### CONTRACT 

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


### ECC Certification for Property Closeout

OLSID 28712 

### Property Address 2517 Ohio St 

### Field Work Started 9/7/2007 

### Field Work Completed 9/7/2007 

### Summary: 

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

# • B1 excavation depth was 12 inches below ground surfaces. 

# • B2 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

### ~;J-H 

# D-J"'...J ECCQCM 

# /IJ!I7/rp T Name Title Date Jeff Hubbard USACE Con Rep**W-~s-07**

# JiJJ~ Name Title Date SignatureNorth Arrow Exterior Paint 

### Omaha Lead Site Owner Name: JAMES X**PIER~~** _ 

# o Good 

### Site Sketch Address: 2517 OHIO ST 

# o Poor

Phone: H: 402-455-2468 W:**-~_** •• :_£ 11111111111111111111111111111111111 

## 28712

Team 

# R. WeJJOn 

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046141.0123

### ------------ Page 1 of
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## Z**~41·7....** Omaha Lead Site Omaha, NE U.S. Environmental Protection Agency Region VII Residential Yard Soils Environmental Restoration Services 1'!{OI'f.R J Y .\("C"l:I..,I.., 11,) be Ctlll1pklCd**b~ I'll)PlTl~**  (1IIIll'l) 1',1I,lllTlhll**l'~t:l** 1·\)1111.1l"P:II)"I\wr '·.I\lll· IJ:lI11l';1I**J-~'\fI(l-22~-(I-L>** Grantor (the property owner), consents to and authorizes the United Sates Environmental Protection Agency (US EPA) or its authorized representatives (or its contractors), the Grantee, to enter and perfonn certain environmental response activities upon the following described premises. For further information please contact EPA at 1-800-223-0425. Property Access Granted By ,\i'J/h ftC; 

## {(C6rlCJ£, (Please Print Name)

## ~,**~~** 

# -0, (Date) NOTE: Granting permission DOES NOT necessarily imply your property will be remediated at this time. I'ROl'un) I\FOR\\·\ IICY\ (1\1 b,' ClllllpklCd**b~ IC~ldl'lll**  ;lllt! (11**PIl)Pl'lt~ ()\\l1cr-l'k,l~C**  l'lllll) Resident Name:**_~~&1~-=-** 

### _ Owner 

## o Renter Residence Address: 

# d0' 

# I,**~C** 

# .:s-r: (CITY) (STATE) (ZIP) Property owned by: 

## S '" 

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# x. 

# Rae.. ",c.... Owners mailing address: 

## <9-8 

# bb LASTJ-1:4J p

### ~C"'..-' Owner's telephone number-Home:

### ~'2 

## - 

## J 7 

## :l 1{ Work: Age of Home? _.:::L:::.......;o;;:;...-....;'-'-- years How long have you lived here? years Has the exterior 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:
_ List ages of occupants under 6 years old who play in the yard for 5 or more hours per week:
_ Comments:
_ AUTHORITY FOR ENVIORNMENTAL RESPONSE ACTIONS The activities to be implemented by EPA under this agreement are pursuant to Seclion 104 ofCERCLA. 42 U.s.c. 9604. EPA's right of access to the property for in Section 100(e) ofCERCLA, 42 U.S.c. 9604 (e), which provides entry for, "delennining lite need for response, or choosing or taking any response action under this title, or otherwise enforcing lhe provisions of lhis title." Access Attempts: First: Second: Third:
_

### pg._of_ 

# List of Existing Conditions Property Address:**':l~11 r~Q~--r**  DVD ID 

# #::Ji5JJu

Description

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...... .......**(...;;;-.o'__~_~.....;;..-.___::Ic,L:~~~~~~-­ ~"'---'_.** **;;......~** ...L....­Contract No. W912DQ-04-D-0017, Task Order DI(OI Omaha Lead Site, Omaha, NE Pronerty Closeout Aereement Property Address BVID 

# I**~6~/'7** 

### O/flO ::Sf

### ..1g~**/~** Property Owner Is the Owner the Resident? DYes

### ~fl'Mf-S. 

### PJetct 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 External Programs at 

### 1-800-223-0425. Additional Comments hy USACE and/or ECC:

CONTRACTOR CERTIFICATION EeC Project Manager Date Name Titlt' Signature

.. 

## PROPERTY OWNER SECTION Thi s agreement documents the completion of remedial/restoration efforts at the property to my satisfaction.



# -**.~agree** that restoration is completed at my property, except as noted Comments 

### (if applicahle):



## /1 

## 1\ 

# IXVIlA1Alh**c{;.y~e.Q** y 

# 1..1-**-.).,~** -tJ 

## 'J Owner's Signitn
.. 

## el Datt

### Pr~ 

# y - .

## Property Owner Satisfaction Survey Form Omaha 

## Lead Superfund Site Perfonnance-Based Contracting (PBC) Pilot Project
Remediation Contractor: 

# ---"-"'''-'''''''"'''''''--------------- Property Identifier Number:
_ Property BVID Number: 

### r.lg'**~/J.---** Property Address:**~S** 

# j? oiflO 

# sr Property Owner's Name:

### :ra-M~es~____Ie"__L..IU 

# ...... r**&~C~£--------­** (above information to be filled out by remediation contractor prior to delivery of fonn to Property Owner) 

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

### 1bis form is provided to you as a means oftlying 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 perfonned by our contractors. 1bis 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 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" ] -2 "very poor" Property Owner's Satisfaction Rating regarding Contractor's Work 10 9 8 7 6 

### 5 4 3 

### 2 1



### Property Owner's Signature:

### CONTRACT 

### #**W912DQ~04~D~0017,** 

### T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE US Army Corps of Engineers 

### Analytical Results Summary OLS #28712 2517 Ohio St
Quadrant Sample Type DE 

# I 81 DE 

# I 82 DE 

# I EA-N 

# I 1 

# I 

# I

# ~pth I Date Collected XRF Results (ppm) (avg.) 12 

# I 9/7/2007 110 12 

# I 9/7/2 

# ""6 0 

# I 9/7/2 177 

# I I I

SAi\IPLEIDSAMPLE 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 B 1 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

# ECCOWNER CHANGE 

# REGlUEST. FORM PROPERTY ADDRESS 

# 5 0 

# [1-**t'lo~3** 9 J'

# ~S~ - 

# :2;7 

# 3 OWNER NAME 

# tOr**~. ~~**  CHANGES REQUESTED: /) 

# j7 

# ltii l 

# qrowd/ 

# !Jt:I5e 1- f 0l'o<je 

# / 'Truck

# ~Q

OWNER SIGNATURE

# 6~ l ACTION TAKEN: 

# fit)£.' 

# jJ eueflt€. 

# re az

# ",e,>~.t

SUPERVISOR INITIAL-Jl..!!L