TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#- 1173'/ 

Date: /<9//7/^<^ 7 

Address: ^"^36 ^ /^^^^ ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

y Executive Summary 

EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Si^ed Access Agreement(s) for adjacent property 

y 

Restoration Agreement 

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

Confirmation data 

Photographs hiL^ ^ ^ So d 

As-built sketch 

Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA '^/^/^^~ 7 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

%y Property informationfi-om Douglas County Assessor's Office 

D 

D 

D 

zhJi//zy<yy/doL^}J^^ce^ 

lo/i^/^r. \ Ignature 

40317120 

iniii 

Superfund 
7y3 4 " ^^'^'5 ZWZn^ ^Z-

Final Report Property Check List (Please place with each file) 

Har d Copy Information 

lX| Property Check List 

Site Working Drawing Map 

EPA originals Map 

Douglas County Assessor's Map 

Property Contact Sheet 

Agreement 

i n Access Agreement 

•jZjKestoration Agreement 

Miscellaneous Documents 

'27Final Map from the Field 

2. Change Orders 

(21 XRF Data 

4. Any emails or PO correspondences 

Property Completion 

^Ty Executive Summary 

2. AS BUILT 

IPiProperty Completion Agreement 

1 ^ Any buyout info or reimbursement info 

f5| Check or money order copies 

'J6][ EPA Property Close Out Fonn 

^.Attached Begin Video 

Electronic Documentation 

Drawings 

[rj EPA original 

|2I7 Working Drawing 

-m AS Buik.vso 

• ^ AS Built.jpg 

Photos 

/Begin Photos 

During/Excavation Photos 

•Sod Photos 

vGO-Day Sod Photos 

Scanned Documents 

Z^XidX Documents 

^Executive Summary 

)Kideos 

^Begi Begn Video 

yAy Movie 
Property Access Checklist 

Property ID; | -] i ;^ Lj 

n^OR K STARTED ON: n<j U/ C'-f 

n WORKCOMPELTED ON: / / Property Address; 2.^3 5 H3rVU;;)<^i -

Renter: Owner: J ^ ^ ^^ CjiSrC^lc ^ 

Address: 7^3 3 HS^VU^ ) S h Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Fax: 

Cell/Pagcr: 

Phone: ^07- - GS O - ^ 2 M 'Ti 

M Notification Letter Sent; & / | 0 / 0 7 By: 

0 Access Agreement Signed: OS / \b 1 0"^ By: 'JJaiv\« K^ 

[ ^ Restoration Agreement Sijined: HS I It /O f By: 

cP<ir>fN» ^-^ ^ 

n Topsoil Sampling (if applicable) / / By: 

LJ Disposal Sampling (ifapplicable) /

 / By; 

Q Garden Sampling (if applicable) /

 / By: 

0^ Utility Clearance Called;Q^/ li/O l By: n r ^ vsi^u^x • 

0 Vidco/Photos (Before) On:j^lj^/_[^ l By: G_»cl v r-eder . 

D Vidco/Photos (During) On: / / By: 

Q^'Viiiieo/Photos (After) On: (^ / P^ / CZ] By: /^/(M/ 

E/Video/Photos (30-Day) (^^0/^o \ On:3^l_C:^l O j By; R.' ^ 

0 ^ Property Completion Agreement Signed: T / / IO 7 By: r/lnc 

n Final Report 

Issued: / / By: - ^ 1 

Air Monitoring (as applicable) 

1 1 Community CH Crew On: / / By: 

Results: 

EH Community CH Crew On: / / By: 1 

Results: 

1 1 Community CH Crew On: / / B.: 

Results: 

Omaha Lead Site 
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Name 6<"vci{r ^/-oi-tsi Omaha Lead Site Date ffa/t/ ^ North Arrow 

Address 7^15 ^ t^^rfAc^ Site Sketch Time \\H ^ fi^^ 

Phone 3??/- ?^3 ^ 

Team V^A^^^U M W I ^<</ BVID# 1773V XRF Code 5510^ 

Sample Number Lead Concentration Confirmation Sample 

fjYe A 1ICs3 1^ No S ^ 

% s No ra' n 

No O " 

No l^ ' 

No ^ 

Yes O No CD 

Yes • No • 

fy]Hri^/y 
Prmt Preview 

Douglas County-Omaha, NE 

Pamel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner State 

Owner Zip 

Sec-TwnRng 

0814800000 

GARCIA 

JUANP 

2935 

MARTHA ST 

OMAHA 

68105 

2935 

MARTHA ST 

OMAHA 

NE 

68105 

28-15-13 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old Assessor 

Site 

New 

Assessor 

Site 

I 

CLARKS PLACE 

0 

43 

1/2 VAC ALLEY AD J & 

50X86 

http //webarc co douglas ne us/dcassessor/details asp"? 

PARCELNB=0814800000 

http //webarc co douglas ne us 8080/RealWarel/details do'? 

id=R0814800000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed This is not a legal document and should not be substituted for a title search, 1 inch = 173 feet appraisal, survey, or for zoning venfication 

http.//www dogis org/dogisalias/dogis/prmtPreview aspx'^PrmtOptData=Douglas County- . 5/3/2007 
CONTACT FORM 

Property ID # nid^i 

Property 

Address: 9^35 l\iaZhcL 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator >\ ^ £ol(ip)Dpzy-hudM5 r)otr€zmznt>^rfz) Comment (s): 
PROt HOUSE HALF DIR STRct.'!' NAME; 'I'YfL SUffXA At"!' AKLA tjif COUL 

ADDFilSS 029S5 MARj^ ^ 3T OMA 6310 5 

^P-OWNER INFORiCi.TION ^^ -

NAME aUAT-l P*GARCIA ETAL DATE OF LAST CHA^K 02-17-200 6 

+ 293 5 MARTHA ST EK/PG OR DOC# 200 5 1505 0 

ADDR HOMESTEAD DELETE 

CITY CMAHA 3T NE SI P 6810 5 NON NLIMERIC ai P CODE 

CURRENT VALUE HCS>ESTEAD 

YEAR DATE LAND— IMPR-- —TOTAL — PAR R3N NUMBER TY CD PCT VALUE 

2007 05-13-2007 5400 74800 80200 IR 

ADDITION NO. 0658 0 LOT 43 HALF BLOCK 0 HALF 

CLARKS PLACE SECT TOWN RANGE PLAT 019 9 

DESCRIPTION - IJUJAJ J JJtiiSLHXr 1 XOrJ- - " 

1 1/2 VAC ALLEY ADJ & 2 50 X 86 

3 a 

5 6 

7 8 

PFl-ADFB PF5-PNFB PF6-PAFB 

PARC 1413 0000 08 


FB 16 STATUS 2 CLASS R 


EXEMPT 0 EXEMPT TYPE TAX DISTRICT 0100 SID F-


PROP HOUSE HALF DIR STFIEET NAME- TYPE SUFFIX APT AREA ZIP CODE 


ADDRESS 00527 S 027 ST 0>iA 68105 


-OWNER INFORMATION­
o> 

Consent For Access To Property 

RlGin o r ENrRYTOPRFMI-SFS 

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 following described 

premises 

Owner^sName: ^^ ^ (^p^fa ^ 

Daytime Phone: 

Addresses of 

Properties covered by 

this Agreement: 

Address:

Address: 

Address: 

Address:

 o^/3 S Ha.rHv^ SH o A 

i 

1 

Address: 

Pi.'Rmsroi Rl si>(-)Nsr .\ciiMiii s 

The EP.A IS requesting access to collect soil samples and remove soil that contains 

elevated concentrations of arsenic and/or lead and may pose a health hazard The soil 

will be removed and the excavated area(s) will be replaced with clean materials and 

restored This work is being performed under the Omaha Lead Site Superfund Site 

remediation program 

An EPA representative will contact the Grantor m-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 will receive wntten documentation 

from EPA that the property has been remediated 

ENVIRONM L NT AL RCSPCWSE AC I IONS 

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 

A 

«Property_^D..: Page 1 of 2 
^isfi' 

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

piles, dog houses, etc, 

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

to save, 

• 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 if EPA is unable to obtain such access, and 

• Allow videotaping and/or photography of the property includmg exterior and 

interior areas ofbuildings 

AGRFTMI NT Nor TO INII RM RF 

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

the equipment used to perform the activities, or to undertake any actions regarding the 

use of said property which would tend to endanger the health or welfare ofthe 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 

Q ^ grant access to my properties [H • do not grant access to my properties 

'<^w /C^^cv^ o^-t)-oi iK-S ^ /-A 

Signature Date Signature ' Date 

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

Page 2 of 2 

«PropeiC/_ID 

Restoration Agreement 

The purpose of this agreement is to pro\ide a mutual agreement as to conditions of property prior to 

remediation aclivilies This will also serve as decontamination for the purpose of asburing that 

restoration activities are completed to the satisfaction of the propertv ouner and the United States 

En\ ironniental Protection Acencv (EPA) 

Property ID 

Property Address -^. ^ 3 , 3 fVS S T Hvi X sv HNNaUa N>€_ e x 10 

^^" " rf^nr s C^:^>rr l ^ 

'''''"'-• Ao7, - Z^<io <&^M-5^ . 

On the attached diagrani(s) indicate area(s) to excavated and depth of e\ca\ation location of all kno\Mi 

utilities subsurface features, surface structures and landscaping features access location(i) to be r^ed b\ 

contractor and the direction of North Indicate distances depths material r> pes etc 1 idic.;!.; d'L'tul pli.Mc> 

h> refersiicipg the photo-log number u ith an arrou indicating direction of \ lew 

Items To Be Ramoved By Owner Before Start Of Rerriediat'C'-!. 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Ovvner's rssponsibility 

Item 

3 ^ccxfcX U^c^Vejr jjy ^ . CLor^^-f>^ f^t 

Item. 

Item 

Item. 

Item 

Item 

Item. 

Item. \ ^ 
((Si 

Items To Be Removed By Contractor During Remediation And-Not-Reptacett' 

(Use additional sheets as necessary) ^g- P Wje_<^ 

Item­

" ^ & ^< - CiCLrcia Losva 4o 

Item 

"^y^v^ LJO ci*33-«-cll 

Item 

5A 

Item 

2 ':p\()o«» k^cAj^ Ua>u> 4^a^<o ot->-

Item 

OA-, ^ ^» ^ pc ^ a V^Ou^civAJT 

item­

'Q yo v^e r V3e^>-> \-D A-^aJkle. cJ U V ^ P I'^-i-JItem 

lo 4-vU°p 

Item 

Q C . CJS> hs>^w^3 X >rocJg-^ o . g-^pecJ- a UDCW^^ . 

item 

\W > \g. i^jacjxA-e^ oj h dlt^ p '^^^^^^^^ 

Item. 

o^^-e^ 

Item 

rl u 1 ct ^ Y\eejeU ^ W - YetK>-o-^<-^ o^vv^ 

Item. 

e>^pec^v 3 \^ ociLjLj^^. 

ItemQlAjKer Xt^lc.^ VD ^^<2.p Gv ^v.pru/^ ^ b^ k 

Item 

l^ ^cr^loit 

Item 

Page 2 of (P 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item. 

\^2 - Qkx;^ C^^ ^^ Kfl.^ Uu^.^^^ t pVou^-J ^ r rsg-gJl^ U P Qp^">^^ 

Item 

f-^ ^ <^ ^ pC-C>- JCb^v * \ J 0 UUziouLA-t-. 

Item 

'^2 . <^^ ^ (^rr.^ r y\^<^<- hi 5 ^ ^ 

Item 

^^><^ IsojL^^ tvNu^tcJL ^^^<^^<i> ^ xjouiLsLJc 

Item 

$ 1^0 

Item 

Item / 

/ 

Item $KA ^ ^- ^ 

IteHi 

Item 

Item 

Item 

Item 

Item 

Item 

Page 3 of tp 
^ 

Item 

Pre-e\isting property area 

tliat IS co\ered uith urass 

Number of trees > 2 inch 

tiimk duinieier 

Nun^bcr of liooi inch 

Irunk diameter 

Number of Sprinkler 

Zones Control Valves 

Timers Heads etc 

Attach a skeich ot the 

sprinkler la\out 

Number of and sl^e of 

each garden' flouer bed 

area 

Attach a sketch of relaine 

SI7CS and locations 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

5 (Y"h<^ 

Each 

MDHJL 

Each 

fj(7v ^ 

Eacii 

fv)^J^ ^ 

Each 

Square Feet 

Page 4 of U^ 
Item 

Agreed upon value of plant 

materials not to be 

replaced bv contractor 

Note this value v\ill be 

used to issue a plant 

voucher to the property 

owner 

Agreed upon list of plant 

materials that uill be 

replaced b> contractor Be 

very specific and detailed 

Include a sketch of were 

each plant VMII be placed 

bv the contractor 

Agreed upon area of 

properrv to be replaced 

VMth grass sod 

Include a sketch of the 

area(s) to be rcpLiced \Mth 

grass sod 

Area ol Citv or Couniv 

propertv to be landscaped 

peT~their requirements 

Include a sketch of the 

area (s) 

Quantity Unit 

$ 

Condition/Type/Species 

Each 

Uic f ^ '^. 

2(f^A sr 

Z SF 

Page 5 of iff 
V^J 

Additional Comments / Instructions. 

Mo • 

[^Chec k 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 

intenor of house, including foundation cracks or fissures 

a^! I I I do not agree [g-nr< £ree I I I do not agree a"ree 

t^^/UA< (AA/^f/t^ U 

Ov>ner's Signature Date Page 6 of 1/ ictor's Signature Date 

> 
-XOe^t -

•^a 

^ • 1 -

t «' ^ •Ai' ^\i\t ^ 

r ^^ ^ti^erhed [, 

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£^t/ntxx( ?oSo.WAZ li 

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Svii2,^vb3 

(k/^^\ 

^^^^pc,^ 

rv^A^W -oV­
^ € C . 

Name G'-^c-^ d-a t'<S Omaha Lead Site Date imlff ^ North Arrnw 

Address. 7 <i ^ 5" i^i^j^ikc Site Sketch Time: lUl^/^^ ^ 

Phone: 3^/''^Z^5Z . 

Team ^^^^'^y^^Qk / BVID# 1773 V XRF Code 550d^ 

Sample Number Lead Concentration Confirmation Sample 

fjYes CD No S- ­

(?^es a No B ' 

mi ^ ppm No ca^ 

No raNo S ' 

ppm Yes ED No ED 

ppm Yes • No \ n 

^H^^t y 
'^~^W PROPERTY CLEARANCE WORKSHEET 

Date 

Project 

XRF ID 

Shot # 

^ 9 T 

^ Z 

3£i2. 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

CYojnjcn Property ID 

Property Omaha Lead -- Fixed Price Address 

Measurement O|07'5l Count/Time 

Field Shots 

Reading Sample Area Shot # 

iOS_ g

1 ^ 

C<; ^ 

 Yz-m" 

4iS_ 

CoU ^-,T f-^

jpHj=Mkn-/FlQu^ecBa3 

Sample Area DZ i^-ic/" 

I n Situ Composite Composite Readings Reading Average (Bag) (Bag) 

C\7 

\ 7 ^ 

^ M 05 

XRF Corrected Value - > 

(use calibration chart or add 1 /^ i ; 2 0 % to value) 

Sample Area t^) Co-^^ 

I n Situ Composite Composite Readings Reading Average (Bag) -7G (Bag) 

f i \ ^ • 7 

\F9{ 1 ^ ^ /cP5 jz-^ N S 

XRF Corrected Value —> NO (use calibration chart or add 

2 0 % t o value) 1 l^lp 

Sample Area Bl6-^^ 

I n Situ Composite Composite Readings Reading Average (Bag) (^-1 (Bag) 

-l'= i f=^Z 

15? / ^ ^ ( o ^ 3 Z sc. XRF Corrected Value ~ >

n3 (use calibration chart or add 

2 0 % t o value) 

fQ 

113 * 

^9;^'=; HA^Tf-A^^ 

Reading Sample Area 

Pass/Fail ? 

Composite Analytical Lab Analytical (Dried & Spilt Sent Number Results Sieved) 7 

Pass/Fail ? 

Composite Analytical Lab Analytical (Dried & Spilt Sent Number Results Sieved) 7 

1 

Pass/Fail ? 

Composite Analytical Lab Analytical (Dried & Spilt Sent Number Results Sieved) 7 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent Number Results (oag i 1 (Bag) Sieved) 7

Confidential 5/2/07 Page 1 of 2 
- '*-.. 2 ii 

4 

3 w 

9 

5 

XRF Corrected Value - > 

(use calibration chart or add~ -—­ - ­ —- —.­ -r- yr'-ir^-'' 

20% to value) 

Sample Area fLdUG ^ 1pfANT es3 ^ \'^^^iVJ Pass/Fail ? 

I n Situ ' Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) ? 1 

4 

2 1 ? 3 rQ^ 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) \0 

USE ADDlTIONA L SHEETS I F 

XR HEEDED F Technician's Signiture 

Confidential 5/2/07 Page 2 of 2 
Omaha Lead Site—Fixed Price EP-R7-07-05 _ Coastal Environmental Group Inc. 

>TT^^TP * www.coastalhazmat.com 

"tPBoit^ COASTA L ENVIRONMENTA L 

C It O U P , IN C 

EXECUTIVE SUMMARY: 

17734—2935 MARTHA ST 

^ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
t As-Built Drawing ^ 

COASTA L aha Lead Superfund STO i a o u r IM C 

Name: ^••-<r- C.'..<S Omaha Lead Site Dale: thljl/ ^ No.-".h Arro w [• 

Address: J ^s'-, i^,..,1kcr. Site Sketch Time U'.i'ifi.—. 

Ptx>ne 

^ 1 

OLS#: 17734 

Date Excavated: 6/19/07 fYlHrii^ 

Date USEPA Signed Off: 7/6/07 

Legend 

Area not Excavated ^ Dripzone Excavated Quadrants Excavated 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 
t • 

Property Completion Agreement 

Thi.s agreement documents tlic completion of remedial aclivilies performed on my pioperty. My 

siyiialiirc will designate that I am salisficd with the restoration of my properly, and thai no items arc in 

questions, now. or at any time in the fulurc. except those items listed below, if any. 

Propi'rty ID: /77:^V 

Property Ad«lrcss: f^^36 lUar-tliri Sf. Owner: KJLI/III ('iciifia 

Phone: uP)0'&&-^-^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

IM I iiRiTc iTstorntioii i.>i complctinl, except HS noted 

 I I do iiof iicrce restoi-Htion is completed 

^An ^ ^^SrlKyuri^.^ k 7'(-0l v/cy 

wncr's Signature Date C«inlractor'ji Signature Date 

I
Omah a Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Juan Qiardci 

Property Address ^li^j lliarHigy. 

Property Identification Number m y 

Material Removed Replacement Value 

Flower bed area \<?>^ 

Trees , 

Itemized 

shrubs/bushes 

Total k p ' 

The acceptance of the replacement certificate and the signature below is full 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ idQ Z ^ has been received by the owner in the form of a gift 

certificate, # 9%3 . to be utilized at hXilCi Z CZ'fZt NLiZSZZl I • 

^ ^ ^ A^ - ( S I Cc^C y-i'-Qi ^ 1 ' /•o 7 

Property Owner's Signature Date Contractor's Signature Date 

4 
INDIAN CREEK NURSERY 2483 

Omaha's Best Kept Gardening Secret 

303 North Saddle Creek Road 

Omaha, Nebraska 68131-2229 

(402) 558-5900 Gift Certificate 

DATE: .<r'3o-o7 

I N THE AMOUNT OF 4^n£ .Jla^ryJAjes^^ ^ l^/^OZ'"' 

ISSUED TO: (l/i m ^J/iAec^C ^ COMPLIMENTS OF: C^ibdH l CZvi^tA - ^^.i ^ 

EXPIRATION I^ATE: S "-^^ "0 ^ S-U> 

Authorized Sigjiatiire 
^tK A 

^P A Property Close Out FWm 

Property W: 

Datc/TInc: 

Quads Excavated: 

Property Addrc«: ^"^3 ^ /l/fo/f^ ^

Owner's Name: dUm Z ^^aiTja -

Contractor Group 

 ^/ ^ 

ExcavatloB General Yes No 

1 If necessary, were the correct quadrant(s) excavated and restored''-.g^j~r^^ Cu*. M-U-S.) l y 

2 If necessa7, were the correct areas of dnp zone excavated and restored'' y 

Grading Sod and VcftctatloB Yes No 

1 Does the grading around the peruneter ofthe house m excavated areas generally slope away 

from the bouse? 

y

2 Has sod been laid in all areas that were excavated'' 

y 

3 Docs the sod appear to be generally healthy and growing'' (Onlv evaluate if inspected at a 30 

day time penod) 

4 Are sodded areas gcnerallv firm and evenly graded'' y 

5 Are thejouits between the sod stnps generally tighf (Orl> evaluate if inspected at a 2-0 dav 

time period) 

6 Was the property graded such that water will not pool on the propei} "> y y 

7 Was damage to landscapmg or plant matenals avoided'' y 

Gi9ins Fences and Rctainint ^al b 

1 Do gates open and close frrelv'' (!•" applicable) 

2 Were all gates or fences taken down during restoration acti\ '"les reinsulied" ;If applicable) 

Yes 

y 

^ 

No 

3 Was damage to gates or fences avoided'' (Ifapplicable) L ^ 

4 Was damage to retaming walls avoided" (If applicable"! U ^ 

Foundation, SidiiKand Gutters 

1 Was damage to the siding or tnm av oided'' 

\es 

•»— 

No 

2 Was damage to the foundation avoided*' i ^ 

3 Was damage to windows avoided'' y 

4

5

 Was damage to windows or door screens avoided'' 

 Was damage to dowTispouts or dovmspout extensions avoided'' 

^ 

^ y 

Sidewalks and Driveways (Concrete) Ves No 

I Was damage to dnveway surfaces avoided'' ^ 

2 Was damage to walkwav surfaces avoided'' ^ 
Owners comments: 

Inspection notes: / / / / 

'y Sad ueaf d p decL JtlN^s^yl. LLL/ ^ ^ MMu/dy 

all ^^-

Removal and restoration acti\ a^es coT'c'e^e inc'udine the 30-i:!a\ sod "vA.'ar^nn 

EPA Representative^-7V^^.i:^/<t^;^^^^_^^ ^ ^/^/ W 7