CONTRAC T # EP-R7-06-04 

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

### AS W Associate s In c Certificatio n fo rPropert yCloseou t BVI D 4775 2 Propert y Addres s 3 1 1 5 R Stree t Fiel d Wor k Starte d 18-Jul-06 Fiel d Wor k Complete d 5-Aug-0 6 

### Summary : Th e excavatio n was performe d i n complianc e 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 of 1 2 inch . Th e F 2 quadran t wa s excavate d t o a dept h o f 1 2 inch . Th e B 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 meet s 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 wer e 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 : None .

Ja n Prawdzi k AS W Projec t Manage r

Nam e Titl e 

### Date denatur e 4026199 2 SUPERFUN D RECORD SCONTRAC T # EP-R7-06-0 4 

### AS W Associate s Inc . Omah a Lead Site Remediation , Omaha , N E 

### EPA 

### Analytica l Resul t Summar y OL S ID : 4775 2 Propert y Address : 311 5 RStreet XR FResult s La b Result s Sampl e I D 

### Avg . (ppm ) 

### (ppm ) 47752-DE-FM 2 76. 1 ±55. 3 

### N A 47752-DE-F2-1 2 1 6 ±49. 3 

### N A 47752-DE-B1-0 6 

### 16 5 ± 

### 66. 3 N A

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

### 'Dat e

Sampl e Designatio n OLSID-DE-Location-dd OL S I D i s aparticula r residentia l propert y 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 l = • Bac k Yard(1 * Quadrant ) F 2 = Fron t Yar d(2n dQuadrant ) B 2 = Fron t Yard(2n dQuadrant) D Z" Dri p Zon e PZ= Play Zon e GA = Garde n E A= Easemen t d ddescribe s th e dept hfro 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 For m Propert y # : Property Address : 3 //5 " f f Date/Time : Owner' s Name : ^e£«y-tf A Orttt/sH t Quad s Excavated : Contracto r Crou p Excavatio n Genera l ) . I f necessary , were 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 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 ? 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 da y lim e period ) 4 .Ar e 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 ? 7 .Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .

D o gate s open 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 ) 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s 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 ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damag e t o drivewa y surface s avoided ? Ye s 

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### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarrant y EP A Representativ e Date :

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

## Propert y Closeou t Agreemen t 

# ? Omah aLea dSuperfun dSite 

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OL S I D Propert y Addres s 

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# - X . J T Property Owne r I s th e Residen t th e Owne r 

### Hie 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 cooperatio n i n givin g EPA/AS Wpermissio n t o acces s you r propert y 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 dat 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 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 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 n o f remedial/restoratio n effort s at th e property t o my satisfactio n 0 7 I agre e that restoratio n i s complete da t m y propert y D I E) o No t Agree : Comments : 

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Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc y Regio n VI ! Residentia l Yar dSoil s Environmenta l Restoratio n Service s Granto r (th e property 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 dfl t ^ ~ L / ^& - U tf £ ~ (Pleas e Prin t Name ) (Propert y Owner Signature ) (Date) NOTE : Grantin g permissio n DOE S NO T necessaril y impl y you r properl y 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 : ' * O / // Y Work : Ag e o f Home ? 00~ f 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 h sidin g sinc e 197 8 ErYE S D N O Ha s th e interio r bee n painte do r covere dsinc e 1978 ? SKYE S D N O Tota l numbe r o f occupants : S ^ Lis t Ages : 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 : 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 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 nI04(e ) o f CERCLA , 4 2 U.S.C . 9604 (e) , whic hprovide s entr y for , "determinin g th e needfo 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._/_of_/ _ Property Address : Owner : . D 

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gnature * Owne r Signature - AS WAssociate s In c r uk - Q 

## Prin t & Sig neadSit e 

### Omah a L Owne rName : DEBORA H M ORDUN A 

### Site S ketc h Addr***:3115RS T Phone : H 

### W : Sampl e Numbe rLea d 

### Sampl e .. g Concentratio n Collected RY.ASCPXA-4775 2 F 1 H ^ ^

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