OLSID 29593 Property Address 2629N / St Field Work Started 10 /

4 1

2007 Field Work Completed 10 / 412 007 Summary: 

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

# • B2 excavation depth was 13 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 

### CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation; Omaha, NE US Anny Corps of Engineers
ECC Certification for Property Closeout
/



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## !2 .; . .,,v ECCQCM / II&O. J.

# ~**-~** Name Title Date Jeff Hubbard USACE Con Rep 

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# lUI 29 593 OWne r Na me : S BRUNKEN

______ ___ _ M Address : 2629 N 15 ST O m a h a Lead Site S i te Sketch Phon e : 

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### page 1 of_ 

### c!).CfS ys 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)**;::J,~ _':~** **~~,,'C::** "c10S;:<'(,**~J** '<.J,C:' l'__ ' _L"' : Environmental Protection Agency (EPA) has contracted \he U.S. Army Corps of Engineers (USACE), Omaha lIOi"II;'" to conduct environmental restoration services for the Omaha Lead Site. USACE Omaha is working**w~h** \lEnvirorlmenllal Chemical Corporation (ECC) to remove lead contaminated soil and provide subsequent restoration Your cooperation is requested in giving EPAIUSACEJECC permission to access your property during the lIremc)val/relstc"al.ion phase. For further information please contact Don Bahnke, EPA Project Manager at (913) 551· or the Office of Extemal Programs, at 1·800·223·0425. Property Access Granted By (P5ease Print Name)

IResident Name: 

### V!J.C/Wr /...()T W owner 

# o renter DResideince Address : 

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## q N Is S. T
IIPr<>Dertv Owned By : 

### S8/JI>IM 

## 8 R VUk.£.tV IIOwners mailing address :---'01""-'52

### ~"-.;,**?:....-...LN-"----..l./,""'0'-'=ST<.L._----"O<..l./I1~tl!hIltJUL...__'M.!.<&:!It._.>!:(p,"'8J"''II. ()~**  ____ ....

### '" I Ov,"e,"s telephone number •**Home: -f,k"-~3"-Lr....:s=:.......L-J.LIj.L'i'7L_** ___ Work:**--------------~ I** 

______ years How long have you lived h e re?

_____ years the exteior been painted or covered with siding sin c e 1978? DYes 

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

# o No

_ _ ___ List A g es :

___________________

### -1 1 number of occupants: ages of occupants under 6 years old who play in the yard for 5 or more hours per week:.

______ _

activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA , 42 U

. S

. C

. 9604
. E PA's right of access pro"",ty 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 action under , or otherwise

. the

. i of this title

. "

First:

___________ Second: : ___________ Third: :

___________Contract No. W912DQ-04-D-0017, Task Order DKOI Omaha Lead Site, Omaha, NE Property Closeout Ar;reement BVID Property Address 

# d1s c 

## ls 

# I Ah J- 9 N I S S F Property Owner Is the Owner the Resident? DYes 

## UJ....t.W 5t1NbM**~~vf{/<€f\)** 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 EPAlUSACElECC 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 ECC Project Manager Name Title Date Signature 

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

# .W Tagree that restoration is completed at my property, except as noted Comments (if applicable):

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# > Properly Owner's Signature DatI"

## Property Owner Satisfaction Survey Form Omaha 

### Lead Superfund Site Perfonnanc:e-Dased Contradln& (PDC) Pilot Projed Remediation Contrador:

__

### ...: £ ::::..: C ::::..: c. =-

_______________ Property Identifier Number:

________ Property DViD Number:

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# ..r Property Address: (). 

## &.;). 1 N IS-**~** 

### T Property Owner's Name:**--= ::..:..<** **tJ IJ** **'-"~ I4** **.:..: ""'**  

### ....**"_' 'O**  _______**J9 ""''-"** **"" "__...::4'~.(l** **..:; /IJ** **'''__** _ (above information to be filled out by remediation contractor prior to delivery of form to Property Owner) 

### ** ••••••••• ** ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Instruc:tions to 

### Property Owner: This fonn is provided to you as a means of trying to capture your level of satisfac:tion with the work of the above-identified Remediation Contrac:tor, 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 vel)' 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 Contrac:tor's work by 

### selecting a numerical rating (ranging from I to 10) using the following rating scale, then please sign & 

### date the fonn and retum it to USACE in the attac:hed self-addressed & 

### stamped envelope. (Additional comments may also be provided in the space provided, at the option of the property owner.)
very good" 5-6 "acceptable" 3-4 "poor" 

### 1-2 "very poor" Property Owner's Satisfadlon Rating mardin, Contractor's Work 10 5 9 4 8 3 7 2 6 1 

### Additional Comments from Property Owner (optional; c:ontinue on back 

### of page if needed)

Property Owner's Signature: 

# KK**z:;;;~** Date: 

# • /::L- 

## - /.:L-

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# 7­ i ­

### 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#29S93 2629 N ISth St
Quadrant Sample Type Depth Date Collected XRF Results (ppm) (avg.) 

### DE 82 13 10/4/2007 48 

### DE II EA-W 0 10/4/2007 19 

### II I II I II II I 

### II II I I I

SAMPLEID· SAMPLE ID is a particular residentiaJ property ID from which the sample is collected. The sample type identifier (with sequential sample number for that location) as**fol1ows ~**  PX = Pre-Excavation XRF sample DE = During and Post Excavation Quadrant describes the sampling location (w i th sequential sample number for that location) as follows ; Fl or F2 = Front Yard One or Front Yard Two Bl or 82 = 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