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

## AS W Associate s In cCertificatio n fo rPropertyCloseou t BVI D 130 8 

### PropertyAddres s 440 7 Leavenwort h Stree t Fiel d Wor k

Starte d 13-Oct-0 6 Fiel d Wor k Complete d 20-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 D Z quadran t wa s excavate d t o a dept h o f 1 0 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 . 4026174 9 

## Comments : None . SUPERFUN D RECORD S


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

## Dat e

& >i\c x Ot&er : <±> 7 2 : y

### 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 : 

## 130 8 Propert y Address : 440 7 Leavenwort h Stree t Sampl e I D 1308-DE-F1-0 6 1308-DE-DZ-1 0 XR FResult s 

### Avg . (ppm ) 

### 89. 3 ±3 9 102. 8 ±39. 6 | 

### La b

Result s 

### (ppm ) N A N A

Ja n Prawdzi k Nam e AS W Project Manage r Titl e Signatun r

Sampl e Designatio n OLSID-DE-Location-d d OLSI D i s aparticula r

residentia l property I D fro mwhic hth e sampl e i s collected . D E= Durin g an dPos t

Excavatio n Locatio no f

th e sampl e a s follows ; F l = Fron t

Yar d(1 * Quadrant ) B 1 = Bac k

Yar d( 1 * Quadrant ) F 2 = Fron t

Yard(2 n dQuadrant ) B 2 = Fron t

Yar d(2 n dQuadrant ) D Z= Dri p Zon e P Z= Pla y Zon 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

### Propert y # : _

Date/Time : Quad s Excavated : 

# Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m PropertyAddress : Owner' s Name : Contracto rGrou p 

### leaver>Wtr M 5 t
Excavatio nGenera l Ye s N o 1 . I f necessary , wer e th e correct quadranl(s ) excavate d an d restored ? 2 . I f necessary , wer e th e correc t areas o f dri p zon e excavate d an d restored ? /

^ Gradin g So d an d Vegetatio n Ye s N o 1 . Doe s 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 ? .2 . Ha s so d bee n lai d i n al l areas that wer e excavated ? 3 . Does (h 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 ) 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 tha t 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 ? / 

# s I / ^ 

# > /

, / / Gates , Fence s an dRetainin 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 ) 

# • y

. /

. / / 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 ? / 

# s S 

# / s 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 ? S 

## S

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP ARepresentativ e & m

## & ^ Date : /o/s//**- .



# ^ ——

# f Contrac t No : E P - R 7 - 0 6 - 0 4 Propert yCloseou t Agreemen t Omah a Lea d Superfun d Sit e 

# ® OLSI D PropertyOwne r CK*,5,vXA ^ ^[ffl Propert yAddres s W V 

### Lfe/jV^/J^aA-f/iS J I s th e Residen t th e Owne rD Ye s 0 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 nse nice 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 t

al l work performe dat

thi s property 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 n Prawdzi k Nam e AS WProjec t Manage r Titl e Dat e Signature 

### 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 Iagre e tha t

restoratio ni s complete da t m y propert y D I D o No t

Agree : Comments :



# s (A , Propert y Owner' s Signatur e Dat e



### -c t 

### / k ativ e Sign a 

# o EP ARepresentatiy e Signatur e Dat e

### Oct . O 4 0 6 12:09 aChapma nDieh l Companie s 402614067 7 

### p . 1

U.S . frtvironmentit l Protectio n Agenc y Regio nVI I 

### Omah aLea dSit e Omaha , N K Residential YardSoi b Environmenta l Restoratio n Service s 

### Granto r (the propert

y owner) , consent s t o an dauthorize s th e Unite dSate s Environmenta l Protectio nAgenc y (USEPA ) or it s authorize drepresentative s (or it s cont r jctors) . th e Grantee , to enter an dperformcertai nenvironmenta l respons e activitie s upo nth e followin g describedpremises . Fo r furthe r informatio npleas e conlac t

EPAat I-800-223-0425 . Propert y Acces s Grante dB y _ (Please Print Name ) (o (Propert y Owne r Signature ) (Dot* ) NOTE : Grantin g permission DOE S NO T naccssarif

y impt y your propert y wil l I * remediate da

t thi s time .



### Residenc e Address : Property owne dby : Owner s mailin g address . Owner' s telephon e number—Home : Ag « o f Home ? _1*13 0 - ^ year s Ho w lon g hav e yo u live dhere ? Ha s (h e exterio r

bee n painte do r

covere dwithaidin g sinc e 197 8 Ha s th e interio r

been painte do r

covere dsinc e 1978' ? 

### Toia l numbe r

o f occupants : ^ - Lis t Ages : O S

Lis t age s o f occupant s unde r

6 year s ol dwh o pla y i nth e yar dlo r 5 o r mor e hour s pe r

week : Comments : ADTHORJT Y FO RfcNVIORNMENTA LRESPONS EACTION S Th e activitie s t o h e implemente db y QP A imde r thi s agnxmcnt

ai e pmsiuu t

t o Sectio n10 4 ofCCRCLA . 4 1 U.S.C . VMM . EPA' t righ t o f vLk-e u l u i h piupen y fo r

i n Section I M(e > o f

CIML l J\ . 4 2 U.S.C . 960 4 (c) . whic hpmvidc t

entr y (or . u d<unniain g th e octt l fo i nipuno: . w chinnin g o r ukl m «n y fcsfmn v ucuo nunder thi s title . ornthcnvi K

enforcin g th e provision s o f fhi s tide. " 

### Acces s AUempis : I - irst : Second : Third :

OC T 03,200 6 11:55 A 402614067 7 900Z'Z O 10 0 

### pag e 1Ge t O 3 O 6 U?:!O a Chapma n Dieh l Companie s 402BI40B7 7 P - 3



### Propert y Address : ^L\D~ 1 / - <?f t V V K ) l+ J O Owner : OLSIO# : Descriptjon : 

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# 130 8 Owne rName : •jpfxTr-.UL.LQ . r'^r'~f^~Pic:T^'°' j Address : 440 7 LEAVENWORT H S T Phone : H ^- / B-P+VC O w-.CR l -°« f r 

## Omah a Lea d Sit e Site Sketc h Exterio rPain t Nort h Arro w Q Goo d xTTN . Q Not pain t >*J X Sampl e Numbe r RYASCPXA-130 8 RYBSCPXA-130 8 RYCSCPXA-130 8 RYDSCPXA-130 8 RDZSCPXA-130 8 RGZSCPXA-130 8 RPZSCPXA-130 8 Lea d Concentratio n YA22 1 Y B 121. 8 Y C 342. 2 Y D 901. 6 DZ 1300 G Z PZ Sampl e Collecte d LAd 

### pp m 

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### 0 Q pp m 

### Q D Pp m 

### D D Numbe ro f Sample s = I 5 i i 1 Sample s Collecte d Firm : Sverdru p Date : Time : Sample s Analyze d XR F Unit : Book : Date : 12/18/199 9 Time : 03:1 4 Staff : Legend : YA= Yar d (NE) , Y B = Yar d (SE) , Y C = Yard (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y



## LEAWNW0RT H



# UEAVENWOR TM 5T . :



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