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 rPropertyCloseou t BVI D 4703 6 PropertyAddres s 34 1 8 U Stree t Fiel d Wor k Starte d 17-Oct-0 6 Fiel d Wor k Complete d S-Nov-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 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 . 4025858 6 

### Comments : None . S I IHERFUNI ) RECORD S Ja n Prawdzi k AS W Projec t Manage r

Nam e Titl e 

### Signaro r

7

### 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 : 4703 6 Property Address : 341 8 U Street XR FResult s La b 

### Sampl e I D Avg . 

### Result s (ppm ) (ppm ) 

### 47036-DE-DZ-0 6 

### 70. 4 ±4 1 N A 

### 47036-DE-BI-0 6 

### 15 5 ±4 6 N A



### Ja n Prawdzi k AS W Projec t Manage r 

## { Nam e Titl e 

### Dat e tsignatuf e

Sampl e Designatio n OLSID-DE-Location-d d OI.S1 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 Yar d ( I ° Quadrant ) B I = Bac k Yar d (I " Quadrant) F 2 = Fron t Yar d (2 n d Quadrant ) B 2 = Fron t Yar d (2TM 1 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

# &EP A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m 1 

### U Propert y# : _ Propert yAddress : - Date/Time : £Owner' s Name : /v \ i'c . / fc~<- ' k le v Quad s Excavated : P ^ Contracto rGrou p Excavatio n Genera l Ye s 1 .I f necessary , wer e th e correc t quadranl(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 ? 

### / Gradin g So dan dVegetatio nYe s 1 . Does th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 

### , / 2 .Ha s so dbeenlai 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 da t a3 0 da y tim e period ) 

# </ 4 .Ar e sodde darea s generall y firman 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 lim 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 ? 

# s 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

# s Gates , Fence s an d Retainin g Wall s .Ye s 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 ) < / Foundation , Sidin g an d Gutter sYe s 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 ? S 4 .Wa s damag e t o window s o rdoo rscreen s avoided ? 

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

# / Sidewalks an d Driveway s (Concrete ) Ye s 1 .Wa s damag e t o drivewa ysurface s avoided ? / 2 .Wa s damag e t o walkwa ysurface s avoided ? I /

N o

M o

N o

N o

N o

### 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 _p t 

### ^ , & Date : TM

# f Contrac t No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t 

### © Omah a Lea d Superfun d Sit e OLSI D Propert y Addres s 

# jf/ au 

# s + fTV vcl ^ <q£~ ' Propert y Owne r , . I s th e Residen t th e Owne r D Ye s g j 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 nservice s fo r th e Omah aLeadSite . 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 wor k performe da t 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 A 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 nPrawdzi 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 no f remedial/restoratio neffort s a t th e propert y t o m y satisfactio n f & I agre e tha t restoratio ni s complete da t m y propert y D I D o No t Agree : Comments : 

# (A^ ; T V .?^u^ (uHJla . 71/0 9 A £ Propert y Owner' s Signatur e » / i Dat e J j i < —i— 

# /i/07/o r / 1 ° [EP ARepresentativ e Signatur e \f Dat ePag e 1 o f Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio nAgenc y Regio nVI I Residentia l Yar dSoil s Environmenta l Restoratio n Service s ACCES S (i db e c o sp;mo l no r -223-U-i : Granto r (th e propert y 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 . , / c s <r~? ~ J<C ' (Pleas e Prin t Name ) 

# /*-„-* * (Propert y Owner Signature ) ^* f (Date ) NOTE : Grantingpermissio n DOES NOTnecessaril y imply you r property wil l b e remediate dat thi s time . PROPERT YIXrOKMATIO N I nresiden t Liiul'o r nroncrt v o\\ n Residen t Name : 

### )Sf D Owne r E-R* e nte r Residenc e Address : 

### Y / < ? (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : X < 

### . 

### I/& - I/ * 

### < ­ Owner' s telephon e numbe r —Home : * " 7~~ ~ Work : Ag e o f Home ? _ /f l / 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 ffl'YES D N O Ha s th e interio r bee npainte do r covere dsinc e 1978 ? E'YE S D N O Tota l 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 RENV1ORNMENTA LRESPONS EACTION S Th e activitie s t o b e implemente db y EP Aunde 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 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 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 title. " Acces s Attempts : First : Second : Third :

# Lis t o f existin g Condition s pg . o f Propert y Address : 3 f /

o Owner : A ? / ' ( - b 4 e / *- . £t X/< i y Description : Date : /o ~ /}-( ) QL S #:

Owne r Signature : AS WAssociate s Inc . Prin t & Sig nVfin t & Sig n

# 4703 6 Exterio rPain t Nort h Arro w 

### i Lea d Site Owne rName : MICHAE L J ECKLE YOmah ! f j Goo d Slt e 

### Sketc h Address : 341 8 US T f j Poo r 

# 4 . Phone : H : W : Q^No t pain t 

### Sampl e Numbe rLead Sampl e LA B Sample s Collecte d 

### Concentratio n Collecte d Firm : f.F . /^T-t 5 A / I 

### RYASCPXA-4703 6 F 1 1 tyt f DD m 0 ^ Date : i 1 •<? ! 

## A - M RYBSCPXA-4703 6 F2 %.&• & pp m D 

### Time : sj>- " - 

## ^T" o n^ \ i= S \ . 

### RYCSCPXA-4703 6 B 1 ^^ 9 pp m 

# n 0- " I* 1 1 

### Sample s Analyze d RYDSCPXA-4703 6 B 2 & */ ~ pp m RDZSCPXA-4703 6 D Z 5%t f °o m 

# n XR F Unit : ^/~ z 

### - Book . S ^- 3

, L Dv^cr^D i A^vm c " " 

# n D 

### Date : / * - -z . -Z^y - La b rMooo^LM-'*^ uj o , _ Resul t 92 2 pp m Pp m 

# n Time : ?^/? 7 

### staff . f^TT^ y Numbe rofSample s — 

# H 1

Omah aLea dSit e 4613 0