### 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 2245 7 Propert y Addres s 6 1 7 Sout h 33 r d 

### Stree t 

### Fiel d Wor k Starte d 1 2-Jun-0 6 Fiel d Wor k Complete d 7-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 F 2 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 o f 6 inch . 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 was excavate d to a dept h o f 1 2 inch . Verificatio n sample s confirme d that th e cleanu p standard s wer e met . Th e sit e wa s backfille d wit h material s whic h meets 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 were conducte d i n compliance wit h wor k plan s an d specifications . •Analytica l dat a provide d i s post excavatio n at th e botto m o f th e excavatio n fo rconfirmatio n purposes Comments : Punc h List : Fenc e was pu t bac k i n place . f <T \

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

### Nam e Titl e 

### /Dat e Signatur e 4026197 2 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 EPA 

### Analytica l Resul t Summar y OL S ID : 2245 7 Property Address : 61 7 Sout h 33 r d

### Stree t XR FResult s Lab Result s Sampl e I D 

### Avg . (Ppm ) (ppm ) 22457-DE-F2-0 6 117.314 6 

### N A 22457-DE-B1-0 6 61.2±41. 3 

### N A 22457-DE-B2-0 6 

### 120. 3 ±4 5 

### N A 22457-DE-DZ-1 2 279. 6 ± 5 4 

### N A 22457-DE-F1-0 6 2 2 1. 3 ±59. 3 

### N A



### Ja n Prawdzi k AS W Project Manage r

Nam e Titl e Sampl e Designatio n OLSID-DE-LocatioiMld OLSI D i s aparticular residentia l propert y I D fro mwhic h th e sampl e i s collected . D E = Durin g an dPost Excavatio n Location o f the sampl e a s fellows ; Fl - Fron t Yard(1 " Quadrant ) B l - Back Yard(1 « Quadrant) F2 - Fron t Yard(? * Quadrant) B 2 - Front Yard(2 * Quadrant ) D Z• = Drip Zon e PZ = Play Zon e OA = Garden E A = Easement d ddescribe s th e depthfro mwhic hth 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 Form Propert y# ' : : 22*f g ? I Date/Time : 

# •• , H 

# 7//yA 1 :av»ted : : Excavatio n Genera l Quad s Excavated ' Propert y Address : 

# 5 

# 33 ' Owner' s Name : y / Contracto r Grou p Ye s No

»•• 1 . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## 0­ ff 2. If necessary , wer e th e correc t area s of dri p zon e excavate dan drestored ? 

# c^ Gradin g So dan dVegetatio n Ye s No 1 . Doe s th e gradin g aroun dth e perimete r of th e hous e in excavatedarea s generall y slope awa y fro mth e house ? 

## C- 1 2.Ha s so dbee n lai d in al l area s tha t wer e excavated ? •*• 

# ( ^ 3.

Doe s th e so dappea r to be generall y health y an dgrowing ? (Onl y evaluat eif 'inspecte d

at a

30 da

y tim e period) 4.Are sodde darea s generall y fir man devenl y graded ? 

## L- * ^ 5.Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat eif inspecte d at a

30 day tim e period) 6.Wa s th e property grade dsuc h tha t wate r wil l no t poo l on th e property ? 

## ^ U 7.Wa s damag eto landscapin g or plan t material s avoided ? 

## L^ ^ Gates , Fence s an dRetainin g Wail s Ye s No



### - 1.

Do gate s ope n an dclos e freely ? (I f applicable ) . ^C -L ^ 

### \^ ^ 2.Were al l gate s or fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

### t^ " 3.Wa s damag eto gate s or fence s avoided ? (I f applicable ) 

### L^ 

## " +s 4.Wa s damag e to retainin g wall s avoided ? (I f applicable ) 

### U" Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e to th e sidin gor tri mavoided ? ** 

# L^

*r 2.Wa s damag eto th e foundatio n avoided ? 

# { — *r 3. Wa s damag eto window s avoided ? 

## L^

^ 4. Wa s damag eto window s or door screen s avoided ? 

## (^ 5. Wa s damag eto downspout s or downspou t extension s avoided ? 

## ^ Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Wa s damag e to drivewa y surface s avoided ? 

## L^ ­ \s 2.Wa s damag e to walkwa y surface s avoided ? 

## LS

### Owner s comments :

\



### Inspectio n notes :



## Remova l an drestoratio n activate s complet e includin g the 30-da y so dwarranty : EPA Representativ e LJgX ) IjafLJL ^ Date : ~fl/V/0 £

### c Contrac t No : E P - R 7 - 0 6 - 0 4 

# t Propert y Closeou t Agreemen t ttjjzll 

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

# <^ 7 5 . ^ Propert y Owne r I s th e Residen t th e Owne r (ET'ie s D N o /f7<A"/ > / . <&* } 

### Complianc e Statement : U.S . Environmenta l Protection Agenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , to ente r an dconduc t environmental restoratio n service s fo r th e Omah aLeadSite . Your cooperatio n i n givin g 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 document certifie s tha tal l wor k

performe da t thi s propert y wa s complete di n accordanc e wit h th e contac t specification s an dEPA requirements . I f

yo u hav e question s o r nee dadditional informatio n pleas e contac t th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 or (402 ) 991-958 3 or 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 AS\V :

CONTRACTO RCERTIFICATIO N Ja n Prawdzi k AS W Projec t Manage r Nam e Titl e Dat e Signatur e 

### Property Owne r Sectio n Thi s agreement document s th e completio n o f remedial/restoratio n effort s a t th e propert y t o my satisfactio n S B I agre e that restoratio n i s complete da t m y propert y D I D o No t Agree : Comments :



# c \cijjcmV cn / 

# oft / O b Property Owner' s Signatur e Dat e 

# f



# ~7 r 

# 77 < x x 

# # 7 " /^ ^ EP A Representativ e Signatur e Dat ePag e 1 o f 

### '-' 7 Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc y Regio n VI I Residentia l 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 _ (Pleas e Prin t Name ) *+

• (Propert y Owner Signature / / (Dgfe ) NOTE : Grantin g permissio n DOE S NO T necessarily impl y you r property wil l b e remediate dat thi s time . Residen t Name : Residenc e Address : 

# 6( 1 (CITY ) (STATE ! (ZIP ) Propert y owne dby : Owner s mailin g address : 

### Owner' s telephon e number

— Home : * ? f O ' ' / 7 £ 5 ^ Work : 

### j 9 

### ' 3 V 

### Ag e o f Home ? _ /£ ' f 

### ^

_year s Ho w lon g hav e yo u live dhere ? V

_year s Ha s th e exterio r bee n painte do r covere dwit h sidin g sinc e 197 8 

### Q^YE S D N O Ha s th e interio r bee n painte do r covere dsinc e 1978 ? B^YE S D N O Tota l numbe r o f

occupants : / Lis t Ages : 

### / J 

### < - / ! ^ 1 

### t

I 

### * > i ' ' , t f r- f / - Lis t age s o f occupant s unde r 6 year s ol d wh o pla y i n th e yar dfo r 5 o r mor e hour s pe r week : L

—_ Comments : _ AUTHORIT Y FO RENVIORNMENTA L RESPONS E ACTION 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 n 10 4 ot'CERCLA . 4 2 U S.C . 9604 . EPA' s righ t o f

acces s t o th e property fo r i n Sectio n 1 04(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 n unde 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 Address : Owner : Description : 

# S . 3 3 Date : OL S #: "2 2



### Owne r Signature : AS W Associate s Inc . Prin t & Sig n Prin t & Sig n

# 2245 7 Owne rName : REYN AVIZCAIN O AddM»»:617S33S T Phone : 

### Omah a Lea d Site Site Sketc h Sampl e Numbe r RYASCPXA-2245 7 RYBSCPXA-2245 7 RYCSCPXA-2245 7 RYDSCPXA-2245 7 RDZSCPXA-2245 7 ROZOOPXA-BB45 7 

## nnzecnx A 2245 7 Lea d Concentratio n Sampl e Collecte d Sample s Collected



## nr\rr . ;c . P . Sample s Analyze d Book : ^ 1 

# ENTERE D

Omah aLea dSit e 4613 0