### - - CONTRAC T# W912DQ-04-D-0017 , T.O . DK0 3 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 2865 7 Propert y Addres s 2504N19S t Fiel dWor k Starte d 09/25/200 6 Fiel dWor k Complete d 09/26/200 6 Summary : •Th e excavatio nwa s performe di n complianc e wit hth e work plan s an dspecifications . •F 2 excavatio ndepth varie dfrpmj4 . t o 6 inche s belo w groun dsurface . •B 2 excavatio ndept h varie dfro m4 t o 6 inche s belo w groun dsurface . •

Verificatio nsample s confirme dthat 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 n wer e conducte di ncomplianc e wit hth e specification s an d wor k plans .

Comments : Concret e pa do norigina l drawin g 5-5-0 4 remove dprio r t o clea nup . XR Fresult s fo r 14 7 pp m eas t pa dan d1 9 pp mfo r wes t pa dsite . 

### EC C Nam e Titl e Dat e JeffHubbar d USAG ECo nRe p 

# 1/^Lltj i Nam e Titl e Date ' 

### S i

4028638 4 

# HI ! HI M

Superfun d

## pag e 1 of . 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 YACCES S (t o b e complete d b ypropert yowner ) U.S . Environmenta l Protectio n Agenc y(EPA) ha s contracte d th e U.S . Arm yCorp s o f Engineer s (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 rpropertydurin g th e removal/restoratio n phase . Fo rfurthe rinformatio n pleas e contact Do n Bahnke , EP AProject Manage rat (913 ) SSI - ZOO S o rth e Offic e o f Externa l Programs , a t 1-800-223-0425 . Propert yAcces s Grante d By (Pleas e Prin t Name )


## • A (Propert yOwne rSignature ) 7 t T ~)(Date ) NOTE : 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 (t o b e complete d b yresiden t and.-o rpropert yowne r- Pleas e Print ! Residen t Name : C>t" » yo" i Omfln A owne r L J rente r Residenc e Address : (CITY ) (STATE ) (ZIP ) PropertyOwne d B y 

# c, 4 y i 

# ^ Owners mailin g address : lc > I 7 Owner' s telephon e numbe r- 

### •itl-Sl%o(&K& ) Work : 

### • ^ v- < Ag e o f Home ? /N O [Jyears Ho wlon g hav e yo u live d here ? > L year s Ha s th e exteio rbee n painte d o rcovere d wit h sidin g sinc e 1978 ? D Ye s E d N o Ha s th e interio rbee n painte d o rcovere d since 1978 ? D Ye s M N o Tota l numbe ro f occupants : Lis t Ages : 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 : xOmments : AUTHORITY FO 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 U 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 . 960 4 (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 rotherwis e enforcin g th e provision s of thi s title. ' Acces s Attempts : First : Of//8/ 0 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 Propert y Addres s 

# ~z- o £ , 5> ~ ( 

# ^ib f /O , IJ&Sl
Propert y Owne r 1 

### I s th e Owne r th e Resident ? D Ye s )9-No 

## ' Osnfln A Complianc e Statement : U.S . Environmenta l Protectio n Agenc y (EPA ) ha s contracte dth e U.S . Arm y Corp s o f Engineer s (USAGE) , Omah aDistric t t o conduc t environmenta l restoratio nservice s fo r th e Omah aLeadSite . USAG EOmah ai s workin g wit hEnvironmenta l Chemica l Corporatio n(ECC ) t o remov e lea d 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 wor k 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 , at

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

CONTRACTO RCERTIFICATIO N Prashan t Khann ao r EC C Projec t Manage r Charle s "Skip"Milto n Nam e f\^ A 

### Dat e Signatur e 1 . » Titl C 

# ^>K; p *A\l U 

# P M /2-/Z-<fl r 

# ,J Y ly 

# ^ 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 . 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) : 

# £ LU~f*~ — /2- ^ -O b Propert y Owner's/Signatur e Dat e

### CONTRAC T# W912DQ-04-D-0017 , T.O . DK0 3 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 #2865 7 2504 N1 9 S t 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. ) D E B 2 6 9/25/200 6 1 9 N A D E F 2 6 9/25/200 6 9 N A P X EA- E 0 9/25/200 6 6 9 N A P X B 1 0 12/12/200 6 14 7 N A P X F 1 0 12/12/200 6 1 9 N A

BVID
BVI D i s aparticula r residentia l propert y I D fro mwhic hth e sampl e i s collected . Th e sampl e typ e identifie r (wit hsequentia l sampl e numbe r fo r tha t location ) a s follows ; P X = Pre-Excavatio nXR Fsampl e -^ = P E= Pre-Excavatio nlaborator y sampl e D E= Durin g an dPos t Excavatio n Quadran t describe s th e samplin g locatio n(wit hsequentia l sampl e numbe r fo r tha t location ) a s follows ; F 1 o r F 2 = Fron t Yar dOn e o r Fron t Yar dTw o ' B I o r B 2 = Bac k Yar dOn e o r Bac k Yar dTw o -=-! • ^
- D Z= Dri p Zon e G A = Garde n P A = Pla y Are a E A = Easemen t Dept hdescribe s th e dept hfro mwhic hth e sampl e wa s collected , pp m= part s pe r millio n•«-—•• • •*••• ! Nort h Arro w 

### ih a Lea d Sit e Owne rName : £ii/ v 

### ^ £ w lA x° m £ / b 

### it e Sketc h Address : 2-^>O c / 

## A ; !< ? sl , Phone : H:(£C ^ 

# r/8 o CCh^^ V Sampl e Numbe r RYAOCPX A RYBSCPXA RYDSCPXA ­ 

### — R — F2 B4- 

### B 2 Lea d Concentratio n pp m ~I72 > pp m l&'2-'2 —pp m Sampl e Collecte d 

## D D ' • .LA B 

## D D 

## D 

# n • 

## • Firm : Datp Time : Sample s Collecte d /^/? 5 5 ' — *• ) * f A< / 7 

## y / Sample s Analyze d R /" * ~~ re * /" • n vA 

### — 92 ­ pp m pp m 

## D D • 

# • n XR F Unit Date : R^ni^ ­



### — PZ — - . ­ pp m 

## D 

# n Time Numbe ro f Sample s Staff :

Omah aLea dSit e 4613 0

# Propert y Owne r Satisfactio nSurve y For m Omah aLeadSuperfim dSite Performance-Base dContractin g (PBC ) Pilo t Projec t Remediatio n Contractor : Property Identifie r Number : Propert y BVI D Number : 

### Propert y Address : £50 (



### - \/ O < ( ? Propert y Owner' s Nam e : C * F^ / & \ (abov e informatio nt o b e fille dou t b y remediatio ncontracto r prio r t o delivery 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 n a 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 ver y intereste di n you 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 wor k performe do nyou r property . Pleas e indicat e you r leve l o f satisfactio nwithth e Contractor' s wor k 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 property owner. ) 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable" 7 

### 3- 4 "poor " 1- 2 "ver y poor " Propert y Owner' s Satisfaction Rarin g regardin g Contractor' s Wor k 1 0 5 9 4 

### 8 )s ~ 3 1 ' 2 

### 6 1 

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

Properl y Owner' s Signature :Nort h Arro w 

### ih a Lea d Sit e Owne rName : £iJ-ry< • f ' F)in n tna . Om z a 

### it e Sketc h Address : 2-5O L l 

## A ; q sf , Phone : ntyc? ) 

# ViA/'^'Sc ) rc/-,,8/s ) ' f Lea d Sampl e Sample s Collecte d Sample ' Numbe r LA B Concentratio n Collecte d Firm : /*/£ $ • RYAGCPX A —H — pp m Datp ' S - ~ *• > ~ { "><

/ RYBSCPXA - F 2 77< ^

pp m D Time : A< / 7 ovr"T ^

r* YA . & f po m 

## D D Sample s Analyze d RYDSCPXA - B 2 /^^Z - pp m 

# n P n" 7 s r * P YA
— D2 - pp m 

# n n YR p I | n jt - R^^U R /" * ~ 7 O i^> n V A • \3t-~ - pp m 

# n n Date : np-'^pp y A



# - B n n Time : Staff : Numbe ro f Sample s

Omah aLea dSit e 4613 0Nort h Arro w r

### ^ Omah a Lea d Sit e Owne rName : ^SW v A> - 1 itonuvw . _ . . 

### - / J > SI , S.t e sketc h Mdress : _^^ O

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### X ) M4<A- b VlS o C CK^s ) / Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : /*7£ 5 

### rwAocrx A R 1 — pp m n D Date - 'S-S-Cr f RYBSCPXA - F 2 77« £ pp m p f Time : AV 7 RYCGCPXA - B4 - DD m 1 1 D Sample s Analyze d RYDSCPXA - B 2 /^^Z - pp m [7 f 

# n 9 - 7 _1 1

e —pp m | i 

# n XR F Unit ' Rnnk R f~*~7c * r^ntvA 

### n o & ppll l 1 1 Date : P * 7 nnn ^ 1 1 2 pp m I | 

# n Time ' j r , Staff : Numbe ro f Sample s - i '2 . j

Omah aLea dSit e 4613 0

### Ma p Outpu t Pag e 1 o f 1 250 4 N 1 9 St/62x9 0

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# Lis t o f Existin g Condition s Propert yAddress : <^o* f / Q . l^ ^

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## Phot o Descriptio n 

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## Propert yChec k List s Q C Locatio n sso n A/ . /^ ' BVI D 

# 2^<^n Date s 9/£S7o^ . S^7^ u 3-Mr-tfe . 

## Excavatio n chec k list XR F chec k lis t Backfil l chec k lis t hav e easemen t ma p hav e easeme t ma p (1 ) reconstructio n ma p hav e sit e ma p hav e sit e ma p (3 ) positiv e drainag e fro m hous e hom e owne ragreemen t easement s sampl e N O lowspot s lin e locato r F 1 sample s N O Rak e Gap s acces s lo g F 2 sample s law n eve n decon . statio n B 1 sample s soi l compacte d tap e barricad e B 2 sample s sidewal k 1 " cut s garde n hos e D Z sample s smoot h transitio n fro m walk s reconstructio n ma p fo rbuildbac k AS-Buil t are a fre e o f debri s fence s ma p correcte d fence s repaire d so d area s shot s mappe d damag e t o property ? mulc h concret e mappe d damag e lis t grave l tree s marke d punchlis t file d note s LI P marked/note d nam e an d dat e 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 Q C Note s

### Ma p Outpu t Pag e 1 o f 1 250 4 N 1 9 St/62x9 0

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### Omah a Lea d Sit e Owne rName : £W y^ 

# ffa u lA x_ . . Slt e 

### Sketc h Address : Z5O C / 

### r Vl< ? 

## _a . Phone : H$5> J < , 

### /V V 

### " 5 Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : /tff. 5 • RYAGCPX A 

## P 1 pp m n Date - 5^5~'<? y

RYBSCPXA - F 2 77< ^

Dp m Time : 1 : <f7 RYCGCPX A

—B4 - nn m Sample s Analyze d RYDSCPXA RDZ^PPX A B 2 -B2 ­ /£^Z ­ pp m pp m 

## D 

# n n XR F Unit 1 Rook " RCZSCPX A 

### PP-"-CPXA /TM»* 7 P 7 pp m 

# n n Time Numbe ro f Sample s r

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# Zj ' Staff :

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