• • 

### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAE)* : 

# l _

_Date : ^H/TD S Address : /^/ 3 T^r^Xe/ SJ
Remediatio nContractor : _Coasta I Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary ^ EPA-providedpropert y sketc h B Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t propert y aRestoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 0 Confirmatio ndat a•__ • •^

/ Photograph s As-built sketc h Satisfactory restoratio nsigne db y Property Ovvne r Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfromDougla s County Assessor' s Offic e D D .

4031779 0 

# iiiil i Superfun d

## ^ Fina l Repor t Propert y Chec k Lis t (Pleas e plac e wit heac h Har dCop y Informatio n ]

/ Propert y Chec k Lis t /X , Sit e Workin g Drawin g Ma p EP A original s Ma p Dougla s Count y Assessor' s Ma p /5 . Propert y Contac t Shee t Agreemen t V. Acces s Agreemen t ^ Restoratio nAgreemen t

[iscellaneou s Document s 'Fina l Ma p fro mth e Fiel d Chang e Order s XR FDat a 4 . An y einail s o r P O correspondence s propert y Completio n fl . Executiv e Suinmar y

2 . A S BUIL T J . Propert y Completio nAgreemen t 4 . An y buyou t inf o o r reimbursemen t inf o 5 ^ Chec k o r mone y orde r copie s EP A Propert y Clos e Ou t Fon n Attache dBegi nVide o Electroni c Documentatio n Drawing s .- 1 . ^ EP A origina l '^

X Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s During/Excavatio nPhoto s So dPhoto s 30-Da y So dPhoto s Scanne dDocument s Fina l Document s ' 7 Executiv e Summar y Video s Begi nVide o M y Movi e 

## file) Jf ^

4" ^y j Q j '^7)1^^^- ^ ^ ' '

### Ai_*
- IdOOlo y r(ivti<-' ^ lQLiad~C£ > Tota l QL ' ^iSquar e Footag e t o b e Excavate d = 150 0 Ropert yClassification : 80 0 .^k . ^ Tota . ^^n e Linea rFootaq e t o b e Excavate d = 0



## Drexe l Stree t Legen d Concret e NorthArro w Omah a Lea d Sit e Omaha , Nebrask a Excavate d Are a Existin g Structur e Permanen t Landscapin g Fenc e Scal e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft Propert yNumbe r OLS-4460 1 Propert yAddres s 191 8 DREXE L S T Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) 

# i , © ' i THG L F1 . B 2 Pla yArea Stree t Boundary \J*«i * ^ •= • •iv<!Ai:>g!.,r;<ji-:: , |f<i
- F 2 D Z Easemen t 

# o 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 right-hand quadrant ; B1 , backyar d left-han d quadrant ; B2 , backyar d right-hand quadrant ; DZ , dri p zon e (1- 3 foo t are a o f soi l aroun d th e foundatio n of th e house) .

## Propert yAcces s Checklis t Propert y ID : ^{^Q l D WOR K STARTE D ON : / / Proper, , A,l.lrc.s,. : y ^/ g 171)/^/ 77
- D WORKCOIVIPELTE D ON : / / Renter : 

# ^^^"'^•• = Sny n7()i7i nLL C Addre.s.s : Plione : Fax : Cell/Pager : Phone : CjT^^.QQJL j Additiona l Information : Fax : Cell/Pajrer :

• Notificatio nLette r Sent : / / By : PN } Acces s Agreemen t Signed : i^/2^_ ^ 

## By : illr/ 5 Q ' Restoratio nAgreemen t Signed : ( j lQ6iry ] 

# ^y-ciy y C JTopsoi l Samplin g (if applicable ) 11 By : C ] Disposa l Samplin g (if applicable ) 11 By : nGarde nSamplin g (if applicable ) 1 1 By : -[ 3 Utility Clearanc e Called : 4 " 1 9^' 1 0 1 

## Byr ^ (i>l^5'^.C«: > VP^|« ' nVideo/Photo s (Before ) On : / / By : mi Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : nVideo/Photo s (3()-Day ) On : / / By : 1 1 Propert y Completio nAgreemen t Siuned :/ / By : D Fina l Repor t Issued :/ / By : Ai r IVIonitorin g (a s applicable ) nCommunit y C U Cre w On : / / By : Results : r~l Communit y [ H Cre w On : / / By : Results : C

U Communit y C U Cre w On : / / By : Results :

Omah a Lea d Sit et Square Footag e t o b e Excavate d = 150 0 Propert yClassification : 80 0 Zon e Linea rFootag e t o be Excavate d = 0 

# 4OtKUCferlAe i

Descriptio n of post excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d right-hand quadrant ; B1 , backyard left-han d quadrant ; B2 , backyar d right-hand quadrant ; DZ , dri p zon e (1- 3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .

## 4460 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName:feW4 . PEARSON ­ • Goo d Sit e Sketc h Address:J9l 8 DREXE L S T 

# i [g'foo r Phone : H^32 - ^i'. ^ ^ Q Not pain t

OmahaLea dSit e 4613 0

### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 162827000 0 PEARSO N ILA R L 191 8 DREXE L S T OMAH A 6810 7 C/ O SUSA N BOWE N L C 191 8 DREXE L S T OMAH A N E 6810 7 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Websit e Lin k 10-14-1 3 C/ O SUSA N BOWE N L C LINDQUIST S AD D T O S OMAH A 0 2 3 45X11 7

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R162827000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 Inc h = 28 8 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogi s alias/dogis/printPreview.aspx?PrintOptData=DougIa s County-.. . 6/7/200 7

## CONTAC T FORM Property ID # 

# ^%o l Property Address : 

# yiMMdS^
- Initial Contact : Date : ^^'/^'/y/Time : Action : Secon dContact : Date: ^ Time : Action : Final Contact : Date : Time : Action : Fina l Action : Transmi t to EP A D Othe r Action : D

Comment : Owne r Commen t (s) :

. 

## Site Coordinato r Commen t (s) :,ifci J sr< . . s * > # COASTA L ENVINONKENTA L CROUP , INC . 

### Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO 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 : Daytim e Phone : <^g/ ' g"/ ^ Owner' s Nam e 

# ff)4t/ c /./^e^m r

Addres s o f Propert y 

# /^Wi^^^^^ 7 '^ ^ "^^ ^ ^ ^ /927 ^ covere d b ythi s 

# D^i^'- I 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 

### 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 subcontractor s th e right 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 2\"^***^* ' COASTA COASTA L L * > - -r^ ^ ENVIRONMENTA L CROUP . IN C 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscape items , woo d piles , do g houses , etc ; •Remov e flowe rbulb sorplant 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 ebyhealt 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 ofth e property . AGREEMEN TNO T To INTERFER E ' . , ,, . v^ 

### Th e Granto ragree s no t to interfer e ortampe rwit h an yofth 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 , orto allo wother s to us e th e propert y in suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coastal Environmenta l Group , at (877 ) 234-6270 . ^Q^gran t access to mypropertie sO I do not gran t access to mypropertie s 

# 4Z^^AT/ ^ S^Tiatur e ^ Dat e 7 Signatur eDat e ^ D a t e ' 7
O I woul d lik e tobe presen t durin g an ysamplin g tha tis required .

Pag e 2 of 2

# mi COASTA L ENVIRONMENTA L CROUP , INC , \ rf 

## Consen t Fo rAcces s To Propert y RIGH TOF ENTR YTO PREMISE S 

### Granto r(th e propert yowner ) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

- lyi-XdJ J 'AJ'-J^P^AM^'^ Owner' 'ne r s s Name:, T

Nam e /\ Daytim e Phone: /-^- 7 ., ^^ / 

# ur 

# iLfr,yy-mi ^

Addres s of Propert y covere d bythi s 

# /^/ ? hU^chk . Agreement : PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A is requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard . Th e area(s ) wil l be excavate d to remov e contaminate d soil . Th e remove d contaminate d soi l wil l be replace d wit h clea n material s an d th e are a wil l be restore d to it s origina l condition . Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e of Coastal Environmenta l Group , contracte d byUSEPA , wil l contac t th e Granto rin-perso n to discus s th e wor kto be performed , th e Granto rwil l hav e an opportunit yto revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e it begins . Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha t it

is complet e anr ! 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 r is grantin g th e EPA , it s employees , contractor s an d subcontractor s th e right to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work . Thi s acces s shal l remai n in 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 of 2COASTA L ENVIRONMENTA L CROUP , 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 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 ofth e property . AGREEMEN TNO TT O INTERFER E 

### 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 equipment 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 yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (877 ) 234-6270 . I gran t access t o m ypropertie s D I d o not gran t access t o m ypropertie s 

# /TU^ei O 

# A IttiP ^ Signatur e Dat e Signatur e Dat e
G I 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 2

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s ofth e property prio r to remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dto th e satisfactio nofth e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Property ID : 

## 7^6'7} / Property Address : 7^7 ^ ///t^i^ ^ S7 ^ Owner : Phone : 

# ? ? 7 • 

# ao M Onth e attache ddiagram(s ) indicate areaCs) to excavate danddept ho f excavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to b e usedb y contractor , andthe directio no f North . Indicate distances , depths , material t\pes . etc . Indicat e digital photo s by 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 . Ite m 

# B oo ^ Item : Item : Item : Item : Item : Item : Item : Pag e 1 of . 

# 7CCASTA-: - 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 : 

## ^t^ C Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 of_ ^( ^ C O. AS TAi . CROUP . IN 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 : 

### ^IL ^ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o f (y ^C O , AE TAi f rs<VinONMCNTA L 

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

### Ite m Quantit y Uni t Condition/Type/Specie s

Pre-existin g property area , that wil l b e excavated , tha t i s coveredwit hgrass .

Numbe r o f tree s > 2 inch trun k 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 . .^nac hasketc ho f th e sprinkle r la

> out .
Numbe r o f an dsiz e o f eac hgarden/ flower bed area . .^nac hasketc ho f relativ e size s an dlocations . 

# 1^ 0 Square fee t 

# A 

# r\6Q h

Each ^ 

# 7 Each

Each /

Each Squar e Feet ^

Pag e 4 

### o f C yC O. A 'S T'A* L ENVIROMM E NTA 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 dupo nlis t o f plan t material s that wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Includ e asketc ho f were eac hplan t wil l b e place d b y th e contractor . Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketc ho f th e area(s ) to b e replace duit h gras s sod . Are ao f City o r Count y property t o b e landscape d pe r thei r requirements . Includ e asketc hof th e are a(s )

Easemen t Area , to b e excavate d 

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

/ $

1 

# 7 Each 

# 10 6 S F

^ S F 

# y S F

Page s 

## of bC CA- S y A' L ENVIMONHCNTA L CROU P INC . II Additiona l Comments / Instructions :

(Ckj>> ^ I / O 

# /^ WP. F ^ i--^ ^ ^e^ ^ B^^'"- ^ /l-a.r7a,^ y L-c^e c 

# lllftp . 'M

• Chec k th e bo x

if Owne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckin g thi s boxCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundatio n crack sorfissures .

n1 do no t agre e

Owner' s Signatur e Date Contractor' s Signatur e Dat e 

### Paqe 6

of i fPROPERTYCLEARANC E WORKSHEE T

Dat e Propert yI D 

### V 

# Yiy p M(or) \ Propert y Projec t Omah a Lea d — Fixe d Pric e 

## c{\ 7 V^4C y'^ ^ Addres s Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d SInot s Sho t # Readin g Sampl e Are a Sho t # Readin g Sampl e Are a 

### h i t i l in-k- ' 

# a-

^

Sampl e Are a 

## 7 Co 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 1 (Bag ) Sieved ) 7 

## ,^

4 2 

### A? , '3 Q 3 ' ^ • ^ S4- ­ 

## y y 

# b y 4 

# 7 6 5 

# ^ XR F Correcte d Valu e —> 

# b ? 5 (us e calibratio n char t o rad d 20"/ o t o value ) 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 q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) 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 ) 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 q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 3 4 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 200/ 0 t o value ) 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 q 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 ) 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 q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 2 3 -» XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# 1 

# + US [ ADDIIIOHAI . SHUT S I F XR F Technician' s Signitur e HECDF D 

### Y



## yJA y1 • • I'- " 

# RESTORATIO NCHANG EORDE R OMAH A LEA D Propert y I D #/ky^J>77/^ 7 /f^/W^/ T /^ ^ 7M^7y/i^(7/<r^of ) Propert y Addres s l^^j D })^^grg ^ Owne r Nam e TYIyjitf y /^t^y^eU T 

# Dat e l/f^/o y Comment s

Owne r Signatur e Contracto r Signatur e< r — *

* 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . \

^

• .- ^ www.coastalhazmat.co m ^-i«,o^ ^ COASTA L ENVIRONMENTA L C n O U P , IN C 

## EXECUTIV ESUMMARY : 44601—191 8 DREXE LS T 'x \N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g ^ COASTA L 

# Oinah aLea dSuperfun dSit e

WHWBJyCBsaifcallon : ao o Scrap e alle yfo racces s i j

B l = 5 7 PP M I

I^S^ ^

OLS# : 4460 1 ,^Date-E)fc¥^ated : 7/20/0 7 Dat e USEP ASigne d Off : 7/27/0 7 Puiiu'mn l L^ndbcap^n g - • Fenc e

—Quattan t BowNBi y

—Stree t Boindai y y~i. . \y ' Tree^Stvu b Ali i ay

"•^ •

.r ' • tTT-^T- f Driexfe l Stree t Norl h Arro w
*ca M 1 inc n - 2 0 ree t o r1 gn d - 51 5 i t

/ ^ F l . F 2 B l Ibb I Quadran t Squar e Footag e t o b e Excavate d - 150 0 TWM D m am e i*iBa rFowaQ e to D e Encavate d - D

- V

Omdti aLea dSit e Omana . Neoraet a Prppert yNumbe r

oils-uso i Propen yAa<Sres 5 1»1 8 DREXE L S T Pos t Excavatio n ConcenVation s (ppm ) B 2 PlayAre a D Z Easemen t 0«ie r 1 <WMi«nJI»«r»i<0jM>«r<tW.t>«Wf<r<lil»t-liM»<»ill«i«»1 , ««CIO»MM>MI»II M 11 1 ••»,» , b»at|»idr>)M>«na ; te, * .<V» i Legen d

Are a no t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## Propert yCompletio n Agreemen t Thi s agrccnicn l documciil s th e completio no f remedial aciivilie s performe do nm y properly . M y sigiialiire wili dcsignal c lhal I a msatisfie dwit hihc rcsloralio noTmy properly , an dlhal n o ilcm s ar e i n qiicslions . now , o r al an y time i nthe fuUirc , excep t thos e ilcm s liste dbelow , ifany . Properl y lb : ^C/<^ / Propert y A.l.lrc.ss : /f/ ^ ff/^y^X^O ^ T O w 

## "^'' " :$o^A M ^c^toei n Phone: ^ ^ ^ , 3^y / Restoratior i Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

I T l iimc v rcstoiiitio ni s i:oniplcttHl , excep t a s note d I I <l< > ^o l ame v re.storatioi i i.sjtjmiplete d 

# imy . Owner s Signatur e Dat e Vat e I

# t PA Propert y Clos e Ou t For m Propert y #: 

# V^^^ / Propert y Address : 1^7^Tv^jj^yPT ^ Datc/Tlmc : Owner' s Name : ,^^$/U j j^/:>uU-e n Quad s Excavated : CoDtracto rGrou p Excavatioi i Gencni l Ye sNo 1.

If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

### ^ 2.If ncccssa.7 , wer e th e correc t area s of drip zon e excavate dan drestored ? L ^ GradlDKSodaBdVcseUlio B Ye sNo 1.

Doe s th e gradin g aroun dth e perimeter ofth e hous e inexca \ate darea s generall y slop e awa y 

### y fromth e bouse ? 2.

Ha s so dbeenlai d inal l area s tha t wer e excavated ? 

### ^ 3.

Doc s th e wdappea rtobe generall y health v andgro w ing ? (Onl v evaluat e if

inspecte d at a

30 da y tim e period ) 4.

Ar e sodde darea s generall y fir man devenl y graded ? t - ^ 5.

Ar e th e join u betwee nth e so dstrip s generall y tight ? (Onl y e\aloat e if inspecte d at a

30 da y tin K penod ) 6.Wa s th e property grade dsuc htha t wate r w ill no t poo l onth e prope'T > ? 

### ^ 1 ".'A'a s damag e to landscaipin g or pla-i t r;ateri8! s Evcided'] ' .. ^ • Gaicv , FCDCC S aa c RcUiDiD f S^ai b Ye s No 

### 1 '. Do gate s openzm dclos e Srei} ? (! f applicable ) ^ ^ 

### 1 2.Wer e al l gate s or fence s take ndow ndurin g restoratio nac!i > ;:it s -e;r.s*.iil!e-d? if applicable ) pN 1 3. Wa s damag e to gate s or fence s avoided ? Of applicable )P> . 4.

'A'a s damag e tc retainin g v^al havoided ? (I f applicable ) f) ^ Foundation , Sidia f ao dGutter sYes N' o 1. Wa s damag e to th e sidin gor trim as oided ? tx ^ 2. W4 s damag e to th e foundatio navoided ? t ^ 3 Wa s damag e to window s avoided ? u ^ 1 4.

Wa s damag e to window s or door screen s avoided ? 1 5. Wa s damag e to downspout s or dovMispou t extension s avoided ?| / ^ , Sidewalk s an dDriveway s (Concrete )Y es No 1 1. ''A'as damag e to drivewa y surface s avoided ? 2.Wa s damag e to walkwa y surface s avoided ? t / •

### Owner s comments :

Injpectic nnct «



## ^-S^ ^ ^'^^y^^ ^ ^^- ^

Remc\a l an drestoratio nacthate s coT.r'et e inc'.udir. e the 30-da\ ' so dv^arrant v EP. A Re preser.tativ^y^^^klfc/t^^^,^^b^.i3^at e : l/ z ?ya 7