### 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 rPropert yCloseou t

BVI D 

### Fiel d Wor k

Starte d 1572 4

15-Aug-0 6 Propert yAddres s



### Fiel d Wor k

Complete d 385 7 Gol d Stree t 7-Sep-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 o f1 2 inch . Th e B 2 quadran t 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 . Th e sit e wa s backfille d wit h material s whic h meet s contrac t 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 purpose s 4026149 9 

### Comments : None . SUPERFUN D RECORDS 

# 1 -

Ja n Prawdzi k Nam e ASWProjec t Manage r Titl e 

### g natur 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 : 1572

4 Propert y Address : 385 7 Gol dStree t Sampl e I D 15724-DE-B1-1 2 15724-DE-B2-1 2 XR FResult s Avg . (ppm ) 24 0 ±58. 3 104. 7 ±50. 6 La b

Result s (ppm ) N A N A



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

### Dat e Tgnatufe ' Sampl e Designatio n OLSID-DE-Location-d d OLS1 D i s aparticula r

residentia l propert y I D fro mwhic hth e sampl e i s collected . D E= Durin g an dPos t

Excavatio n Locatio no f

the 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(2TM 1 Quadrant ) B 2 = Fron t

Yar d(2TM 1 Quadrant ) D Z= Dri p Zone 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

# &EPA

Propert y# : Date/Time : Quad s Excavated : 

# Remediation/Excavatio nContrac t (ASW ) EP APropert y Clos e Ou t For m [ Propert y Address : 3g5* ? 4tf/ / Owner' s Name : C7</V i / F* r Contracto r

Grou p Excavatio n Genera l Ye s N o \ . I f necessary , were th e correct quadrant(s) excavate d an d restored ? 2 . I fnecessary , wer e th e correc t area s o f dri p zon e excavate d an d restored ? S S Gradin g So d an d Vegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 2 . 2 . 4 . 5 . 6 . 7 . Ha s so dbee nlai di nal l area s tha t wer e excavated ? Doe s th e so dappea r

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 ) Ar e sodde darea s generall y fir man devenl y graded ? Are th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat

a3 0 day tim e period ) Wa s th e propert y grade dsuc htha t wate r wil lno t poo l o nth e properly ? Wa s damag e t o landscapin g o r plan t material s avoided ? / / / / / / / 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 . Was damag e to 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 windows o rdoo rscreen s avoided ? 5 . Wa s damag e t o downspout s o rdownspou t extension s avoided ? / / / / / Sidewalk s an dDriveway 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 ? / S

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentativ e ^ . XZ y _Date : 9/Jtf/af

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

### ® OL S 

### I D J-gVJ^i-ft/* - Propert y Owne r

SclvRoeOe ^ Propert y Addres s 

## 3#5 7 Gc>/<£s t I s th e Residen t

th e Owne r

J S 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 dat

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 at

1-800-223-0425 . Additiona l Comment s b y EP Aand/o r ASVV :

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: ; a t th e propert y t o m y satisfactio n 03 - 1 agre e that

restoratio ni s complete dat my property D I D o No t

Agree : Comments :



### S~ \ 

# (1 J 

# ! V^x^^l^^^tiJ^^ v v ^/Propert y Owner' s Signatur e



### I/ I v^£M M ^ L aAAc^vjacoVx ^ \ J EP A Representativ e Signatur e 

# olf n /<> &

' V Dat e 

# o?/nl&( * ii Dat ePag e 1 o f Omah aLea dSit e Omaha , N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s U.S . Environmenta l Protectio nAgenc y Regio nVI I

PROPERT YACCES S (t o b e coinplele db y Propert y O ir arecibi r esi; i form aespano l po r

favo r ikun ea l1-SOO 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 ^-^£LT\PsyrVf A < : / / l\/ ? (Pleas e Prin t Name ) 'ropertlpwner'sTgnaiure ) OTE : Grantin g permissio nDOES NO T necessaril y imply you r property wil l b e remediate dat thi s time . Residen t Name : PROPERT YINFORMATIO N eie db y residen t

and/o r properl y o\\ne r I B Owne r D Rente r 

### Residenc eAddress : 3 & 5 1 Go(<Q . (CITY ) (STATE ) (ZIP ) Propert y owne dby : Owner s mailin g address : Owner' s telephon e number—Home : Tr"2.~ x



# 1 3 ~ ? 7 C ? Work : Ag e o f Home ? QOP1 I year s Ho w lon g hav e yo u live dhere ? _ E^YE S E'TE S year s Ha s th e exterio r

bee npainte do r

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

bee npainte do r

covere dsinc e 1978 ? Tota l numbe r

o f occupants : ^- ^ Lis t Ages : t o y/ C o\o L 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 : 

### D 

### N O D 

### N O

AUTHORIT Y FO RENVIORNMENTA 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 (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 Propert y Address : 3&£~ I (jL O Owner : Date : Oi l 2 . «// O ( p OLSI D #: /572V " Description :



# 5- 1 

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Xvvne r j>igna|ur e 'rint/fe Sig n 

### AS WAssociate s Inc . 2H*** * jaO^Co c 

### Prili t & Sign J

## 1572 4

Owne rName : JENNIFE R scHROEDE R Omah a Lea d Sit e Address : 385 7 GOL D S T Phone : H : 402-20&-970 6 

### Site Sketc h W : 402-351-792 2 Exterio rPain t fj Poo r f j No t pain t Nort h Arro w 

# J Sampl e Numbe r RYASCPXA-1572 4 F 1 RYBSCPXA-1572 4 F 2 RYCSCPXA-1572 4 B 1 RYDSCPXA-1572 4 B 2 RDZSCPXA-1572 4 D Z RPZSCPXA - 1572 4 P Z Lea d Sampl e Concentratio n Collecte d 

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### ; Numbe ro f Sample s - .*j i LA B D 

### D 

# n D D D D

- Sample s Collecte d Firm : fyjf-TZ/stflt J Date : g-So-G f Time : l/?<&

^ Sample s Analyze d XRFUnit : 103 7 Book : /j q Date : " 7 - H-OS " Time . P /v

\ Staff : L A Legend : F 1 = Fron t Lett , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k

Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrants ar e a s viewe d fro m th e street , facin g propert y

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