### 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 of Engineer s 

### EC C Certificatio n fo r Propert y Closeou t BVI D 2834 9 Propert y Addres s 1 53 0 Willi s Av e Fiel dWor k Starte d 09/15/200 6 Fiel dWor k Complete d 09/27/200 6 Summary : •Th e excavatio nwa s performe di ncomplianc e wit hth e wor k plan s an dspecifications . •F 2 excavatio ndepthvarie dfro m2 t o 4 inche s belo w groun dsurface . • 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 nwer e conducte di ncomplianc e wit hth e specification s an d wor k plans .

Comments : None . EC C Projec t Manage r Nam e Titl e Dat e Jef f Hubbar d USAG ECo nRe p Nam e Titl e Dat e



# • II I Superfun d 4028653 3

## pag e 1 of . Omah a Lea d Site ; Omaha , N E Residentia l Yar d Soil s 

### U.S . Environmenta l Protectio n AgencyRegio 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 Agency(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 ) 551 ­ 700 3 o rth e Offic e o f Externa l Programs , a t 1 -800-223-0425 . Propert yAcces s Grante d By 

### O F (Pleas e Prin t Name ) 

# t (PropeTfyOwne rSignature ) / 7 -(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 (f o b e complete d b yresiden t and'o rpropert yowne r• Pleas e Print ) Residen t Name : > 08 owne r rente r Residenc e Address : (jj \ l\\ $ (CITY ) (STATE ) (ZIP ) PropertyOwne d By : > Owners mailin g address : Owner' s telephon e numbe r- Home : fo2. - *-5~>8 O Work : Ag e o f Home ? // O o year s Ho wlon g hav e yo u live d here ? year s Ha s th e exteio rbee n painte d o rcovere d wit h sidin g sinc e 1978 ? LJ Ye s Ha s th e interio rbee n painte d o rcovere d since 1978 ? LJ Ye s Tota l numbe ro f occupants: _ Lis t Ages : 

### (/ ) _is 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: _

omments : AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTION S Th e activitie s t o b e implemente d b yEP A unde 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 l 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 akm g an yrespons e actio n unde rthi s title , o rotherwis e enforcin g th e provision s o f thi s title. " Acces s Attempts : First : Second: : Third : :

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# Lis t o f Existin g Condition s Propert yAddress : /53 Q DV D 

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### Prin t Prin t & Sig n

### CONTRAC T # W912DQ-04-D-0017 , T.O . DK0 3 Environmenta l Chemica l Corporatio n U S Arm yCorp s 

### Omah a Lea d Remediation , Omaha , N E o f Engineer s 

## Analytica l Result s Summar y BVI D #2834 9 1530 Willi s Av e Sampl e

Typ e

D E P X Quadran t F2 EA- S Dept h 4 0 Dat e Collecte d 9/25/200 6 9/25/200 6 XR F Result s (ppm ) (avg. ) 2 1 6 0 La b Result s pp m (avg. ) N/

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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 ih e samplin g locatio n(wit hsequentia l sampl e numbe r fo r tha t location ) a s follows ; F l 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 .

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Ornah aLeadSite 4613 0

### 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 /\QOrcS S / ^> - .^^ 5 t * t i ( f c TM / '^•o ^ i s \ / i ^"* s-L-^ 

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__cir f O F6>h#H 0 , , _ Propert y Owne r 7^r$v-—+j+LL4£ . Tier th e Resident ? D Ye s D N o 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 environmenta l restoratio nservice 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 lea d contaminate dsoi l an dprovid e subsequen t restoratio nservices . You r cooperatio n i ngivin g EPA/USACE/EC C permissio n t 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 work 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 Titl e D J 

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# !Kr, l i 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-U^^'^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) :


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# Propert y Owne r Satisfactio nSurve y For m Omah aLeadSuperfun dSit e Performance-Base dContractin g (PBC ) Pilo t Projec t Remediatio n Contractor : Property Identifie r Number : Propert y BVI D Number : Propert y Address : J ' ^'3" 0 

### Propert y Owner' s Name : Q /T f (abov e informatio n t o b e fille dou t b y remediatio ncontracto r prio r t o deliver y o f for mt o Property 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 work o f th e above-identifie dRemediatio n Contractor , a s applicabl e t o th e soi l cleanu p actio na 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 nyou r opinio nregardin g th e wor k 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 propert y owner. ) 9-1 0 "excellent " 7- 8 "ver y 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 9 4 X3 7 2 6 I 

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

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