CONTRAC T # EP-R7-06-0 4 

### AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E EPA 

### AS W Associate s In c Certificatio n fo rPropert yCloseou t BVI D Fiel d Wor k

Starte d 40 6

31-Jul-O S PropertyAddres s

Fiel d Wor k

Complete d 210 2 Sout h 8 t h Stree t 21-Aug-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 (YA ) quadran t wa s excavate d t o a dept h o f 6 inch . Th e F 2 (YB ) quadran t wa s excavate d t o a dept h o f 6 inch . Th e B 1 (YC ) quadran t wa s excavate d t o a dept h o f 6 inch . Th e B 2 (YD ) quadran t wa s excavate d t o a dept h o f 6 inch . Th e dri p zon e 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 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 . Analytica l dat a provide d i s pos t excavatio n a t th e botto m o f th e excavatio n fo rconfirmatio n purpose s



### Comments : Th e pla yzon e wa s excavate d t o a dept h o f 6 inch .



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

4025943 5 

### f Da'te Signatur e rSite:CWii£ . 

### I D 

### Break: . Other: . 

# cn^J i SUPERFUN D RECORD SCONTRACT # EP-R7-06-04 AS W Associate s Inc . Omah a Lea d Site Remediation , Omaha , N E 

### EP A 

## Analytica l Resul t Summar y OL S ID : 40 6 

## Propert y Address : 2102 Sout

h 8 t h

## Stree t Sampl e I D 406-DE-YA-0 6 406-DE-YB-0 6 406-DE-YC-0 6 406-DE-YD-0 6 406-DE-DZ-0 6 406-DE-PZ-0 6 XR FResult s 

### Avg . (ppm ) 13 5 ±45. 6 10 3 ±46. 6 

### 19 6 ±4 8 

### 96. 9 ± 

### 39. 6 15 3 ±4 7 173. 6 ±48. 3 La

b Result s 

### (ppm ) N A N A N A N A 14 2 N A

Ja n Prawdzi k Nam e AS W Projec t Manage r Titl e Sampl e Destinatio n OLSID-DE-Locatioa-d d OLSI D i s a particula rresidentia l propert yI D fro m whic h th e sampl e i s collecte d

- DE - During an d Por t Excavatio n Location of th e sample as follows ; Ft - Fron t Yard(1 * Quadrant) B I - Bac k Yard(1 " Quadrant) F2 - PromYardO " Quadrant) B 2 - Front Yard(2 1 * Quadrant) DZ-Dri p Zone PZ"RayZon e O A "Garde n EA - Easemen

t dddescribe s the dept

hfro mwhic hthe sample wa s collected .

- N A = Not Applicabl e

# <vEP

A Remediation/Excavatio n Contrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : Date/Time : Quad s Excavated : Propert yAddress : 

## 2/0 2 5 8 Owner' s Name : 3"tfT g t 8>otrZ 9 Contracto r

Grou p Excavatio n Genera l Ye s N o 1 . I f necessary , were th e correct quadrant(s ) excavate dan drestored ? 2 . I f necessary , were th e correc t area s o f dri p zone excavate dan drestored ? 

### c^ - L* - * ^ ^ - Gradin g So dan dVegetatio n Ye s N o ] . Does th e gradin g aroun dth e perimeter o f th e hous e i n excavate darea s generall y slop e away fro mth e house ? 2 . Ha s so dbeen lai di n al l area s tha t were 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 dat

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 ? 

### l ^ I /

^

^ l ^ s ~ S 

### /

^ s Gates , Fence s an dRetainin 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 to 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 ) 

### L- - L / 

## u / 

# u < / L /

S " 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 ? S . Wa s damag e t o downspout s o r downspou t

extension s avoided ? 

### (S 

# t / L/ 1 

## u / 

# S \ s / / ' • 

## 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 ? 

### \ / L / 

### I

### Owner s comments : V -„ « a.- • I > r



### T 

### .••*. *



### Inspectio n notes :

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

# u eP EP A Representativ J

j JCfr \

### Contrac t No : E P - R 7 - 0 6 - 0 4 Propert y Closeou t Agreemen t Omah a Lea d Superfun d Sit e OLSI D Property Addres s Propert y Owner I s th e Resident th e Owner

H^Ye s D N o Complianc e Statement: ^ U.S . Environmenta

l Protectio n Agenc y (EPA ) or it s authorize drepresentatives , (or it s contractors) , to enter an dconduc t

environmenta

l restoration service s for

th e Omah aLea

dSite . You r cooperation i n giving 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 document certifie s that

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

nee dadditiona

l informatio n pleas e contac t th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 or

(402) 991-958 3 or

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 Jan Pnwdzi k AS WProjec t Manage r Nam e Titl e Dat e Signatur e



### Property Owne r

Sectio n Thi s agreemen

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

y to m y satisfactio n 

### u/Ia i I agree ma

t restoration i s completeda t m y propert y O I D o No t

Agree : Comments :

roperty Owner' s Slgnati£ p Date EP A Representativ e Signatur e Dat e

### Pag e 1 of

_ U.S . Environmenta l Protectio n Agenc y Regio n VI I Omah aLea dSite Omaha , N E Residentia l Yar dSoil s Environmental Restoratio n Service s Granto r (th e propert

y 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 dperformcertai n environmenta l respons e activitie s upo n th e followin g describedpremises . Fo r furthe r informatio n pleas e contac t EPA a t 1-800-223-0425 . Propert y Acces s Grante dB y iCZ.C C 

### (Please Print

Name ) 

# / B (Proplfiy Owne

r Signature) ' ^ 1 ] , JTJate ) J NOTE : Grantin g permissio n DOE S NO T necessaril

y imply you r

propert y wil l b e remediate da

t thi s time .

Residenc e Address : Propert y owne dby : (CITY ) (STATE ) (ZIP ) Owner s mailin g address : Owner' s telephon e number—Home : ^O2'&>5" / - < ( o ( a8 Work : W *-" • 

### / 

### ? 7 / year s 

### D N O D N O Ag e o f Home ? I cA o year s Ho w lon g hav e yo u live dhere ? Ha s th e exterio r

bee n painte do r

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

bee n painte do r

covere dsinc e 1978 ? M YE S Total numbe r

o f occupants : . 3 Lis t Ages : L£ f

A-ViQ£/C 3 ' 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 : Comments : AUTHORIT Y FO RENVIORNMENTA LRESPONS E ACTION S Th e activitie s to b e implemente db y EPA under thi s agreement

ar e pursuan t to Sectio n 104 o f CERCLA , 4 2 DSC . 9604 . EPA' s right o f acces s to th e property fo r

i n Section I04(e ) o f

CERCLA , 4 2 U.S.C . 960

4 (e) , whic hprovide s entr y for , "determinin g th e needfo 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 title. " 

### Acces s Attempts : First : 07//8/O G Second : Third :

# Lis t o f existin g Condition s Pg - of . 

## Property Address : ^l | O2 ~ . 8~ ~ 

### Owner : Description : 

## : O7[fB /



## / j . &Q U ~2 . f

l Date : O7fB/°t * OLSID #

ie r Signature : Prin t A Sig n AS WAssociate s In c PriAjf & Sig n

# 40 6

Owne rName : Address : 210 2 S 8 S T Phone : H : _ 

### Omah a Lea d Site Site Sketc h W : Exterio rPain t 0 Goo d D Poo r Q Not pain

t Nort h Arro w 

# t Sampl e Numbe r RYASCPXA-40 6 Y A RYBSCPXA-40 6 Y B RYCSCPXA^O S Y C RYDSCPXA-40 6 Y D RDZSCPXA-40 6 D Z RGZSCPXA-40 6 G Z RPZSCPXA-40 6 P Z Lead Concentratio n 

### 431. 6 pp m 404 pp m 1149. 6 pp m 

### 42 0 pp m 940. 8 pp m



### pp m 

### (o'Li o pp m Sampl e

Collecte d



### 0 D D LA B 

# a a a a 0 a a Numbe ro f Sample s - 5 

### 1 Sample s Collecte d Firm : Sverdru o Date : Time : Sample s Analyze d XRFUnit : Date : 4/10/199 9 Time : 10:3

2 Staff : Book : Legend : Y

A = Yar d (NE) , Y B = Yard (SE) , Y C = Yard (SW) , Y D = Yard (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y

Re v 4 0461410)2 3