page1of-%T/J@.IOmahaLeadSiteOmaha.NEU.S.EnvironmentalProtectionAgencyRegionVIIResidentialYardSoilsEnvironmental RestorationServicesPROPERTYACCESS(tobecompletedbyproperlyowner).-zj:;:,.2c;.,LC'.:'...:..-&.=.,,,..,:.,.':<._..>,.3,223;;:iI---~~--~-U.S.EnvironmentalProtectionAgency(EPA)hascontractedtheU.S.AmyCorpsofEngineers(USACE),OmahaDistricttoconductenvironmentalrestorationservicesfortheOmahaLeadSite.USACEOmahaisworkingwlhEnvironmentalChemicalCorporation(ECC)toremoveleadcontaminatedsoilandprovidesubsequentrestorationservices.YourcooperationisrequestedingivingEPNUSACUECCpenisdiontoaccessyourpropertyduringtheremovallrestorationphase.ForfurtherinformationpleasecontactDonBahnke.EPAProjectManagerat(913)551-7003ortheOfficeofExternalPrograms.at1-800-223-0425.PropemAccessGrantedByY(PleasePrintName)q-dld7(Date).I~esidentName:7~dfllLK5ownerMenterAResidence~ddress:dsagSTDLa?ProperlyOwnedBy:s.&/3-k~bck/TLbOwnersmailingaddress:251%v-5t.4Om4b,f6Wl8Bf;??dOwner'stelephonenumber-Home:q4u A3305)73b-4g23work:7~6-Ytld.8CgeofHome?yearsHowlonghaveyoulivedhere?yearsHastheexteiorbeenpaintedorcovered withsidingsince1978?0yesflNOHastheinteriorbeenpaintedorcoveredsincet978?C1YesNOnumberofoccupants:ListIListagesofoccupantsunder6yearsoldwhoplayintheyardfor5ormorehours perweek:I-[comments:AUTHORITYFORENVIRONMENTALRESPONSEACTIONSTheactivitiestobeimplementedbyEPAunderthisagreementarepursuanttoSection104ofCERCIA.42U.S.C.9604.EPA'srightofaccesstothepropertyforinSection104(e)ofCERCLA.42U.S.C.9604(e).whichprovidesentrylor."determiningtheneedlorresponse,orchoosingoctakinganyresponseactionunder thistitle,orotherwiseenforcingtheprovisionsofthislitle.'TAccess Attempts:First:Second::Third::ListofExistingConditionsPropertyAddress:x3gBR/S~IDVDID#Owner:'JAs:klgQ&RFIE,L~Date:y-J/-U9WID#,?/&L?Ref:PhotoDescription#SEE'-fErC/&Fs*Wy-3305-/ LUCY)ContractNo.W912DQ-04-D-0017,TaskOrderDKOlOmahaLeadSite,Omaha,NEPro~ertvCloseoutAereemeot-BVIDPropertyAddress3/2032-88'1~rzlt.PropertyOwnerIStheOwnerthcResident?Yesla46yfic-,C8~.ngLbComplianceStatement:U.S.EnvironmentalProtectionAgency(EPA)hascontractedtheU.S.ArmyCorpsofEngineers(USACE),OmahaDistricttoconductenvironmentalrestorationservicesfortheOmahaLeadSite.USACEOmahaisworkingwithEnvironmentalChemicalCorporation(ECC)toremoveleadcontaminatedsoilandprovidesubsequentrestorationservices.YourcooperationingivingEPA/USACE/ECCpermissiontoaccessyourpropertyduringtheremovalfrestorationphaseissincerelyappreciated.ThisdocumentcertifiesthatallworkperformedatthispropertywascompletedinaccordancewiththecontractspecificationsandEPArequirements.IfyouhavequestionsorneedadditionalinformationpleasecontactDonBahnke,EPAProjectManager,at(913)551-7003ortheOfficeofExternalProgramsat1-800-223-0425.AdditionalCommentsbyUSACEand/orECC:.-.....-a...CONTRACTORCERTIFICATIONPrashJamesD.GarciaECCProjectanagerDate&)wndent1....PROPERTYOWNERSECTIONThisagreementdocumentsthecompletionofremediaI/restorationeffortsatthepropertytomysatisfaction.Q/;agreethatrestorationiscompletedatmyproperty,exceptasnotedComments(ifapplicable):A..,PropertyOwnerSatisfactionSurveyFormOmahaLeadSuperfhdSitePerformanceBasedContracting(PBC)PilotProjectRemediation Contractor:PropertyIdentifierNumber:PropertyBVIDNumber:3/a.?Property~ddress:as&8'ST1?@1572?~PropertyOwner'sName:C~IFRMFJ~LA(aboveinformationtobefilledoutbyremediationcontractorpriortodeliveryofformtoPropertyOwner)..............................................................................InshuctionstoPromrhrOwner:Thisformisprovidedtoyouasameansoftryingtocapture yourlevdofsatisfactionwiththeworkoftheabove-identified RemediationContractor,asapplicabletothe soilcleanupactionatyourproperty.TheU.S.EnvironmentalProtectionAgency@PA)andtheU.S.ArmyCorpsof Engineers(USACE)areveryinterestedinyouropinion regardingtheworkperformedbyourcontractors.This formisintendedtoprovide aneasy meansfor youtoexpressyouropinionabouttheworkperformedonyourproperty.Please indicate yourlevelof satisfactionwiththeContractor'sworkbyselectinganumericalrating(rangingfrom1to10)usingthefollowing rating scale,thenpleasesign&datetheformandreturnittoUSACEintheattachedself-addressed&stamped envelope. (Additionalcommentsmayalsobeprovidedinthespaceprovided,attheoptionofthepropertyowner.)9-10ccexcellent"7-8"verygood"5-6"acceptable"3-4"poor"1-2"verypoor"Pro~eFtvOwner's~ati~onRatinemardin%Contractor'sWorkIAdditionalCommentsfromProuertvOwner(o~tionakcontjnueonbackof~aueifneeded)..PropertyOwner'sSignature:Date:16-3i9-09