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 c Certificatio n fo rPropert y Cioseou t BVI D Fiel d Wor k

Starte d 1564

2 19-Jun-0 6 Propert y Addres s Fiel d Wor k

Complete d 270 9 Sout h 30 th Street 11-Jul-0 6 

### Summary : Th e excavatio n wa s performe d i n compliance 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 1 quadran t wa s excavate d t o a dept h of 1 2 inch . Verificatio n sample s confirme d tha t th e 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 placements 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 at th e botto m o f th e excavatio n fo rconfirmatio n purpose s 

### Comments : None .

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

### Signatur e

4026196 7 SUPERFUN D RECORD SCONTRAC T # EP-R7-06-0 4 AS W Associate s Inc . Omah a Lead Site Remediation , Omaha , N E EPA 

### Analytica l Resul t Summar y 

### OL S ID : 1564

2 Propert y Address : 270 9 Sout h 30 t h

### Street Sampl e I D 15642-DE-B1-1 2 15642-DE-F1-0 6 XR F Result s Avg . (ppm ) 19 0 ±54. 6 57. 5 ± 4 2 La b

Result s (ppm ) N A N A

Ja n Prawdzi k Nam e AS W Project Manage r Titl e Simpl e Deilgnatio n OLSID-DE-Locarlon-dd OLSI D i i aparticular

residential propert

y I D fro mwhic h th e sampl e i s collected . D E » Durin g an dPost

Excavatio n Locatio n o f th e sampl e a s follows ; F I = Front Yard(1 * Quadrant ) B l = Bac k Yard(1 « Quadrant) F 2 - Front Yard(2 - Quadrant ) B 2 « Front Yard(2 " Quadrant ) D Z = Dri p Zon e PZ = Pla y Zon e G A • Garde n E A = Easemen t

- d ddescribe s th e dept

h fro mwhic h th e sampl e wa s collected . N A = No t Applicabl e

# £EP

A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : Quad s Excavated : Propert y Address : Owner' s Name : 

### 3 0 Contracto r

Grou p /4$U / Excavatio n Genera l Ye s > o 1 . I f necessary , wer e th e correc t

quadrant(s ) excavate dan drestored ? 2 . I f necessary , wer e 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 . 2 . 3 . 4 . 5 . 6 . 7 . 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 away fro mth e house ? Ha s so dbee n lai di n al l area s tha t wer e excavated ? Doe s th e so dappear

t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte daL a3 0 day tim e period ) 5t>fii l C0*\fMtN aM $+/ & f t T Ar e sodde darea s generall y firman devenl y graded ? Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t

a3 0 da y tim e period ) Wa s th e propert y grade dsuc h tha t wate r wil l no t poo l o n th e property ? Wa s damag e t o landscapin g o r plan t material s avoided ? C ^ (- «

• 1 t —• 

# \ s K_ ~ ' 

### /

* r Gates , Fence s an dRetainin g Wall s frp/offpitn f * f 1 . D o gate s ope n an dclos e freely ? (I f applicable ) y ^ HtffjS * So*** . $ec l M*. V Ye s N o r-t j 4*»'/ l k/4'' t

or \"TT*7Cx 

### / / 1 ' ^ • \ 2 . Wer e al l gate s o r

fence 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 r fence s avoided ? (I f

applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### ^ f t

^ 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 / L * i / 

## i s \ s ^ ^ ^ s » 

# \ s Sidewalk s an dDriveway s (Concrete ) 

### Ye s JV 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 ? ^ \ > / /

### Owner s comments : V --V *



### Inspectio n notes :



### Removal an drestoratio n activate s complete includin g th e 30-day so dwarranty : EP A Representativ e /\JgK , / \cJmJ* - Date:

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

### Propert y Closeou t Agreemen t Omah a Lea d Superfun d Sit e 

## OLSI D Property Owne r 

# *»•/* , » v Propert y Addres s 

## 7 7* 1 

## f W I s th e Resfden t

th e Owne r

0/Ye s D N o Complianc e Statement : £ / U.S . Environmenta

l Protection Agency (EPA) o r it s authorize drepresentatives , (o r it s contractors) , t

o ente r an dconduc t

environmenta

l restoratio n service s fo r

th e Omah aLea

dSite . You r cooperation i n giving EPA/AS W permissio n to acces s you r propert y durin g th e removal/restoratio n phas e i s sincerely appreciated . Thi s documen t certifie s that

al l wor k performe da

t thi s propert

y wa s complete di n accordanc e with th e contac t specification s an dEPA requirements . I f yo u hav e question s o r

nee dadditiona l informatio n pleas e contac t th e EP A Publi c Informatio n Center s a t (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 :

Ja n Prawdzl k Nam e CONTRACTO RCERTIFICATIO N

AS W Projec t

Manage r Titl e Dat e 

### Propert y Owner

Sectio n Signatur e Thi s agreemen

t document s th e completio n o f remedial/restoratio n effort s a t th e propert

y t o my satisfactio n O f I agree tha

t restoratio n i s complete da

t m y propert y D I D o No t

Agree : Comments :

^ Property Owner' s Signatur e 

### JyW^lf l T\ff~1k±, ) EP A Representativ e Signatur e Date



# 1-1 3 -0f c

Dat ePag e 1 of . U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSite Omaha , N E Residential Yar dSoil s Environmental Restoratio n Service s Granto r (th e propert

y owner) , consents to an dauthorize s th e Unite dSate s Environmenta l Protection Agenc y (USEPA ) or it s authorize drepresentative s (or it s contractors) , the Grantee , t o enter an dperfor mcertain 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 at 1-800-223-0425 . 

# c Propert y Acces s Grante dB y ~

_ (Pleas e Print

Name ) (Pro p rt y Owne r Signature ) ( (Date ) NOTE : Grantin g permissio n DOES NO T necessaril y impl y you r

property wil l b e remediate da t thi s time . Residen t Name : f

i 

### C o Residenc e Address : 2 £ Q < ? S 3 O D Owne r Of* \A M A D Renter Propert y owne dby : Owner s mailin g address : (CITY ) (STATE ) (ZIP ) 5 AJ £ <£&l O $" " Owner' s telephon e number—Home:r4tiQ - \Lfl ^ ~ ,



# 7 Work(j^ & )3/ 9 ~ Ag e o f Home ? Ha s th e exterior

been painte do r

covere dwith sidin g sinc e 197 8 year s Ho w lon g hav e yo u live dhere ? _ P"YE S . year s Ha s the interio r

bee n painte dor

coveredsinc e 1978 ? 

### y Lis t

Ages : B'YES



### ' V ^ > D N O

Q N O Tota l numbe r o f occupants : ' —f ' y - 7 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 : / " » _ 5 Comments : AUTHORIT Y FO RENVIQRNMENTA L RESPONS E ACTION S Thewtivitie i to b e implemente db y EPA under thi i •freement

ire punuwi t

to Sectio n 10 4 o f

CERCLA . 4 2 U.S.C . 9604 . EPA' i right ofacoe u to th e propert y for i n Section 104(e

) o f CERCLA , 4 2 U.S.C . 960

4 (e) , whic h provide s entry for , "determinin g th e needfor raponie , or choosin g or takin g any respons e actio n under

thi s title , o r otherwis e enforcin g th e provision s o f thi s tide. " Acces s Attempts : First : Second : Third :

## Lis t o f existin g Condition s 

# pg . _

# o f Property Address : 27<3< ? g Owner : Date : OL S # 

### Description : 

## F2. " ' i t\ , 

## u / »Af : \on\C . f t A ^trlV N Si A g 

# \ j 

# \/e/y

Owne r Signature : Prin t « & Sig n AS W Associate s Inc . Prin t & Sigri ^

## 1564 2

ExCAVPTPfeD 

## Ace A

Omah aLea dSit e 4613 0