### CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE 

# m

us Army Corps

of Engineers .EC:C:. 

# ,.,

ECC Certification for Property Closeout

OLSID 25747 

### Property Address 1512 N 40 th 

### St 

### Field Work Started 9/4/2007 

### Field Work Completed 9/6/2007 

### Summary: 

# • The excavation was perfonned in compliance with the work plans and specifications. 

## • F1 excavation depth was 5 inches below ground surfaces. 

# • F2 excavation depth was 3 inches below ground surfaces. 

# • B2 excavation depth was 5 inches below ground surfaces. 

# • Drip zone excavation depth was 12 inches below ground surfaces
.. 

# • Verification samples confinned that cleanup standards were met. 

## • The site was backfilled with material which meets the contract specifications. 

# • The backfill was compacted to acceptable standards. 

# • Sod placement and site restoration were conducted in compliance with the specifications and work plans.



### Comments: None

ECCOCM 

# o/J7!C:{ Title Date Jeff Hubbard USACE Con Rep 

### W-).'-,iJ1 Name Title Date Signature

# ---

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## f· 1 Lead Concentration**15~** ppm

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... .. .. .. • • " Owner Name**:e~h1tEt~f1I'iUf:;l~HiR** ..**-_-....._~** -**Addr't$s~** 1512 N 40 ST Phone: H:**~_~~?""** W; 

### C. 

## 01; Ids**OLS_--LF~P....:....A,",-** Quadrant FI 

## 5" F2 

### 3" BI**O·~** B2**~I#'** DZ 

### 12'" 

### EA-E**o~** 

### Omaha lead Site SIte S etch Exteliot PainL 

## 25747 00 GJPdO



## .**~oor** 

## n N01 paint XRF Code 2 7 

### g Date 

# 9t1fuz
LogBook "#01



## t i

## page 1 

## of_

## ~~?I-f? Omaha lead Site Omaha, NE Residential Yard Soils Environmental Restoration Services U.S. Environmental Protection Agency Region VII 

# '. PROPERTY ACCESS (to be completed by property owner)**~ilra** reC'Jlf**es~a fcr~a**  en es,:a:-'i01 ::;O( favor Harne aJ i °80'J·223·':425 U.S. Environmental Protection Agency (EPA) has contracted the U.S. Army Corps of Engineers (USACE), Omaha District to conduct environmental restoration services for the Omaha lead Site. USACE Omaha is working with Environmental Chemical Corporation (ECC) to remove lead contaminated soil and provide subsequent restoration services. Your cooperation is requested in giving EPA/USACE/ECC permission to access your property during the removal/restoration phase. For further information please contact Don Bahnke, EPA Project Manager at (913)**551~**

003 or the Office of External Programs. at 1-800-223-0425.

(Please Prinl Name)

d: t d tth' 

### r rt Wb Grant' 

# . , 

# . " NOTE DOES NOT 

### .

_________ 0**o~** ._.____ _ _ __ _._ __ _ , PROPERTY INFORMATION (to be completed by resident and'or property owner· Please P"nt) Resident Name: 

# /JIJj) £,£..s" /I.) Downer**~r** Residence Address: 

## /SIrJ. /I 

## tit' $7: OM/}1h1- 11).., (CITY) (STATE) (ZIP) Property Owned By: 

### "Tfllen k/tlflPP Owners mailing address: 

# ptJ. ,8dX 

## P,.j lit 

# 0J11Ilff.4 

# Nt tR?IPb Owner's telephone number - Home: 

## i'**S-~** 

### sf'?.s Work: Age of Home?

______ years How long have you lived here?

_____ years Has the exteior been painted or covered with siding since 1978?

### ~es 

# o No Has the interior been painted or covered since 1978?

### ~s 

# o No Total number of occupants:

__ 

## ..:.f
__ List Ages:**--------------------~** List ages of occupants under 6 years old who play in the yard for 5 or more hours per week:

_ Comments: AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS IThe activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA. 42 U.S.C. 9604. EPA's right of access to he property for in Section l04(e) of CERCLA, 42 U.S.C. 9604 (e), which provides entry for, "determining the need for response. or choosing or aking any response actIon under this title, or otherwise enforcing the provisions of lhis title." Access Attempts: First: Second: : Third: : _pg._of_ 

# List of Existing Conditions Property Address: 

## jS/tJ. If

## l./~ 71 S:rr 

## DVD ID #
_ Owner: TItRO 

## /(It/Ope Date: 

# 2-/s- tJ 

# 2 BVID# ()S- ') 

# 'f?

Ref: 

### Photo Description # 

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### Contract No. W912DQ-04-D-0017, 

### Task Order DKOI 

### Omaha Lead Site, Omaha, NE Property Closeout Agreement BVID 

### Property Address

# ll'~Z¢" tJ '10 ST (JS 

## ?Lf'l Property Owner Is the Owner the Resident? DYes 

## 2J....bW T 11 R 

# n. k: lItA-pf 

### Compliance Statement: U.S. Environmental Protection Agency (EPA) has contracted the U.S. Army Corps of Engineers (USACE), Omaha District to conduct environmental restoration services for the Omaha Lead Site. USACE Omaha is working with Environmental Chemical Corporation (ECC) to remove lead contaminated soil and provide subsequent restoration services. Your cooperation in giving EP A1USACEIECC permission to access your property during the removal/restoration phase is sincerely appreciated. This document certifies that all work performed at this property was completed in accordance with the contract specifications and EPA requirements. If you have questions or need additional information please contact Don Bahnke, EPA Project Manager, at (913) 551-7003 or the Office of Ex tema I Programs at 1-800-223-0425. Additional Comments by 

### USACE and/or ECC:

CONTRACTOR CERTIFICATION EeC Project Manager Name Title Date Signature 

## PROPERTY OWNER SECTION This agreement documents the completion of remediallrestoration efforts at the property to my satisfaction
.

.

# ~ragree that restoration is completed at my property, except as noted Comments (if 

### applicable): 

# ) l\ r 

# IX'"**J:i~/?-00**

Property Owner's Signature Datt'

# •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Property Owner Satisfaction Survey Form Omaha Lead Superfund Site**Perfonnanc~Based** Contracting (PBC) Pilot Project
Remediation Contractor:
.... 

### _**£~cc..::;....:!!:=::.-** Property Identifier Number:
_ Property BVID Number:

### _-,,~..c;...;...;;:.s~2_LJ~? 

# __**/,.~** Property Address: --'**~-:.........l,-** ..... 

### _ __ 

### NL..:....-_J-j.r..=o::....-_.s_r Property Owner's Name:

### _T:~~,""",R~G"""--,-K",-,1./-....,,.e**?~e** 

## ....... 

# _ (above infonnation to be filled out by remediation contractor prior to delivery of fonn to Property Owner)
Instructions to Property Owner: 

### This fonn is provided to you as a means of trying to capture your level of satisfaction with the work of the above-identified Remediation Contractor, as applicable to the soil cleanup action at your property. The U.S. Environmental Protection Agency (EPA) and the U.S. Army 

### Corps of Engineers (USACE) are 

### very interested in your opinion regarding the work performed by our contractors. This form is intended to provide 

### an easy means for you to express your opinion about the work performed on your property. Please indicate your level of satisfaction with the Contractor's work by selecting a nwnerical rating (ranging from 1 

### to 10) using the following rating scale, then please sign & 

### date the form and return it to USACE in the attached self-addressed & 

### stamped envelope. (Additional comments may also be provided in the space provided, at the option of the property owner.) 9-10 "excellent" 7 -8 "very 

### good" 5-6 

### "acceptable" 3-4 

### "poor" 1-2 "very poor" Property Owner's Satisfaction Rating regarding Contractor's Work 

### 10 5 

# JL::J 9 4 8 3 7 2 6 1 Additional Comments from Property Owner (optional; continue on back of page if needed)

# (YU{~~~~~ 

# cUe;{ fYQJZ

# ~61VrL~. C\
Property Owner's Sigoature:

# f~**~:** /s4:=.1k ')

### CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE 

# m

us Army Corps

of Engineers .EI:C. 

# ...

Analytical Results Summary OLS # 25747 1512 N 40 th 

### St

XRF Results Quadrant Sample Depth Date Collected (ppm) (avg.) Type 

### DE F1 5 9/4/2007 

### 159 

# I \:') 9/4/2007 

### DE 3 

### 100 

### DE R') 9/4/2007 5 

### 110 

# I 9/4/2007 

### DE DZ I 

### 12 100 

# I DE 0 

# I 9/4/2007 86 

### EA-E 

# I 

# I I

SAMPLE 10- SAMPLE ID is a particular residential property ID from which the sample is collected. The sample type identifier (with sequential sample number for that location) as follows: PX Pre-Excavation XRF sample DE During and Post Excavation Quadrant descnbes the sampling location (with sequential sample number for that location) as follows; FI or F2· Front Yard One or Front Yard Two BI or B2 Back Yard One or Back Yard Two DZ = Drip Zone GA=Garden PA Play Area EA Easement Depth describes the depth from which the sample was collected. ppm· parts per million