### 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 

### 30064 Property Address 

### 1614 Locust St Field Work Started 

### 8/1/2007 Field Work Completed 

### 8/17/2007 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. 

# • B1 excavation depth was 

### 4 inches below ground surfaces. 

# • B2 excavation depth was 

### 4 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. 

# • Site restoration was conducted in compliance with the specifications and work plans.

Comments: None

## ~<{+**b~,J~** ECCOCM 

## 10 

# &./() 1­ 

# , Name Title Date Jeff Hubbard USACE Con Rep 

# ]OIl/1m Name Title Date Signature( 

# 30064 ·

.. L,i**"'t<:.~** .....**,,~** F- Owner Name: Et'h9f;h'E**(:\i~SONS-li"** 

### . 

## . .. -.- Address: 614 LOCUST ST

Phone: H; 0 

### Z**~~** W:**({3~,** 

# t
Team 

### FBr()(.U,v OLS 

# FD**1HS6£i~1E5** XRF Code Quadrant Lead Concentration Date Fl 

## 5 ,'t0uJ 2.72 ppm 

# B-2 - 20=>+- F2 

## 3 irJCH 

## 1'10 ppm Bl 

## 'I iblClJ 2.15: ppm B2' 

### y ppm LogBook 

### "JCJ./ J 3 

### Z. DZ ppm

### ~LEASEMef\J+ 

### 185 ppm ppm ppm ppm



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## page 1 

## of_ 

# StJtJW Omaha lead Site Omaha, NE Residential Yard Soils U.S. Environmental Protection Agency Region VII Environmental Restoration Services 

# .• PROPERTY ACCESS (to be completed by property owner) Pai3**re~.~:)lf** e$:2l**~C(:Ila** en**es~a;lvj** :::or !avcr li'::W1t? 31 i-SOO 223**C4~5** U.S. Environmental Protection Agency (EPA) has contracted the U.S. Anny Corps of Engineers (USACE), Omaha District to conduct environmental restoration services for the Omaha lead Site. USACE Omaha is working with Environmental Chemical Corporation (ECG) to remove lead contaminated soil and provide subsequent restoration services. Your cooperation is requested in giving EPAIUSACEJECC permission to access your property during the removal/restoration phase. For further information please contact Don Bahnke, EPA Project Manager at (913) 551­ 7003 or the Office of External Programs. at 1-600-223-0425. Properly Access Granted By (Please Print Name)
(Date) 1 . NOTE G f DOES NOT rt 1/ b eel' t d tlh' t'

____________**~_~ ~_**  - - ._. .__ - - I PROPERTY INFORMATION (to be completed by resIdent and'or property owner· Please Print) Resident Name: 

### NEW J..IP€ CHURCH of GOb

### ~ner 

# o renter Residence Address: 

## /6/1{ Lac...!) sr Si OMIJ/I/i 

## Ne.. (CITY) (STATE) (ZIP) Property Owned**By:_--=5~8t-/-L./YJ~€** _ Owners mailing address:

_ Owner's telephone number - Home: 

## liM

­ 3..1(6­ 

### = - 

## 1(3.5-.2 Work: 

### ------------il IAge of Home? 

### VIfC.lt..NT 

## I- Or years '..----.How long have you lived here?

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

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

# o No Total number of**occupants:_~** _ list Ages: 

## ---------------------41 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 The 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 104(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, Of otherwise enforcing the prOVISions of Ihis ti1le." Access Attempts: First: Second:: Third: : _pg._of_ 

# List of Existing Conditions Property Address: DVD 

## ID # 

# :::IJ::Xp 

# Y
Owner: 

# 1leJA2J...i£e,Cburt:b Qf Date:

# '11~ 0'] BVID#

# 2ccxo~ 

# &JO Ref: 

### Photo # 

### Description

Owner Signature ECC 

### Print & 

### Sign Print & Sign

# --- Contract No. W912DQ·04·D-0017, Tasle Order DKOI Omaha Lead Site, Omaha, NE PronertY Closeout Agreement 

### DVID Property Address 

# I**_/~** II{ 

### IJJC'l/ST 

### lfi 

# - SO(} (; 'I**~1)** Property Owner Is the Owner the Resident? DYes

### AJ~w 

### I..JFF 

### C#IJR.C II Compliance Statement: U.S. Environmental Protection Agency (EPA) has contracted the U.S. Army Corps ofEngineers (US ACE), Omaha District to conduct environmental restoration selVices for the Omaha Lead Site, USACE Omaha is working with Environmental Chemical Corporation (BCC) to remove lead contaminated soil and provide subsequent restoration services. Your cooperation in giving EP AlUSACEIECC 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 External Programs at 1-800-223-0425. Additional Comments by USACE and/or ECC:

CONTRACTOR CERTIFICATION Prashant Khanna or ECC Project Manager Charles "Skip"Milton Name Signature Date Title



### PROPERTY OWNER SECTION This agreement documents the completion of remedial/restoration efforts at the property to my satisfaction. Iil-/"ragree that restoration is completed at my property, except as noted Comments (if applicable):



# X/'tD 0

# (i)/I~;;A , 

# 102 -/t1 

# tff7- Property (Jwner's""Signature 

### Date

# •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Property Owner Satisfaction Survey Form Omaha Lead Superfund Site**Perfonnan~Oased** 

### Contracting (POC) Pilot Project**_--Io"'-=~** _ 

### Remediation Contractor: 

# £cc Property Identifier Number:
_ Property OVID Number:**--.;: s~a-'::.O...LI** **&~·..Lr** 

## _ Property Address:**_~Jt;:;.l"/~'i&....-~L=tJ~C-=tJ5=...£.r_=S:....I&....-** 

## _ Property Owner's Name:**...I.M.LJ£~lsJ,---=L:aJlI.l-P...loE~C.o::::.l·** If[,£.."

### :...11

### R~C;:.Ljltl.--l()..:.IFi..........:G""';""'....IIt;:2 .... 2b,--
_ (above infonnation to be filled out by remediation contractor prior to delivery of ronn to Property Owner) 

### Instnlctions to Property Owner: 

### This fonn is provided to you as a means oftrying to capture your level of satisfaction with the work ofthe 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 perfonned by our contractors. This fonn is intended to provide an easy means for you to express your opinion about the work perfonned on your property. Please indicate your level of satisfaction with the Contractor's work by 

### selecting a numerical rating (ranging from 1 to 

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

### date the fonn 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 "vel)' good" 5-6 "acceptable" 3-4 "poor" 

### 1-2 "vel)' poor" Property Owner's Satisfaction Rating regarding Contractor's Work 10 5 9 4 8 3 7 2 6 1 

### Additional Comments from Property Owner (optional; continue on back of page ifneeded)

Property Owner's Signature: 

# >(L.ei<..R([)IJ A.2:A Date: 

## J4

-**/~** 

## - (/J 

# 1

### CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE US Army Corps of Engineers 

### Analytical Results Summary Sample ID # 

### 30064 1614 Locust St

Sample Quadrant Depth

Type 

# I DE F1 6 

## I DE F2 4 

# I DE 81 5 

# I DE 82 5 

# I PX EA 0 

# I Date Collected 8/2/2007 8/2/2007 

## I 8/2/2007 

## I 8/2/2007 

## I 8/2/2007 

## I 

# I XRF Results (ppm) (avg.)
L.IL. 

### 190 215 133 185

Sample 10- Sample ID is a panicular 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 PE • Pre-Excavation laboratory sample DE During and Post Excavation Quadrant describes the sampling location (with sequential sample number for that location) as follows; F 1 or F2 • Front Yard One or Front Yard Two B I or 92 Back Yard One or Back Yard Two DZ DripZone GA = Garden PA = Play Area EA

- Easement Depth describes the depth from which the sample was collected. ppm = parts per million