TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: M i Date: t ^\y 

Address: \^^ ^ ff%­ h i 

Remediation Contractor: Coastal Environmental Group_ Year: 200i 

% 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

d Video of property (DVD) 

Executive Simimary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confinnation data 

, / 

d 

d 

Photographs ^"^ ^ h^^ ^ V^OrfWV) ^ ^1 ^

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 

Property information from Douglas County Assessor's Oflfice 

 Vf<Hr<y ^ 

Date ' 

30054846 

HI 

Superfund 
vv 

Property Access Checklist 

Property ID: /^ft-7 1 n WORKSTARTED ON: / / 

Property Address: p ;^-J p(yf\^f ^ n WORK COMPELTED ON: / / 

Owner: HV/ZyTJC^ QfaV^t l Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

(Mof) g\3q--Tnu 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

,0\Access Agreement Siened:^ / J^/O^ ByR . 

IT ./Q Restoration Agreement Signed:^! g_lC ^ By=^ e 

D Topsoil Sampling (if applicable) 1 1 By: 

D Disposal Sampling (if applicable) 1 1 By: 

Q Garden Sampling (If applicable) 1 1 By: 

n Utility Clearance CaUed: / / By: 

^ Video/Photos (Before) On:^/26/09 

By= QhaMi/ ^ 

n Video/Photos (During) On: / / By: 

D Video/Photos (After) On: / / By: 

n Video/Photos (30-Day) On: / / By: 

n Property Completion Agreement Siened: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

• conununity • Crew On: / / 1 

Results: 

0 Conununity O Crew On: / / By: 

Results: 

• Conununity • Crew On: II . By: 

Results: 

Omaha Lead Site 
• • 

Douglas County Account I n|Mjm||ion Page 1 of3 

Douglas County^ Nebraska Property Record - R1239810000 

Print Report 

NEW Feature - Parcel Dimensions available (§) scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ^ -^ -^ Auto Sales Search 

Owner 

GREER MYRTICE C 

ETAL 

1737 PARK AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3981 OOOO 12 

Account Type: Residential 

Parcel Number: 1239810000 

Parcel Address: 1737 PARK AV 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 15 BLOCK 18 50 X 150 

Value Informatio n 

Land Improvement Total 

2009 $6,800.00 $113,700.00 $120,500.00 

2008 $6,800.00 $113,700.00 $120,500.00 

2007 $6,800.00 $113,700.00 $120,500.00 

2006 $6,800.00 $114,100.00 $120,900.00 

2005 $6,800.00 $114,100.00 $120,900.00 

2004 $6,800.00 $114,100.00 $120,900.00 

Sales Informatio n 

Sales Date: 2004-08-30 

Deed Type: WD BooJIr: 2004 Page: 115891 

Price: $100,000.00 

Grantor: DEBORAH 8 ARCHER ETAL 

Grantee: MYRTICE C GREER 

Valid/Invalid: Valid 

Exclusion Reason: 

Saies Date: 2004-04-28 

Deed Type: QC SooJIr: 2004 Page: 065859 

Price: $0.00 

Grantor: DEBORAH CLAPPER ETAL 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=Rl 2... 9/17/2009 
Douglas County Account InJ^jr^^on Page 2 of 3 iJHr^^o 

Grantee: \ DEBORAH S CLAPPER ETAL 

Valid/Invalid: Invalid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 1.0 150.0 50.0 No 

Improvemen t Informatio n 

Building 1 

wr 

r t w 

230 

**.r H r 

ri " '^ •l j u o SvcofKtnoor l« | '7^70 MB ^t j 

>y L "'""" A 7»WflC*3if 

K L 

^'o'rr 

airrfr9oc»'in 

It.*»0 wt t 

2 1/2 STORY FINISHED 

iliHm.i,utMiia»M^iiiuu'*M.-Bsaaa 

CUCK TO ENLARGE IMAGE 
 CUCK TO ENLARGE IMAGE 


Square Footage: 2608.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 10.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1885 0% 1885 123 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1176.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 9/17/2009 
Douglas County Account InJ^jm^o njur^ic n ^^^ ^ Page 3 of 3 

Porch End Screen 160.0 

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=Rl2... 9/17/2009 
Property ID #

A S :

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 Ipun i 

 \IA} r^^K.fiV 

 Date: Time; Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit lo EPA D Other Action: D 
Page 1 of2 

"> 

Create Another Ticket Bacic to irth Internet y. Send Email ] 

• YOUR TICKET NUMBER IS 2369038. 

Original Call Date: 9/21/09 Time: 3:36 pm Op: ELIZABETH18790 


Work to Begin Date: 9/23/09 Time: 4:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1737 Street: PARK AVE 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF 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 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/21/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/21/2009 
OLS#: 18871 

Date Excavated:10/6/09 

Date USEPA Sioned Off: 10/23/09 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site Area Sodden: 3258 sq ft 

18871 

Owner Name: DEBORAH S ZUCK 

Address: 1737 PARK AV 

Phone: H: 402-533-9039

Sample Number 

RYASCPXA-18871 Fl 

RYDGCPXA-16671 F2-

RYCSCPXA-18871 Bl 

RYDSCPXA-18871 B2 

RDZSCPXA-18871 DZ 

Uab RYCSCPLA-18871 

Result 440 ppm 

Omaha Lead Site 

Site Sketch 

 W: 402-393-2633 

Lead 

Concentration 

Sample 

Collected LAB 

/> & ppm D 

3^>:5"

ppm 

 ppm 

-B — -B -

^APA A ppm U 

g ^ ppm U 

ppm D D 

ppm D D 

Number of Samples = H 

Exterior Paint North Arraw 

• Good 

g^oo r 

Q Not paint 

Samples Collected 

Firm: _£Xja_l£sAlXiLL. 

Date: e>C - 2_7-rOM 

Tirt)e: \fij 

Samples Analyzed 

XRF Unit: ^ ' ' ^ Book: ^ A 

Date: ^'AJA^ ^ 

Time: A^/ ^ 

Staff: ^ 

Omaha Lead Site 46130 

Legen d 

Concret e Drip Zone Excavated Quadrants Excavated 

Area replaced with Are a replace d wit h Area left bare 
 Sod ^ ' 
 Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
CKC V^ AV/ ^ 

18871 

Owner -WanTSTDEBORAH S ZUCK 

Address: 1737 PARK AV 

Omaha Lead Site 

Site Sketch 

Exterior Paint 

• Good 

g^oo r 

North Arrow 

[]] Not paint 

Samples Collected 

Firm; %=V ^ \fts\:\ o 

TM-rt.ti 

Omaha Lead Site 46130 
# • mM 18871 

Omah Exterior Paint North Arrow a Lead Siie Owner Name: DEBORAjH S ZUCK • Good Site Sketch Address: 1737 PARK AV Q^oo r 

Phone: H: 402-533-9039 W: 402-393-2833 Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 ^^. A \Q.S\:\c . 

RYASCPXA-18871 733 ppm \3A Date: C^Q ­ 2.ZJO M 

nYDOCrXA-10071 

RYCSCPXA-18871 ~B T 

RYDSCPXA-18871 B2 Samples Analyzed 

RDZSCPXA-18871 Di XRF Unit; ^ ^ "^^ Book: 0 y 

Lab RYCSCPLA-188 Date: ^A^A^j d 

Result' 440 p 

TM-^tr 

Omaha Lead Site 46130 
18871 

Owner Name: DEBORAH S ZUCK 

Address: 1737 PARK AV 

Phone: H: 402-533-9039

Sample Number 

RYASCPXAr18871 F1 

•RYDOOPXA-10071 Fi -

RYCSCPXA-18871 Bl 

RYDSCPXA-18871 B2 

R02SCPXA-18871 DZ 

Lab RYCSCPLA-18871 

Result 440 ppm 

ENTERED 

jyli2 9iow; 

: J 

:• • il : 

Omaha Lead Site 

Site Sketch 

 W: 402-393-2833 

Lead Sample LAB Concentration Collected 

/3f i ppm D 

ppm - B — - B ­ 3g ^ ppm 

J/Aff<iy ppm D 

D 

ppm n D 

opm D D 

Numt>er of Samples = : H 

ZIZS2SKIZZ: 

c 

] tpZ'^B^ ./^ 

E ifV 

ys.-

f \V 

ir 

.7.3.^ 

^cX 

..iA{. .17. 

S I A cvi«JUA­

^ci.r\ ^ • A 

Exterior Paint NorthArrow 

• Good 

Q^oo r < ^ 

• Not paint 

Samples Collected 

Firm: V^^f t \ftAVT\r . 

Date: g>C - TLIS Q M 

Time: \A'. o- y 

Samples Analyzed 

XRF Unit: ^A"^ - Book: ^" A 

Date: ^AJA^ ^ 

Time: P^/f ^ 

Staff _ : _ j

(>>-' ^ 

^^A ^ 

"V 

jr: 

x « ^ 

^ 

Omaha Lead Site 46130 
,y°"*^e. 

COASTA l 

C R O tl P IN C 

Consent foi Accciss To Fropferty 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

follov/ing described premises: 

Owner's Name: ifhi^mA^AZ'^y. ^^ ^ 

Address of Property / W Atti^ Ai/i^ 

covered by this 

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) will 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 performed, the Grantor will have an 

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

before it begins. Once the work is finished, 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 vAiW 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 and 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 
yf'' i 

s COASTA l 

IHVtRONH^KTA l 

% C ft O U r IH C  .A 

( Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

t Water and maintain replacement vegetation, including fertilizer application, as 

necessary' subsequent to an initial watering period by EPA; 

( Abide by health and safety guidance provided by EPA; 

' If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

t Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his 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 contact Coastal 

Environmental Group, at (402) 991-1199 

algrgran a t access to my properties G t do not grant access to my properties 

Signature Date 

Q I wouid like to be present during any sampling that is required. 

Page 2 of 2 
^- -» 0 

Restorataon Agreement 

The purpose 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 purpose of assuring that restoration 

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

Protection Agency (EPA). 

Property ID: AYx"? / 

^Property Address: / 75- 7 fi^^iYj^ J] / 

Owner: AA^/tr/rf: ^Y£^! ^ 

Phone: AAaA) 9A(/' 797Z^ 

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 Videographioally document the existing conditions ofthe property and the basement if 

necessary. 

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

The (enovat. storage, dii.posal, and/or return o( these itoms is the Owner s responsibility. 

IIBIII. J 

Item: / / ' y 

Kem: 

Item: 

Items to be Removed by the Contractor During Remediation and Wot Replaced_ 

Item:^ / 

y^H^//A?M(yf ^ ^ /^ySAAA<. . fldt^CY^ 

Item: A 

Item: 

Item: 

Page 1 of - > 
p 

COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

I ttem: 5> / . 

> 

Ksm: 5./ / l 

Kem: 

Item: 

item 

Pre-existing propeny area, 

that will be excavated, that 

is covered whh grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Thners, Heads, etc. 

Attach ;i sketcli ol the 

••ri'l'klci tilV'.HIi 

Number of and size of 

each garden/ flower bed 

area. 

Alliith ;i skfiL-li 1)1 rtlniivf 

M/fS nnd loc;iiiiMiN 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Ncif Ihi- \nlii c «il l hiUSl'C IU !<: Ut .1 fllHIli 

voiKJtt'.' Id llie i!ri)|)crl> 

DM ner. 

Easement Area, to be 

excavated 

Landscape Inventory 

Quantity Unit 

^A,0Z 

Quadrants 07-

Each 

/ 

Each 

/ 

Each 

/ 

I Each 

Square Feet 

y S 

A Each 

Condition/Type/Species 

S/A'^^ 

fd/^Ai^ 

pUoAc// 

f J o :gX5'-^XA-Q_,^J^ 

Pag ^ e 2 of 
C O A S 1 A L 

O k O U ' . • N C 

! Additional Comments / Instructions: v? .«^ ^ ^ 

I /.or tit^A'fce. 

I A^^ y AU /HoAcAi^ u// A/>^'^ A-^ P<3-

Q 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. 

I agree O I do not agree 

%yy . li. y^ . .^/^/g f- QJ^r,r.^ r. ^l^lcAl '^ Owner's Signature Date ' Contractor's Signature Da 

f ^ 

Page 3 of / 
BVID# /g)^> l 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

/^/i ^?f 

Omaha lead FP 2nd year option 

Address 

Sample time i^g l yf^fk. A\"­ am/pm 

XRFID# ^-^8 ^ sample length 30 sec 

Shot# 

M 

J3£^ L 

l^gg. 7^P3 

Reading 

> ^ -i ^ Z-^. 

/V^ :fc /f r 

m IB-?­ -t 1^ 

£-Mr 

Sample area 

E> ^ 

Depth 

__Shot# 

Z5Zt 

?^/=^ 

Readini 

^ f ^IX M mnzwi^M. rzj ^ -^p 

Sample area 

^ 

Depth 

i^- Average f^-^.^ \<r Average ^C / j^ ^ 

Shot# Reading 

.3M_± 1 

!^ :ib ? ^ 

Sample area 

ISl 

Depth 

Shot# Reading Sample area 

Depth 

^1) J^ 1^ 

Average "ZAA^ ( ^ Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature mPrint Fiii'i^nlni;-W\ Caro M 
I* • ( » 

fAQL\ Omaha Lead Site—Fixed Price EP-R7-07-05 

i ^^^^ ^ o Coastal Environmental Group Inc. vJl ^ 5 ^ \ . • P vvww.coastalhazmat.com 

%PHoi« ^ COASTA L INVIIONNINTAL O O U r, IN C 

EXECUTIVE SUMMARY: 

BVID #18871-(1737 PARK AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

-COASTAL TO DROP OF BAGS OF MULCH FOR PROPERTY OWNER. (COMPLETED 

10/23/09) 
4

0% EPA 

EPA Property Close Out Form 

Property*:_133L1 L PropertyAddre«:;ni^lFj^^l ^ 3X " 

Datc^roc: 

Quad Contractor Group ^^^^TTi T RrvX/trOTYVgntQ-i s Excavated: '&\,f^2 , Vfl 

Excavation General 

1. If necessary, were the correct quadiant(s) excavated and restored? 'PT ^ 

2. If necessaiy, were the correct areas ofdrip zone excavated and restored? Z^ 

Gradin Yes No g Sod and Vcgetattoa 

I. Does the {reding around the perimeter ofthe house in excavated areas generally slope away y^ 

fix>m the house? ^_ _ 

2. Has sod been laid in all areas that were excavated? ~7? ^ 

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

day time period) y

4. Ate sodded areas generally Hrm and evenly graded? y 

5. Arc the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day y tinte period) 

6. Was the property graded such that water will not pool on the propert>'? y

7. Was damage to landscaping or plant materials avoided? z^ 

Gates, Fences aad Retatolng Wails Yes No 

1. Do gates open and close freely? (Ifappiicable) y 

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

3. Was damage to gates or fences avoided? (Ifappiicable) l y 

4. Was damage to retaining wails avoided? (Ifappiicable) 

Foupdation, SidinKand Gutlers Yes No 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? AZ 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? Z^ 

Sidcwallts and Drivcwayi (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 17 
Owners comments: 

Inspection notts: 

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

EPA Representative ) Jg \ [{y./^j L ^ Date: /O/S.t/;; ^ 
Propeily Completion Agreement 

I'liis agreemeni documenis the completion of" remedial activilies perrorined on my properly. My sigiiiilure 

will designate ihat I am satisiied wilh the rcstoralion of my properly, and tlial no items are in questions, 

now, or at any time in the future, excepl those ilem.s listed below, il'any. 

Property II): \^ f \ 

I'ropcTtyAtidTcsl^" |7^7 ^^)(^ /^\J£ 

Qyyner: Y\\{{inaiA^^yyK' 

I'lionc: 

Restoration Items in Question: 

Item: filAy 

Item: 

Item: 

Item: 

Kem: 

Item: 

-J 

Additional Comments: 

^0^-y '\c^ ^Q^ Ay\\/^y ) <='^^y y^(y^f>^4 I f op f 

^I a(;rre rr.vtorafion i.v compleled, except as nofed 

 I I <lo not agree resloration iv completed 

CLjh^^yT^^y 

Owflcrrs .Signndirc Date Cffmractor's Si|rnature Date 

I