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 1983 6

2-Jun-0 6 Propert yAddres s

Fiel d Wor k

Complete d 150 8 Sout h 25 l h Avenu e 6-Jun-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 1 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 the cleanu p standard s wer e met . • 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 f th e excavatio n fo rconfirmatio n purpose s 

### Comments : None . 

### I D

Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e 4026073 6

SUPERFUN D RECORD SCONTRAC 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 Summary OL S ID : 1983 6 t h 

### Propert y Address : 150 8 Sout h2 5 Avenu e Sampl e I D I9836-DE-GZ-I 2 19836-DE-DZ-0 6 I9836-DE-BI-0 6 XR FResult s Avg . (ppm ) 65. 2 ±

### 80. 6 

### 155. 6 ±86. 3 47175. 3 La hResult s

(ppm ) N A N A N A



### Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e 

### Signatur e Sampl e OI.SI D i s u particula rresidentia l properl yII ) fro m whic h th e sampl e i s collecte d Dl : = Durin g an d Pos t Hxeavatiui t Locatio n o rth e sampl e a s follows ; l ; l -Fro m Yar d (I * Quadrant ) R l - n.'ie k

Yar d ( I "Quadrant ) 1- 2 = I'ro m Yar d (2'" 1 Quadnml ) (3 2 - Fron t Yar d (2" d Quadrant ) 07 . = Dri p Zon e I V - Pla yZon e (iA~(inrde n K A~ Kascincn 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

# § Contract No : E P - R 7 - 0 6 - 0 4 Propert yCloseou t Agreemen t 

### Omah a Lea d Superfun d Sit e 

### ® 

# OLsr o Propert y Owne r Property Addres s 

## iro ? / IT* * I s th e Residen t

th e Owne r

CD/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

environmental restoratio nservice s fo r th e Omah aLea

dSite . You r cooperatio ni ngivin g EPA/AS Wpermissio nto 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 tha t

al l wor k performe dat

thi s property wa s complete di naccordanc e withth 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 th e EP A Publi c Informatio nCenter s at (402 ) 7 3 1-304 5 or

(402 ) 991-958 3 or

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



## Propert y Owne r

Sectio n Signatur e Thi s agreemen t

document s th e completio no f remedial/restoratio neffort s at th e propert

y t o my satisfactio n ET I agree that

restoratio ni s complete da

t m y property D I D o No t

Agree : Comments :

[ 

# 0<rv ^ Q (^tJk/L^ j Property Owner' s Signatur e 

# ""/^x #

# i^ ^ \ , ER A Representativ e Signatur e 

# 7 - 

# ;& - o & Dat e 

# ~l-fP-ci (

Dat e

# &EP

A

Propert y # : Date/Time : Quad s Excavated : 

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y Address : f5# 5 «$./g? 6 Owner' s Name : ."DONAL D 7 [I I ' J D . Contracto r Grou p Excavatio nGenera 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 ? 

## LS ^ , 

## / / Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimeter o f th e hous e i n excavate darea s generall y slop e away fro mth e house ? 

### 2 . Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3 . Doe s th e so dappear

t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat

a3 0 da y tim e period ) 4 . Ar e sodde darea s generall y fir man 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 ? i.* ' ( ^ 

### L / i ^ LS '

^

/ s Gates , Fence s an dRetainin g Wall s Ye s N o 

### 1 . D o gate s ope nan dclos e freely ? (I f applicable ) stnt * J l n + - i , \

*?0'i£o/Qftvite . P/vC,X/4Ji\t . j v vf-irrMj t

pr. ^ 2 . Wer e al l gate s o r

fence s take n dow ndurin g restoratio nactivitie s reinstalled ? ^ 1 (I 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 ? 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 r doo r screen s avoided ? 

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

### L s ^ (S

^ (S / •

Sidewalk s an dDriveway s (Concrete ) Ye s N o 

### 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? 

### I / 

# IS ' f

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e



## TM .fW/L/

/ Dte : 7/I//0 &

# § 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 Owne r Da^AvS LMTM.OU» J Propert y Addres s 

# I5~0< 5 5 . 25"/^v/£ I s th e Residen t

th e Owne r

RYe s D N o Complianc e Statement : U.S . Environmental Protectio nAgenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , to 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 nto 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 naccordanc e withth 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 th e EP A Publi c Informatio nCenter s at (402 ) 7 3 1 -304 5 o r

(402 ) 9 9 1 -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 Jan Prawdzi k

AS WProjec t

Manage r Nam e Titl e Dat e



## Property Owne r

Sectio n Signatur e Thi s agreemen t

document s th e completio no f remedial/restoratio neffort s at th e property t o my satisfactio n PLI agre e tha

t restoratio n i s complete da

t m y propert y D I D o No t

Agree : Comments :



# ^TLs&rte) ^^J^J f 

### Propert y Owner' s Signatur e /WA^.(^dW^ ^ | I P ARepresenWiv e Signatur e 

# X),/ 7



# - ^ - a6 > Dat e 

### & 7/0 6/ C

> k 

### V 1 Date 'Pag e 1 of .

U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSit e Omaha , N E Residential 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 n Agenc y (USEPA ) o r it s authorize drepresentative s (o r it s contractors) , th e Grantee , t o ente r an dperfor mcertai n environmenta l respons e activitie s upo n th e followin g describe dpremises . Fo r furthe r informatio n pleas e contac t EP A a t 1-800-223-0425 . 

### Propert y Acces s Grante dB y &OaJ/\.L£ > (Pleas e Prin t

Name ) (Propert y Owne r Signature ) (Date ) NOTE : Gra min g permissio n DOE S NO T necessaril y impl y you r property wil l b e remediate dat thi s time . Residen t Name : 

### Residenc e Address : /?O Q S (CITY ) (STATE ) (ZIP ) Property owne dby : Owner s mailin g address : Owner' s telephon e number

—Home : Ag e o f Home ? 1 O Work : year s Ho w lon g hav e yo u live dhere ? _ Ha s th e exterio r

bee n painte do r

covere dwit hsidin g sinc e 197 8 D YE S year s Ha s th e interio r

bee n painte do r

covere dsinc e 1 978 ? 

### • 7 Tota l numbe r

o f occupants : /_^ . _Lis t Ages : 5KY E 

## OKN O aN O t Lis t age s o f occupant s unde r

6 year s ol dwh o pla y i n th 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 F.PAunde r thi s agreemen t

ar e pursuan t

t o Sectio n10 4 o f

CER.CLA , 4 2 DS C 960

4 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 needfo 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 _ Property Addres s 

# : 

# /s° 8 Owner : Date : OLS # Description :

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

# <vEP

A

Propert y # : Date/Time : Quad s Excavated : (AS W



## Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y Address : <5*0 S < 5 . <s ? & Owner's Name : T 7>eHrtL D l Contracto r

Grou p •rt \

Excavatio n Genera l Ye s N o 1 . I f necessary , were th e correc t quadranl(s ) excavate dan drestored ? 2 . Unnecessary , wer

e th e correc t

area s o f dri p zone excavate dan drestored ? 

# •is 

# ^ / / Gradin g So dan dVegetatio n 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 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 dat

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

a3 0 day tim e period ) 6 . Wa s Ui e propert

y grade dsuc hthat

water wil l no t poo l o n th e property 1 ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

### Ye s ^ 

### <^ " 

### LS

L^ " ( ^ 

### N o ,*•



### x / Gates , Fence s an dRetainin g WaJJ s 1 . D o gate s open an dclos e freely ? (I f applicable ) oat ? / 4 .*., o/* f 2 . Wer e al l gate s o r

fence s take n dow n durin g restoratio n activitie s reinstalled ? Ye s N o *)V^ 1 A It

J (I 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 d Gutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 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 r doo r screen s avoided ? 5 . Wa s damag e to downspout s or downspou t

extension s avoided ? 

# u ^ L /

^ \ S /

Sidewalk s an d Driveways (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 ? L /

^ •