### 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 Engineer s 

### EC C Certificatio nfo r Propert y Closeou t BVI D 

## 3251 1 Propert y Addres s 372 2 N2 8 S t Fiel dWor k Starte d 09/08/200 6 Fiel dWor k Complete d 09/15/200 6 Summary : • Th e excavatio nwa s performe di ncomplianc e wit hth e wor k plan s an d specifications . •F l excavatio ndept h varie dfro m4 t o 6 inche s belo w groun dsurface . •F 2 excavatio ndept h varie dfro m4 t o 6 inche s belo w groun dsurface . •Dri p Zon e excavatio ndept hvarie d fro m1 2 t o 1 3 inche s belo w groun d surface . • Verificatio nsample s confirme dtha t 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 h th e specification s an d wor k plans .

Comments : None .
.i Q 

### EC C Projec t Manage r 

# \\~M-P L Nam e ^ 

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

4028642 8 

# mill Superfun d

# 3251 1 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : FRAN KS MURPH Y f j Goo d 

### Sit e Sketc h Address : 372 2 N 2 8 S T fj Poo r Phone : H : W : pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d Sample s Collecte d fA.T T RYASCPXA-3251 1 RYBSCPXA-3251 1 RYCSCPXA-325 1 1 RYDSCPXA-3251 1 RDZSCPXA-325 1 1 La b RYASCPLA-3251 1 Resul t 49 8 pp m 

# ENTERE D Ai m

Omah aLea dSit e 4613 0

## pag e 1 of
. Omah a Lea d Sit e Omaha , NE Residentia l Yar d Soil s U.S
. Environmenta l Protectio n Agenc yRegio n VI I Environmenta l Restoratio n Service s PROPERT Y ACCES S (t o be complete d bypropert yowner ) US
. Environmenta l Protectio n Agenc y(EPA ) ha s contracte d th e U.S
. Arm yCorp sof Engineer s (USAGE) , Omah a Distric t to conduc t environmenta l restoratio n service s fo rth e Omah a Lea d Site
. USAG E Omah ais workin g wit h Environmenta l Chemica l Corporatio n (ECC ) to remov e lea d contaminate d soi l an d provid e subsequen t restoratio n services . You rcooperatio n is requeste d in givin g EPAAJSACE/EC C permissio n to acces s you rpropertydurin g th e removal/restoratio n phase . Fo rfurthe rinformatio n pleas e contact Do n Bahnke , EP AProject Manage r at (913 ) 551 ­ 700 3orth e Offic e of Externa l Programs , at 1-800-223-0425 . Propert yAcces s Grante d By (Pleas e Prin t Name ) 

# 2 ;PropertyOwne rSignature ) | (Date ) V NOTE : Grantin g permissio n DOE S 

## / necessaril yimpl yyou rpropert ywil l be remediate d at thi s time . 

## ;>ESAK>F PROPERT YINFORMATIO N (t o be complete d byresiden t and/o rproperl yowne r• Pleas e Print ) owne r Residen t Name : [$/cC , D rente r J^ \ Residenc e Address : 

# ;> (CITY ) (STATE ) Propert yOwne d By : : C 

### H ( Owner s mailin g address : s, 

## ^^ Owner' s telephon e numbe r- Home : CMCQ ) M J/ C/ ) ") Op Work : Opc j - CK/ ? / O Ag e of Home ? | C/ ^

year s Ho w lon g hav e yo u live d here ? / / year s Ha s th e exteio rbee n painte d orcovere d wit h sidin g sinc e 1978 ? LlKYe s 

### No Has th e interio rbee n painte dorcovere d since 1978 ? LJ Ye s Tota l numbe r of occupants : Lis t Ages : Lis t age s of occupant s unde r6 year s ol d wh o pla y in th e yar d fo r5 ormor e hour s pe rweek : omments : AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTION S Th e activitie stobe implemente d byEP Aunde rthi s agreemen t ar e pursuan t to Sectio n 10 4of CERCLA , 42 U S.C
. 9604 . EPA' s righ t of acces sto he propertyfo r in Sectio n 104(e ) of CERCLA , 42 U.S.C
. 9604 (e) , whic h provide s entr yfor , "determinin g th e need fo rresponse , orchoosin g or akin g an yrespons e actio n unde rthi s title , orotherwis e enforcin g th e provision sof thi s title. " Acces s Attempts : First : Second : Third :

### Contrac t No . W912DQ-04-D-0017 , Tas k Orde r DK0 1 Omah aLea dSite , Omaha , N E Propert y Closeou t Agreemen t BVID Propert y Addres s 33S-J I 

# .?ojk i N2 ? s r Propert y Owne r I s th e Owne r th e Resident ? B"Tes D N o 

## £LJS £MVRPH 1 Complianc e Statement : U.S . Environmenta l Protectio nAgenc 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 environmental restoratio n service s fo r th e Omah aLea dSite . USAG EOmah ai s workin g wit hEnvironmenta l Chemica l Corporatio n(ECC ) t o remov e lead 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 withth 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 Title . Dat e Signatur e \t 

# 5k;/ ) M;Uu A 

# (W to-ZS'0(f 

# l\v v . XA PROPERT Y OWNE RSECTIO N Thi s agreemen t document s th e completio no f remedial/restoratio neffort s a t th e property t o m y satisfaction . ii=rlagre e tha t restoratio ni s complete da t m y property , excep t a s note d Comment s (i f applicable) :



## r > Propert y Owner' s Signat u Dat e

# Propert y Owne r Satisfactio n Surve y For m Omah aLeadSuperfim dSit e Performance-Base dContractin g (PBC ) Pilo t Projec t Remediatio nContractor : Propert y Identifie r Number : Propert y BV1 D Number : Propert y Address : J^ A / / ^ f -S7 " 

### Propert y Owner' s Name : £LlS f (abov e informatio n to be filled out by remediatio n contracto r prio r to deliver y of for mto Propert y Owner ) 

### Instruction s t o Propert y 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 wor k o f th e above-identifie dRemediatio n Contractor , 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 n Agenc y (EPA ) an dth e U.S . Army Corp s o f Engineer s (USAGE ) ar e very intereste di n you r opinio n regardin g th e work performe d b y ou r contractors . Thi s for mi s intende dt o provid e a neasy mean s fo r yo u t o expres s you r opinio n abou t th e wor k performe do n you r property . Pleas e indicat e you r leve l o f satisfactio n withth e Contractor' s work 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 n pleas e sig n & dat e th e for man dreturni 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 n th e spac e provided , at th e optio no f th e propert y owner. ) 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable " 3- 4 "poor " 1 - 2 "ver y poor " Propert y Owner' s Satisfactio n Ratin g regardin g Contractor' s Wor k 1 0 5 9 4 

### 8 3 

### 7 2 6 1 

### Additiona l Comment s fro mPropert y Owner (optional ; continu e o nbac k o f pag e i f needed )

Propert y Owner' s Signature : L>OoQ_ D 

### J\\UJJY" ) Vw v Date :

### CONTRAC T # W912DQ-04-D-0017 , T.O
. DK0 3 

# .n . Environmenta l Chemica l Corporatio n Omah a Lea d Remediation , Omaha , N E U S Arm yCorp s o f Engineer s 

## Analytica l Result s Summar y BVI D #3251 1 372 2 N 2 8 S t
Sampl e

Typ e

D E D E D E P X Quadran t D Z F 1 F2 EA- E Dept h 1 3 1 2 6 0 Dat e Collecte d 9/8/200 6 9/8/200 6 9/8/200 6 9/8/200 6 XR F Result s (ppm ) (avg. ) 17 5 5 9 24 4 5 6 La b Result s pp m (avg. ) N/

A N/

A N/

A N/

A

BVID
BV1 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-Excavaiio 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 I o r F 2 = Fron t Yar dOn e o r Fron t Yar dTw o B Io 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

# pg-_ot _ 

# Lis t o f Existin g Condition s Propert yAddress : / U £< F 

## ^ 

## J ^ DV D 

## I D # 

# Owner : Date : BVID #

Ref : 

## Phot o 

## # Descriptio n

Owne rSignatur e EC C 

## Prin t & Sig n Prin t & Sig n 

# P

## Propert yChec k List s Q C Locatio n ,?•}•? ? AJ . ?& > BVI D 3tt i 

## <& 

## Date s £ 6 ^

M-J^O - f-7<5V£ 

## Excavatio n chec k lis t hav e easemen t ma p hav e sit e ma p hom e owne ragreemen t lin e locato r acces s lo g decon . statio n tap e barricad e garde n hos e reconstructio n ma p fo rbuildbac k fence s so d area s mulc h grave l note s nam e an d dat e 

# C Q C Note s 

## XR F chec k lis t hav e easeme t ma p (1 ) hav e sit e ma p (3 ) easement s sampl e F 1 sample s F2 sample s 

### B 1 sample s B 2 sample s D Z sample s AS-Buil t ma p correcte d shot s mappe d concret e mappe d tree s marke d LI P marked/note d 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 Jk * 

## Backfil l chec k lis t reconstructio n ma p

_ L positiv e drainag e fro m hous e N O lo wspot s N O Rak e Gap s law n eve n soi l compacte d sidewal k 1 " cut s smoot h transitio n fro m walk s are a fre e o f debri s fence s repaire d damag e t o property ? damag e list punchlis t file d

# 3251 1 QExterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : FRAN KS MURPH Y n Goo d 

### Sit e Sketc h Address : 372 2 N 2 8 S T Poo r Phone : H . W : pain t Sampl e Numbe r RYASCPXA-3251 1 F 1 Lea d Concentratio n D0 

### m Sampl e Collecte d LA B 

# 0- 1 Firm : Date : ^ Sample s Collecte d fAT T RYBSCPXA-3251 1 F 2 Time : I [ • RYCSCPXA-3251 1 RYDSCPXA-3251 1 B 1 B 2 pp m 

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# n Sample s Analyze d RDZSCPXA-3251 1 D Z pp m 

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# 3251 1 ain t Nort h Arro w 

### Omah c i Lea d Sit e Exterio rP rOwne rName : FRAN KS MURPH Y [~ ] Goo c i 

### Sit e Sketc h Address : 372 2 N 2 8 S T f_ ] Poo r Phone : H : W : [T^Jot ptain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r R Concentratio n Collecte d * ~ Firm : r £ . fA~ T fY\uS.\> J f * j ^ J ^ ^ RYASCPXA-325 1 1 F 1 & / ~ ^ po m n [P f Date : ^ ' 1 3 - ' ^ RYBSCPXA-325 1 1 F 2 

### /£ > 

### 7 -- S pp m Time : 1 1 - ' \. O f^ ^ RYCSCPXA-325 1 1 B 1 >J^- "5 ^ p m 

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