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 2200 2 PropertyAddres s 9 1 7 S 27 t h Stree t Fiel d Wor k Starte d 9-Jun-0 6 Fiel d Wor k Complete d 5-Jul-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 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 a t th e botto m o f th e excavatio n fo rconfirmatio n purposes . 4025855 8 Comments : None . SUPERFUNI ) RECORD S 

### Ja n Prawdzi k 

### AS W Project Manage r 

# x s

Nam e 

### Titl e 

## Stfjnatur e

### 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 : 2200 2 t h 

### Propert y Address : 91 7 S 27" 1 

### Stree t Sampl e I D XR FResult s Avg . (ppm ) 

### La b Result s (ppm ) 

### 22002-DE-B2-0 6 155151. 6 

### 29 0 2002-DE-DZ-I 2 402. 5 ±6 7 N A



### Ja n Prawdzi k AS WProjec t Manage r Nam e Titl e Dat 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 Post Excavatio n Locatio n o f th e sampl e a s follows ; F l = Fron t Yar d (I " Quadrant ) B l = Bac k Yar d (1 ° 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 d describe s th e dept h fro m whic h th e sampl e wa s collected . N A= No t Applicabl e

# Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : • Propert y Address : i / 7 Date/Time : Owner' s Name : /*?,' ( A e/l f Quad s Excavated : 

## Dz . 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 ? 

### S 2 .I f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? 

### / Gradin g So d an d Vegetatio n Ye s N o 1 .

Does 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 

# s

fro m th e house ? 2 .Ha s so d bee n lai d i n al l area s that wer e excavated ? 

# < / 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 da

ytim e period ) 

# < / 4 .Are sodde d area s generall yfir m an d evenl ygraded ? 

## y 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 ) 

# s 6 .

Wa s th e propertygrade d suc h tha t wate rwil l no t poo l o n th e property ? 

# y 7 .

Wa s damag e t o landscapin g o rplan t material s avoided ? 

# s Gates , Fence s an d Retainin g Wall sYe s N o 1 .

D o gate s ope n an d clos e freely ? (I f applicable ) v / 2 .Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? . (I f applicable ) S 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 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 ? 

# y 5 .Wa s damag e t o downspouts o rdownspou t extension s avoided ? 

# 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 ? /

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complet e includin g th e 30-day so dwarranty : EP A Representativ e BQ^^- ^ Date :

## Owner s comments : 

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### Inspectio n notes :



## Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EPARepresentativ e &" " ^ 2 Date : /

# t» 1 Pag e 1 o f 

# (/'A/ / w ~ Omah aLeadSit e bmahafN E U.S . Environmenta l Protectio nAgenc y Regio nVI I Residentia l Yar dSoil s Environmenta l Restoratio n Service s PROPERT YACCES S d o b e complete d I n Pror . -223-042 : Granto r (th e property 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 

# , Hi- ; iU..L. qk.ji. i / ( A (Pleas e Print Name ) (Propert y Owner Signature ) (Date ) NOTE : Grantin g permissio n DOES NO T necessarily impl y you r property wil l b e remediate dat thi s time . PROPERT YINFORMATIO N (t o b e complete db \residen t and'o r nropen v owner— F Residen t Name : D Owne r D Rente r Residenc e Address : h 2 ? S ; (CITY ) (STATE ) (ZIP ) Property owne dby : Owner s mailin g address : Owner' s telephon e number—Home : 3$~0 ' 1^ 1 work : 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 DlxYE S D N O Ha s th e interio r bee npainte do r covere dsinc e 1978 ? CVfE S D N O Total numbe r o f occupants : ^ Lis t Ages : 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 A unde r thi s agreemen t ar e pursuan t t o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property fo r i nSectio n I04(e ) o f CERCLA , 4 2 U.S.C . 960 4 (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 titl e " Acces s Attempts : First : Second : Third :

# § . Contract No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t 

### ® Omah a Lea d Superfun d Sit e 

# OLsr o Propert y Addres s

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### A | Propert y Owne r I s th e Residen t th e Owne r 6 f Ye s D N o I'T) \t-A ^ G1 l<t- T\O if-lo ^ 

### Complianc e Statement : U.S . Environmenta l Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , (o r it s contractors) , t o ente r an dconduc t environmental restoratio n service s for th e Omah aLea dSite . You r cooperatio ni n givin 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 that al l work performe dat thi s propert y wa s complete di n accordanc e wit hth e contact specification s an dEPA requirements . If

you hav e question s or nee dadditiona l informatio n pleas e contac t the EPA Publi c Informatio nCenter s at (402 ) 7 3 1-304 5 o r (402 ) 991-958 3 o r th e EPA Offic e o f Externa l 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 Signatur e 

## Propert y Owne r Sectio n Thi s agreemen t document s th e completio n o f remedial/restoratio n effort s at th e property t o my satisfactio n S LI agre e tha t restoratio n i s complete da t m y property D I D o No t Agree : Comments : 

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

_ o f j f Propert y Address : Owner : Date : "5-MO-UN* OL S # Description :

Owne r Signature : ASWAssociate s Inc Prin t & Sig nOmah aLea dSit e 4613 0