### C ONTRACT 

### # 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 29560 Property Address 3836 Maple St Field Work Started 

### 8 /

28/ 2007 Field Work Completed 

### 8 /

28 /

2007 Summary: 

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

## • B I excavation depth was 3 inches below ground surfaces. 

# • B2 excavation depth was 12 inches below ground surfaces. 

# • Drip zone excavation depth was 6 inches below ground surfaces. 

## • Drip zone garage excavation depth was 6 inches below ground surfaces. 

## • Verification samples confinned that cleanup standards were met. 

# • The site was backfilled with material which meets the contract specifications . 

# • The backfill was compacted to acceptable standards. 

# • Sod placement and site restoration were conducted in compliance with the specifications and work plans .

Comments: None



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### 19na**~** Jeff Hubbard USACE Con Reg 

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## 29560 

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# II**III ~IIIM** **~** III' Owner Name: SERT '**ttJo~** ftiiCCARREt Address: 3836 MAPLE ST

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### 325 ppm 

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. .**M~~MI?N:T .** **:** Omaha Lead Site 46130Page 1 of

__________ Omaha Lead Site Omaha, NE 

### u.s. Environmental Protection Agency Region VII Residential Yard Soils Environmental Restoration Services**I)I~(** lIl] R I ') \( (I \
.... {{(1**l~,-** lllll1piLh .. d h\ [J]UPl'll) (l\\ 111..1 \ [\u,\ 1lll l 'll l,t.] 1\11111.1 l,,)l.llllli )llli I,l\l)] Ildllll' .11**1-~rJI) =2~**  (J 1'=" 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 

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### -:SO (Please Print Name) (Date) NOTE: Granting permission DOES NOT necessarily imply your property will be remediated at this time. I'I(()I'I I{ 11 1,\1 olnl \ II()'\ (Ill hl llllll)lkll'd I') ll',,[(klll ,lilt! tll plllpl'J1) U\\lll'J Pk,he [J tll ll) Resident Name:

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### __ !JR . (CITY) , (STATE) (ZIP) Property owned by:**_....:::s~ /lf1,'--'--'''1e** **-=** 

### ___________ ___________ Owners mailing address:

___________________________________________________________ Owner's telephone number

- Home:

____________________ Work: 

## 35/-**<;~91** 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 WIder this a greemeru are pursuant to Section 104 ofCERCLA , 42 U.S . c. 9604 . EPA's right of access to the pro perty for in Section I04 ( e) ofC E R

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A, 42 U. S.c. 9604 (e ) , which provides entry for, "detennining the need for response. or choosing or taking an y response action under this title, or otherwi se enforcing the proviSion s of this titl e. " Access Attempts: First:
______________________ Second:
_______________ Third:

___________________pg._of_ 

## List of Existing Conditions Property Address: 

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## Owner: LOI.s CUI> 

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### Description**N~IJ£**



### Owner Signature Print & 

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

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## ;;21 s 00 Property Owner Is the Owner the Resident? [l..-Yes 

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### CUD"S (J Compliance Statement: U.S. Environmental Protection Agency (EPA) has contracted the U.S. Army Corps ofEngineers (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 AlUSACElECC 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 Prashant Khanna or ECC Project Manager Charles "Skip"Milton Name Title Date Signature 

### PROPERTY OWNER SECTION This agreement documents the completion of remediallrestoration efforts at the property to my satisfaction. [1J./I agree that restoration is completed at my property, except as noted Comments (if applicable):

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## •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Property Owner Satisfaction Survey Form Omaha 

### Lead Superfund Site Perfonnance-Based Contracting (PBC) Pilot Project Remediation Contractor:

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_______________ Property Identifier Number:

________ Property BVID Number: 

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.......... ___________ (above infonnation to be filled out by remediation contractor prior to delivery of fonn to Property Owner) Instructions to Property Owner: Ibis fonn is provided to you as a means of ttying 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. Ibis 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 retum 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 

# C}2--­ 5 4 8 3 7 2 6 1 Additional Comments from Property Owner (optional; continue on back ofpage if needed)

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Property Owner's Signature: Date: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 # 

### 29560 3836 Maple St
XRF Results Date Collected 

# I Quadrant 

# I Sample 

## I Depth 

## I (ppm) (avg.) Type DE B1 3 8/21/2007 252 

### I II II II I DE B2 12 8/21/2007 325 

### I I II II II DE DZ 6 8/21/2007 72 

### II II I I 

# t=gl II 8/21/2007 148 DZ-G 6 

### II II I

SAMPLEID· 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 : Fl or F2 "" Front Yard One or Front Yard Two B1 or 82 =- Back Yard One or Back Yard Two DZ = Drip Zone GA - Garden PA • Play Area EA • Easement Depth descr ibes the depth from which the sample was collected . ppm · parts per mill i on