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

### AS WAssociate s In cCertificatio n fo rPropertyCloseou t BVI D Fiel d Wor k

Starte d 5 9

9-Oct-0 6 PropertyAddres s

Fiel d Wor k

Complete d 1 11 7 Kava n Stree t 27-Oct-0 6 

### Summary : Th e excavatio n wa s performe d i n complianc e wit h th e wor k plan s an d specifications . Th e Y A(F1 ) quadran t wa s excavate d t o a dept h o f6 inch . Th e dri p zon e wa s excavate d t o a dept h o f1 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 fexcavation . Th e sit e wa s backfille d wit h material s whic h meet s 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 . Analytica l dat a provide d i s pos t excavatio n a t th e botto m o fth e excavatio n fo rconfirmatio n purposes . 4025857 2 

### Comments : None . SlIPERFUM ) RECORD S Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e 

### Dat e Signatur eCONTRAC 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 OL S ID : 5 9 

### Propert y Address : 111 7 Kava nStree t Sampl e I D 59-DE-YA(Fl)-0 6 59-DE-DZ-1 2 XR FResult s Avg . (ppm ) 

### 72.4139. 3 129. 7 ±4 6 La b

Result s (ppm ) N A N A

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

### Dal e ^ignafure

Sampl e Designatio n OLSID-DE-Location-d d OLSI D 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 no f

th e sampl e a s follows ; F l = Fron t

Yar d(1 ° Quadrant ) B l = Bac k

Yar d(1 ° Quadrant ) F 2 = Fron t

Yar d(2 n dQuadrant ) B 2 = Fron t

Yar d(2 n dQuadrant ) D Z= Dri p Zon e P Z= Pla y Zon e G A= 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 nContrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y# : Date/Time : 

### Quad s Eicavated :



### OO P 5 V P/

S PropertyAddress : / / / 7 AV v Owner' s Name : /^gnj^- e f- h Contracto rGrou p X ? 

### {AS W

Excavatio n Genera l 

### Ye s 

### N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate d an d restored ? 2 . I f necessary , wer e th e correc t areas o f dri p zon e excavate d an d restored ? / 

# y Gradin g So dan dVegetatio nYe s N o 1 . Does th e gradin g aroun dth e perimeter o f th e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 2 . Ha s so dbeenlai di nal l area s tha t were excavated ? 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 . Ar e sodde darea s generall y firman devenl y graded ? 5 . Are th e joint s betwee nth e so dstrip s generally tight ? (Onl y evaluat e i f inspecte dat

a3 0 day tim e period ) 6 . Wa s th e propert y grade dsuc htha t wate r wil lno 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 d Retainin g Wall s Ye s N o 1 . D o gate s ope n an d clos e freely ? (I f applicable ) 2 . Wer e al l gate s o rfence 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 rfence s avoided ? (I f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) /

^ ! / / 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 ? 3 . Wa s damag e t o window s avoided ? 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 extension s avoided ? , / S / « / / Sidewalks an d Driveway s (Concrete ) 

### Ye s 

### M o 1 . Wa s damag e t o drivewa ysurface s avoided ? 2 . Wa s damag e t o walkwa ysurface s avoided ? 

### < S < /

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-day so dwarranty : EP ARepresentativ e &-^j&~ r Date : ^

_

# § Contrac t No : E P - R 7 - 0 6 - 0 4 PropertyCloseou t Agreemen t Omah a Lea d Superfun d Sit e ilsSv /

OLSI D Oj/J/'-y^fc'tt v /£<X»6£ f Propert y Owne r

' Propert y Addres s 

# i i/ i KW^/ j 'i 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 aLeadSite . 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 property 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 Aand/o r ASW :

CONTRACTO RCERTIFICATIO N Ja nPrawdzi k

AS WProjec t

Manage r Nam e Titl e Dat e



## Propert y Owne r

Sectio n Signatur e 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 6B , Iagre e tha t

restoratio ni s complete dat my propert y D I D o No t

Agree : Comments : 

# i^t^r a , , /^W<^Jt

r Propert y Owner' s Signatur e 

# v_J oAAM^d/l/vAAi* &Ifrr ^

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### * w v 

### W ^ u 

### I EPAmepresentativ e Signatur e 

# /•d/Wo C pat e 

# /&/.?//** > Dat e

# Lis t o f existin g Condition s pg . o f Propert y Address :

: | ) | * 7 \* ~ 

### 0 \ Vf t l/ \ 

### 6 7 

### Owner : "M^r V O ( A f\r f /"Date : ^ - 3 0 OLSI D # Description : 

# \Atf\d er A

Owne r Signature : /> | ^x , 7^ ^ i^yi^O ^ AS W Associate s In c 

# B^k 

# Br. S Prin t & Sig nrin t Sig n

# 5 9

Owne rName : Address : 111 7 KAVA N S T Phone : H : 

### Omah a Lea d Sit e Sit e Sketc h w Exterio rPain t 

## D Goo d L I Poo r Q ] Not pain t Nort h Arro w Sampl e Numbe r RYASCPXA-5 9 Y A RYBSCPXA-5 9 Y B RYCSCPXA-5 9 Y C RYDSCPXA-5 9 Y D RDZSCPXA-5 9 D Z RGZSCPXA-5 9 G Z RPZSCPXA-5 9 P Z Lea d Concentratio n 633. 6 pp m 196. 3 pp m 244. 8 pp m 249. 8 pp m 1849. 6 pp m

pp m pp m Sampl e Collecte d K J 0 

## D D LA B

D D D Numbe ro f Sample s = 5 Sample s Collecte d Firm : Sverdru p Date : Time : Sample s Analyze d XR F Unit : Date : Time : Staff : 

### 11/9/199 9 Book : 

### 11:1 3 Legend : Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Play

Re v 4 046I4I.OI2 3