CONTRAC T # EP-R7-06-0 4 

### 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 y Closeou t BVI D 

### Fiel d Wor k Starte d 1796 9

25-May-0 6 

### Propert

yAddres s Fiel d Wor k Completed 213 0 Sout h 33 r t 

### Street 19-Jun-06 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 was excavate d to a dept h of 1 2 inch . Th e B 1 quadran t was excavate d to a dept h of 1 2 Inch . Th e B 2 quadran t wa s excavate d t o a dept h o f 6 inch . Th e dri p zon e was excavate d to a dept h o f 1 2 inch . Verificatio n samples confirme d tha t th e cleanu p standard s wer e met . Th e site was backfille d wit h material s whic h meets contrac t specifications . Th e backfil l was compacte d to acceptabl e standards . So d placements 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 data provide d i s pos t excavatio n a

t th e botto m of th e excavatio n fo rconfirmatio n purpose s Comments : 

### None .

Ja n Prawdzl k Nam e AS W Projec t Manage r Titl e 4026070 0 

## ' bat e

SUPERFUN D RECORD S 

### Site; Q 

### I D Other:_

_ CV-l-7 'CONTRAC 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 OL S ID : 1796

9 Property Address : 213 0 South 33 r d

### Stree t Sampl e I D 17969-DE-F1-1 2 17969-DE-B1-1 2 17969-DE-B2-06 17969-DE-DZ-1 2 XRFResult s Avg . (ppm ) (-15.3 ) ±67. 6 17. 6 ±76. 3 150. 4 ± 83. 3 65. 9 ±75. 6 La

b Result s (ppm ) 

### N A N A N A N A

Ja n Prawdzi k Nam e ASW Projec t Manage r Titl e 

### Signature ' Sampl e DeafcpMti m OLSID-DE-Locatfon-d

d OLSID i s aparticula

r residentia l propert y ID fro mwhic hth e sampl e i s collected . DE » Durin g an dPoe

t Excavation Location of th e sample a s follows ; Fl - Front Yard(1 " Quadrant) Bl - Bac k Yard(1 " Quadrant) F2 - Fron t Yard(2 - Quadrant) B 2 - Front Yard(2 * Quadrant) D Z- Drip Zone P Z-PlayZon e GA-Garde n EA = Easemen

t d ddescribe s th e dept

hfro mwhic hth e sampl e wa s collected .

- N A = No t

Applicable

# &EP

A

Propert y # : Date/Time : Quad s Excavated ; ' fl s Rl , B l 4 J> Z



# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y Address : o?*3 0 3 • 3 3 Owner' s Name : "DAVl D 

### IQ : 

### C O A M Contracto r Grou p 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 ? 

### y

, / 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 dbeen lai di n al l area s that wer e 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 . 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 property grade dsuc h tha 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 ? 

### , / ( / 

## rfll / 

## tfi<

. / / Gates , Fence s an d Retainin g Wall s Ye s N o 1 . 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 ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### /

, /

, /

, / 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 ? 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 to window s o r door screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t

extension s avoided ? 

### i /

. / 

# y , / 

# / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? 

### / I /

# f i SA ST

Owner s comments :

Inspectio n notes :



## Removal an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EPA Representativ e £cun* / / } j$L
- Date :

# f Contrac t No : E P - R 7 - 0 6 - 0 4 Property Closeou t Agreemen t Omah a Lea d Superfun d Sit e @ ) OLSI O Property Owne r 

### /?% ?



### bMi t SkAMkA d Propert y Addres s 

# A3I O 5.3 3 5 

# * ~

I s th e Residen t

th e Owne r

( ^ 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 for th e Omah aLea

dSite . Your cooperation i n givin g EPA/AS W permissio n to acces s your propert y durin g th e removal/restoratio n phas e i s sincerely appreciated . Thi s documen t certifie s tha t

al l wor k performe da

t thi s propert

y wa s complete di n accordanc e wit h th e contac t

specification s an dEPA requirements . I f yo u hav e question s o r

needadditiona l informatio n pleas e contac t th e EP A 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

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 Nam e AS W Projec t Manage r Titl e Dat e Signatur e 

### Property Owne r

Sectio n Thi s agreement

document s th e completio n o f remedial/restoratio n effort s a t th e propert

y to m y satisfactio n 8 3 I agree 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 EP A Representativ e Signatur e Dat ePag e 1 o f
U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSit e Omaha , N E 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 dB y (Pleas e Prin t Name ) (Propert y Owner Signature ) (Date ) NOTE : Grantin g permissio n DOES NO T necessarily impl y you r propert y wil l b e remediate dat thi s time . Residen t Name : D Owne r D Rente r Residenc e Address : 5 > ^ 7 , (CITY ) (STATE ) (ZIP ) Property owne dby : Oil/i f Owner s mailin g address : 2 / $ 0

- 7 * 1 f Work : Owner' s telephon e number

—Home : Ag e o f Home ? _/x^- O _year s Ho w lon g hav e yo u live dhere ? 3 t ) _year s Ha s th e exterio r

bee n painte do r

covere dwit h sidin g sinc e 197 8 D YE S 

### Ha s th e interio r

been painte do r

covere dsinc e 1 978 ? Total numbe r

o f occupants : _jX - Lis t Ages : 5< T "- ^ ' D N O 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 : 1 9 ~* ~ 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 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 propert y fo r i n Sectio n I04(e ) o f

CERCLA . 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 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 Propert y Address : 1/3 0 4 , 3 1 Owner : Date : y-l,o~o< - OL S #: / 7 Description :

r4 »*l/» « tC r



### / • »



### Owne r Signature : AS WAssociate s Inc . Prin t & Sig n 

# 7 Prin t & Sig nOmah a Lead Sit e Sit e Sketc h

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