TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^q C Date: \ j U j \ ^ 

Address: ^'^^Y ^U ^ U 

Remediation Contractor: Coastal Environmental Group_ Year: _200ft 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

k Executive Summary 

5/ EPA-provided property sketch 

M Signed Access Agreement for subject property 

"H' Signed Access Agreement(s) for adjacent property 

t / Restoration Agreement 

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

-B­ Confirmation data 

^ Photographs .__ ' •• 

U As-built sketch 

^ Satisfactory restoration signed by Property Owner 

\B7 Property close-out check list signed by EPA 

TI Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

/ Property information from Douglas County Assessor's Office 

^ 1 {(7 

Ignature Date/ 

30055475 

H 

Superfund 
Property Access Checklist 

Property m ; (^ q 

Property Address: 2595 fe( FUiSO n Av < 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON:. 

_/

I

 I 

I 

Owner. flon5v\r^

^•••"^^ V.KV ^ 

H f(»V: ^.r^ni^ Renter 

Phone: 

Fax: 

">•"«

Fax: 

 ^<nl'?^n 7 

Cell/Pager: 

Additioaai biformation: 

Cell/Pager 

D Notification Letter 

0 Access Agreement 

Qf Restoration Agreement 

D Topsoil Sampling (If applicable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

Q Utility Clearance 

^ Video/Photos (Before) 

O Video/Pliotos (Daring) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

S|2^ Property Completion Agreement 

[^ FinalReport 

Sent: / / 

Signed: ^/11./O ^ 

Signed: 4_/jl./i[ 3 

/ / 

/ / 

/ / 

Called: ^/I2_/i[fl 

On: ^liXfil ^ 

On: / / 

On: / / 

On: / / 

Signed: \£t tli-fi ^ 

Issued: / / 

By: 

^r- Mflirro5. 

By­- r.Kr\^ 

By: 

By: 

By: 

By:qr//l*/^o^ 

^yP[Ockxy\c 

By: 

By: 

By: 

By: 

By: 

Air Monitorine (as applicable 

D Community OCrew 

Results: 

On: / / By: J 

DCommnnity

Results: 

 QCre w On: / / By: 

QComnninity

Results: 

 QCrcw On: / / By: 1 

Omaha Lead Site 
1 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

Ip'H^ 

•L'3^*6 eUi^nn Av-c 

Date: Time: Action: 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 
Douglas Coimty Accoimt Inforte|io r|||i c n Page 1 of2 

Douglas County, Nebraska Property Record - R l 134720000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w O n Ma p Information is valid as of 2009-8-3 Treasurer's Tax Report 

New Feature - • • • ^ Auto Sales Search 

Owner 

HICKERSON FLORENCE 

ETAL 

2598 ELLISON AVE 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 347 2 OOOO 11 

Account Type: Residential 

Parcel Number: 1134720000 

Parcel Address: 2598 ELLISON AV 

OMAHA NE 68111-0000 

Legal Description: FORT VIEW ADD LOT 2 BLOCK 0 S 66.5 FT LT 1 & S 66.5 W 10 FT 66.5 X 60 

Value Informatio n 

Land Improvement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$2,400.00 

$2,400.00 

$2,400.00 

$2,400.00 

$2,400.00 

$2,400.00 

$36,000.00 

$36,000.00 

$30,400.00 

$30,400.00 

$30,400.00 

$13,600.00 

$38,400.00 

$38,400.00 

$32,800.00 

$32,800.00 

$32,800.00 

$16,000.00 

Land Informatio n 

Acres SF Units Deptii Widtii Vacant 

0.1 4620.0 1.0 66.0 70.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 1... 8/22/2009 
Douglas County Account InforflMtion Page 2 of2 

2*98 ELLISON AV 

f^,y , H.-.n t 

RANCH 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 964.0 Percent Complete: 100 0% 

Perimeter ' 0.0 Quality: Fair 

Unit Type: Condition: ; Fair 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: \ Drywall Baths: i 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Buiit 

1949 0% 1949 59 

Detail Type Detail Description Units 

Add On Canopy 44.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 964.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 1... 8/22/2009 
Page 1 of2 

"> 

[,_C^reate Another Tick^^^ Irth Intemet \ j [ Send Ernajl; 

• YOUR TICKET NUMBER IS 2362522. 


Original Call Date: 9/12/09 Time: 4:54 pm Op: ELIZABETH18790 


Work to Begin Date: 9/16/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2598 Street: ELLISON AVE 


Twp: 16N Rng: 13E Sect-Qtr: 33-SE 


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 OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


Depth of Excavation: 4ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP DEBORAH Alt: 

Emerg: 9185747098 

Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

http'://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/12/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RO N 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://vmvir.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/12/2009 
As-Built Drawing OLS#: 696 

Date Excavated :9/25/09 

COASTA L Omaha Lead Superfund Site Date USEPA Signed Off: 10/23/09 

Area Sodden: 1476 sa ft 

696 

Owner Name : 

Address : 2598 ELL ISON AV 

Omaha Lead S 

Site Sketch 

t e Exterior Paint 

• Good 

North Arrow 

/ \ 

Phone : » W: •

r~l

 Poor 

 Not paint i 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm;

Samples Collected 

 Sverdrup 

RYASCPXA-696 YA 140.4 ppm 0 D Date: 

RYBSCPXA-696 

RYCSCPXA-696 

RYDSCPXA-696 

YB 

YC 

YD 

60 

66.7 

ppm

ppm

ppm

 0 

0 

• 

a

0 

D 

Time; 

Samples Analyzed 

RDZSCPXA-696 

RGZSCPXA-696 

RPZSCPXA-696 

DZ 

GZ 

PZ 

60.8 ppm

ppm

ppm

 g l 

• 

• 

n 

n 

n 

XRF Unit;

Date:

Time:

 12/7/1999 

 12:59 

 Book 

Number of Samples = 4 1 Staff: 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW). DZ = Drip Zone, GZ = Garden, PZ = Play 

Stied HANDICAP 

RAMP 

YC = 55 PPM @ 8" 

V2~ 

Y6 = l-'c I 

y y. y.. 7. .y.'../. yy y y y y 

EA = 68 PPM @ 1 ..t y .1 

feL^Ul <g.OH A.V. 

046141 0123 

Legen d 

Concrete TA Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with I 

So Area left bare d Rock/Mulch ' ' 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
Mt 696 

H Exterior Paint North Arrow 

Owne Omaha Lead Site r Name: rt^HTt^^' JiU]^lo^a _ • Good Address: 2598 ELLISON AV Site SItetch 

/K • Poor 

Phone: H; W: 

Q] Not paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm: Sverdrup 

RYASCPXA-696 YA 140.4 ppm 

-:5 a Date: 

RYBSCPXA-696 YB 60 ppm 0 n Time: 

RYCSCPXA-696 YC 66.7 ppm 

Samples Analyzed RYDSCPXA-696 YD ppm n 

RDZSCPXA-696 DZ 

:i^ 

60.8 ppm D D XRF Unit: Book 

RGZSCPXA-696 GZ 

ppm D Date: _ 12/7/1999 

RPZSCPXA-696 PZ 

ppm a • 

Time: _ 12:59 

Staff; Number of Samples = 4 1 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden, PZ = Play A 

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Exterior Paint 

North Arrow Omaha Lead Site Owner Name: _B^^''^ * ^^^^Ot^^ ^ 

Sit • Good e Sicetch Add ress: 2598^LLISON AV t • Poor 

Phone: H; W; []] Not paint 

Sampl Lead Sample 

Samples Collected e Number LAB Concentration Collected Firm Sverdrup 

RYASCPXA-696 YA 140,4 ppm 0 D Date 

RYBSCPXA-696 YB 60 ppm 

a a 

Time 

RYCSCPXA-696 YC 66.7 ppm 

a 0 Samples Analyzed RYDSCPXA-696 YD 

ppm a D 

RDZSCPXA-696 DZ 

60.8 ppm a D XRF Unit: Book 

RGZSCPXA-696 GZ 

ppm a 

Date: 12/7/1999 a RPZSCPXA-696 PZ 

ppm D 

Time 12:59 

Staff Number of Samples 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone. GZ = Garden, PZ = Play 

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696 

Omah Exterior Paint North Anow a Lead Site Owner Name: 

Sit • Good e Sketch Address: 2598 ELLISON AV • Poor 

Phone: H: 

W: 

IQ Not paint 

Sample Number Lead

Concentration

 Sample 

 Collected LAB 

Fimfi:

Samples Collected 

 Sverdmp 

RYASCPXA-696 YA 140.4 ppm !•! D Date: 

RYBSCPXA-696 YB 60 . ppm 0 D Time: 

RYCSCPXA-696 

RYDSCPXA^96 

YC 

YD 

66.7 .ppm

.ppm

 0 

a 

0 

D Samples Analyzed 

RDZSCPXA-696 DZ 60.8 .ppm 0 D XRF Unit: Book: 

RGZSCPXA-696 

RPZSCPXA-696 

GZ 

PZ 

.ppm

.ppm

 a 

• 

a

• 

Date:

Time:

 12/7/1999 

 12:59 

Numt>er of Samples = ; 4 1 : Staff: 

L TM ! 

Legend: YA = Yard (NE), YB = Yard (SE). YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone. GZ = Garden, PZ = Play 

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Omaha Lead Application • • • • Page 1 of2 

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http://r7arcims.r7comp.epa.gov/ols/Events.cfm 1/26/2010 
Omaha Lead Application • • 

Lead XRF ResuHt 

Data Sample ID LocaUan Analyte HO 

Oac 07 19 M RYASCPXA-(96 YARD - F l L£AO 0 

Dec 07 1999 RDZSCPXA-696 :ORIP AREA LEAD 0 

Dee 07 1999 RYBSCPXA-69i YARD - F2 LEAD 0 

Oac 07 1999 ReDSCPXA-696 CARDEN AREA LEAO 1 

Dec 07 1999 RYC8CPXA-696 .YARD - 8 1 LEAD 0 

[updata j 

L^dtl Lah Results 

ibato Sampla ID Location I Analyte 

1 Dec OS 1999 RYC8CDLA-696 YARD - S l Lead 

ArssiHe XRF Results 

iDat a Sample ID LocaUon Analifte 

1 Dec 07 1999 RYA8CPXA-696 !YARD - F l ARSENIC 

2 Dec 07 1999 RDZ8CPXA-696 DRIP AREA ARSENIC 

3 Dec 07 1999 RYB8CPXA-696 YARD - F2 ARSENIC 

4 Dec 07 1999 RaDSCPXA-696 GARDEN ARl ARSENIC 

9 Dec 07 1999 RYC8CPXA-696 YARD - B l ARSENIC 

AfsaidcLnhWeaidtB 

lOata Sample 10 (Location | Analyte 

1 Dec OS 1999 • RYC8COLA-696 iYARO - ftl A7senic 

• • Page 2 of2 

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http://i7arcims.r7comp.epa.gov/ols/Events.cfm 1/26/2010 
tittst sr,,,^ 

COASTA l \ y IHVIftONnl KTAl 

c R o u r INC 

Consent fcf Access To Property 

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: 

fia/^^ce Owner's Name: Daytime Phone: ^3 / -s^a-? 

Address of Property 

covered by this P'Z^'^ CkUSVA ^ 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 perfomied under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, v\nll contact 

the Grantor in-person to discuss the work to be perfonned, 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 confimi that it Is complete and meets with the Grantor's approval. Upon 

completion, the Grantor vinll 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 
V^-yy-^J

 COASTA L 

" ' PflO^ * C > O U > 1 » C 

* 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; 

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

necessary' subsequent to an initial watering period by EPA; 

c 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. 

« 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 

1 ^ grant access to my properties D I do not grant access to my properties 

Signature Date Signature Date 

D I would like to be present during any sampling that is required. 

Page 2 of 2 
C O' A i T A:.^ 

C n O ^ r 

RestoratSoF^ Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe 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 owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: <^^ ^ 

Property Address: f^f ^ AR/y/^PJA J 

\ Owner: i^lyC>/ek^7U^€Z 

Phone: 

^r/pZ97> i 

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: 

fhe lenoval. storage, disposal, and/or return of these items is the Owners responeibility. 

Kem: 

fl/>U>€^H^^^r/^S 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Item: 

3Mty/ / P/MTS I ytt.<A j^iPS/l^6f^ 

hem: ' 

Item: 

Item: 

U 

Page l - ^ 
€(y^ 

C O'A ^ T A t 

Items to Be Removed By Contractor During Remediation and Replaced 

I item: 

AyJOCC/f 

Ksm: 

t^yt/cA .g^jg^jg^ ft:: yey^yiU&^. Kem: 

Kem: 

l-andscape Inventory 

Item Quantity Unit Condition/Type/Species 

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

is covered with grass. 

Nuinber of trees > 2 inch Each 

trunk diameter y 

Number of trees <= 2 inch Each 

^ trunk diameter 

Number of Sprinkler 

Zones. Control Valves, 

Each Timers, Heads, etc. 

Miat ^ h a skcicli ol the 

'.pi'i'lvloi l;;y;ui; 

Number of and size of 

each garden/ flower bed Each 

3 tyiSif ^ (;y>c/e fiyp^cPL Say^9^ area. Square Feet 

Ali.ith ;i '.koicii 1)1 rcialivf 

^i/cs mid loc;iiiii;iv 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\CI'" ll"ti' \nliic t.s'\\\ ni 

i;.;<'t' 10 Is; u( .! 'iliiiii 

\(iin.-in.': K; the i;ropcrl> 

\it\ ner. 

^ c y B ^ O^^yyUftA^y ^ Easement Area, to be Each 

excavated ^ 

Page 2 . ^ 
C »• O U >• . t N € 

1 Additional Comments / Instrucfions: 

^y^<:yti^kfr1^K 

^^^ /y.r A.> ^<^^^^^^'-^^' ^ 

L. 

jl ^ 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. 

jW^ I agree Q I do not agree 

Owner's Signature Date extractor's Signature Date 

Page 3 of y 
BVID # (y:>^t 

XRF PROPERTY SAMPLE SHEET 


Date ^ ^ Address ^'^'Y?? trij.^<.c^ Aoo 

Project Omaha lead FP 2nd year option Sampletime am/pm 

XRFID# g^og ? sample length 30 sec 

Shot # Reading Sample area Shot# Readinc Sample area 

WP

m

^ . 

t wy

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i ^ 

. Depth 

im 

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S 

. ^ // 

mDepth 

Tm iJ H ?

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Average hj^ I i Average .^ ^ ^ / Q 

Shot # Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sampte area Shot* Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Samplearea XRF Avg. 

Signatun 'MMM 

Print yaM i C/iiim 

^ 
ii # 

-^ .... ** 

/^O. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

3 ^^^ 7

\^^'y

 a Coastal Environmental Group Inc.

 www.coa8talhazmat.com 

M ^p ^ 

COASTA L ENVKONMENTAl 

c ao u r, IN C 

EXECUTIVE SUMMARY: 

BVID # 696- (2598 ELLISON AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
StlL EPA 

EPA Property Close Out Form 

t^»a) is^^g Bl»"5o^^V(3^ 

Property #: \ p ^IP, . . . 

Date/Time: STeSN^rjSimSffi^gZX 

Quads Excavated; V- \ 

Contractor Group /^^M-Zt T 

Excavation Yes No General 

1. If necessary, were the correct quadnmt(s) excavated and restored? V[ 

2. If necessary, were the correct areas of drip zone excavated and restored? c y ^ 

Grading Sod and Vegetation 

Yes No 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away y from the house?

 ^_____ 

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

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

4. Are sodded areas generally firm and evenly graded? y 

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

time period) ! / 

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

7. Was danuge to landscaping or plant materials avoided? l y 

Gates, Fences and Rctatnlng Walls 

Ves No 

1. Do gates open and close freely? (Ifapplicable) 

ly 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) 1?' 

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

-y 

IP^­ 4.

 Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, Siding and Gutters 

Yes No 

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

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? | : 

4. Was damage to windows or door screens avoided? y^ 

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

Sidewalks and Driveways (Concrete) 

Yes y<o 

1. Was damage to driveway surfaces avoided? 

~y 

2. Was damage to walkway surfaces avoided? 

1?^ 
Owners coinments: 

Inspection notes: 

I 

L 

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

EPA Representative 1 )cr>. /)^/, . ^ _ , Date: /^6.7 , 
Property Completion Agreement 

Ihis agreemeni documenis the complclion of remedial acliviiies perloimcd on my properly My signalure 

will designate ihal I am satisfied wilh the restoration of my propeily, and Ihal no items are in questions, 

now, or al any lime m the fiiture, except ihose ilems listed below, if any 

Property ID: \^C^^p 

Property Address: 2.5^ ^ ElitSP n 

Owner: P\or€r>C£ . \\\CJI^^5Q A 

Phone: i4Q|. q5 ( ^ aAQl 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

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Owner's Signatiire Date Shtrarlai 's Signiilurc