### 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 yCloseou t BVI D 2091 9 PropertyAddres s 1203825 t h 

### Avenu e Fiel d Wor k Starte d 3-Oct-0 6 Fiel d Wor k Complete d 19-Oct-0 6 

### Summary : •Th e excavatio n wa s performe d i n complianc e wit h th e work 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 D Z quadran t 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 meets 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 . 4026175 5 

### Comments : SUPERFUN D RECORD S 

### None . Ja n Prawdzi k AS W Projec t Manage r

Nam e Titl e 

### ^ SignafureCONTRAC T# EP-R7-06-0 4 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

### Analytica l Resul t Summar y OL S ID : 2091 9 Propert y Address : 1203 S 25 th

### Av e XR FResult s Sampl e I D 

### Avg . (ppm ) 

### 20 9 19-DE- F1-0 6 

### 77. 6 ±56. 3 20919-DE-F2-0 6 

### 16I.3±6 4 20919-DE-DZ-1 2 

### 11 7 ±60. 3

Ja n Prawdzi k AS W Projec t Manage r

Nam e Titl e 

### bat 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 I = Fron t Yar d (I " Quadrant ) B l = Bac k Yard (1 s 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 

### La b Result s 

### (ppm )

N A N A N A

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : Propert y Address : 120" $ Date/Time : Owner' s Name : SlaJelt'i t Quad s Eicavated : Contracto r Grou p Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 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 N o 1 .

Does th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y / fro mth e house ? 2 .Ha s so dbeen lai di n al l area s tha t were excavated ? 

# s 3 .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

# y day tim e period ) 4 .Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 .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 ) 

# / 6 .

Wa s th e propert y grade dsuc htha t wate r wil l no t poo l o nth e property ? 

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

# y Gates , Fence s an dRetainin g Wall s Ye s N o \ .

D o gate s ope n an d clos e freely ? (Ifapplicable ) 

# s 2 .Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) 

# s 3 .Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

# ^ 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## 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 ? y 3 .Wa s damag e t o window s avoided ? i / 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? ^ 5 .

Wa s damag e t o downspout s o rdownspou t extensions avoided ? * / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e t o drivewa ysurface s avoided ? L / 2 .Wa s damag e t o walkwa ysurface s avoided ? ^

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EPA Representativ e *$Q», &^ , Date : J'/ t <7

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

### ttgfe)) Omah a Lea d Super-fun d Sit e OLSI D Propert y Addres s 

## ilo i S JSMC Propert y Owne r I s th e Residen t th e Owne r & Ye s D 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 aLea dSite . 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 work performe da t thi s propert y 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 AOffic 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 no f remedial/restoratio neffort s a t th e propert y t o m y satisfactio n 8 9 I agre e tha t restoratio ni s complete dat my property D I D o No t Agree : Comments :



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# /0/i(/0 6 Propert y Owner' s Signatur e ' Dat e ^ 

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### EP/ft Representativ e Sigrtajlir e 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 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 A a t 1-800-223-0425 . Propert y Acces s Grante dB y (Pleas e Prin t Name ) ( 1 (Propert y Owne r Signature ) I (Date ) 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 : f(\fl&£\ t 

### d £ B Owne r D Rente r Residenc e Address : / (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address: _ Owner' s telephon e number—Home : Work : Ag e o f Home ? (_y Q year s Ho w lon g hav e yo u live dhere ? _ / Q year s Ha s th e exterio r bee npainte do r covere dwit hsidin g sinc e 197 8 G l YE S D N O Ha s th e interio r bee npainte do r covere dsinc e 1978 ? GrYE 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 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 (h e propert y fo r i nSectio n104(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 title. " 

### Acces s Attempts : First : Q t Second : Third :

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

### Propert y Address : 

# S . Owner : Date : OL S #: 

### Description : 

# \

Owne r Signature : AS WAssociate s In c Prin t & Sig n

### Omah aLeadSit e Sit e Sketc h

Omah aLea dSit e 4613 0