TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID*: J^^^ ^ Date: yn7de> 

Address: i2^^/6- 7Zi7icy Ai/e. 

Remediation Contractor: Coastal Environmental Group Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

5/ Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

\y Confirmation data 

< / Photographs 

y As-built sketch 

Satisfactory restoration signed by Property Owner 

/ Property close-out check hst signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's OfSce 

D 

D . 

D 

Date^ 

'08 

40317775 

Miniiiii 

Superfund 
Final Report Property Check List (pica,sc place with each fik)

Hard Copy Information rw

1. Property Checlc List . G^11

2. Site Worldng Drawing Map ,' 

.T E^PA originals Map ; 

4. Douglas County Assessor's Map 

5. Properly Contact Sheet : 

i

Agreement 

1. Aeeess Agreement 

2. Restoration Agreement 

Miscellaneous Documents 

i. Final Map from the Field 

2. Change Orders 

3. XRF Data 

4. Any emails or PO eorrespondenees 

Property Completion 

1. Exeeutive Summary 

2. AS BUI FT 

3. Property Completion Agreement 

4. Any buyout inio or reimbursement inlo 

5. Cheek or money order eopies 

6. FPA Propeity Close Out Form 

7. Attaehed Begin Video 

1

2

-^

4

F^lectronic Documentatio n 

Drawiiif^s 

1. EPA original 

2. Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

 Begin Photos 

 During/Ftxeavation Pliolos 

 Sod Photos 

 3()-Day Sod Photos 

'

•/

Scanned Documents 

 Final Doeumenis 

 Exeeutive Summary 

'

2 

Videos 

 Begin Video 

My Movie 

• yt'^ ^ 

 [ly , IJII 

 f^^rcC\ 
y. 

'(9^ 

Property Access Checklist 

Property ID: n WOKKSIAKlliD ON: _/ 7 

D WOKK COMPELIED ON: I / Proper,, Ad<lres.s: ^ / ^ /^2/g.^/^ ^ 

Renter: ^^'""' He Ouycy/y^dyTr^ 

Phone: 

'7^ 

Fax: 

Ccll/Paiii-r: y^^yy^mi- Plione: 

Additional Infonnation: '»jyi7yi,&y I'ax: 

Cell/Pas'cr: 

to Nofilkation Letter 

Smt: lb_llJl_l C ^ B.v: CkTT^ 

, Q Access A<jrecmeiit Siuned://) I f D I /7 ^ 

Bv: CM^rs 

Rcstoiiition Amecincnt Sii>ue±_lO/M'6^ By: dlUH S 

n Top.soil .Sani|)lin<; (if a|)plical)le) Bv: 

cn Dispo.sal Samplinji (if a|)plical)lc) 

Bv: 

[ H Cardcii Sainplin<> (if ap|)licabk') Bv: 

n Utility Clearance Called:/Ji_/|j6/Z9" 

^yi^.yyl%iL^r^i'i^p'^^ 

ra^ Video/Photos (Before) 

O'r.JO'JP/ ^ ^ILC7/UZ^ 

n Video/Photos (During) On: Bv: 

n Video/Photos (After) On: Bv: 

n Video/Photos (3(»-Day) On: Bv: 

I I Pro|)erty Completion A^reenicnf Sisjncd: / / Bv: 

I I Final Re|)or< Issued: Bv: 

Air IVIonitorin" (as a|)[)lical)le) 

n i Conununity CU Crew On: / / 

By: Results: 

1 CD Community Clj Cre« On: 

BV: / - / 

Results: 

_ 

1 cn Community CU CrcM On: / / 1 

ResnKs: 1 

Omaha Lead Site 
27392 

pyM^tfv 

Omaha Lead SiteP ^ , x 

46130 
Owner Name: TAMARA M RICH 

Address: 2615 PATRICK AV 

Phone: H:

Sample Number 

RYASCPXA-27392 Fl 

RYBSCPXA-27392 F2 

RYCSCPXA-27392 Bl 

RYDSCPXA-27392 B2 

RDZSCPXA-27392 DZ 

RPZSCrXA-27392 "PZOmaha Lead Site 

Site Sketch 

 W: 

Lead Sample LAB Concentration Collected 

% ^ g ppm D 

y z ^ ~y ppm D 

'7*7'' 7 ppm D 

^37 ^ ppm D 

_^^3_pp m nr D 

ppm D D 

ppm D D 

Number of Samples L ^ 

^ ^.—vH­

\ 

)[ 

7. d'cii I 

ST^ 

vjy^3 • ^ 

^ 

y: ^ <t.. 

7). 9^^ V 

% 

;£Z.^ •<7.\ 

sir 

27392 

Exterior Paint 

North Arrow 

• Good 

H'^o r 

Q Not paint 

Samples Col ected 

Firm: ¥DA.CK 1 \( y 

Date: O l { ZZ. jo q 

Time: iU-fi O 

Samples Analyzed 

XRF Unit: ^/ - Book: e f 

Date: ^V^'^ ^ 

Time: /^^ ^ 

Staff: 7:yz^-^ 

ENl-EBED 

J U t 2 7 2IIU4 

> ^ 

.?>:^. 

f37 

7 

y 

^ ^^-je 

UJ 

3 

Omaha Lead Site 

46130 
Douglas County Account Information 

Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R200085000 0 

Print Report Information is valid as of 2007-8-24 View on Map Values not finalized until after Board of Equalization Treasurer's Tax Report 

Owne r 

SCOTT NANCY L 

2615 PATRICK AVE 

OMAHA NE 68111-0000 

Propert y Informatio n 

Key Number: 0085 0000 20 

Account Type: Residential 

Parcel Number: 2000850000 

Parcel Address: 2615 PATRICK AV 

OMAHA NE 68111-0000 

Legal Description: PATRICKS ADD LOT 4 BLOCK 4 W 40 FT 

Valu e Informatio n 

Land Improvement Total 

2007 $1,100.00 $31,700.00 $32,800.00 

2006 $1,100.00 $31,700.00 $32,800.00 

2005 $1,100.00 $31,700.00 $32,800.00 

2604 $1,100.00 $10,200.00 $11,300.00 

2003 $1,100.00 $10,200.00 $11,300.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2006-08-04 

Deed Type: WD Book: 2006 Page: 092094 

Price: $37,900.00 

Grantor: 

Rich Tamara M 

Grantee: Scott H Nancy L 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.12 5280.0 40.0 1.0 132.0 40.0 No 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/5/2007 
Douglas County Account Information Page 2 of 2 

2615 Patrick Av 

7-0 n n 

17 tr 

7ifi First Floor 

673 OSQ F I 

SU 2fiO b-**:'jiidFI'Xir 

40V OSq PI 

>0 6 0 WO" 

'fry Enei jrtiflWai . ni -. 

1 1/2 story Fin BinwJi Bock 8 ftG3/D Sq ri 

Clic Click to Enlarge lma£e k to Enlarge Image 

Square Footage: 1081.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Owner Occupied: No Condo Square Footage: 0.0 

Buil 1 1/2 Story Fin Rooms: 6.0 t As: 

HVAC: Central Air to Air Units: 1.0 

Exterior: Frame Siding Baths: 1.0 

Interior: Drywali Bedrooms: 2.0 

Roof Cover: Composition Shingle Stories: 1.5 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1913 0% 1913 93 

Detail Type Detail Description Units 

Add On Stone Trim 150.0 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 624.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Screen 168.0 

Porch End Screen 63.0 

User Attic Full Finish 408.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/5/2007 
Douglas County NE GIS Map 

Disclaimer: This map is not guaranteed 

to be accurate, correct, cunent, or 

complete and conclusions drawn 

are the responsibility of the user. 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

1 Coordinator 

Comment (s): 

f7^9^ 

yy'^ z<yyy7 /y^z^ccyzTk/ 

Date: loU Time: ^/^ Action: /Jr^«g>^7^^< ^ 

Date: A/ > Time: /^5Z? Action: /^WT^c/^yL 

Date: "^^ Time: //< / Action: ^,4^'^/^ <<^^/^,g»^a4g_ 

Transmit to EPA D Other Action: D 

1 
m t 

i£0 sr.,. 

— » Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVtRONMENTA l 

C N 0 U ' , IN C 

EXECUTIVE SUMMARY: 

27392—2615 PATRICK AVE 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

Property Owner was issued a check #5019 in the amount of $300.00 for a dog kennel which was taken 

away and thrown out along with other debris during remediation activities at the property. 
As-Built Drawing 

COASTA L Oinaha Lead Superfund Site 

27392 

OwrtM- Name: TAK'ARA M KICM Omahc i Lea d Sita txtoftcc Paint NL* U I AXTOWI 

Sit s Skatct i Q Good Address: 26i 5 PATRICK AV 

Phone: f- ___ ^ a NolpairJ 

Sarr.pl« Kijmber Laad Samplos Col e«ed LAB ConcoTtratiOfi Coiloctad tauXL RYASCr>XA-?7392 F' n 

RYaSCPXA-2739'2 F? yL^~ 7 ppm D T,rne: I U • iS^ J 

RYCSCHXA-2.1-397 HI "7*/-"7 ppm D 

RYDSCPXA-2739 Samptea Analyzed 2 B2 n RDZSCPXA-27392 DZ XRt Unit; .^/ ^ BOOK ^/ ^ 

Re2&eP^fe«.-Z739Z -»^ - PP*n D D Di^c: ^y9-^f ^ 

RP^aCPXA-j^THl**? f7 ~ PP"« D n Time: ^9^^^ ^ 

• Staff /yj^^ / Miimbc ol Sarriplns =11_^ 

PO has a dog close gate everyday. 

Leave clotheslines poles if removed ENTERED 

during remediation activities. Remove j u i 2 7 2au4 

and replace dog kennel. Remove all 

trees if possible. Save pine trees dig 

around them in F1 and F2 

yyy$^y^iy^>>'^^>^­

^^^^y7yy \ y,^^.^,,^-^ 

y>6^K.. 1 xxv.«.^.j^^ 

fij^fihl ^ I Ai d 'isl.-

OLS#: 27392 

Date Excavated: 11/5/07 

Date USEPA Signed Off: 11/30/07 

46 !T^) 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Enviromnenta l Group Inc , 
S i ^ EPA B

 t 

EPA Property Close Out Form 

Property #: ^7^q ^ Property Address: ^Q 6?! 6 ) fri'hr\07^ . ANTC -

Date/Time: (i /a ^ Owner's Name: i\T-r\^t^i <^, n\\ ' 

Quads Excavated: Contractor Croup C tsr, %-^ fK\ 

ExcavatioD General Yes No 

1. If necessary, were the correct qiiadrant(s) excavated and restored? y 

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

Grading Sod and Vesetation 

Yes No 

1 1. Does the grading around the perimeter ofthe house in excavated areas generally slope away ^ 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 

day time^riod) 

4. 

Are sodded areas generally fum and evenly graded? y 

1 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 damage to landscaping or plant materials avoided? 

y 

Gates, Feoces and Retaining Walls 

Yes No 

I. Do gates open and close freely? (If applicable) ^ y 

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

3. Wasdamage to gates or fences avoided? (If applicable) 1 ^ 

4. Wasdamage to retaining walls avoided? (If applicable) 4V 

Foundation, SidioKand Cutters Yes No 

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

2. Was damage to the foundation avoided? 1 ^ 

3. Was damage lo windows avoided? ^ 

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

5. Was damage to dowTispouts or downspout extensions avoided? ^ 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? y 
/ 

V 

Owners comments: 

Inspection notes: 

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

EPA Representati>^I ^ ,y0^^ , ^lyy ^ Date: 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items arc in questions, 

now, or at any time in the future, except those items listed lielow, ifany. 

Property ID: "3 H O^Q ' 1 

Property Address: ^^^^ ^ 'Prrh c y c M AxT f 

Owner 

MIKAQVJ S ( oft " 

Phone: i &17-' C)(..uc7i 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I agree restoration Is completed, except as noted 

 I I do nol agree restoration is completed 

/yy^ / yZ-Ty • ,r.7rj^ 

Date Contractor's Signature Date 

I
Property Damage Settlement 

Property ID 27392 

Property Address 2615 Patrick AVE 

Owner Nancy Scott 

Phone 402-517-0660 

I have received from the contractor. Coastal Environmental Group Inc. (Coastal), a sum of $ 300.00 as 

compensation for a dog kennel that was thrown away during the removal of lead-impacted soil from the 

property. 

Check Number 5019 

Value of Check $300.00 

Made Out To Nancy Scott 

Description of Miscellaneous Propertv Damage 

Coastal accessed the property at 2516 Patrick Ave to complete lead restoration during excavation at the 

property a dog kennel was taken away and thrown out along with other waste debris. Coastal has agreed to 

pay the homeowner $300.00 as a buyout for the homeowner to replace at her leisure. 

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be lair compensation for the miscellaneous property damage described above and 

release Coastal Environmental Group Inc from further obligations or liability related to this property 

damage. 

IT/ZZA 22 

Contractor's Signature Dkte 

Page 1 of 1 
ENVIRONMENTAL SERVICE GROUP, INC 

825 S 26TH ST 

COUNCIL BLUFFS, lA 51501-5968 

g TOTHE " ORDER OF. 

PAY V^iW\6^ 4c^ff 

W^ mm^^ 

VMIiF»|)aeaiili.NA. 

Nebmka 

wdhfargocom 

FOR U\\t ^1>^^ 

11-0000 50 I "111' i: 101.0000 581: E.Ei«7^E.50qaii'^^ ^ / 
Z 'g-y; / / 

' r 

/ 

27392 ^ 

Omah Exterior Paint 

'\lorth Arrow a Lea d Site Owner Name: TAMARA M RICH • Good Site Sketc h Address; 2615 PATRICK AV 

^ [i^^Poor 

1 

Phone: H W: Q Not paint 

; S

Sample Lead Sample 

Samples Collected Number 

Concentration Collected LAB 

Firm: fPA CAI | f^^" u

RYASCPXA-27392 F1 

ppm D Date o-iizyjau 

I 

RYBSCPXA-27392 F2 

ppm D Time lU.-fiO 

5 

RYCSCPXA-27392 B1 

ppm D 

Samples Analyzed RYDSCPXA-27392 B2 ppm \D7 n 

RDZSCPXA-27392 DZ ^^3 ppm uy D XRF Unit: # / • 2 - Book ^ y N 

RGZGCPXA-27392 -GZ— ppm n n 

Date: ^ 79-^f^ 

RPZSCPXA-27392 "PZ" ppm D 

Time: 7 ^ ^ 

Staff: 7=yJ^ ^ Numbe I r of Samples - ^ 

fdMsy 

2.0y^Pibi<izzlz"ti^-- yi. BNTERED; 

jijt 2 7 im^

 • ^^• tip\ci.u 

y . '\^cc^ ./: 

p^TKi/.,fc: 

Omaha Lead SiteP ^ x Ah\\\ \ 
PROPERTY CLEARANCE WORKSHEET 

Date ll'oyoi 

Project Omaha Lead -- Fixed Price 

Property ID 

Property 

Address 

Measurement 

Count/Time 

Field Sliots 

Shot * 

Composite 

Average 

(Bag) 

\51 

9^ 

Composite 

Average 

(Bag) 

i<do 

ZZh" 

Composite 

Average 

(Bag) 

B l 

lot 

Composite 

Average 

(Bag) 

l/h 

\H5' 

Composite 

Average 

(Bag) 

Z l 1<^Z 

Z^IS' Pa-hy(Z.fo Ay ^ 

Reading Sample Area 

Composite Analytical Lab Analytical 

(Dried & Spilt Sent Number Results Sieved) 7 

Pass/Fai l ? 

Composite Analytical 

Lab Analytical (Dried & Spilt Sent Number Results Sieved) ? 

j 

Pass/Fai l ? 

Composite Analytical 

Lab Analytical (Dried 8t Spilt Sent Number Results Sieved) 7 

Pass/Fail ? 

Composite Analytical 

Lab Analytical (Dried & Spilt Sent Number Results Sieved) • » 

1 

~.—..__^^^^^ 

Pass/Fai l ? 

Composite Analytical 

Lab Analytical (Dried & Spilt Sent Number Results Sieved) •> 

XRF ID 

Shot # Reading 

2e>o no 

l y ^ i«n 

^12 . t,\ 

7ZO 121 

Sample Area 

I n Situ Aliquot Readinq 

1 

2 

3 

4 

.5 

Sample Area 

I n Situ Aliquot Reading 

1 

2 

3 

4 

5 

Sample Area 

In Situ Aliquot Readinq 

] life 

2 P^ 

3 •7, 1 

4 (tfO 

5 I0(o 

Sample Area 

Aliquot 

1 

2 

3 

4 

5 

I n Situ 

Readinq 

P«' 

7^ 

I I Z 

U l 

9< 

Sample Area 

I n Situ Aliquot Readinq 

1 

2 

3 

4 

.•; 

0107-51 

Sample Area 

r)7 li-lM 

/CA ' Ai 

R \ ft-VO 

(»>Z P,-l o 

D 2 12-|M 

Composite Readings 

(Bag) 

/i^T 

IhZ. 

I 7 n XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

^A -hJ 

Composite Readings 

(Bag) 

\^K 

/(/7 

t h i 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

K\ B-iO 

Composite Readings 

(Bag) 

101 

l i l 

L l 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

fez S-/0 

Composite Readings 

(Bag) 

/ / 9 

11)1, 

i Z t XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

Composite Readings 

(Bag) 

XRF Corrected Value - > 

(use calibration chart or add 

2 0 % to value) 

I/.?/ AODIimHA f SHffI S I f 

XRF Technician's Signiture NffDf! ) 
,^iec sr^ - * 

/ COASTAL tNVlRONMfNTA L 

C H C U P , IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to anci authorizes the Unitetd States 

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

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

following cJescribed premises: 

lUAyy 

Owner's Name: _ y Daytime Phone: /--/"/ / <3 ^j' ^ 

Address of Property -zd^/^ 77^^"^^ -^^ 

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 Grantors 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, 

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 
Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This wil l also sene as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property owner and the United Slates Environmental 

Protection Agency (EPA). 

Property ID: y^'-y^t ^ ' p 

Property AddressV ^^ ^ V /'^Zr7^y:j ^ 77 ^ 

r\.. Owne — A r y.. I 'a nn r~ym •• Z^A/t/c^y 3>ydrr 

Phone ^^y77a^7) ^^^.</fr z 

On the attached diagram(s) indicate area(s) to excavated and depth of e.\ca\ation. location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction o f North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the phoio-log number with an arrow indicating direction of \ iew. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

".e remcve!. storage, cisposa!, ar.d.cr -etL-rr. cf tnese items is the 'Owrie's respcr.sibi'ity. 

Item: 

yifAM-t5 

Item:

\y\ 

Item: 

"^j ^ CM^S 

Item: ^^- ^ 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

^M^A^'^T'-'^*^''^^ -^""^ C5os^^e5 

Xbc-^sv^ f W ^y^^^^^\^^^^^^^f^ 

Item: 

t)b ^ ^>^^c \ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: s^^ 

Item: 3^(U 

Item: 

^K: ^ i-r / ^ ru^u A 

Item: d/s^L f^/lAJZ P7^if J^JMyQiZ^-

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item 

Item 

Item: 

Item 

f I

Page 3 of. 
COASTA L 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with "rass. 

Number of trees > 2 inch 

trunk diaineter 

Number of trees =2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control X'a.hes. 

rimers. Heads. e;c. 

;.'v-;,.ts;-r ;a'v om 

Number of and size of 

each garden flower bed 

area. 

M.'c^ ;;;'^: a)C;i:Mn>, 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

7 ^ /^*^// 

f/Ay y 

•Y^u/s t ^ Each 

JyHyiyo<. 

yi Lach 

Each 

Each 

JUU l ^ i V. V. 1 

Page 4 of 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this \alue will be 

used to issue a plant 

>oucher to the propert) 

o>N ner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

\er\' specific and detailed. 

Each 

Include ri sketch nf were 

ciicli plant ^'v ill be pi:;ced 

b\ ib.e connacio!. 

.Agreed upon area of 

propem to be replaced 

H ith grass sod. 

SF 

^ t :..,i c „ - ^ cl,'' ! ''. .'.'x 

'ryi^r i ! .'Area of Cir\ or Counr\ .nicaoii..ii\ orv.uuni\ i I 

propertx to be landscapea y^^'T^^^i^^/^ h 

per their ••equiremenis. y i SF 

Easement .Area, to be SF e\ca\ated 

Page 5 of 
COASTA L • NVIRONHINTA L C • O U r . INC . 

Additional Comments / Instructions: 

y^^ / / 7^6 y^T/ ^ cf^777<4'E7. 

/?iysy ^47reT7i^h'^ . 

'T7t^ysy7^^y^y^^,/^7c,cy3 ^ F /is s /'^y<^, 

'ITTh^e' jy^Zy /y^T^T^j)/'^'^l> y^<iy /Ze^Zyzt/j^-ei^4P) 

/lAyh yy<^r Z^^^/T^C^ . 

^ // ^ /^y^,^//^/^/ ^ ^y^u^ , ^ef/^7^^^1^ ­

• 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. 

n I do not agree 

yy/^ 7^7 /c//aZ7^ 

Daw Contractor's Signature Date