### CONTRACT # 

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


### ECC Certification for })roperty Closeout
OLSID 29190 

### Property Address 2713 N 26 1h 

### St 

### Field Work Started 10/5/2007 

### Field Work Completed 10/10/2007 

### Summary: 

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

# • B1 excavation depth was 5 inches below ground surfaces. 

# • Verification samples confirmed 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

### ~J:v.J ECCQCM

## ~~cJor Name Title Date Jeff Hubbard USACE Con Rep 

### 11- J 3-d/ 

### Name Title Date

# ------- 29190 North Arrow Exterior Paint 

### Oma .a Lead Site Owner Name: MARLA M WYN 

# o Good 

### Site Sketch Address: 2713 N 26 Sf 

# o Poor 

### NA

PIlQne-:_H_: w.;:.:.:... ----­

### ~Notpajnt 

# - Team 

# TiliJ ve... OLS

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### Quadrant Date 

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# JdIk CONTRACT 

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

# m

us Army Corps

of Engineers 

## .Eec:. 

# '"

Analytical Results Summary OLS#29190 2713 N 26 th 

## St
Depth 

# I Quad,.., 

# I Sample Type 

# I DE 

## I 81 

### 5 

# I 

# I I 

# I II 

# I II 

# IB' I I 

# I 

# I I I 

# I II II 

## II 

# I II II 

## II XRF Results Date Collected (ppm) (avg.) 111 10/6/2007 

## I I II 

# I I 

# I 

# I 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 describes 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

## page 1 

## of_ 

## ,;>.. 

# CI/ CftJ 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)**;:-ZJ;~** '''':'::.:,)' CS:d**'~f"'_~** e,::1 ':5;:Z::"C,**.:~.** ·Zl'.'C·

..... r:t. : E::.' 

### :2::**':'~:J** 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 EPAIUSACElECC permission to access your property during the removallrestoration phase. For further information please contact Don Bahnke. EPA Project Manager at (913) 551­ 7003 or the Office of Extemal Programs, at 1-800-223-0425. Property Access Granted By

(Date) 1 . OTE G 

### r DOES NOT rt 1/ b d' ted tth' 

## r ! • • . •• • . PROPERTY INFORMATION (to be completed by rrsldent and or property owner· PleDse Pflnl) Resident

### Name:JIA~nAJ, 

# LtJr 

# X, owner 

# o renter Residence Address: .:; 

# ?/s N 

# J" S'l: (J/u'thll11 (CITY) (STATE) (ZIP) Property Owned By: 

# roM LA W 

# "IN fI) Owners mailing address: 

# bJ.lf1 R£IH> ST**tJlrJlJ~** 

## AIL Owner's telephone number - Home: 

# fP3cr

- 

# r6S' Work:

## _~ -11

,**~ge** of Home?

______ years How long have you lived here?

_____ years

Has the exteior been painted or**cove~ed** 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: 

# -------------------11

Ust 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 trhe actlvities 10 be implemented by EPA under thiS agreement are pursuant to SeclJon 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, Q( chOOSing or**~aklllg** any response action under this llUe, or othel'Wlse enforcing the Dl'ovisions of Ihis tItle." Access Attempts: First:
_ Second: ; - Third: : _ I

# -- pg._of_ 

# List of Existing Conditions Property Address:

# ~7/3 

# N. 9.fp 

# 36 DVDID# 

# cJ9/9D
Date: 

# qjIJJ;o7 BVID# 

# c2 

# 2, 

# 90 Owner:**..I:.....I...-~~oa",....-~~.LL...I<---**

Ref: 

### Photo # 

### Description

Owner Signature 

## ECC Print & 

### Sign Print & 

### Sign

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

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

# I ,.2 

## II f. 

### ? 

## N j(o..s.,­ 

# :l q I 

# ro a NO Property Owner Is the Owner the Resident? DYes 

# rn f}

## ~J--I] Wi/II Jj 

### 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 A/USACEIECC 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 ECC Project Manager 

### Name Title Date Signature 

## PROPERTY OWNER SECTION This ag reement documents the completion of remedial/restoration efforts at the property to my satisfaction
.



### . T agree that restoration is completed at my property, except as noted 

### Comments (if 

### applicable):

/



## -

# Im~A$~~A Properly Owner's Signature {/ Datt'

# Property Owner Satisfaction Survey Form Omaha Lead Superfund Site Perfonnance-Based Contracting (PBC) Pilot Project Remediation Contractor:**_---llI£-.Jo,C..::L~** 

## _ Property Identifier Number:
_ Property OVID Number: 

# :J- 

# r /9' tJ Property Address: 

# p1 ?l:? N 

# ¥a Sr Property Owner's Name: 

## WORLh \N %" 

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

## •••••••••• *** •••••••••••••••• ** ••••• *.** ••••• * •••••• ** ••• ***.*****.** •••• ***** Instructions to Property Owner: 

### 'This form 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 (US ACE) 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 numerical 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 9 

### 4 8 

### 3 7 2 

### 6 1 

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



### Date:

_ Property Owner's Signature: