### CONTRAC T# EP-R7-06-0 4 

### AS WAssociate s Inc . Omah a Lea d Siit e Remediation , Omaha , N E EPA 

### AS WAssociate s In cCertificatio n fo rPropert yCloseou t BVI O Fiel d Wor k

Starte d 1562



### 16-Oct-0 6 Propert yAddres s Fiel d Wor k

Complete d 71 1 Pin e Stree t 27-Oct-0 6 

### Summary : Th e excavatio n wa s performe d i n compliance wit h th e wor k plan s an d specifications . Th e Y C quadran t wa s excavate d t o a dept h o f1 2 inch . Th e Y D quadran t wa s excavate d t o a dept h o f 6 inch . Th e G Z quadran t wa s excavate d t o a dept h o f1 2 inch . Th e E Z quadran t wa s excavate d t o a dept h o f 6 inch . Th e dri p zon e wa s no t excavated . Verificatio n sample s confirme d tha t th e cleanu p standard s wer e met . Verificatio n samples were collecte d fro m th e botto m of 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 placements an d sit e restoration s were conducte d i n compliance wit h wor k plan s an d specifications . 4026174 8 

### Comments : None . SUPERFUN D RECORD S



### Ja n Prawdzi k Nam e AS WProjec t Manage r Titl e 

### Date Signatur eCONTRAC T# EP-R7-06-0 4 

### AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E Analytica l Resul t Summar y 

### OL S ID : 

### 1562 Propert y Address : 71 1 Pin e Stree t Sampl e I D 1562-DE-YC-1 2 1 562-DE-YD-0 6 1562-DE-GZ-1 2 1562-DE-EZ-0 6 XR FResult s Avg . (ppm ) 

### 119. 3 ±45. 3 1 1 7. 3 ±45. 3 18 2 ±49. 6 78. 9 ±35. 6 La b



### Result s (ppm ) 12 5 

### N A N A N A



### Ja n Prawdzi k Nam e AS WProject Manage r Titl e Daf e Signatur e

Sampl e Designatio n OLSID-DE-Location-d d OLSID i s aparticular

residential 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 1 = Fron t

Yar d(1 " Quadrant ) B 1 = Bac k

Yar d(1 " Quadrant ) F 2 = Fron t

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

Yar d(2TM 1 Quadrant ) 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

# Remediation/Excavatio nContrac t (ASW ) EP A Property Clos e Ou t Form Propert y# : _ Date/Time : Quad s Excavated :



### 0156 2 Propert yAddress : /' ' Owner' s Name : / n • ' cf e Q f - / Contracto rGrou p x l £ . _____ Jfl/v,<? s f

AS W

.->> -e rc 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 correct areas o f dri p zon e excavate d an d restored ? / 

# y Gradin g So d an d Vegetatio n Ye s N o 1 . Does th e gradin g aroun d th e perimete ro f th e hous e i n excavate d area s generall yslop e awa y fro m th e house ? 2 . Has so d bee n lai d i n al l area s tha t wei e excavated ? 3 . Does th e so d appea rt o b e generall yhealth yan d growing ? (Onl yevaluat e i f inspecte d at a 3 0 daytim e period ) 4 . Are sodde d area s generall yfir m an d evenl ygraded ? 5 . Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i f inspecte d a t a 3 0 da y tim e period ) 6 . Wa s th e propertygrade d suc h tha t wate rwil l no t poo l o n th e property ? 7 . Wa s damag e t o landscapin g o rplan t material s avoided ? , / •/ " / 

# y s 

# /



# . / ' ^

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 

# s y 

# s / Sidewalks an d Driveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa ysurface s avoided ? 2 . Wa s damag e t o walkwa ysurface s avoided ? / i /

### Owner s comments :

Inspectio nnotes :

* " 3 o ? of t «i? j I,,£re sc o 77> / 5 /y/? ^ /?- r / 9 Xrnfo *



### Removal an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EPARepresentativ e £) 0 

### / n•& ^ Date : / / 

# ^

### ^r ) 

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

### ® OLSI D fTflfcKA 6 

### ' ' 3frW-& * Propert y Owne r

• i . < - Property Addres s 

# '\, e

# stI 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 wor k performe da t

thi s propert y 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 

### Signatur e



### Propert y Owne r

Sectio n Thi s agreement

document s th e completio no f remedial/restoratio neffort s at th e property t o my satisfactio n fes H agre e that

restoratio ni s complete da t m y propert y D I D o No t

Agree : Comments :

^.-^ ^

^^^^^ ^ 

### •ass^^ ^ JJ^Jpefl y Owner' s Signatur e 

## JeylAxo . ^iW^at

^ , jEF ARepresentativgjtignatur c 

# Il/6t>f6 6 1 l 1 Dat e 

# /. / / O 

# &/6 (

/ 

### o 

## * •

## / 1 1 Dat efcy 

### Pag e I o f

U.S . Environmenta l Protectio nAgenc y Regio nVI I



### U \ACCES S d o Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s ipert v Owner ) 1-800-2:3-042 5 Granto r (th e propert y owner) , consent s t o an dauthorize s th e Unite dSates 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 ) 

## IP - 

# £ O b (Date ) NOTE : Grantin g permissio nDOES NO T necessaril y impl y you r proper!) ' wil l b e remediate dat thi s time .

Residenc e Address : 1) \f t * £ (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : tt(i&( o Work : ^96 '

- ^ 

### year s D N O D N O 

### Owner' s telephon e number—Home : Ag e o f Home ? I ( " I year s Ho w lon g hav e yo u live dhere ? Ha s th e exterio r

bee npainte do r

covere dwit hsidin g sinc e 197 8 E TYE S Ha s th e interio r

bee npainte do r

covere dsinc e 1978 ? O'YE S 

## •"" ? x9< ? UC ~ t-J Tota l numbe r

o f occupants : ^_ > Lis t Ages : O f

7 / ^ Q \/ 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 : Comments : AUTHORIT Y FO RENV1ORNMENTA LRESPONS EACTION S Th e activitie s t o b e implemente db y EP Aunde 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 n104(e ) o f

CERCLA , 4 2 U.S.C . 960 4 (t:) , whic hprovide s entry ' 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< : provision s o f thi s title. " 

### Acces s Attempts : First : Second : Third :

# Lis t o f existin g Condition s 

# pg - of



# - Propert y Address : // / \\Y\ t Owner' :

- x 

### Date : - OL S # 

### Description : 

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# jexw^-l- e

Owne r Sig n

# 156 2

Owne rName : v . 

### C H \ M Address : 71 1 FINES T Phone : H : pp^. Om 

### ah a Lea d Site Slt e 

### Sketc h Exterio rPaint Q ] Goo d Q Poo r Q Not paint Nort h Arro w



# A Sampl e Numbe r RYASCPXA-156 2 Y A RYBSCPXA-156 2 Y B RYCSCPXA-156 2 Y C RYDSCPXA-156 2 Y D RDZSCPXA-156 2 D Z RGZSCPXA-156 2 G Z RPZSCPXA-156 2 P Z Lead Concentratio n 302. 6 925. 6 

### 44 0 525. 2 pp m

pp m pp m pp m pp m pp m Sampl e Collecte d D 0 0 

# a a LA B 

# a a a a a Numbe ro fSample s = ! 4 Sample s Collecte d Firm : Sverdru p Date : Time : Sample s Analyze d XRFUnit : Date : 6/19/199 9 Time : 10:0 5 Staff : Book : Legend . YA= 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 = Pla y

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