### CONTRAC T# EP-R7-06-0 4 AS W Associate s Inc . Omah a Lea d Sit e Remediation , Omaha , N E 

## AS W Associate s In cCertificatio n fo rPropertyCloseou t BVI D Fiel d Wor k

Starte d 2058 0

9-Aug-0 6 Propert yAddres s Fiel d Wor k

Complete d 350 2 Poppleto n Avenu e 13-Sep-0 6 

## Summary : Th e excavatio n wa s performe d i n complianc e wit h th e work plan s an d specifications . Th e F 1 quadran t wa s excavate d t o a dept h o f 8 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 that 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 placements an d sit e restoration s were 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 4026151 0 

## Comments : None . SUPERFUN D RECORD S



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

## /Signatur e

### CONTRAC 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 : 2058 0 Propert y Address : 350 2 Poppletor i Stree t Sampl e I D 20580-DE-DZ-0 6 20580-DE-F1-0 8 (Coul dno t

excavat e furthe r

du e t o tre e roots ) 

### XR FResult s 

### Avg . (ppm ) 151.3±4 7 

### 42 2 ±

### 64. 5 La b

Result s 

### (ppm ) N A M A

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

## Dal e 

## Signatur e

Sampl e Designatio n OLSID-DE-Location-d d 

### OLSI D i s aparticular

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 th e sampl e a s follows ; F l = Fron t Yar d(l a

### Quadrant ) B l = Bac k Yar d(1 ° Quadrant ) F 2 = Fron t Yar d(2 n d

### Quadrant ) B 2 = Fron t Yar d(2 n d

### 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 depthfro mwhic hth e sampl e wa s collected . N A= No t Applicabl e

# SEP

A Remediation/Excavatio nContrac t (ASW ) EP A Propert y Clos e Ou t For m Propert y # : Date/Time : _ Quad s Excavated : Propert y Address : Owner' s Name : Contracto r

Grou p 

# -I T

Excavatio nGenera l 

### Ye s 

### N o 1 . 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 ? 

### • / y Gradin g So d an d Vegetatio n Ye s N o 1 . Doe s 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 . Ha s so d bee n lai d i n al l area s tha t wer e excavated ? 3 . Doe s th e so d appea rt o b e generall yhealth yan d growing ? (Onl yevaluat e i f inspecte d a t a 3 0 daytim e period ) 4 . Ar e 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 ylight ? (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 properly ? 7 . Wa s damag e t o landscapin g o rplan t material s avoided ? / / 

# y y y 

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

# y y y y 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 ? y 

# y y y 

# y 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 ? * / V /

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e tf^jfa** , _Date :VB ) 

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

# ® OLSI D Propert y Owne r 

# fi-0^ K*IH ? Propert y Addres s 

## >JT^ 2 fc,,} ^ I s th e Residen t

th e Owne r

Q^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) , to 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 propert y 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 da t

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 ILP 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 Programs 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



## Propert y Owne r

Sectio n Signatur e Thi s agreemen t

document s th e completio no f remedial/restoratio neffort s a t th e propert y t o m y satisfactio n 0" i agre e that

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

Agree : Comments :



### t 

# ^ ^ ^ /: 

# ^Sy^

_ Propert y Owner' s Signatur e 

# rT^/ T ^ P / / EP ARepresentativ e Signatur e 

# <3 - I6>-O( ~ Dat e Dat ePag e 1 o f 

## •/ / U.S . Environmenta l Protectio nAgenc y Regio nVI I Omah aLea dSit e Omaha . N E Residentia l Yar dSoil s Environmenta l Restoratio n Service s PROPERT YACCES S (t o li e complete d b yPropert yOwner ) ir a recibi rest a form a csoario l no rfavo rilam ca l N800-223-042 : 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 conjac t EjP Aa t 1-800-223-0425 . Property Acces s Grunte dB y (Pleax e Prin t frame ) (Propertf okruf r Signature ) NOTE : Grantin g permissio nDOE S .\'O T necessaril y impl y vou r propert y wilFbt i remediate da t thi s tim e

Residen t Name : PROPERT Y INFORMATIO N :> y residen t

and'o r propert y owntT-J

—P Owne r Residenc e Address : ?66 2 PkppW.4r/ \Av/G , r 

### > D Rente r



# ME , (CITY ) (STATE ) (ZIP ) Propert y owne dby : X ^ Owner s mailin g address : Owner' s telephon e numbe r —Home : T02. - b8t>"5T&?OL - \Work : _ _ 

## (<& 0 Ag e o f Home ? _ _/O Q _year s Ho w lon g hav e yo u live dhere ? year s Ha s th e exterio r

bee npainte do r

covere dwit hsidin g sinc e 197 8 D^YE S D N O Ha s th e interio r

bee npainte do r

covere dsinc e 1978 ? 0 YE S D N O Tota l numbe r

ofoccupants : ' y Lis t Ages : 5~ \1 L 3 ) Lis t age s ofoccupant 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 RENV10RNMENTA 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 . %04 . EPA' s righ t o f acces s t o th e propert y fo r

i nSectio n104(e l o f

CliRCLA . 4 2 U.S.C . %0 4 (e) , whic hprovide s enlr\ ' 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 titl e" Acces s Attempts : First : Second : Third :

# Lis t o f existin g Condition s pg . _

# o f Propert y Address : 35^)2 . Owner : :Q7//f/0 

## f C o (4 e s Date:Q7//0 £_OLSI D # Description : 

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### Omah a Lead Site Sit e Sketc h



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