TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 'K<o\ Date: ^ u \\\ 

Address: 'hl'hQ '^}m\-^ 4r 

Remediation Contractor: CoastalEnvironmental Group_ Year: _2010ARRA 

SOIL REMEDIATION 

PROPERTV FILE FOLDER DOCUMENTS 

1/ Video ofproperty (DVD) 

y 

/ 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject properly 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Settlement documents (i.e., for damage or to replace plants, etc.) 

Confirmation data 

Photographs ( K S^^I^IIO M ^ 6^AAVl^1?ot^ \ h^^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

y Property infomjation from Douglas County Assessor's Office 

D 

Signature 

30237327 

Superfund 
Property Access Checklist 

PropertylD: i^^ ^ / n WORK STARTED ON: / / 

PropertyAddress; 3$^^ ^ l-hhrvUl ^ n WORKCOMPELTED ON: / / 

Q^"*"" Renter: - i\AhjyU^ 

Address: ^ Phone: 

'^yjQyy^JL- Fax: 

Cell/Pager: 

Phone: ^S^ " SllZ/<Sl'-"^^ ^ Additional Inforniation: 

Fax: 

Cell/Pager: 

D Notification Letter 

Succes s Agreement 

K[^^ Restoration Agreement 

D Topsoil Sampling (if appUcable) 

n Disposal Samplmg (if applicable) 

D Garden Sampling (if appUcable) 

H UtiUty Clearance 

t^Video/Photos (Before) 

\ IJ Video/Photos (During) 

D Video/Photos (After) 

n Video/Photos (30-Day) 

Q Property Completion Agreement 

n Final Report 

Air Monitoring (as appUcable) 

• Commumty • Crew On:

Results: 

G Community D Crew On:

Results: 

• Conununity • Crew On:

Results: 

Sent: /

Signed:/^ /

Signed:^ /

/ / 

/ / 

/ / 

/ 

 l^// 0 

/^/ ^ 

CaUed: _il/i_/Ao . 

On: J O Jff J_0 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

/ / 

/ / By: 

/ / By: 

Omaha Lead SNa 

By: 

By: Xvi^«.< 

By: tsi^tlt 

By: 

By: 

By: 

By: \vl-^/\o VWAx. 

By: v»\o< 

By: 

By: 

By: 

By: 

By: 1 

1 
Douglas County Account I r^^^tio n Page 1 of2 

Douglas County, Nebraska Property Record - R2029770000 

Print Report 

View Interactive GIS Mao Information is valid as of 2010-8-30 Treasurer's Tax Reoort 

New Feature ••->• • Subdivision Sales Search 

Owner 

L0PF7 ANTONIO 

3220 HAMILTON ST 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 2977 OOOO 20 

Account Type: Residential 

Parcel Numtier: 2029770000 

Parcel Address: 3230 HAMILTON ST 

OMAHA NE 68131-0000 

Legal Description: PROSPECT PLACE LOT 8 BLOCK H S 1/2 LT 7 & E 10 FT S 1/2 

Value Informatio n 

Land Improvement Total 

2010 

2009 

2008 

2007 

2006 

2005 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

$1,100.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4320.0 0.0 72.0 60.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R202... 9/2/2010 
Page 1 of2 

% 

"> 

I Create Another Ticket [ Back to Irtii Intemet I Send Email 

• YOUR TICKET NUMBER IS 2630921. 

Original Call Date: 11/01/10 Time: 10:58 am Op: ELIZABETH18790 


Work to Begin Date: 11/03/10 Time: 11:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3230 Street: HAMILTON ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtUity Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITYOFOMAHA-TRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/1/2010 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

At: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/1/2010 
OLS#: 25501 ^ ^ As-Built Drawing ^ ^ Date Excavated: 11/4/2010 

Date USEPA Sianed Off: 11/23/2010 

COASTA L (Jmaha Lead Superfund Site Area Sodden: 1590 sa ft 

26r-523/ 

Name: /}/t/^,\> /<>/»(??• . 

Address: 1i^-ic/jf4jmi7o',j.t,T 

Phone: SST'91,5 7 

Oinaha Lead SKe 

Site Sketch 

Date:

Time:

 f/(3/e>S-. 

i- • vtf 

NorthArrow -

Team cs/^y ^ y4'St—> BVID # 3 S^^i> / XRF Code 1037 ^ooij: 13 Z 

Sample Numt)er Lead Concentration ConfinTiatlon Sample 

fZ)fA5£.^XA­ T.'SSOi 

/g 6

7^ T

7^ 7 ' '

—

 PP'" 

 PP'" 

 ppm ppm 

 ppm 

ppm 

ppm 

f t Yes n

f 2 Yes O

J/ Yes a

fla Yes C3

ves P 

ves • 

Yes • 

GJ

 No TM ^ 

 No 5 / 

 No g ^ 

 No s^r 

NO P -

NO P 

NO P 

 zs 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch 

i g Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
^ ^ 2^6"^ / 

Name; ^Jffo^,h Lojoe^z. 

Acidress: 3^'^o//4^»^2£7c>f^^T 

Phone: 551'fbS l 

Omaha Lead Site 

Site Sketch 

Date:

Time:

 -7^37^1 -

 X-'^ o 

North Arrow V 

Team Cs7<.^y^ x^su- J BVID # D j-j ^ / 

S^ffiH-A I><vt^'i t-O-lZ-osr n'<^''P n 

XRF Code 103 1 Booti-' 13 2 

Sample Number 

fZYA5CP%A - 'Z<5S0\ 

Lead Concentration 

/gf t PP'" 

j^^ ^ ppm 

"L' , ' Dom 

f l

f 3

{?/

5 i

Confirmation Sample 

 Yes a No 2; ^ 

 Yes Q No ^ 

 Yes a -• ­ ^ 

 Yes tD 

Omaha Lead Site 46130 
z.^€roi 

Name: 4AAA7 D LopAZ . Omaha Lead Site Date: r/ts/^ r NorthArrow 

Address: 3i» 3o f/At-'^utOfsi i-T Site Sketch Time: JL-v<> 

Phone: gg7-9fc5 7 \ 

Team €Ls7^^^ •^jt O BV1D# Oi"5Z> / _ XRF Code t03 7 BooiJ : 132 

Sample Numt>er Lead Goncentration Confirmation Sample 

P/ Yes a No 2 ^ 

j§T " ppm f 2 Yes a No 5 ^ 

J / Yes a No ^ 

j^* ^ * ppm 6 l Yes C3 No E" 

ppm Yes D NO D 

— ppm V65 Q NO O 

" ~ ppm Tta • NO • 

ET m 

^^£fiE £ 

StPlS 2IIIIL 

+• y *~Vn y—^ 

t — t 

2.71 7i?7 

6/ iS:2 

- 1 

/^/ fz 

N7 158 

\ 

eu^ TM^Mce* 

U M H 

JTJfmxZriJj s y 

Otnaha Lead Site 46130 
...-'^"-',,. 

'7-.y 

t O - £ 1 A I E^ Vltto^KI , it. 1 

c I o l l » ^ c 

C:OIIJ:BII\ ft)! Acc;oj;i--. 'i o Tiopc-^iiy 

RIGHT OF ENTRY TO PREMISES 

Granto! (the property' owr^ei) consenlK tc and aulhorizes the Uniled Slates 

Enviionmental Protection Agency (FPA) oi its aulhorized representatives, collectively 

the Grantee, to enter and perfornn certain environmental lesponse activities upon the 

following described premises: -•cr-zr—VJ9 / 

Ovvnei ivnei's Name: A i 

V-vJ? 

Address of Property 

covered by this i;i?) Q Hcvm'il'hdK 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard The area(s) v^ill be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor In-person to discuss the work to be perfomied, the Grantor will have an 

opportunity to review and approve the planned soil removai, and restoration work 

before it begins. Once the work is finistied, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors end subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
I

r CAE 1 A 1 

LKVI»0KKhK1Z. l 

CHOU ' • •• C 

' Remove obslructions inciuding boats, liaileis, vehicles, playscape ilemr, wood 

piles, doo houses, elc; 

< Remove i\owe\ bulbs oi piaiils thai the Grantoi or the Granloi's lenenl may vv'ish 

to save; 

Water and maintain lepiacernenl vegetation, including ferliiizer applicstion, as 

necessary' subsequeni to an initial watering period by EPA; 

< Abide by heallh and safety guidance provided by EPA; 

' il the property' is rented, assist EPA in obtaining tenant sppiovai foi access lo 

the property' to perform the work 

 Allow videotaping and/or photographing of the property, 

AGREEMENT NOT TO iNfTERFERE 

The Grantor agrees nol to interlere or tamper with any of the v^'ork activities, oi with any 

of the work done, or with the equipment used on Iris property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contaci Coastal 

Environmental Group, at (402) 991-1199 

[ffl! G I do not grant access to my properties fJ I grant access to my properties 

/07.1s Id 

Signature Date Signeture Date 

• I wouid like to be presettt dutir<6 any samplins \hz\ Is lequiied. 

Paae 2 of 2 
COA S T A L • MVIKONMBMTAL OROUP , INC . 

Restoration Agreement 

The piupose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as documentation for the piupose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: ^S^ O 1 

Property Address: ^ S d Hor^ i I-K5-K s 7 

Owner:4y^^^~J ^ ^ 

Plione: 4r6a-^^^^S'77 ^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or retum ofthese items is the Owner's Fesponsibility. 

ttem: 

yLJcyi ^ 

Kem: 

Item: 

Kem: 

items to be Removed by the Contractor During Remediation and Not Reoiaced 

Kem: 

yOo-^ 

Kem: 

Kem: 

Kem: 

Pagel of. 
COA S T A L • NVIMONHKN T A L O • O U P , INC . 

items to Be Removed By Contractor During Remediation and Repiaced 

Kem: 

.y><y 

Kem: 

<So ^ 

Item: 

Kem: 

Landscape inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each ^ ^ trunk diameter 

Nimiber of trees <= 2 inch ^7 Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

Attach a sketch of the 

sprinlder layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be Each excavated 

Page 2 of. 
COA S T A L 

o n o u p , INC . 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibK you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underiying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removal or replacement of soil by the EPA 

If you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

O Please check this box if you understand the information outlined above. 

-^^•vc ?^^HVTA ( 

D Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

~@NI agree CH I do not agree 

Owner's Signatune Date Contractor's Signature Date 

Page 3 of 
XRF PROPERTY SAMPLE SHEET 

BVID# 2.'5SO( 

Date 

Project 

XRF ID# 

I-I'L ­ ZoU 

Omaha Lead ARRA 

2>^o^^ 

Address 

Sample time 

sample length 

3Z.d>CP A/AMii-ri3N 

30 sec 

am/pm 

Shot# 

llr 

18 

1^ 

Average 

Reading 

^1 i 14 

80 i 15 

Ae t (4 

g3 t 14 

Sample area 

£A 

Depth 

/ " 7 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# 

7 

Z Z 

ZJ3 

Reading 

zzo'-z-o 

ZOG i Z-{ 

nA '. z 

Sample area 

3 7 

Depth 

4" 

Shot# Reading Sample area 

Depth 

Average ZO I t Z\ {/ Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Average 

/

^ ^ 

/ 

Depth 

Average 

Depth 

Signature 

Print Pn^c, (WftiM 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

20 

SOIL 

2011-01-12 12:09 

90.95 

Final 

Avg of 17-19 

3230 HAMILTON ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 91.774 

Supervised By: 

Certificate of Verification 

17 

SOIL 

2011-01-12 12:07 

30.57 

Final 

25501 

3230 HAMILTON ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.215 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm

Pb 80.058

Supervised By: 

Certificate of Verification 

18 

SOIL 

2011-01-12 12:08 

30.19 

Final 

25501 

3230 HAMILTON ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.067 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm

Pb 78.413

Supervised By: 

Certificate of Verification 

19 

SOIL 

2011-01-12 12:09 

30.19 

Final 

25501 

3230 HAMILTON ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 14.873 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

24 

SOIL 

2011-01-12 12; 12 

91.71 

Final 

Avg of 21-23 

3230 HAMILTON ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 220.460 

Supervised By: 

Certificate of Verification 

21 

SOIL 

2011-01-12 12:10 

31.31 

Final 

25501 

3230 HAMILTON ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.363 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 206.921 

Supervised By: 

Certificate of Verification 

22 

SOIL 

2011-01-12 12:11 

30.24 

Final 

25501 

3230 HAMILTON ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.909 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 177.099 

Supervised By: 

Certificate of Verification 

23 

SOIL 

2011-01-12 12:12 

30.16 

Final 

25501 

3230 HAMILTON ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.077 
/ ^A. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc. 

V~*^<<? www.coastalhazmat.com 

^"Lntiy^ COASTA L INVIHONHIHTAt 

C a o U P, IN C 

EXECUTIVE SUMMARY: 

BVID #25501-(3230 HAMILTON ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 11/23/2010 
EPA Property Close Out Form 

'Jsfy\'^t- Property #: <y^SO . I 

Date/Tlrae: Owner's Name:, /^ rlm^^^uiiyP ^ H ^ 

Quads Excavated: 

Contractor Group 

Excavation Genenil 

1. If necessaiy, were the coirect quadnnt(s) excavated and restored? 

2. If necessaiy, wete thc corrrci areas ofdrip zone excavated aod restored? 

Grading Sod and Vegetatioa 

I. Does tbe grading around the periineter ofthe house in excavated areas generally slope away 

from tfae house? 

2. Has sod been laid in all areas that were excavated? 

3. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected at a 30 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate ifinspected at a 30 day 

time period) 

6. Was the property graded such that water will not pool on the property? 

1. Was damage lo landscaping or plant materials avoided? 

Gates. Fences anti Remnlng Walb 

I i. Do gates open and close freely? (tf applicable) 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 

3. Was damage to gates or fences avoided? (Ifapplicable) 

4. Was damtge to retaining walls avoided? (Ifapplicable) 

Foundation, SidiflKand Gntfen 

I. Was damage lo the siding or nim avoided? 

2. Was damage to Ihe Toundation avoided? 

3. Was damage lo windows avoided? 

4 Was daniage to windows or door screens avoided? 

S. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Drfaeways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Wa^ damage to walkway surfaces avoided? 

Yes No 

/ 

y 

Yes No 

y 

y 

y 

y 

y 

y 

y 

Yes Nu 

/ 

/ 

/ 

/ 

Yes No 

/ 

/ 

y 

y 

y 

Yes No 

/ 

y 
Ort'oers comments: 

I 

ninspection notes: 

Removal and restoration activates complele including the 30-day sod warranty: 

EPA Representative ^^> 1 Date:^___jilt3|io_ 
Property Completion Agreement 

This agreemenl documents Ihe compiclion ol remedial aclivilies perloimed on my properly My signaluie 

will designate ihai I am satisfied with the restoralion of my properly, and thai no items are in questions, 

now. or al any lime in the fulure, excepl those ilems listed below, if any 

Property ID: ^'t>^V I 

PropertyAddress: 3^3 0 /-hTn^-Othn ^ 

-=2 ^ 

^^7^ "m-S^VTf 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

b s 1 R|:rcc icstorAlion \s compleled, except as nnleri 

[ I I rto not AKrec rcslorAtinn it completed 

Date arioi''s

s Sienatur Sig e ' Dale