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 

### 2271 3 Propert yAddres s 52 9 

### S 2 7 S t 

### Fiel d Wor k Starte d 12-Jun-06 Fiel d Wor k Completed 27-Jul-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 B 1 quadran t wa s excavate d t o a dept h of 1 2 inch . Th e dri p zon e wa s excavate d t o a dept h of 1 2 inch . Verificatio n samples 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 . Sod placement s an d site restoration s were conducte d i n complianc e 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 purposes Comments : Th e garde n zon e wa s excavate d t o a dept h of 1 2 inches .

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

## 'Dat e gnatu r 4026198 7 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 OLS ID : 2271 3 Property Address : 52 9 Sout h 27 t h

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

### Avg . (ppm ) (ppm ) 22713-DE-B1-1 2 

### 142. 3 ± 

### 35. 6 

### N A 22713-DE-DZ-1 2 156. 3 ±42. 6 

### N A 22713-DE-UC-1 2 

### 73. 4 ±41. 6 

### N A

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

## Da e Sampl e Damnatio n OLSID-DE-Location-dd OLS1 O i s aparticular residential property I D fro mwhic hth e sample i s collected . D E- Durin g an dPos t Excavatio n Locationo f the sampl e a s follows ; F l = Front Yard(1 * Quadrant ) Q l - Bac k

Yard(I*Quadrant ) F2 - Fron t Yard(2° < Quadrant) B 2 - Front Yard(2 * Quadrant ) D Z• Dri p Zone P

Z= Pla y Zone GA = Garden E A= Easement dddescribe s the dept hfro mwhic hthe 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 # :

__Propert y Address : 3'2 * Date/Time : Owner' s Name : Quad s Excavate871 _ Contracto r Grou p Excavatio n Genera l 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 

## 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 evaluate i f inspecte dat a3 0 da y tim 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 dat 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 properly ? 

### 1 . 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 ope n an dclos e freely ? (f 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 ? 2 .Wa s damag e t o walkwa y surface s avoided ? Ye s N o 

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### Owner s comments :

Inspectio n notes :

ni y ' st c 

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### Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e _& ^ ^ _ Date :

### Contract No : E P - R 7 - 0 6 - 0 4 

# s Property Closeou t Agreemen t 

## |w | Omah a Lea d Superfun d Sit e OLSI D Propert y Addres s 

# 52 ? S . j-to* - Propert y Owne r I s th e Residen t th e Owne r D Ye s H - N o 

# Alia * S«U« 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 environmenta l 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 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 dat thi s propert y 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 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 Prawdzl k AS WProjec t Manage r Nam e Titl e Dat e Signatur e 

## Propert y Owne r Sectio n Thi s agreement document s th e completio n o f remedial/restoratio n effort s at th e property t o my satisfactio n {B - 1 agre e tha t restoratio n i s complete da t m y propert y D I D o No t Agree : Comments :


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### / EP A Representativ e Signatur e ' Dat ePag e 1 o f Omah aLea dSit e Omaha , N E U.S . Environmenta l Protectio n Agenc y Regio n VI 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 C n £ j ^ 3 H ( t x 3 1 C (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 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 : S ~ Y > ­ c f t / 7 Ag e o f Home ? / / &

_year s Ho w lon g hav e yo u live dhere ? f "^* ^ year s Ha s th e exterio r bee n painte do r covere dwit hsidin g sinc e 197 8 IJ r YE S Ha s th e interio r bee n painte do r covere dsinc e 1978 ? 

### ErYE 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 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 ofCERCLA , 4 2 U. S C 960 4 EPA' s righ t o f

acces s t o th e propert y fo r i nSectio nI04(e ) ofCERCLA , 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 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 . _ o f _ Propert y Address : Owner : /f/^f s Description : 5 " 7 - 1 5t/f<f c J» .

Date : *>l-2-Y'tf OLS# : t t 7 / /

Owner Signature : AS W Associate s Inc . Prin t & Sig n Prin t & Sig n

# 2271 3 Exterio rPaint Nort h Arro w 

### Omah a Lead Site Owne rName : ALBET O SALCED O [3 Good 

### Sit e Sketc h Addro««:529S27S T [3 Poo r

Phone : H - 402-553-469 7 W : 0 ^

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