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 rPropertyCloseou t BVI D 2213 2 PropertyAddres s 442 7 Leavenwort h Stree t Fiel d Wor k Starte d 7-Sep-0 6 Fiel d Wor k Complete d 11-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 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 B 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 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 . 4026167 8 

### Comments : None . SUPERFUN D RECORD S Ja n Prawdzi k AS W Project Manage r

Nam e Titl e 

### baf e Signatur e d

### CONTRAC 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 : 2213 2 Propert y Address : 442 7 Leavenwort h S t XR FResult s La b 

### Sampl e I D Avg . 

### Result s (ppm ) (ppm ) 

### 22132-DE-F1-0 6 272. 6 ±59. 6 N A 

### 22132-DE-B2-0 6 

### 136. 3 ±4 1 N A 

### 2132-DE-F2-0 6 30. 2 ±40. 3 N A 

### 22132-DE-DZ-1 2 

### 69. 2 ±

### 44. 3 N A



### Ja n Prawdzi k AS W Project Manage r

Nam e Titl e 'Dat e Signature

Sampl e Designatio n OLSlD-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 n o f th e sampl e a s follows ; F l = Fron t Yar d(l f lQuadrant ) B l = Bac k Yar d(\ aQuadrant ) F 2 = Fron t Yar d(2 n dQuadrant ) B 2 = Fron t Yar d(2 n dQuadrant ) D Z= Dri p Zon e PZ= Play Zone 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

# -I T Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : ^ 

### / 3 . Propert y Address : t ^ <, f Date/Time : i? - Owner' s Name : T O Quad s Excavated : Contracto r Grou p Excavatio n Genera l Ye s N o 1 .

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

### / 2 .

I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### *S 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 

### • S 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 dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

### / 4 .Are sodde darea s generall y firman 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 day tim e period ) 

### / 6 .

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

### / 1 .Wa s damag e t o landscapin g o r plan t material s avoided ? 

### S Gates , Fence s an dRetainin g Walt s Yes No I .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 ) 

## s 3 .

Wa s damag e t o gate s o rfence s avoided ? (I f applicable ) 

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

# 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 ? S 2 .Wa s damag e to th e foundatio n avoided ? S 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 downspouts o rdownspou t extension s avoided ? V Sidewalk s an d Driveways (Concrete ) Ye s N o 1 . Wa s damag e t o drivewaysurface s avoided ? i / 2 . Wa s damag e t o walkwa ysurface s avoided ? i /

### Owner s comments :

Inspectio n notes :



## V ; '. . r 

## . 

## <>• , '• ­ 

## ''"'" ' "'" "

Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwarranty :

### Contract No : E P - R 7 - 0 6 - 0 4 I*TM'-- ) 

### Propert yCloseou t Agreemen t Omah a Lea d Superfun d Sit e 

### ©

• V f 2 7 

### OLSI D Propert y Addres s 

### Propert y Owne r 

## "T O I s th e Residen t th e Owne r D Ve s E LN o Complianc e Statement : U.S . Environmental Protectio n Agenc 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 n givin 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 A requirements . I f

yo u hav e question s o r nee dadditiona l informatio npleas e contac t th e EP A Publi c Informatio nCenter s a t (402 ) 731-304 5 o r (402 ) 991-958 3 o r th e EP A 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 W Project 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 neffort s a t th e propert y t o m y satisfactio n (JB- I agre e tha t restoratio ni s complete dat my property D I D o No t Agree : Comments :

Propem y Owner' s Signatur e Dat e 

### A^ \^yi/CiCi/' ^ (-(yr ^ /EP A Representativ e Signatur 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 PROPERT Y b y Propert y Owner ) n e n l 1-800-223-042 : 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 Aa t 1-800-223-0425 . Propert y Acces s Grante dB y (Pleas e Prin t Name ) 

# 1 7 

# . (Proper ^ OtJnerS&trtfttH? ) , \(Date ) NOTE/ : Grantinapermissib n DOE S NO T necessaril y imply you r property wil l b e remediate da ^ thi s time . PROPERT YINFORMATIO N etec i o v resid e onerl v owne r Residen t Name : T". Q 0 - Owne r D Rente r Residenc e Address : Lf Q \J& * C0p/e. + k (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : r - O , Owner' s telephon e number

—Home : Work : Ag e o f Home ? _Q \ & year s Ho w lon g hav e yo u live dhere ? / / year s Ha s th e exterio r bee npainte do r covere dwit hsidin g sinc e 197 8 0YE S 

### D 

### N O Ha s th e interio r bee npainte do r covere dsinc e 1978 ? BrE S 

### D 

### N O Tota l numbe r o f occupants : _J

—_ Lis t Ages : 

### V T ^ 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 : 

# •I A 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 agreement,-ir 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 n104(e ) ofCERCLA , 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 : Second : Third :

# Lis t o f existin g Condition s pg . _

# o f Propert y Address : W.2. 7 S J ~ 

### Owner : "T O Date : O8/i7/Ot > OLSI D #: ^ |3 2 Description :

Owne r Signature : AS WAssociate s Inc . Prin t & Sig n Prio1& . Sig nOmah a Lea d Site Address : Site Sketc h Phone : Sampl e Numbe r



### Omah aLea dSit e 4613 0