## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAID# : 2^79^ ^ Date : 

# lllllo 7 Address : 

# ^2(^ ZF^pr.Si
- Remediatio nContractor : _Coasta l Environmenta l Group _ Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S

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### D 

# s / Vide o o f property (DVD ) Executiv e Summary EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s ' ' As-built sketc h.. .

D D D 

### Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A Descriptiono f area s no t meetin g RO D cleanu p criteri a^ Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e D D D

4031790 7 

# Ililll i Superfun d 

# ItliJo ?

' Dat e

## Propert yAcces s Checklis t 

# f Propert y ID : ^^Q^^ ^ nWOR K STARTE D ON : / /_ ON : / _ Propert y .Address : ^^ ^ 7^// ^ ^ nWOR K COMPELTE D / Renter : Phone : Fax : 

# u IHEU'K/O T Cell/Paaer : Phone : jj^'^ ) ^g^C J , ^^C^ : Additiona l Information : Fax : Cell/Pager :

• Notificatio nLette r Sent : Bv : S ' Acces s Agreem e n t Sif!ned:^/^/Q 2 B.V-
- t^VA^^IvXiartf ^ S ' Restoratio nAgreemen t Signed : ^/^/a > By : ^C^^,MLr.u;t r O Topsoi l Samplin g (i f applicable ) / / By : C

U Disposal Samplin g (if applicable ) Bv : I I Garde nSamplin g (i f applicable ) Bv : I I Utility Clearanc e Called : :^//4/ ^ ^ B.v:fe
- jl^b^n^ l '^// b l a D Video/Photo s (Before ) On : By : P I10/0 7 fjyy^-c-y^^etr l Vi-(kd nVideo/Photo s (During ) On : Bv : nVideo/Photo s (After ) On : Bv : nVideo/Photo s (3«-Day) On : Bv : I I Propert y Completio nAgreemen t Signed : / / Bv : nFina l Repor t Issued : Bv : Ai r Monitorin g (a s applicabl e » C

U Communit y C U Cre w On : / / 

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D Communit y C J Cre w On : / / 

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# B.v : Results : j
nCommunit y C U Cre w On : / / By : Results : Omah a Lea d Sit eTota l CJ^pFan t Squar e Footag e t o b e Excavate d = 41 1 PropertyClassification : 80 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 6 6 

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06^M(^]1 ' Pacifi cstree t Legen d NorthArro w 

### Omah a Lea d Sit e N Omaha , Nebraska |?^y^ ] Concret e yy \ Excavate d Are a Propert yNumbe r OLS-2093 2 ^^ g Existin g Structur e Scal e • •— • Fenc e Propert yAddres s 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f t 436 2 PACIFI C S T ^^y ^ Permanen t Landscapin g ,.A^' ' ^1.3, ^

———Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Stree t Boundar y F 1 . B2 Pla yAre a 

# .\0,v vHG L % V^]y * i — Hyiirol>r)L<iq KIn , F 2 DZ Easemen t (Q ) Tree/Shru b B l Garde n Othe r Descriptio n of pos t excavatio n areas : F1 , fron t yar d left-han d quadrant : F2 , fron t yar d hgtit-han d quadrant ; Bl , badtyar d left-han d quadrant : B2 , backyar d right-hand quadrant ; DZ . dri p zon e (1- 3 foot are a of soi i aroun d th e foundatio n o f th e house) .

## 2093 2 Owne rName : DANIE L E JENSE N Address : 436 2 PACIFI C S T Phone : 

## .H3? 1 J'i'TlSiyv : Sampl e Numbe r RYASCPXA-2093 2 RYBSCPXA-2093 2 RYCSCPXA-2093 2 RYDSCPXA-2093 2 RDZSCPXA-2093 2 RGZSCPX A2003 2 f^PZ3CPXA-2093 2



# ENT Z i^gy i 

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-v J Lea d Concentratio n ? s ^ 1 pp m g< . c< l Appn n Vp O cXoQv n pp m pp m

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## CONTAC T FOR M Propert y ID # 

# io']y t Propeit y Address : 

# \') y lu y Initia l Contact : Date : J Time : \S^ 0 Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP A D Othe r Action : D

Comment : Owne r Commen t (s) : 

# \^ v ^ ^ h^ t Sit e Coordinato r Commen t (s) : 

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## 0§<l / "^ 1>lfc O SI-4 , .- * .s*' ' COASTA L ENVIRONMENTA L CROUP . IN C 

## Consen t Fo rAcces s T o Propert y

' . . • • ' ^ ' . RIGH TO F ENTR YT O PREMISE S ' : • „ ., . ^ ' : - 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit 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 ^ °ft ( •^S^ r

Owner' s Nam e Daytim e Phon e jwner s Name : -v . — » ^ 

# q'b2-3?q-l33 ^

Addres s o f Propert y covere d b ythi s Agreement : 

# rvncaag ^ n e \o?io ^ 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 o f lea 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 it s origina l condition . Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t 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 yha 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 subcontractors 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 f performin 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 o f 2V*^'^'^ / COASTA COASTA L ! ENVIRONMENTA L G R 0 U r. INC . 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s orplant s tha t th e Granto r orth e Grantor' s tenan t ma ywis h to save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessarysubsequen t to an initia l waterin g perio d byEPA ; •Abid e byhealt h an d safet yguidanc e provide d byEPA ; • If th e propert y is rented , assis t EP A in obtainin g tenan t approva l fo racces s to th e propert yto perfor m th e work . •Allo wvideotapin g and/o rphotographin g of th e property . AGREEMEN TNO T TO INTERFER E 

### Th e Granto ragree s no t to interfer e ortampe rwit h an yof th e wor k activities , orwit h an y of th e wor k done , orwit h th e equipment use d on hi s property , orto undertak e an y action s regardin g th e us e of sai d propert ywhic h woul d ten d to endange rth e healt h or welfar e of th e Grantee sorth e environment , or to allo wother s to us e th e propert y in suc h a manner . Should you hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , at (877 ) 234-6270 . / SI gran t acces s to mypropertie s D I do no t gran t acces s to mypropertie s 

# Vainr , ^^^^ ^

g-6-o" ^ Signatur e Dat e Signatur e ^ Dat e 

# X I woul d lik e to be presen t durin g an ysamplin g tha t is required .

Pag e 2 of 2v^ ^ *.* > COASTA L ENVIRONMENTA L y CROUP . IN C 

### Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit 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 :

Owner' s Name : Daytim e Phone : 

# Qa n ' ^ "i^r . Ts, , .\eOaa a ^^-3^M-i^:3 M 

# 3 Addres s o f Propert y covere d b ythi s 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 o f lea 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 it s origina l condition . Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t 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 yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin 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 f performin 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 o f 2C^'TP *COASTA L - ^ / -«C rENVIRONMENTA L CROUP , 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work . •Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT o INTERFERE 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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 you hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (877 ) 234-6270 . gran t acces s t o m ypropertie sD i d o no t gran t acces s t o m ypropertie s

Signatur e Dat e Signatur eDat e

OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Pag e 2 o f 2COASTA L C AO U P . IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreement a s to condition s o f th e propert> ' prio r to remediatio nactivities . Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio no f th e propertv ' owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EP.A) .

Propert yID : 

### Property Address : __ ^ 

# U('^ie ^ \PcxQ . -(- • e yy^\ ^ Phone : 

# o ^ O X-^1 ^ 1 

# ^ 

# d o - 

# ^. 9 i. z Onth e attache ddiagram(s ) indicate area(s ) to e.xcavatedan ddept hof excavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e use db y contractor , andth e directio no f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b

y referencin g th e photo-lo g number wit ha narro w indicatin g directio no f view . 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility . Item : Item : 

# ^-\\ ^ gv\j\\i:n, . Vm , Luc> c^ ^^'^ ^ ~~^\ Item : ; Item : Item : Item : ^- ^ Item : ^ Item : y ^ Pag e 1 of . 

# kCOASTA L ENVIKONMEMTA L cn o u p . IN C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# Ih i ^iMfh . ^ W<\\\if f Item : Item : 

# 'V\vio\) i — y > 

# 4 y Item : / Item : y Item : 

# y / Item : Item : / Item : / Item : / Item : / Item : 

# 7 / Item : 

# 7 7 / Item : / Item :

Pag e 2 of .COASTA L iNViKONnCNTA L O R O U F . I f * C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : Item : 

# 4i?i i ^Ov f Item : Item : 

# \IWI^ ^ 

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Item : / / Item : Item : / /

Item : / ' Item : / / Item : 

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Item : y ' Item :



### Page3of_W _— « * COASTA L CNVINONHCNrA L CROU P IN C 

### Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

## Ite m

Pre-existin g propert y area , that wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trunk diamete r

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho ^ th e sprinkle r layout .
Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Aitac hasketc ho f relativ e size s an dlocations . 

## Quantit y 

# 4l 1 

# y y (1( 7

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Eac h

Each

Eac h

Eac h Squar e Fee t 

## Condition/Type/Specie s 

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Pag e 4 of .- - <» COASTA L ENVIMONMCNTA L 

## Ite m Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree duponlis t o f plan t material s tha t wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Includ e asketc ho f wer e eac hplant will b e place d b > th e contractor . Agree duponare ao f property t o b e replace d wit hgras s sod . Includ e asketc ho f th e area(s ) t o b e replace dwit h gras s sod . Are ao f Cit y o r County property t o b e landscape d pe r thei r requirements . Includ e asketc ho f th e are a(s )

Easemen t Area , t o b e excavate d 

## Quantit y Uni t Conditlon/Type/Specie s 

# W ^ $ 

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# y Eac h 

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Pag e 5 o f 

# UCOASTA L ENVIKONMENTA L G « O U P IN C 

### Additiona l Comment s / Instructions : 

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### n Chec k th e boxi f Owne 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 boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .

nI d o no t agre e 

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# ?r\\/ n Owner' s Signahir e Dat e Contractor' s Signatur e Dat e 

### Pag e 6 of .PROPERTYCLEARANC E WORKSHEE T

Dat e Propert yI D 

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# jyl?'( q ^ I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) • ? 2 ^ • y 3 !^5 < 4 

## 1 

# 2 f XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# c^ 9 Sampl e Are a Pass/Fai l ? 

## HAy ^ I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) ? 2 

# f^ 3 

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# 10 1 4 XR F Correcte' d Valu e 

# TM ^ —> 5 (us e calibratio n char t o rad d 20 % t o value ) 

# lA i Sampl e Are a Pass/Fai l ? 

## - / 4-t y I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved ) ? 1 

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## \^7^-i c Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved ) 7 

# \3 2 XR F Correcte d valu e -- > 

## i^ ' (us e calibratio n char t o rad d 2 0 % t o value ) 

# k k Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 3 4 XR F Correcte d Valu e —> 5 (us e calibratio n char t o rad d 20 % t o value ) tIS I AOOIIIOHA L SHlfl i I I H[[DFI ) XR F Technician s Signitur e (^

^ixJXXJt \ \iC^ W Jl^^.yK..,^' ^ ^ \• ^ i—>' / 

# [%^iW^'0l ^ ^ ^i^at M zzy V" \?^:=- 1 ^ ' ^ 9 ^ ^ Tota l ^H l an t Sq u uar e Footag e to be Excavate d = Property Classification : 80 0 TotalWi e Li i p p Zon Zon e Linea rFootag e to t) e Excavate d =

Desaiptio n of pos t excavatio n area s Fl , fron t yar d left-han d qtiadrant ; F2 , fron t yar d nghl-hswi d quadrant : Bl , badtyar d teft-nan d quadrant , 82 , backyar d nam-nan o ouaar r OZ . dri p zon e (1- 3 toot are a of soi l aroun d th e foundatto n of th e house ;

### Pag e 1 o f tsimmons@lkgs.he.ne t From : "Lehma n Carlton " <ctl(gctlehman.net > To : "tsimnnons@lkgs.he.net " <tsimmons(gcoastalhazmat.com > Sent : Thursday , Augus t 09 , 200 7 6:2 7 A M Subject : Fwd : Acces s Agreement s 

### Beginforwarde dmessage : From : France-lsetts.Pauletta(gepamail.epa.go v Date : Augus t 8 , 200 7 4:18:4 6 P M CD T To : ctl@ctlehman.^net , r.brown@erllc.com , mmateus@enviroservicesqroup.co m Subject : Acces s Agreement s 

### Thre e property owner s hav e contacte dm e today . The y ha dquestion s abou t th e proces s an dwhat area s o f thei r property wer e contaminated . I think I answere dal l o f thei r immediat e questions . I tol dthe mthat someon e fromCoastal woul db e contactin g the mt o develo p arestoratio n agreement . Eachproperty owne r indicate dtha t the y woul db e sendin g inasigne d acces s agreement . Thi s i s aheads-u p t o b e ready . 

# N Rozalin dPietranton i #40 8 ^104S9t h402-709-863 6 \Tro y Taylo r #^226 1 82 9 S 21s t 402-213-881 3 Patt y Jense n \#2093 2 Pacifi c 402-384-133 4 • yc y 

### —Paulett a

8/9/200 7

### i,!ML \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 oj^^v' l Coasta l Environmenta l Grou p Inc . \^'^T ^

www.coastalhazmat.co m ^•<i.ni yCOASTA L ENVIRONHENTA L C R 0 U r. IN C 

# EXECUTIV ESUMMARY : 20932^36 2 PACIFI C S T

^ N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e Tota l Quadran t Squar e Footag e t o b e Excavate d = 41 1 Properl yClassificatio n 80 0 Tota l Dri p Zon e Linea rFootag e to be Excavate d = 6 6



### Pacifi cStree t Legen d NorthArrow Omah a Lea d Sit e OLS# : 2093 2 Omaha . Nebrask a y

^

Dat e Excavated : 9/7/0 7 Propert yNumlae r feaie U^PASigne d Off : 9/27/0 7 OLS-2093 2 Scal e -•— • F«nc e Propert yAddres s 1 Inc h = 2 0 ree l o r1 g M - 5 x5 I t 436 2 PACIFI C S T Pofmanen t Landscapin g o,<^*«l, . Pos t Excavatio n Concentration s (ppm ) F 1 B 2 Pla yAre a —

——Quadran t Boundar y 

## J^/ V HC5 L ^^^^ ^ Stre« t Boundar y F 2 D Z Easemen t (Q ) Tr««iShru b 8 1 I3arde n (Dthe r

DescnptM Tct fpoo l eMca wjBo n aiva s P1 . fron t yar d lef t rian d quadran t F^ . Iron t yar d righ t han d auadfan i 3 1 bac^var d lef t han d quadrant . B 2 bacttvar d righ t r^ar\ d quadran t O Z dn p ion * (1- 3 foo l ar M o f ao d aroun d tt wfoundatio n tfttiahouM) Legen d Are ano t Excavatet i Vyyl Dripzon e Excavatei dK ^ Quadrant s Excavate d Contract ! # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## sa c 

# EP A EP A Propert y Clos e Ou t For m Propert y # : 

# ^c93"?' . Propert y Address : y^ 6 y /^^^rT// ? ^ Date/Tinic : Owner' s Name : yii^/7c y 'yi.'ity ) 

# . 1l/l/(r 7 Quad s Excavated : Contracto r Grou p ' Excavatio nGenera l Ye s No I .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio n Ye s N o I .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y 

## \ y ' fro mth e house ? L^- " 2 .Ha s so dbeenlai dinal l area s that were excavated ? 3 .Doe s th e sodappea r t o b e generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 .

Ar e sodde darea s generall y fir man devenl y graded ? 

# 7^ ^ 5 .Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 

# y ^ 6 .Wa s th e propert y grade dsuc htha t water wil l not poo l onth e propert\ ? 7 .Wa s damag e t o landscapin g o r plan t material s avoided?^ ! /,/y'^y ' 

### L y ^ Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s openan dclos e freely? (If applicable ) 

# t/ ' 2 . Wer e all gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

## ly 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# z y 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### y ' Foundation , Sidin g an dGutter s Ye s No I .Wa s damag e t o th e sidin g o r tri mavoided ? 

# 7>r ' 2 .Wa s damag e t o th e foundatio navoided ? 

# y y ^ Wa s damag e t o window s avoided ? 4 , Wa s damag e t o window s or doo r screen s avoided ? 

# y Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ye s 

### y< o 1 . Wa s damag e t o drivewa ysurface s avoided ? 

### y " / 2 . Wa s damag e t o walkwa ysurface s avoided ? 

# yy

## . 0>*'jner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representativ e 

# Date:?fc6 ^

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n of remedial activitie s performe d on my property .My signatur e wil l designat e that I

amsatisfie dwit hth e restoratio n of my property , andthat no item s are in questions , now , or at any tim e inth e future , excep t thos e item s liste dbelow , if any . Propert y ID : "7 (2^ 7 ^ 7 Propert y Address : //2^^ y y^y:j/>y^'<; r Owner : f2 . 

# ly . lyiyri ^ t7yyyspA y Phone : ^^/ ; (^^^- ^ 

### Restoratio nItem s inQuestion : Item : 

# i Item : 

## 'A\yy~^ ^ o (^ Item : 

### Item : Item : item : Additiona l Comments :

I \jy(/s mrestoratio nis completed , excep t as note d II do no t agre e restoratio n is complete d

Owner' s Co n vner Signatur Signatur e e Dat e Contractor' s Signatur e I

## Propert yDamag e Settlemen t

Propert y E D 2093 2 Propert y Addres s 436 2 PACIFI C S T Owne r Da n& Patt y Jense n Phon e 402-384-133 4

I hav e receive dfromth e contractor . Coasta l Environmental Grou p Inc . (Coastal) , asu mo f $ 300.0 0 a s compensatio n fo r mulc han dplan t remove dfromproperty at 436 2 Pacifi c S t whic hwa s remove ddurin g th e removal o f lead-impacte dsoi l fromth e property . Mone y Orde r R10007092680 8 Valu e o f Chec k $300.0 0 Mad e Ou t T o Da n& Patt y Jense n Descriptio n o f Miscellaneou s Propert vDamag e Coasta l accesse d th e propertya t 436 2 Pacifi cS Tt o complet e lea d restoratio n durin g excavatio n th e property mulc h an d plant s wer e remove d durin g thi s possess . Coasta l has agree d t o pa yth e homeowne r$300.0 0 a s a buyou t fo rth e homeowne rt o replac e and/o rrepai rat thei rleisure . M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e ^i rcompensatio n fo rth e miscellaneou s propert ydamag e describe d abov e an d releas e Coasta l Environmenta l Grou p In cfro m furthe robligation s o rliabilit yrelate d t o thi s propert y damage .

wner' s SignatiA-e Date Contractor' s Signature Date

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