### 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 27592 Property Address 1504 Yates St Field Work Started 9 /

21 / 2007 Field Work Comp leted 9/22/2007 Summary: 

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

# • Fl excavation depth was 5 inches below ground surfaces. 

# • B2 excavation depth was 

### 12 inches below ground surfaces. 

# • Verification samples confirmed 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 of the home owner.

Comments: None
ECCOCM

# I~**Pc o+** 

# diid h- Y' Title Date . ature Jeff Hubbard USACE Con Rep 

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# ~ Name Title Date Si e

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# _--_.---­ 275'12 North Arrow Owner Name: 

## &Kteenth ('it. 

## Ltd Omaha Lead Site Address: 

### Hm'l 

# Yate9 de Parlner:ltr ite Sketch Phone: H : ----- 

### W:.3i5'- 7.3f[C 

# ---

Exterior Paint 

# o Good 

# o Poor 

## Q( Not paint Team 

## XLotle OLS·_.J.-'.aL

____ XRF Code 

### tZ75" Quadrant Lead Concentration Date FI 

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• • • • _ •••••• ••• •••**~** • •••• '••• •••**~** •••••**~** • ••••**~** •••••**~** ••• •• : •••••**~** •••••**~** ••• • •**~** •••••**~** 046141 .0 1.2.3Page 1 of

_____ Omaha Lead Site Omaha, NE 

## u.s. Environmental Protection Agency Region VII Residential Yard Soils Environmental Restoration Services**PI~(** Jill R I" \l( I**~'"** (It) bl' l(llllpklL,1 b\ PIOp
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..**~ ~** **_~** .. (J 1:2" Grantor (the property owner), consents to and authorizes the United Sates Environmental Protection Agency (USEPA) or its authorized representatives (or its contractors), the Grantee, to enter and perform certain environmental response activities upon the following described premises. For further information please contact EPA at 1-800-223-0425. Property Access Granted By 

# !11 ; c\.,,,<l 

# '***S" c.** **~\'Z...** (Please Print Name) (Date) NOTE: Granting permission DOES NOTnecessarily imply yourproperty will be remediated at this time. I'RO!'I RI\ 1,\1 (lI\\1 \ IIU,\ (Itl hL**LUlll~'ktl'lllJ\** Il'''llkllt .lIlt! III )1ltll1l'tl) t)\\ 111
..'1 " PI..',j"'.' PI lilt) Resident Name: _--UV:.LS"C
.....

"'f!I.!>tV'-"yL-...!.J-.=OILLT

_____ DOwner 

## o Renter Residence Address:**_/,--,Si""--"O"-'t-,-~'(Itu..LTl-",-,,.s,,--,,.:s<Jr,--_** (CITY) (STATE) (ZIP) Property owned by: 

### j{pTiJ sTfCtCr LIM/UP 

## P IM TN!/? S/fIP Owners mailing

### address:·**_~.2.""-J"'-",Q."-I/'---'N"'--_"J"_'I_" ---,,** **,,-,r'---_--'OL.LLJMUJ.t!<LJ.l.If11-'-7;q ---"1\.J"-1E~--,h",,-,,,?.L'/JI..!()~_**  Owner's telephone number
- Home:

__________ Work:

__________ Age of Home?

_________ 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 Section 104 ofCERCLA. 42 U.s.c. 9604. EPA's right of access to the property for in Section 104(e) ofCERCLA, 42 U.S.c. 9604 (e), which provides entry for, "determining the need for response, or choosing or taking any response action under this title, or otherwise enforcing the provisions of this title." Access Attempts: First:
___________ Second:

________ Third:

_________

## List of existing Conditions pg._of_ Property Address: 

# 150<4

# ~Q+e:s 5+ owner:\Lo-5tree1 

# Umded Date:2)2:DlDloLSID#:

# Q159~ Description: 

# DOQe<

Owner Signature: ASW Associates Inc. Print & 

### Sign Print & 

### SignContract No. W912DQ-04-D-0017, Task Order DKOI Omaha Lead Site, Omaha, NE Property Closeout Agreement DVID Property Address 

# I /S7) I{ I(

## ~TES Property Owner Is the Owner the Resident? 

## 0 Yes lIJ.--1iio Compliance Statement: U.S. Environmental Protection Agency (EPA) has contracted the U.S. Army Corps ofEngineers (US ACE), 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/USACElECC 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 ofExtemal Programs at 1-800-223-0425. Additional Comments by USACE and/or ECC:

CONTRACTOR CERTIFICATION

# ~~:::**Jam~D!'!7\a/.** ECC Project
- -_!.II_a_g_er_-+-:::-

____

# --t--::::---::>"'""f-,_~ ........ 

# ""'....,.'--_--1 Namf

# ~.'**~~erintendent** Date

# sr~ 

# IY . PROPERTY OWNER SECTION 

# f' This agreement documents the completion ofremediallrestoration efforts at the property to my satisfaction. I agree that restoration is completed at my property, except as noted Comments (if applicable):

Prolfefti Owner's Signature**~** Date

## Property Owner Satisfaction Survey Form Omaha Lead Superfund Site Perfonnance-Baseel Contracting (PBC) Pilot Project Remediation Contractor:

__**..J.E~C""CI.-** 

### _______________ Property Identifier Number:

________ Property BVID Number:**~** 

## ?s 9' ,J Property Address: 

### /SOI.{ 

## 'lltT££ Property Owner's Name: 

## ItRTJ)**sr~Ur** '-IMITE/) 

## PtttTNflcSIfIP (above infonnation to be filled out by remediation contractor prior to delivery of fonn to Property Owner) ****************************************************************************** Instructions to Property Owner: 

### lbis fonn is provided to you as 

### a means oftrying to capture your level of satisfaction with the work ofthe 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. Anny 

### Corps ofEngineers (USACE) are very interested in your opinion regarding the work perfonned by our contractors. lbis 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 I to 10) using the following mting scale, then please sign & 

### date the fonn and retum it to USACE in the attached self-addressed & 

### stamped envelope. (Additional comments may also 

### be provided in the space provided, at the option ofthe property owner.) 9-10 "excellent" 7-8 "very good" 5-6 "acceptable" 3-4 "poor" 

### 1-2 "very poor" Pro e Owner's Satisfaction Ratin 

### 10 5 9 4 8 3 7 2 6 1 Additional Comments from Property Owner (optional: continue on back 

## or page ifneedeel)

### CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation US Army Corps 

### Omaha Lead Remediation, Omaha, NE of Engineers 

### Analytical Results Summary OLS # 27592 1504 Yates St Quadrant Sample Type Depth Date Collected XRF Results (ppm) (avg.) 

### DE F1 5 9/19/2007 97 

### DE B2 12 9/19/2007 53

SAMPLEID· SAAIPLE 10 is a particular residential property 10 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 :a: During and Post Excavation Quadrant describes the sampling location (with sequential sample number for that location) as follows ; FJ or F2 "'"' Front Yard One or Front Yard Two BI 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