OLS ID 23772 Property Address 427 N 41S'St 

Field Work Started 9/5/2007 Field Work Completed 9/6/2007 

Summary: 

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


F1 excavation depth was 3 inches below ground surfaces. 


F2 excavation depth was 6 inches below ground surfaces. 


Drip zone 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 were conducted in compliance with the specifications and work plans. 


Comments: Per owner's requests: Shrubs (LIPI, 4' x lo', 428ppm), Flowers (LIP?, 3' x 207, 

490ppm), Shrubs (LIP3,6' x 36', 137ppm) were left in place. 

DJJJ ECC OCM 

Name Title ate ature Jeff Hubbard USACE Con Rep 11- $07 

Name Title Date ~i#&hre 
Analytical Results Summary 

OLS # 23772 

427 N 41StSt 

Quadrant Sample 

TYpe 

Depth Date Collected XRF Results 

(PP~)(avg.1 

SAMPLE ID-- SAMPLE ID is a particular residential property ID 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 = During and Post Excavation 

- Quadrant describes the sampling location (with sequential sample number for that location) as follows; 

FI or F2 = Front Yard One or Front Yard Two 

B1 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. 
U.S. Environmental Protection Agency (EPA) has contracted theU.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 is requested in giving EPAIUSACUECC permission to accessyour property during the 


removallrestoration phase. For further information please contact Don Bahnke, €PA Project Manager at (913) 551-


003 or the Office of External Programs, at 1-800-223-0425. I 

Property Access Granted By &w u,.?b@&) 

(PleasePrint Name) 

3-90- 03 

(Date) 

- 7 

- -

~ v v o r ~ - = = m OPERTY INFORMATION 

f and orproperfy owner - Please Pnni) I 

Resident Name: SdkdN uM&xd Ker renter I I Residence Address: %? 4l Ln-- O/ulA/M ,hlk 

I ' (STATE) (CITY) (ZIP) 

IProperly Owned By: ~#Mf 

Owners mailing address: 

' 

Owner's telephone number - Home: 32Y - $!p Work: 2 Ibge of Home? years How long have you lived here? years 

Has the exteior been painted or covered with siding since 1978? Yes 

Has the interior been painted or covered since 1978? Yes I 

otal number of occupants: 

Ibis1 ages of occupants under 6 years old who play in the yard for 5 or more hours per week: 

Comments: I 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS 

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCCA. 42 U.S.C. 9604. EPA's right of access to 

the property for in Sectiol 104(e) of CERCLA. 42 U.S.C.9604 (e),which provides entry for ."determiningthe need for response, or choosingor 

:

taking any response adion under this tiUe, or otherwise enforcing the provisions of this tlle." 

Access Attempts: 

First: Second: : Third: : 
l 

Ref: I 

Photo Description 

# 
L,

ll:.h Mfiyof 

CY-IANGES REQUESTED: I 

ACTION TAKEN: 

r 

SUPERVISOR INITIAL 


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 EPA/USACE/ECC 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 Bahnite, 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 

Prashant Khanna or I ECC Project Manager 

Charles '-
 A 1 

Name Title 

\ Snu*csD*C?\A 

/ / 

This agreement documents the completion of remedialtrestoration efforts at the property to my satisfaction. 

01;agree that restoration is completed at my property, except as noted 

Comments (if applicable): 

1') ‘P&N&lf F+t?dv DOW~SPOVT 70 S*Q@r @way PVC PP,P~\ 

PboFrty Owner's Signature Date 
Property Address: '/a? A/ Y/ST 

Property Owner's Name: #A hr LubLd CI> 

(above information to be filled out by remediation contractor prior to delivey of form to Property Owner) 

.............................................................................. 
Instructions to Prowrtv Owner: 

This form is provided to you as a means of trying to captureyour level of satisfaction 

with the work of the 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 of Engineers (USACE) are very interested in your opinion regarding the work performed by our contractors. Thisform is intended to provide an easy means for you to express your 

opinion about the work performed on your property. 

Please indicate your level of satisfaction with the Contractor's work by selecting a 

numerical rating (ranging from 1to 10) using the following rating scale, then please sign & date 

the form and return it to USACE in the attached self-addressed & stamped envelope. (Additional 

comments may also be provided in the space provided, at the option of the property owner.) 

9-10 "excellent" 7-8 "very good" 5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Pro~ertvOwner's SatisfactionRatine tw~ardin~Contractor's Work 

Additional Commends from Prowrtv Owner (o~tiond: continue on backof ~apcif needed)