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 rPropert y Closeou t BVI D 

### Fiel d Wor k

Starte d 1799 2

19-Jun-0 6 Propert y Addres s Fiel d Wor k

Complete d 2 12 6 Sout h 34t h Stree t 27-JUI-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 F 2 quadran t wa s excavate d t o a dept h o f 6 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 meets contrac t specifications . Th e backfil l wa s compacte d t o acceptabl e standards . So d placements an d sit e restoration s wer e conducte d i n compliance wit h wor k plan s an d specifications . Analytica l dat a provide d i s pos t excavatio n at th e botto m o f th e excavatio n fo rconfirmatio n purpose s
Comments : None .

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

### Dat e Signatur e

4026201 4 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 EP A 

### Analytica l Resul t Summar y OL S ID : 1799

2 Property Address : 212 6 Sout h 34 t h

### Stree t Sampl e I D 17992-DE-F2-0 6 XR FResult s 

### Avg . (ppm ) 118. 6 ±53. 3 Lab Result s



### (ppm) N A

JanPrawdzi k Nam e AS W Project Manage r Titl e 

# 'Dat

e Signatur

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

residentia l property I D fro mwhic hth e sampl e i s collected . D E= Durin g an dPost

Excavatio n Locatio no f the sampl e a s follows ; F l = Fron t Yard(1 " Quadrant ) B l - Back Yar d(1 " Quadrant ) F 2 - Front Yard(2n

dQuadrant ) B 2 = Fron t Yard(2 n dQuadrant ) D Z= • Dri p Zon e PZ» Play Zon e OA = Garden E A = Easemen t d ddescribe s th e dept

hfro mwhic hth e sampl e wa s collected . NA=No t Applicabl e

# &EPA

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

# Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m

" j »* y 

### / 

# $/nJjM^-Il Propert y Address : Owner' s Name : Contracto r

Grou p 

### 6 5 3 V

Excavatio n Genera l Ye s N o ] . I f necessary , wer e 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 ? 

### L- ~ C

— . - — 

### * ^ 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 dbee n lai di n al l area s tha t 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 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 da t

a3 0 da y tim e period ) 6 . Wa s th e propert y grade dsuc h tha t wate r wil l no t poo l o n th e property ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

### U ^ 

### L ^ 

## L L i

— 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 ) C- * I • U " L ^ ^ ^ s s 

### x ' 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 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 ? 

### L- - i^ - L" - L- - I / ,*•

"" " »* •

^ ~ S 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 ? 

### \ S \^ - 

# s * s

### Owner s comments :

'*- :



### Inspectio n notes :

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

iv e L J/n , IVjJL L Date : g/l//0 6 EP A Representat

# § Contrac t No : E P - R 7 - 0 6 - 0 4 Property Closeou t Agreemen t Omah a Lea d Superfun d Sit e VJ y OLSI D Propert y Owne r 

## 2^<tt6 \<SW W Propert y Addres s 

## 2/2 6 £ i ^ I s th e Residen t

th e Owne r

p^Ye s D N o Complianc e Statement : 

### U.S . Environmental Protectio n Agenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , to enter an dconduc t environmenta

l restoratio n service s for

the 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 sincerel y appreciated . Thi s documen t certifie s that

al l work performe dat

thi s property wa s complete di n accordanc e wit

hth e contac t

specification s an dEPA 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 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 Nam e AS WProjec t Manage r Titl e Dat e Signatur e 

### Propert y Owne r

Sectio n Thi s agreement

document s th e completion o f

remedial/restoratio n effort s a

t th e propert y to m y satisfactio n 9 ^ I agre e that

restoratio n i s complete da

t m y property D I D o No t

Agree : Comments :

D M AtlAaa d THA T t s 

### o f AStn j 

## a*** * ST . 

# 7

_ ropert yOwner' s Signatur e Dat e EP A Representativ e Signatur e Dat eP«g e 1 of

_
U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSit e Omaha , M 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 ) or it s authorize drepresentative s (or it s contractors) , th e Grantee , to enter an dperformcertai n environmental respons e activitie s upo n th e followin g describe dpremises . Fo r furthe r informatio n pleas e cjiqjac t EP A at 1-800-223-0425 . Propert y Acces s Grante dB y (Properl y Owner Signature ) NOTE : Grantin g permission DOES NO T necessaril y imply you r

propert y wil l b e remediate da

t thi s time . Residen t Name : Residenc e Address : 2/2. ^ G 

### Propert y owne dby : (CITY ) (STATE ) (ZIP ) Owner s mailin g address : 

### 5> . Owner' s telephon e number—Home : Ag e o f Home ? Work : year s Ho w lon g hav e yo u live dhere ? _ 

### Ha s th e exterio r

bee n painte do r

covere dwithsidin g sinc e 197 8 Jfe^YE S year s Ha s th e interio r

bee n painte do r

covere dsinc e 1978 ? Tota l numbe r o f occupants : *2 - _Lis t Ages : 

### YE S P N O D N O 

### 3 O 3 3 Lis t age s o f occupant s under

6 year s ol dwh o play i n th e yar dfo r S o r mor e hour s per

week : Comments : AUTHORIT Y FO RENVIORNMENTA L RESPONS E ACTION S The activitie s t

o b e implemente dby EP

A under thi s agreemen

t ar e pursuant t o Sectio n 104 o f CERCLA , 4 2 U.S.C , 9604 . EPA' s righ t o f acces s t o the propert y fo r i n Sectio n 104(e) o f

CERCLA , 4 2 U.S.C . 960

4 (e) , whic hprovide s entry for , "determinin g th e needfo r response , o r choosin g o r takin g an y respons e actio n under

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 p g 

# .J_of_ L Property Address : 

### : \JO S Owner : \JOSO A 

## Date : OLS# : Description : 

# CONDITIONS ' V/Diym£ 6 o p



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# * i Owner Signature : 

# R/U . Prin t & Sig n AS W Associate s Inc .

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