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 2081 3 Propert yAddres s 1 1 1 5 Sout h 36t h Stree t Fiel d Wor k Starte d 8-Jun-0 6 Fiel d Wor k Complete d 19-Jun-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 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 of 12 . Verificatio n sample s confirme d tha t th e cleanu p standard s were 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 purpose s Comments : Th e Garde n zon e wa s excavate d t o a dept h o f 1 2 inch .



### Ja n Prawdzi k AS W Projec t Manage r Nam e Titl e Date

4026200 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 

### EP A 

### Analytica l Resul t Summar y OLS ID : 2081 3 Property Address : 111 5 Sout h 36t h

### Stree t XRFResult s Lab Result s Sampl e I D Avg . 

### (ppm ) (ppra ) 20813-DE-F2-0 6 110. 5 ±4 9 

### N A 20813-DE-DZ-1 2 58.314 1 

### N A 20813-DE-GZ-1 2 37 8 ±6 5 

### N A 20813-DE-DZ-1 2 300. 3 ± 66. 6 

### N A

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

### e ignatur e Simpl e Designatio n OLSID-DE-Location-dd OLSI O i s aparticula r residential property I D fro mwhic hth e sampl e i s collected . D E- Durin g an dPost Excavatio n Locatio no f th e sampl e a s follows ; F l = Fron t Yard(1 * Quadrant ) B 1 = Bac k Yard(1 " Quadrant ) F 2 - Fron t Yar d(2 ndQuadrant ) B 2 - Fron t Yard(2 n dQuadrant ) D Z= Dri p Zone PZ= Play Zon e O A= • Garde n E A - Easemen t d ddescribe s th e dept hfro mwhic hth e sampl e wa s collected .

- NA = No t Applicabl e

# &EP A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : 2091 3 Propert y Address : 1115 " ff . Date/Time : 4* t \f 

### Owner' s Name : t)f \/?€QJ 5 Quad s Excavated : Contracto r Grou p A * 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 ? 

# • / Gradin g So dan dVegetatio n Ye s N o 1 . Doe s 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 dbee n lai di n al l area s tha t wer e excavated ? 

# s 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 .Are sodde darea s generall y fir man devenl y graded ? 

# / 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 n th e property ? 

# J 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 

### 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 take n 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 ) i / 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### k / 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 ? 

# y 2 .Wa s damag e t o th e foundatio n avoided ? 

# / c

/ 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 ? ^ 

# / Sidewalk s an dDriveway s (Concrete )Ye s N o 

### 1 .Wa s damag e t o driveway surface s avoided ? 

# / 2 .Wa s damag e t o walkwa y surface s avoided ? 

# , /

## Owner s comments :

Inspectio n notes :

f/'/A f



## Removal an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EPA Representativ e $**,$*!* , Date : 8ft/e x

# § Contract No : E P - R 7 - 0 6 - 0 4 Property Closeou t Agreemen t ® 

### Omah a Lea d Superfun d Site OLSI D Property Addres s 

# IM S S.3CA*/ - Property Owne r 

# ALe&e A fW s I s th e Residen t th e Owne r ( S 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 ente r an dconduc t environmental restoratio n service s fo r th e Omah aLea dSite . You r cooperatio n i n givin g EPA/AS Wpermissio n t 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 wor k

performe da t thi s property wa s complete di n accordanc e withth e contac t specification s an dEP A requirements . I f

yo u hav e question s or nee dadditiona l informatio n pleas e contact th e EPA Publi c Informatio n Center s a t (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 :

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 at th e propert y to my satisfactio n 0 ^ I agre e tha t restoratio n i s complete da t m y propert y D I D o No t Agree : Comments :

Property Owner' s Signatur e Dat e P A Representativ e Signatur e Dat ePage 1 of . Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc 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 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 pfL'tLTTnfcL/ ^ *~'* z \ (Pleas e Prin t Name ) (Propert y Owne r Signature ) / (Date ) NOTE : Grantin g permissio n DOE S NO T necessaril y impl y you r property wil l b e remediate dat thi s time .

Residenc e Address : (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : Owner' s telephon e number—Home : . X / 2 " Vy'f''* ? Work : Ag e o f Home ? / Q * V year s Ho w lon g hav e yo u live dhere ? year s Ha s th e exterio r bee n painte do r covere dwit hsidin g sinc e 1 97 8 D N O 

### Ha s th e interio r bee n painte do r covere dsinc e 1 978 ? D N O 

### 1 o> * Tota l numbe r o f occupants : __£

__ Lis t Ages : p . Lis t age s o f occupant s unde r 6 year s ol dwh o pla y i n th e yar dfo r 5 o r mor e hour s pe r week : Y Comments : ___ _ AUTHORIT Y FO RENVIQRNMENTA 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 n 10 4 o f CERCLA , 4 2 U.S. C %0 4 EPA' s righ t o f

acces s t o th e property fo r i nSectio n 1 04(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 n unde 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 :

# Lis t o f existin g Condition s pg . o f Property Address : Owner : .g>^/4» * Description : l/5~ ~ 5 . 1 6 * Sfryt f Date : '-/-l?- ^ OLS# :

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### Owne r Signature : AS WAssociate s Inc . t 

### Prin t & Sig n Prin t & Sig n

## 2081 3 Exterio rPain t Nort h Arro w 

### Omah a Lead Sit e rOwne rName : D M SEAL S n Good 

### Sit e Sketc h Addresft:iH5S36S T S^Poo r

Phone : H . 402-345-256 1 W : Q Not paint 

### Sampl e Numbe r RYASCPXA-2081 3 RYBSCPXA-2081 3 RYCSCPXA-2081 3 RYDSCPXA-2081 3 RDZSCPXA-2081 3 RGZSCPXA-2081 3 F 1 F2 B 1 8 2 D Z G Z Lead Concentratio n 

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# n Sample s Collecte d Firm : fbf t tff e T L Date : £/ / / &£ T Time : AAopt * Sample s Analyze d XRFUni t JQQ ? Book : 11*?

Time : P M La b RDZSCPLA-2081 3 Resul t 12 6 pp m Numbe ro f Sample s = : 3 | 

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