### CONTRACT # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE us Anny Corps of Engineers

ECC Certification for Property Closeout

OLSID 28403 Property Address 2018 Willis Ave. Field Work Started 9/20/2007 Field Work Completed 9/22/2007 Summary: 

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

## • Fl excavation depth was 8 inches below ground surfaces. 

## • Drip zone excavation depth was 0 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 owners request Bushes (LIPI, 2', 432ppm) were left in place.

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## OVoV. J ECCOCM 

# tcJL3Ulo+ Name Title Date re 

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Jeff Hubbard USACE Con Rep II } 

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# 1m Name Title Date 

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## 28403
Exlerior Paint Owner**Name~** PLEASANT GREEN 8A?T1ST Omaha Lead Site 

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### Site Sketch Ad dress: 2018 WJLLIS AV 

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. CONTRACT 

### # W912DQ-04-D-0017, T.O. DK04 Environmental Chemical Corporation Omaha Lead Remediation, Omaha, NE 

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us Anny Corps

of Engineers 

# ., • ECC:.



### Analytical Results Summary OLS#28403 2018 Willis Ave

Quadrant Sample Type DE F1 DE DZ DE EA-S' 

### I I I I 

# I Depth

8 0 0 

### II II II 

### II 

### II Date Collected
9/22/2007 9/22/2007 9/22/2007 

### I I II II II XRF Results (ppm) (avg.) 67 154 217 

# I II 

# I II 

### I

SAMPLEIDSAMPLE 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 BI or 82 = 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 millionpg._of_ 

# List of Existing Conditions Property Address:

# ~Q12 l<)lflj 42 

# Avf.- DVD 10 

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# 8403 l-ecfflf)'t**0~** Owner:

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# exuats Date: 

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Ref: Photo 

### # Description

Owner Signature 

### ECC Print 

### & Sign Print 

### & Sign

## page 1 

## of_ 2t34D Omaha lead Site Omaha, NE Residential Yard Soils Environmental Restoration Services U.S. Environmental Protection Agency Region VII 

# '. PROPERTY ACCESS (to be completed by property owner) ;::,ara**~E~** bl{ es:a**rc~"'~a** en**es;:a~vl** ::Jf favor**1iJr~,:e** 21 &OJ 223**~'a:S** 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. Environmental Chemical Corporation (ECC) to remove lead contaminated soil and provide subsequent restoration USACE Omaha is working with

(Please Print Name) 

# 1-0Z-0? (Date) services. Your cooperation is requested in giving EPA/USACEJECC permission to access your property during the removal/restoration phase. For further information please contact Don Bahnke, EPA Project Manager at (913) 551· 7003 or the Office of External Programs, at 1-800-223-0425.
Property Access Granted By 

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NOTE G f 

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### • DOES NOT 1 . 

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___________ __**~___** _ _ __ _ __ _ __ _ _ _ __ __ J PROPERTY INFORMATION (to be completed by res/dent and or property owner· Please PriM)



## , ( list Ages: 

### ----------------------11 Owner's telephone number

- Home: ijiJ,2

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## &q, 27 Work:

_ ........**'O"";;';~.;..&-~** Age of Home?

# ~, 

# c50 years How long have you lived here?
Has the exteior been painted or covered with siding since 1978? Has the interior been painted or covered since 1978? 

# at' Yes
Irotal number of occupants: 

### (1

## L.~ list ages of occupants under 6 years old who play in the yard for 5 or more hours per week:

_ Comments: AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS The activities to be implemented by EPA under thiS agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to he property for in Section 104(e) of CERCLA, 42 U S.C. 9604 (e). which provides entry for. "determining the need for response. or choosing or aking any response action under this tllle. or otherwise enforcing the provisions ofthis title." Access Attempts: Resident Name:

# P1~**Gre~ &"h~**  

# l:**~J ~wner**  

# o renter 

## 'A Residence Address:

## H~**uJ,IIr'~ /1V~**  (!)rna)UJ 

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/J1YJlf, Property Owned By: (,)_'**~~~~~~~~~_~~~** _

First: Second: : Third: :
_ ... I

### Contract No. W912DQ-04-D-0017, Task Order 

### DKOI Omaha Lead Site, Omaha, NE

BVID Property Address 

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## f ltJILL/r;; A-Ll**~~s.;{)s** 

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### Property Owner ls the Owner the Resident? DYes 

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### Compliance Statement: 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 EP A/USACEIECC 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 of External Programs at 

### 1-800-223-0425. Additional Comments by USACE and/or ECC:

CONTRACTOR CERTIFICATION PrllSftant Khaftft8 eT

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### Signature TitleEGQ..

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## ::5W1Py I 

## n t2.n lUI 

## PROPERTY OWNER SECTION This agreement documents the completion of remedial/restoration efforts at the property to my sati sf action.

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

### Comments (if applicable):

# XM~()gL .
I 

### tPropertf Ownfr's Signatu re Date 

### J



### j- e:lS--d 

## 7

## Property Owner Satisfaction Survey Form Omaha Lead Superfund Site Perfonnance-Based Contracting (PBC) Pilot Project 

# ECc Remediation Contractor: 

# ----==-=-=""""----------------- Property Identifier Number:

_ Property BVID Number: 

### .Jg**to~** 

### Property Address: 

### ;).()/8" lUll-LiS. 

## !lv Property Owner's Name: 

### P/"fI}SftNr fi/2U)1 88? 

## nSf CIt 

## 'fe-II
(above information to be filled out by remediation contractor prior to delivery offonn to Property Owner) 

### ******** •••••• * •••••••••• ***.* •••• * •••• * •••••••••••••• *.**** ••• * •• * •• *.*.*****
Instructions to Property Owner: This fonn is provided to you as a means of trying to capture your 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. Army 

### Corps of Engineers (USACE) are very interested in your opinion regarding the work perfonned by our contractors. This 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 1 to 10) using the following rating scale, then please sign & 

### date the fonn 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" 

### Property Owner's Satisfaction Rating regarding Contractor's Work 10 5 9 4 8 3 7 2 6 1 

### Additional Comments from Property Owner (optional; continue on back of page if needed)

Property Owner's Signature:

# f~-- Date: 

## 1/-25"-0'7