## CONTRAC T# W912DQ-04-D-0017 , T.O . DK0 2 Environmenta l Chemica l Corporatio n Omah a Lea d Remediation , Omaha , N E U S Arm yCorp s o f Engineers 

## EC C Certificatio nfo r Propert y Closeou t BVI D 3642 4 

## Propert y Addres s 245 6 Camde nAv e Fiel dWor k Starte d 06/15/0 6 Fiel dWor k Complete d 06/30/200 6 Summary : •Th e excavatio nwa s performe di ncomplianc e wit hth e wor k plan s an dspecifications . •F l excavatio ndept hvarie dfro m6- 8 inche s belo w groun dsurface . •F 2 excavatio ndept hvarie dfro m6- 8 inche s belo w groun dsurface . •Dri p Zon e excavatio ndepthvarie dfro m1 0 t o 1 3 inche s belo w groun dsurface . •Verificatio nsample s confirme dtha t cleanu p standard s wer e met . •Th e sit e wa s backfille dwit hmateria l whic hmeet s th e contrac t specifications . •Th e backfil l wa s compacte dt o acceptabl e standards . •So dplacemen t an dsit e restoratio nwer e conducte di ncomplianc e wit hth e specification s an d wor k plans .

Comments : Lef t plant s pe r owner' s reques t >40 0 pp m(498 ) B 1 an dlef t tree s pe r owner' s reques t i nF ] >40 0 pp m(498) .

Ski p Milto n EC C Projec t Manage r Nam e Titl e Dat e Signatur e JeffHubbar d USAG ECo nRe p Nam e Titl e Dat e

4028629 1 

# lllllUi Superfun d

# 3642 4 Owne rName : JIMMI E L BYR D Address : 245 6 CAMDE N AV

Phone : H : 402-453-923 3 Sampl e Numbe r RYASCPXA-3642 4 F 1 RYBSCPXA-3642 4 F 2 RYCSCPXA-3642 4 B 1 RYDSCPXA-3642 4 B 2 RDZSCPXA-3642 4 D Z Jjr^JO/^pV A IGA^ A f^~ f l r*UMil'l < A/Y£O4ii 4 • V»^. - RPZSCPXA-3642 4 P Z Omah a Lea d 

### Sit e 

### h Sit e Sket c W : Lea d Sampl e LA B Concentratio n Collecte d ££> / ppm , [* { D /^"f /

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## D pp m [ | 

## D Numbe ro f Sample s = 5 " 

## O Exterio rPain t >^t h Arro w f j Goo d Q Poo rA ^£ No t pain t / Sample s Collecte d Firm : ^f S S H f 'A H Date : lo / < J / O ^ Time : 3' . 2 . 1 Sample s Analyze d XRFUnit : ^/ ^

Book : ^7 & Date : /ff-Z&~£2^ t Time : /-J^^~ 7 Staff : JsV*7 ^

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Omah aLea dSit e 4613 0

## pag e 1 o f
Omah a Lea d Sit e Omaha , N E Residentia l Yar d Soil s U.S . Environmenta l Protectio n Agenc yRegio n VI I Environmenta l Restoratio n Service s PROPERT Y ACCES S (t o b e complete d b ypropert yowner ) favo rI'am e a l 1-800 - U.S . Environmenta l Protectio n Agency(EPA ) ha s contracte d th e U.S . Arm yCorp s o f Engineers (USAGE) , Omah a Distric t t o conduc t environmenta l restoratio n service s fo rth e Omah a Lea d Site . USAG E Omah a i s workin g wit h Environmenta l Chemica l Corporatio n (ECC ) t o remov e lea d contaminate d soi l an d provid e subsequen t restoratio n services . You rcooperatio n i s requeste d i n givin g EPA/USACE/EC C permissio n t o acces s you rpropert ydurin g th e removal/restoratio n phase . Fo rfurthe rinformatio n pleas e contac t Do n Bahnke , EP AProjec t Manage ra t (913 ) 551 ­ 700 3 o rth e Offic e o f Externa l Programs , a t 1-800-223-0425 . Propert yAcces s Grante d B y (Pleas e Prin t Name) ' CVx-o'ie- . Q 8 rSignaTute)'—^/~ —-"s^ - —f l - ' /] ' (Date ) ~)TE : Grantin g permissio n DOE S NO T necessaril yimpl yyou rpropert ywil l b e remediate d a t thi s time . PROPERT YINFORMATIO N (f o b e complete d b yresiden t and/o rpropert yowne r• Pleas e Print ) Residen t Name : L . . owne r I

_ I rente r Residenc e Address : o2*T6(g > STY ) (STATE ) (ZIP ) PropertyOwne d By:J) { Owner s mailin g address : C 

# T Owner' s telephon e numbe r- Home : i62. ~ T$ " Z> ~ 7^S_ 5 Work : Ag e o f Home ? C^- 0 year s Ho wlon g hav e yo u live d here ? year s Ha s th e exteio rbee n painte d o rcovere d wit h sidin g sinc e 1978 ? Q^^Ye s D N o Ha s th e interio rbee n painte d o rcovere d since 1978 ? 

### H Ye s 

### D N o Tota l numbe ro f occupants: _ Lis t Ages : 

### xf e Lis t age s o f occupant s unde r6 year s ol d wh o playi n th e yar d fo r5 o rmor e hours pe rweek : Comments : 

# y AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTION S Th e activitie s t o b e implemente d b yEP Aunde rthi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 IJ. S C . 9604 . EPA' s righ t o f acces s t o h e propert yfo ri n Sectio n 104(e ) o f CERCLA . 4 2 U.S.C . 9604 (e) . whic h provide s entr yfor , "determinin g th e nee d fo rresponse , o rchoosin g o r akin g an yrespons e actio n unde rthi s title , o f otherwis e enforcin g th e provision s o f thi s titl e " Acces s Attempts : First : Second : : Third : :

## Contrac t No . W912DQ-04-D-0017 , Tas k Orde r DK0 1 Omah aLeadSite , Omaha , N E Propert y Closeou t Agreemen t BVID ^ V^ Y Propert y Addres s ^ ^ C* ~ d* i Propert y Owne r ^,^; c /7|/ 

## ^ / IstheO w ne r th e Resident ? B^Ye s D N o Complianc e Statement^ / ' U.S . Environmenta l Protectio nAgenc y (EPA ) ha s contracte dth e U.S . Arm y Corp s o f Engineer s (USACE) , Omah aDistric t t o conduc t environmenta l restoratio n service s fo r th e Omah aLea dSite . USAG EOmah ai s workin g wit hEnvironmenta l Chemica l Corporatio n(ECC ) t o remov e lead contaminate dsoi l an dprovid e subsequen t restoratio nservices . You r cooperatio ni ngivin g EPA/USACE/EC C permissio nt o acces s you r propert y durin g th e removal/restoratio nphas e i s sincerel y appreciated . Thi s documen t certifie s tha t al l work performe da t thi s propert y wa s complete di naccordanc e wit hth e contrac t specification s an dEP A requirements . I f

yo u hav e question s o r nee dadditiona l informatio npleas e contac t Do nBahnke , EP A Projec t Manager , a

t (913 ) 551-700 3 o r th e Offic e o f External Program s a t 1-800-223-0425 . Additiona l Comment s b y USAC Eand/o r ECC :

CONTRACTO RCERTIFICATIO N Prashan t Khann ao r EC C Projec t Manager Charle s "Skip"Milto n Name . V A \ v Titl e . . A 

## * D a t e Signatur e V . 

# Svao Mil U^fl \ 7-lfrlH , J3>v.V > PROPERT Y OWNE RSECTIO N 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 satisfaction . 

## / \/ f I agre e tha t restoratio ni s complete da t m y property , excep t a s note d/ /

/ Comment s (i f applicable) : / / / / p ( 

# 5 4 <; v dt f 

# < a^^M tM > (_ , '- / 

# /-\ (An'rtt f ^. r 

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## erty Owner' s Signatur e / Dat e 

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# Propert y Owne r Satisfactio n Surve y For m Omah aLeadSuperfun dSite Performance-Base dContractin g (PBC ) Pilo t Projec t Remediatio n Contractor : Propert y Identifie r Number : Property BV1 D Number : J ^ V2
- Propert y Address : 2 

## Propert y Owner' s Name : _<3-
- / 

## ^ ^ /£ . _A ^- L 6 (abov e informatio nt o b e fille dou t b y remediatio ncontracto r prio r t o deliver y o f for mt o Propert y Owner ) 

## Instruction s t o Property Owner ; Thi s for mi s provide dt o yo u a s amean s o f tryin g t o captur e you r leve l o f satisfactio n withth e work o f th e above-identifie dRemediatio nContractor , a s applicabl e t o th e soi l cleanu p actio na t you r property . Th e U.S . Environmenta l Protectio nAgenc y (EPA ) an dth e U.S . Army Corp s o f Engineer s (USAGE ) ar e very intereste di nyou r opinio nregardin g th e work performe d b y ou r contractors . Thi s for mi s intende dt o provid e a neas y mean s fo r yo u t o expres s you r opinio nabou t th e work performe do nyou r property . Pleas e indicat e you r leve l o f satisfactio nwithth e Contractor' s work b y selectin g a numerica l ratin g (rangin g fro m1 t o 10 ) usin g th e followin g ratin g scale , the npleas e sig n& dat e th e for man dretur ni t t o USAG Ei nth e attache dself-addresse d& stampe denvelope . (Additiona l comment s ma y als o b e provide di nth e spac e provided , a t th e optio no f th e propert y owner. ) 9-1 0 "excellent " 7- 8 ''ver y good " 5- 6 "acceptable " 3- 4 "poor " 1 - 2 "ver y poor " Propert y Owner' s Satisfaction Ratin g regardin g Contractor' s Wor k

' 0 ^ ^

5 9 • 4 

### 8 3 7 2 6 1 

### Additiona l Comment s fro mPropert y Owne r (optional ; continu e o n bac k o f pag e i f needed ) 

# /

_ Propert y Owner' s Signature;^/^?? ? ft/I / * t f XL/XT ^ Date : / / /f } /L • f f f-^-fa * ' /• • / f ,

## CONTRAC T# W912DQ-04-D-0017 , T.O . DK0 2 Environmenta l Chemica l Corporatio n Omah a Lea d Remediation , Omaha , N E U S Arm yCorp s o f Engineers 

## Analytica l Result s Summar y BVI D #3642 4 245 6 Camde nAv e
Sampl e

Typ e Quadran t Dept h Dat e Collecte d XR F Result s (ppm ) (avg. ) La b Result s pp m (avg. ) P X EA- S 2 6/14/200 6 13 6 N A D E D Z 1 3 6/15/200 6 9 8 N A P X EA- W 2 6/15/200 6 14 7 N A D E F 1 8 6/15/2006 8 3 N A D E F2 8 6/15/200 6 10 8 N A



## BVID
BVI D i s a particula rresidentia l propert yI D fro m whic h th e sampl e i s collecled . Th e sampl e typ e identifie r(wit h sequentia l sampl e numbe rfo rtha t location ) a s follows : P X = Pre-Excavalio n XR F sampl e P E = Pre-Excavatio n laboratory ' sampl e D E = Durin g an d Pos t Excavatio n Quadran t describe s th e samplin g locatio n (wit h sequentia l sampl e numbe rfo rtha t location ) a s follows ; F l o rF 2 = Fron t Yar d On e o rFron t Yar d Tw o B1 orB2 = Bac k Yar d One orBac k Yar d Two D Z = Dri p Zon e G A= Garde n P A= Pla yAre a E A= Easemen t Dept h describe s th e dept h fro m whic h th e sampl e wa s collecled . pp m = part s pe rmillio n

## Propert yChec k List s Q C Locatio n Z4g(* Cambt * 4i/ L °' ^ 

## BVI D 3L*i M 

## Date s ,s - o C 

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## Excavatio n chec k lis t hav e easemen t ma p hav e sit e ma p hom e owne ragreemen t lin e locato r acces s lo g deco n statio n tap e barricad e garde n hos e reconstructio n ma p fo rbuildbac k 

### fence s so d area s 

### mulc h grave l note s nam e an d dat e

Q C Note s 

## XR F chec k lis t hav e easeme t ma p (1 ) hav e sit e ma p (3 ) easement s sampl e 

### F 1 sample s 

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### D Z sample s AS-Buil t ma p correcte d shot s mappe d concret e mappe d tree s marke d LI P marked/note d nam e dat e easemen t mappe d windo wwell s mappe d a cmappe d Lo g boo k u p t o dat e 

## Backfil l chec k lis t reconstructio n ma p positiv e drainag e fro m hous e N O lo wspot s N O Rak e Gap s law n eve n soi l compacte d sidewal k 1 " cut s smoot h transitio n fro m walk s are a fre e o f debri s fence s repaire d damag e t o property ? damag e list A/A . punchlis t file d

### O n 

## nah a L ead S t e rOwne rName : JIMMI E L BYR D 

## Site S ketc h Address : 245 6 CAMDE N A V

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