m 

### N o 

### B pp m 

### No E L pp m 

### Ye s N o 

### D pp m 

### Ye s N o 

### D &+ 1 AJf f fas c 

# 5 .

i



### £ V Omah a Lea d Sit e 4613 0