## TRANSMITTALo f

OMAHALEA D SIT E SOILREMEDIATIO NFIL EFOLDE R SAID^: _y_lk_
. Date ; ^ 

# n(i i Addres.s : U? ^ 1 ^ ^ [ ^ ^ H Y Remediatio nContractor ; Coasta l Environmenta ) Group

_Year ; 2010ARR A
SOILREMEDIATJO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# A Vide o o f property (DVD ) / 

### Executiv e Summar y / 

### EPA-provide dproperty sketc h Signe dAcces s Agreement fo r subject properl y 

# y Signe dAcces s Agreement(s ) fo r adjacenl properl y 

# y Restoratio n Agreemen t Sefllemen l document s (i.e. , fo rdamag e o rt o repJac e plants , etc. ) Confirmatio n dat a 

# y Pholograph s \( t 6^^/l"1l< ^ ^ t> ^ <WAtu^ o V ^G ^ As-buil l sketc h 

# y Satisfactor yrestoratio n signe d b yPropert yOwne r 

# 7 Propert yclose-ou t chec k lis t signe d b yEP A • /

Descriptio n ofarea s no t meetin g RO D cleanu p criteri a 

### /
. Utilit yclearance s 

# 7 Propert yinforjnal ^ fro m Dougla s Count yAssessor' s Offic e 

# y l

3023742 2 

# • 1 1 Superfun d

# ^ v Propert yAcces s Checklis t PropertylD ^ j/]C^' [ D WOR K STARTE D ON : __/__/
_ D WOR K COMPELTE D ON : / l_ 

### Property AddressT jl^Zo/l/"5 1 '^zYF ^ Owner : IY \ ^

^^ ^ 

### Srn Address : 

# lists'^^ 1 -ST Phone : (MQ Q ^ j'b ^ ^ Fax : Cell/Pager :
D Notificatio nLette r ^!<^Acces s Agreemen t l^r Restoratio nAgreemen t UTopsoi l Samplin g (i f applicable ) O Disposal Samplin g (i f applicable ) D Garde nSamplin g (i f applicable )
^ UtiUt y Clearanc e [^;3^ideo/Photo s (Before ) t ^ Video/Photo s (During ) D Video/Photo s (After ) nVideo/Photo s (30-Day ) Q Propert y Completio nAgreemen t D Fina l Repor t Ai r Monitorin g (a s applicable )
• Communit y • Cre w On : Results :

• Communit y • Cre w On : Results :

• Communit y • Cre w On : Results : Sent : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

/ / 

### Signed : ijr^i^lfX ) Svgned : _lJ2 l ZZ/l O 1 1 1 1 1 1 Called : ^ v / t ; / v o 

### On : ji^ii£^4y y On : / / On : / / On : / / Siened : / / Issued : / /
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### Dougla s County Accoun t In : Pag e 1 of 2 % " Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f2010-8-3 0
Owne r JOHNSO N MAR Y 161 8 N 3 1 S T OMAH AN E 68111-000 0 Propert yInformatio n ­ R162749000 0 Prin t Repor t Vie wInteractiv e GI S Ma o

Treasurer' s Ta xReoor t Ne wFeatur e ••-•• •Subdivisio n Sale s Searc h

Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n Lan d 201 0 200 9 200 8 200 7 200 6 200 5 Lan d Informatio n Acre s S F 274 9 000 0 1 6 Residentia l 162749000 0 162 0 N 3 1 S T OMAH AN E 68111-OOO O LINDSAY S AD D LO T3 BLOC K0 3 1 X 104. 5

$500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0
Unit s Deptt i Widti i Vacan t 0.0 7 3224. 0 0. 0 104. 0 31. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R162.
. . 9/2/201 0

### Pag e 1 of 2 ^ " > yCreat e Anothe rTicke t ] [ Bac k to Irt h Interne t 

### Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2635824
. Origina l Cal l Date : 11/05/1 0 Time : 12:2 9 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/09/1 0 Time : 1:0 0 p m State : N E County : DOUGLA S Plac e : OITIAH A Address : 16 2 0 Street : N31S T S T Twp : 15 NRng : 13 E Sect-Qtr : 16-l W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL LCLEAR S TO : (877)662-421 1 : UISrSUR EI FCORNE RLOT
. Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F OPPDGPR S QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

### Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/5/201 0

### Pag e 2 of 2 

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OPPDGPR S OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/5/201 0

# As-Buil t Drawin g *^ COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2619 6 Dat e Excavated : 11/11/201 0 Dat e USEP ASiqne d Off : 12/2/201 C 

### 2619 6 Are a Sodden : 155 0 s a f t 0«me rName : MAR YJOHNSO N Address : 162 0 N 3 1 S T

Phone : H Sampl e Numtje r RYASCPXA-2619 6 F 1 RYBSCPXA-2619 6 F 2 RYCSCPXA-2619 6 B l RYDSCPXA-2619 6 B 2 RDZSCPX A2010 0 •RGZ5CPXA-20I9 0 -xs z RPZccpxA-aGioe—PZ Omah a Lea d Sit e Sit e Sketc h w : Lea d Concentratio n Sampl e Collecte d LA B _jQj4_pp m 

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Omah aLea dSite 4613 0 

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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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# 2619 6 

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\ Owne rName : MARYJOHNSO N Address : 162 0 N 31 ^ S

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### CoiiJ?eri \ lo l Acc(i$;i ^ 'l o froptiit y RIGH TO F ENTR YT O PREMISE S 

### Granto i (th e property ' owner) consent s t o an d authorize s th e Unite d Stale s Environmenta l Protectio n Agency(EPA ) o i it s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : .-7 ^ ty 2 / 

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. Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o rts origina l condition
. Thi s wori < i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d byUSEPA
. wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 of2

# Y ' > 

# /Yy'-' ^ ^ ^ ^ COA S 1 Ai 

## \yy 7 

## f t •VtiOhh ffTi l C « 0 L ' ' 

### Remov e obstruction s incluciin g boats , traileis , vehicles , playscap e items , woo d piles , do g houses , etc , Remov e flovv'e rbulb s o i plant s tha t th e Granto i o i th e Grantoi' s tenan t ma ywis h ( t o save ; Wate ran d maintai n leplacemen t vegetation , includin g fertili2e fapplication , a s necesssP) ' subsequen t t o a n initia l waterin g perio d b yEPA ; < Abid e b yhealt h an d safet yguidanc e piovide d b yEPA , > I fth e property ' i s rented , assis t EP Ai n obtainin g tenan t approva l fo i acces s t o th e property ' t o perfor m th e work
. I Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT o INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe i wit h an yo fth e v/or k activities , o i wit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9

[ 0 I gran t acces s t o m ypropertie s • I d o no l gran t acces s t o mypropertle E 

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## Restoratio n Agreemen t Th e purpos e ofthi s agreeinen t i s to provid e amutual agreeme ma s l o condition s ofth e property prio r to remediatio nactivities
. Thi s will als o ser\' e a s documentatio nfo r th e purpos e o f assurin g iha l resloralio n activitie s are complete dto th e satisfactio no f th e property owner andth e Unite dStale s Environmenial Protectio nAgenc y (EPA)
.

Propert j Propert y Owner : Phone : ID :

. \ddress : 

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# e e / Al^thi;* ' 

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### Onlhe attache ddiagrani(s ) indicate area(s ) to e.xcavale , surfac e structure s andlandscapin g feature s an d acces s location(s ) lo b e usedby lh e contractors . Indicate distances , depths , materia l types , etc . Photographicall y an dVideographicall y document th e existin g condition s ofth e propert y an dth e basement i

f necessapv'
. 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : . 

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### Ite m l're-e.\istin g propert y area , tha t wil l b e exca\ated
. that I S covere dwit hgras s Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s ' = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves
. Timers
. Heads , et c \Iliicl l ; i skelc hi> l ih c spimklc i kiNou i Numbe r o f an dsiz e o f eac hgarden ' flowe r be d area . Nil,I k l l : i sl

- cicl i 1^1 iclaii'
. c •-]/.<.- • ;IIK Ili \alii'ii s .Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . \()i i ilii v Milli e \\'\\ \h i ;|vi>( l 1( 1 issij c 1 1 |j|illl l .(HH'lu i l o li u pmpcii x in\nil , Easemen t Area , t o b e excavate d 

### Quantit y 

# 3 1 8 2

e ^ Landscap e Inventor y Uni t Quadrant s

Eac h
Eac h

Eac h

Eac h Squar e Fee l 

### Condition/Type/Specie s

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Pag e 2 o fCOASTA L cR o 1. 1 ^

p N r
Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. I i Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

O Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
.

^ I agre e I I I d o no t agre e 

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## Certificat e o fVerificatio n

8 5 SOI L 2011-01-2 5 14:4 0 90.7 7 Fina l Av g o f82-8 4 162 0 N 3 1 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 223.41 4 Supervise d By : 

## Certificat e o fVerificatio n

8 2 SOI L 2011-01-2 5 14:3 9 30.3 3 Fina l 2619 6 162 0 N 3 1 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.93 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 229.61 9 Supervise d By : 

## Certificat e o f Verificatio n

8 3 SOI L 2011-01-2 5 14:4 0 30.2 3 Fina l 2619 6 162 0 N3 1 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±23.08 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 143.82 9 Supervise d By : 

## Certificat e o fVerificatio n

8 4 SOI L 2011-01-2 5 14:4 0 30.2 1 Fina l 2619 6 162 0 N3 1 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 18.93 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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Supervise d By : 

## Certificat e o f Verificatio n

8 1 SOI L 2011-01-2 5 14:3 8 90.6 2 Fina l Av g o f 78-8 0 162 0 N3 1 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 201.30 9 Supervise d By : 

## Certificat e o fVerificatio n

7 8 SOI L 2011-01-2 5 14:3 6 30.1 8 Fina l 2619 6 162 0 N 3 1 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.05 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 195.73 8 Supervise d By : 

## Certificat e o fVerificatio n

7 9 SOI L 2011-01-2 5 14:3 7 30.2 6 Fina l 2619 6 162 0 N3 1 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±21.86 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVID ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 207.29 9 Supervise d By : 

## Certificat e o fVerificatio n

8 0 SOI L 2011-01-2 5 14:3 8 30.1 8 Fina l 2619 6 162 0 N3 1 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.87 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o fVerificatio n

7 7 SOI L 2011-01-2 5 14:3 5 90.6 9 Fina l Av g o f74-7 6 162 0 N 3 1 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 179.48 6 Supervise d By : 

## Certificat e o fVerificatio n

7 4 SOI L 2011-01-2 5 14:3 4 30.3 5 Fina l 2619 6 162 0 N3 1 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±20.62 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 138.60 8 Supervise d By : 

## Certificat e o fVerificatio n

7 5 SOI L 2011-01-2 5 14:3 5 30.1 6 Fina l 2619 6 162 0 N3 1 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 18.78 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 7 6 Mod e SOI L Tim e 2011-01-2 5 14:3 5 Duratio n 30.1 8 Sequenc e Fina l Flag s BVI D 2619 6 ADDRES S 162 0 N3 1 S T QUADRAN T B l DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r P b 144.13 2 ±18.81 6 Supervise d By :

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ( f^ Coasta l Environmenta l Grou p Inc
. v \ 

### \ "' " Z ^

www.c0astaiha2mat.co m '^ i P„o^yCOASTA L ENVIRONMENTA L CROUP , IN C 

# EXECUTIV ESUMMARY : BVI D #26196-(162 0 n3 1 st )
N o Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :

## EP APropert y Clos e Ou t For m 

# \^V o •^ ^ "y Y Y Proptrt y # : 

# t G

# 1 1 (
. Date/Time : Quad s Excavated : V | i f Contracto r Crou p (y^W ^
_ Ye s N o Excavatio nGenera l 1
.If necesswy , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2
.If necessary , wer e th e correc t area s ofdri p zone excavale dan drestored' ' / Ye s N o Doe s th e gradin g aroun dth e pcrimeie r ofth e hous e i nexcavaicri area s generall y slop e awa y Gradin g So dan dVegetatio n 

### / fromth e house ? 

### / 2
. Ha s so dbeenlai dinall area s that wer e excavated ? 3 Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a'SQ i 

# y da y tim e period ) 4
..Ar e sodde darea s generall y firman devenl y graded ? 5Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period )
. . „ . 

# y y 6
.Wa s the property grade dsuc hthai wate r wil l no t poo l onth e property' ' 

# y - 

# V 7
. Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Fence s an dRetainin g Wal k Ve s Nc j I
.D o gale s openandclos e freely ? f I f applicable ) 2
.Wer e all gate s or fence s take ndowndurin g restoratio nacliviiie s reinstalled ? (Ifapplicable ) 

# Y I'^ Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

# ~ y 'I Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# ' Y
Foundation , Sidin g an dGuMer s 1 Wa s damag e t o th e sidin g o r tri mavoided ? 2
. Wa s damag e t o (he foundatio navoided ? Ve s / / N o

1^ Wa s damag e l o window s avoided' '

Wa s damag e t o window s o r doo r screen s avoided ? / / 5 Wa s damag e i o down.spoiit s o r downspou i extension s avoided' ' / Sidewalk s an dDriveway s (Concrete ) I 1 Wa s damag e l o drivewa y surface s avoided ? Ye s 

## y N o
2
. Wa s damag e t o walkwa y surface s avoided' ' /

## Owner s comments :

j !n.";pectiio nnotes :

Removal andrestoiatio nactivate s complete includin g the 30-da Y so dwarranry : HP ARepresentaiiv t Qc ^ ^ Date : i:z44ic.__
.%

-% 

## Propert yCompletio n Agreemen t
Thi s ajiiecmen i documents lh e complclio n ol remedia l aclivme s perlonne don mypioperi y Mysignalui e wil l designat e iha l I am satisfie d wil h lh e restoratio n of mypropeity
. an d Iha l no item s ar e m question s now , or al an ylim e m th e future , excep l ihos e ilem s hsle d below , ifan y



## '?D^f ^ Restoratio n Item s in Question :

Item : Item : Item : Item : Item :
Additiona l Comments :

F v l I a(;rc cir^toriiljo n is complcled , rxctp l it s noler i l._ J ' '^^ "" ' a^if crfsloratio n is complete d 

### /c 2 

### - / . /c ? 

# t /Iy . Owner' s Signatnr Dal e Dal e natnr e e C^nf i ailo i 's SicnaliiM '