### CONTRAC T # EP-R7-06-0 4 

## AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

### EPA 

## AS W Associate s In c Certificatio n fo rPropert y Closeou t BVI D Fiel d Wor k

Starte d 16860

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

Complete d 234 1 Sout h 33 r d 

### Street 12-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 . 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 meets contrac t 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 compliance wit h wor k plan s an d specifications . 

## Comments : None .

Brea k O'O > 

## Other :

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

£ Titl e 'Dat 6 4026196 3 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 : 1686

0 Propert y Address : 234 1 Sout h 33 r d

### Street Sampl e I D 16860-DE-F1-0 6 XR FResult s 

### Avg . (ppm ) 9 0 ±6 1 Lab

Result s 

### (ppm ) N A



### Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e Dat e Signature ' Sampl e Designatio n OLSID-DE-Locition-d

d OLSIO 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 n o f th e sampl e a s follows ; F l = Fron t Yard(1 " Quadrant ) B 1 = Bac k Yar d(1 " Quadrant) F 2 - Front Yard(2 - Quadrant) B 2 - Fron t Yard(2« lQuadrant ) D Z= Dri p Zon e PZ = Play Zone GA = Garde n E A = Easement d ddescribe s th e dept

hfro mwhic hth e sampl e wa s collected .

- N A = No t

Applicabl e

# &EP

A

Propert y # : Date/Time : Quad s Excavated : 

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y Address : ^3^ 1 5.3 3 Owner' s Name : Contracto rGrou p Excavatio n Genera l 

### Ye s 

### N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 . I f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? 

### i / * / 

### Gradin g So dan dVegetatio n Ye s 

### N o 

# 1 . 2 . 3 . 

### 4 . 5 . 6 . 1 . Doe s the gradin g aroun dthe perimete r of the hous e in excavate darea s generall y slop e awa y 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 da t

a3 0 da y tim e period ) Ar e sodde darea s generall y fir man 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 property 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 ? 

### / S 

### * / 

# S S / / Gates , Fence s an dRetainin g Wall s Ye s 

### N o I. D o gate s ope n an dclos e freely ? (I f applicable ) 2 . Wer e al l gate s o r

fence s taken 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 ) 

### S S 

# s s 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 ? 

# s



# s s S 

# * / Sidewalk s an dDriveway s (Concrete ) Ye s N 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 ? «/ J

## Owner s comments :

Inspectio n notes :

Removal an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e 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 

# /* » 

# **, * Propert y Addres s 

# 2.J WS. V I s th e Residen t

th e Owne r

Q^Ye s D N o Complianc e Statement : U.S . Environmental Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , (o r it s contractors) , to enter an dconduc t

environmental restoratio n service s fo r th e Omah aLeadSite . You r cooperation i n givin g EPA/AS Wpermissio 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 wit h 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 at (402 ) 731-304 5 o r

(402 ) 991-958 3 o r

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 WProjec t

Manage r Titl e Dat e 

## Propert y Owne r

Sectio n Signatur e Thi s agreement

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

y to my satisfactio n 0 3 I agree tha

t restoratio n i s complete da

t m y property O I D o No t

Agree : Comments : 

# rltJ\ k Jf>jjJ2 A Propert y Owner' s Signatur e 

# f^/oJ/ , J ^ (^

— EP A Representativ e Signatur e 

# -j . (£.06 * Dat e 

# 7-/ A <s £

Dat ePag e lo f 1

U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSite Omaha , N E Residentia l Yar dSoil s 

### Environmenta l Restoratio n Services Granto r (th e propert

y owner) , consent s t o an dauthorize s th e Unite dSate s Environmental 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 dperformcertai 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 at 1-800-223-0425 . Propert y Acces s Grante dB y (Please Print Name ) 

### (Propert y Owner Signature ) (Date) NOTE : Grantin g permissio n DOES NO T necessaril y impl y your

propert y wil l b e remediate da

t thi s time . Residen t Name : /j)/? A 

### D A A / 8</R 

## Residenc e Address : 2-34 J $ 3 3 5Y/ W D Owne r

QtfflH A 

### P Rente r

/V £ (CITY ) (STATE ) (ZIP ) Propert y owne dby : 

### Owner s mailin g address : t— ^ f\ i v[\C— • Owner' s telephon e number—Home : 'y* \[ -"2,O O \Work : Ag e o f Home ? I O D year s Ho w lon g hav e yo u live dhere ? year s 

### Ha s th e exterio r

been painte do r

coveredwithsidin g sinc e 197 8 D YE S Ha s th e interio r

been painte do r

covere dsinc e 1978 ? u YE S D N O Tota l numbe r o f occupants : J Lis t Ages : i 7- ( < I ( " 7 4 . "?> ; H i . 4 O Lis t age s o f occupant s under

6 year s ol dwh o pla y i n th e yar dfo r 5 o r mor e hour s per

week : ( "2 - Comments : AUTHORITY FO RENVIORNMENTAL RESPONS E ACTION S Th e Ktivitie i to b e implemente db y EPA unde r thi s agreement

ar e pursuant to Sectio n 104 o f

CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f acces s to th e propert y fo r i n Section I04(e ) o f

CERCLA , 4 2 U.S.C . 960

4 (e) , whic hprovide s entr

y for , "determinin g th e needfo r

response , o r choosin g o r 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 title. " Acces s Attempts : First : Second : Third :

# Lis t o f existin g Condition s Pg - of . 

## Property Address : 2-34 ) g 3 2 Owner : Date : Description :

Owner S i Prin t & Sig n AS WAssoeiate s In c Prin tOwne rNam*: .

Addrom : Omah a Lea d Site Site Sketc h Aort h Arro w Phone : H : 31 1 • C.QQ I w ¥£& - /PO O 

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