## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# pl l SAI D # : 

# lf>? ^ Date : Address : l^i' V ^ ^1 ^

4f Remediatio nContractor : Coasta l Environmenta l Grou p Year ; 200 % 

### SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S

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-I T Video of property (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreement(s ) fo r adjacen t propert y RestorationAgreement Settlemen t document s (i.e. , fo r damag e or t

o replac e plants , etc. ) Confirmationdata Photograph s As-built sketch 

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### Satisfactor y restoratio nsignedb y Propert y Owne r Propert y close-out check list signedb y EP A Descriptionof area s not meeting ROD cleanup criteri a Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Office [ ! 

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## B r " ^ Restoratto nAgreonen t 

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### By : D Garde nSamplin g (f f applicable ) 1 1 

### By : ^ Utili ^ aearanc e 

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### / / By : !>Q^ Pnper ^ Completio nAgreemoat 

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### On : / / B r 1 Results : D Commnnit y D Crei r | On : / / | By : ResnHs : OCommnnft y OCrci r | On : / / | By : ResnlU :

Omah a Lea d Stt e

## Douglas Count y Accoun t t^^rjj^tio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R082288000 0 Prin t Repor t NE WFeatur a - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VlO WO H Ma p 

### Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ ^ - • Aut o Sale s Searc h Owne r FULLERTO N HARR YE ETA L 192 3 8 3 7 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumtier : 228 8 OOO O 0 8 Accoun t Type : Residentia l Parce l Number : 082288000 0 Parce l Address : 192 3 S 3 7 S T OMAH AN E 68105-000 0 Lega l Description : CLU B TERRAC E LO T1 5 BLOC K2 5 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $14,100.0 0 $70,900.0 0 $85,000.0 0 200 8 $14,100.0 0 $70,900.0 0 $85,000.0 0 200 7 $14,100.0 0 $73,200.0 0 $87,300.0 0 200 6 $14,100.0 0 $73,200.0 0 $87,300.0 0 200 5 $14,100.0 0 $73,200.0 0 $87,300.0 0 200 4 $6,400.0 0 $73,200.0 0 $79,600.0 0 Lan d Informatio n 

## Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6250. 0 1.0 125. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08..
. 9/17/2009

### Dougla s County Accoun t :^^n|utio n Pag e 2 of 2

192 3 5.3 7 S t

J79C4ql l -jnr

BsnnSlKki t 1. 5 stor y
CLIC KTO ENLARG E IMAG E Squar e Footage : 1132. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : I 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : I 1. 0 Interior : | Drywal l Baths : 1. 0 Roo fCover : ! Slat e Bedrooms : j 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : I Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 195 2 0 % 195 2 5 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 853. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Basemen t Singl e 1. 0 Porc h Ope n Sla b 100. 0 Porc h Sla b Roo fCei l 28. 0 Use r Atti cFul l Finis h 279. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.
. . 9/17/200 9

### • • •



## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action :

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### • YOU RTICKE T NUMBE RI S 2388344
. Origina l Cal l Date : 10/17/0 9 Wor k t o Begi n Date : 10/21/0 9 Time : Time : 1:5 8 p m 7:1 5 a m Op : ELIZABETH1879 0

State : N E Address : 402 2 County : DOtJCLA S Street : BUR T S T Place : OMAH A
Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 17-S E Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : Coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ALTS7 2 ATTNEBR l CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

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### Phon e Numbe r UtiHt y Typ e
ALT87 2 WINDSTREA M COMMUNICATIO NN A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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### Day : 8002413624 9 Alt : Emerg : 8002413624 9

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### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

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OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE R 

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PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o flea d an d maypos 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 its 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 fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l have a n opportunityt 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 confim i 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 EPAtha t th e property ha 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 , contractors an d subcontractors 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 fperformin g th e worit

. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2

### •• • • ,*^*^'"- ^

COASTA L tNTINONH(KTA l

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Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; G Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t maywis h t o save ; < Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d byEPA ; eAbid e b yhealt h an d safetyguidanc e provide d byEPA ; *I fth e propertyi s rented , assis t EPAi n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work

. «6

Allo wvideotapin g and/o rphotographin g o fth 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 fth e wor k activities , o rwit h an y ofth 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 ofsai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , at (402 ) 991-119 9
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## Restoratsoc i Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreeme ma s t o condition s ofth e propert y prio r t o remediatio nactivities
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.

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### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e lenoval

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. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

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P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r Ti S c C a K S pp m 184.24 8

< LO D < LO D 95.05 1 < LO D 50.83 5 < LO D < LO D < LO D < LO D 257.59 2

< LO D 38.43 4 < LO D < LO D 23313.48 4 526.22 4

< LO D < LO D < LO D < LO D < LO D < LO D < LO D ±

±
d b

±
±

± ± Erro r 22.98 9 22.85 4 16.71 8 8.64 8 23.25 1

7.18 4 17.01 3

6.20 1 28.52 9 15.31 3 32.78 4 77.51 8 25.06 4 80.82 0 229.20 2 549.16 7 125.45 2

30.01 1 229.19 6 486.25 3 105.86 5 895.82 1 2207.46 1 1310.31 0 Supervise d By : V

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 71 2 Mod e SOI L Tim e 2009-10-2 6 09:2 0 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 1838 3 LOCATIO N 192 3 s 3 7 s t INSPECTO R VENTR Y COR l b 2 CO R 2 6 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A



### pp m Erro r P b 169.72 0 ± 21.42 2 C d 26.16 6 ± 15.11 8 A g < LO D 16.54 3 S r 99.30 4 ± 8.48 0 U < LO D 22.26 1 R b 40.66 1 ± 6.43 4 T h < LO D 15.71 7 S e < LO D 6.66 8 A s < LO D 27.68 7 H g < LO D 14.45 8 Z n 272.29 6 ± 32.52 4 W < LO D 80.72 1 C u < LO D 34.72 9 N i < LO D 81.23 2 C o 232.20 8 ± 134.79 0 Fe 18637.20 1 ± 474.40 4 M n 500.69 9 ± 116.39 4 C r < LO D 159.81 8 V < LO D 37.44 8 T i < LO D 370.80 8 S c < LO D 15.42 4 C a < LO D 617.23 0 K < LO D 1232.82 4 S < LO D 805.08 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R CO R 1 CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T i S c C a K S pp m 455.65 1

< LO D < LO D 109.22 2

< LO D 40.40 2 27.52 9 < LO D < LO D < LO D 246.22 7

< LO D 54.37 0 < LO D < LO D 15778.40 8

422.81 1

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : 

## Certificat e o f Verificatio n

71 3 SOI L 2009-10-2 6 09:2 1 30.0 0 Fina l 1838 3 192 3 s 3 7 s t VENTR Y b 2 6 clearenc e ep a gu n EP

A

±
±

± ±

±
±

± Erro r 33.80 6 21.68 2 15.74 5

8.83 5 23.57 1

6.59 2 14.84 8 6.63 8 42.05 6 13.94 4 31.09 6 79.65 4 25.65 6 82.24 0 178.47 3 436.91 7 107.88 1

34.54 5 318.28 4 326.06 0 109.52 7 1398.66 3 1802.62 0 1280.77 1 V

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3207 5 Readin g N o 71 4 Mod e SOI L Tim e 2009-10-2 6 09:2 2 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 1838 3 LOCATIO N 192 3 s 3 7 s t INSPECTO R VENTR Y COR l b 2 CO R 2 6 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 196.66 0 ± 24.43 6 C d < LO D 23.32 2 A g < LO D 16.85 9 S r 105.37 1 ± 9.29 1 U < LO D 25.09 9 R b 45.38 9 ± 7.25 5 T h < LO D 17.88 4 S e < LO D 7.29 9 A s < LO D 31.49 0 H g < LO D 16.94 5 Z n 267.04 1 ± 34.83 0 W < LO D 102.80 3 C u 51.02 3 27.88 7 N

i < LO D 93.54 9 C o < LO D 204.59 6 F e 16760.31 1 ± 480.76 0 M n 397.03 2 ± 114.39 4 C r < LO D 164.22 3 V < LO D 53.79 8 T i < LO D 540.21 2 S c < LO D 22.42 1 C a < LO D 888.22 2 K < LO D 1275.08 9 S < LO D 949.39 4 Supervise d By :

# p Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 72 0 Mod e SOI L Tim e 

### 2009-10-2 6 09:2 5 Duratio n 

### 120.0 0 Sequenc e Fina l Flag s AV^RAGE = ]Avg^'7i6^7r9-2 l 'tOCAT^ON ^ 1923T37-st- ^ INSPECTO R VENTR Y CO R 1 e m CO R 2 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m Erro r

•::.- . : ••'

. •• V . . t • " -P

C " ^ '< LO D T^r: ; 13:54 3 

## ca ^ < LO D " 22759 4 A g < LO D 16.50 9 S r 113.77 4 ± 9.30 8 U < LO D 23.45 3 R b 49.08 2 ± 7.12 3 T h < LO D 12.69 2 S e < LO D 6.56 8 A s < LO D 12.66 8 H g < LO D 14.81 7 Z n 47.49 8 ' ± 17.20 9 W < LO D 89.16 6 C u < LO D 35.73 9 N i < LO D 83.28 4 C o < LO D 150.00 2 Fe 9987.91 2 ± 360.69 4 M n 315.41 5 ± 99.33 9 C r < LO D 134.13 2 V < LO D 182.20 0 T i < LO D 490.13 4 S c < LO D 51.89 6 C a < LO D 1015.97 1 K < LO D 767.00 1 S < LO D 881.07 3 y ^ Supervise d By : CA P 

# • M i 

# m

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1



### XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPLE LOCATIO N INSPECTO R CO R1 CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T i S c C a K S Supervise d By : 

## Certificat e o fVerificatio n

71 6 SOIL 2009-10-2 6 09:2 3 30.0 0 Fina l 

### 1838 3 192 3 s 3 7 s t VENTR Y e m 

### 1 clearenc e ep a gu n EP

A

pp m ± 

### 16.59 5 ± < LO D < LO D 104.38 1 ±

< LO D 47.63 0 ± < LO D < LO D < LO D < LO D 40.63 1 < LO D < LO D < LO D < LO D 10124.79 5 ±

284.35 7 ±

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Erro r 

### 9.21 0 21.07 5 15.36 0 8.32 2 

### 20.95 7

6.47 4 10.81 5

5.93 7 11.29 4 11.76 3 14.96 4 77.54 7 33.07 9 76.22 9 139.00 6 338.09 5

91.06 9 154.87 0 289.78 1 388.97 1 136.61 0 1267.22 2

63.25 0 903.93 2 V

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 

### 71 7 Mod e SOI L Tim e 

### 2009-10-2 6 09:2 4 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 1838 3 LOCATIO N 192 3 s 3 7 s t INSPECTO R VENTR Y CO R 1 e m CO R 2 

### 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m Erro r P b < LO D 12.33 6 C d < LO D 26.86 8 A g < LO D 19.12 1 S r 114.36 6 ± 10.82 5 U < LO D 27.52 5 R b 50.07 4 ± 8.31 9 T h < LO D 14.82 2 S e < LO D 8.41 9 A s 21.88 5 i 9.79 4 H g < LO D 19.30 2 Z n 55.76 7 ± 21.10 1 W < LO D 106.45 1 C u < LO D 44.58 1 N l < LO D 97.81 3 C o < LO D 163.98 1 F e 8584.06 7 ± 389.27 4 M n 219.67 4 ± 104.01 1 C r < LO D 21.76 4 V < LO D 42.08 1 T i < LO D 423.59 3 S c < LO D 14.31 3 C a < LO D 566.97 9 K < LO D 28.37 3 S < LO D 492.29 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 71 8 Mod e SOI L Tim e 2009-10-2 6 09:2 5 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 1838 3 LOCATIO N 192 3 s 3 7 s t INSPECTO R VENTR Y COR l e m CO R 2 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A



### pp m Erro r P b < LO D 13.13 6 C d < LO D 20.96 4 A g < LO D 15.82 2 S r 132.05 4 ± 9.45 9 U < LO D 22.23 5 R b 47.18 8 ± 6.69 4 T h < LO D 12.53 3 S e < LO D 6.47 3 A s < LO D 12.50 0 H g < LO D 13.76 4 Z n 37.59 4 ± 15.15 7 W < LO D 83.47 4 C u < LO D 28.95 7 N l < LO D 82.15 2 C o < LO D 145.24 3 F e 10467.07 7 ± 354.17 1 M n 473.33 6 i 109.75 9 C r < LO D 164.09 0 V < LO D 344.41 0 T i < LO D 624.14 0 S c < LO D 27.03 9 C a < LO D 1055.62 0 K < LO D 1743.08 3 S < LO D 1111.03 2 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 

### 71 9 Mod e SOI L Tim e 

### 2009-10-2 6 09:2 5 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 1838 3 LOCATIO N 

### 192 3 s 3 7 s t INSPECTO R VENTR Y CO R 1 e m CO R 2 

### 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T i S c C a K 

### S pp m 

### 20.67 5 < LO D < LO D 104.29 7

< LO D 51.43 6 < LO D < LO D < LO D < LO D 56.00 1 < LO D 41.24 2 < LO D < LO D 10775.70 6



### 284.29 2

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±

±
±

±
±

± Erro r 

### 9.92 3 21.46 8 15.73 4 8.62 6 23.09 3

7.00 7 12.59 8

5.44 2 12.18 5 14.43 8 17.61 3 89.19 1 24.22 6 76.94 1 151.77 8 361.23 5

92.51 8 195.80 3

52.52 8 523.83 4

29.62 1 1174.06 5 1233.29 6 1017.02 8 V

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

. 

### ^ ^ wvvw.coastaihazmat.co m COASTA L SIO U p . m c 

# EXECUTIV ESUMMARY : BVID #18383-(192 3 S 3 7 ST )
No Issue s o r Concern s Issues/Concern s Detail Explanation :5 

# 0

EP APropert y Clos e Ou t For m Propert y Addres-1^? ^ ^ S^.. ^ ^ Propert y #:_ia2i2l£L
_ Date/Time : OwVer'sName t .^.OrXmrr f fdirTr . - Quad s Excavated : j^Z
. Contracto r Crou p QQQ^itil

- Ye s N o Excavatio nGenera l I
.If necessary , were th e correc t quadrant(s ) excavatedan drestored ? 

# Z A
2
. I f necessary , were th e correc t area s ofdri p zon e excavatedandrestored ? 

# y
Ye s N o Gradin g So d an d Venctatio n I
.Doe s th e gradin g aroun ddi e perimeie r ofth e hous e I nexcavate darea s generall y slop e awa y 

# zz r fromth e house ? 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# y 3
.Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ?

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) 6
.

Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e property ? 

# y 7
.Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s aa dRetainin g Wall s i
. O o gate s ope nan dclos e h-eely ? (Ifappiicable ) Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivilie s reinstalled ? 3
. Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) (Ifappiicable ) Ves N o 

# y 

# zA A y ' 4
. Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) Foupdation , Sidia g an dCutler s 1
. Wa s damag e t o di e sidin g o r tri mavoided ? 2
. Wa s damag e t o Ih e foundatio navoided ? 

# z A y ^ 3
. Wa s damag e t o window s avoided ? 4 Wa s damag e t o window s o r doo r screen s avoided ? 5
. Wa s damag e t o downspout s o r downspou l extension s avoided ? 

# Z '
Sidewalk s an d Driveway s (Concrete ) 1 Wa s damag e l o drivewa y surface s avoided ? Ves / No


# ~ y 2
. Wa s damag e t o walkwa y surface s avoided ? 

### yI 

# 0- 0 owner s comments :

pinspec t ionnoies :

Remova l an dreslorationaclivate s complet e including th e 30-da y sodwarranty : v/i i av,iivait 3 v,uiiij./icic ; iii\.iuuiii g iij c .j\j-ua y su u w a 

## EP ARepresentativ e 

# L^CT hY)aji,l ^ Date:il/£ /

# 0

Propert yCompietio n Agreemen t
thi s agreemen t documeni s th e completio n o l remedia l activitie s perioime d o n m yproperl yM ysignatur e wil l designat e Iha l I a m satisfie d wit h lh e rcstoralio n o f m ypropeily

. an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e future , excep l Ihos e ilem s liste d below , ifan y

Propert yID : \^^<^ ^ Propert yAddress : .|(^; ^ S 3 1 "Sf
- Owner : (.)a^{c ^

FT^IlP.r-t Phone : ^0 ^ .O^J- j I

. \S 1 S Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
Additiona l Comme i 

## ^jSyir yynj2yyey^^<ry ^ '^^y/^yxji^:^^^- ^ 

# ^V P

] nfiTe e rentoraiio n i t completed , excep t a $ note d I 1 d o no t «|>rc crestorntio n i s complete d 

# A T

wncr* s Signatiit- fDat e Cont i ftcfoi's Signatur e Dal e I

# PB m \ fc L

. ..._.. _. 

## / jQk ^ Omah 

## a a 

## ea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^A I Coasta Coasta ll Environmenta

Environmenta ii Grou

Group p inc

. vl ^ SLyyA wvitw.coa8taihazmat.co m

^-•tpnoT* ^ COASTA L sao u r. m c 

# EXECUTIV ESUMMARY : BVID #18383-(192 3 S 37 ST )
No Issue s or Concern s Q Issues/Concern s
Detail Explanation :

# 0

EP APropert y Clos e Ou t For m Propert y it : ]9Pi9)? i
. . Propert y Address;

- V^/ < ^\t,^ L Date/Time : OwVer'sName r ..Ol^hyr f , ^0U£^ = Quad s Excavated : J^^2 ^ Contracto r Grou p rVYT-^x l
Ye s N o Excavatio nGenera ) 1
.If necessary , were th e correc t quadrant(s ) excavatedandrestored ? 

# y f
2
.I f necessary , were th e correc t area s ofdri p zon e excavate dandrestored ? Ye s N o Gradin g So dan dVegetatio B I
.Doe s the grading aroun ddi e perimeter ofth e hous e i nexcavaie darea s generally slop e awa y 

# z y 6x)mthe house ?
_______ ^ 2
.Ha s sodbee nlai dinall area s tha t wer e excavated ? 

# y 3
.

Doe s the so dappea r to b e generally health y an dgrowing ? (Only evaluate if inspecteda t a3 0 day tim e period) 4
.Are soddedarea s generally fu man devenl y graded ? 5Ar e th e joint s betweenth e so dstrip s generally tight ? (Only evaluate if inspecteda t a3 0 da y tim e period) 6
.Wa s the propert y grade dsuchtha t wate r wil l no t pool o nthe propeny ' 

# y 7
.

Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRctainlni j Wall s Ves N o i
.D o gate s ope nan dclos e freely ? (Ifappiicable ) 

# y 2
.Were all gate s o r fence s taJie ndow ndurin g restorationactivilie s reinstalled ? (Ifappiicable ) 

# z A
3
.

Wa s damage t o gate s o r fence s avoided ? (Ifappiicable ) 

# y ^ 4
.Wa s damage t o retainin g wall s avoided ? (Ifappiicable ) Foupdation , Sidia g an dGutler s Yes /J o 1
.Wa s damage to the sidin g or trimavoided ? 2
.Wa s damage to the foundationavoided ? Wa s damage to window s avoided ? 4Wa s damage to window s o r door screen s avoided ? 5
.

Wa s damage l o downspout s or downspoul extension s avoided ? 

# A '
Sidewallt s an dDriveway s (Concrete ) Yes / N o 

### 1
.Wa s damage to drivewa y surface s avoided ? 2
.Wa s damage to walkwa y surface s avoided ? 

## y

# : 0 0 0>»'Dcrs comments : • ^ ^

Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y sodwarranry : EP ARepresentativ e *—'{yY \]y)Of^J^., y Date : / 1 / 6 /

# 0

Propert yCompletio n Agreemen t
fhi s agreemen t documeni s th e completio no f remedial aclivme s perioime do hm y properl y M y signatur e will designal e ihal I amsatisfie dwit hth e re.<iloralio no f my propeily
. andIha l n o ilem s ar e i nquestions , now . o r ai an y lime i nth e future , excep t Ihos e ilem s liste dbelow , ifan y PiopcrryfD : )^39) ^ 

### Propert y Address : ']0^2.? J ' S 3^ 7 "^ V Owner : f^a/Mr g R)llP.r-> - Phone : /^ Q Z• ?3 M I>1 5 7 S " Restoratio nItem s inQuestion :

Item : Item : Item : 

### Item : Item : Item :
Additiona l Comirie i 

# o. Ceffy /

y^yy^A\jA^yy^cy-<r^ ^'^^^^,,,^^,..^,..0^ ^

I Agre e rcstoralio ni ncomptcted , rxccp t a s note d
y I I rfo no t i|>re c restoratio ni s complele d 

# A T 

# ^^ljJL7/r<^lllv^ 7 9^?^^^mj D \\\^\ct \ wncr' s Sienatur e Dat e Cont i arlor' s Signatur e Dat e