### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID # : ^^N ^ Date : •2^'^2y\cf ] Address : lf^3 2 U\ ^ ^ t Remediatio nContractor : _Coasta IEnvironmenta l Group

_Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f property (DVD ) 4031474 6 

### Q

^ Executiv e Summary Q ^ EPA-provide dproperty sketc hSuperfun d Iv

/ Signe dAcces s Agreemen t fo r subjec t property M hSigne dAcces s Agreement(s ) for adjacent property Q

/ Restoratio nAgreemen t r^ljJ V Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) B ^ Confirmatio ndat a^ 

# [ ^ Photograph s pr^-^j>yg^^c ^ ^ QJiOj^okm ^ So-cU^ sc Aj^nj Jsc ^ '• aAs-buil t sketc h B ^ Satisfactor y restoratio nsigne db y Propert y Owne r B ^ Propert y close-ou t chec k lis t signe db y EP A Nlji l Descriptio no f area s no t meetin g RO D cleanu p criteri a SK ^ Utilit y clearance s CB ^ Propert y informatio nfro mDougla s Count y Assessor' s Offic e



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# m^ Propert yAcces s Checklis t Piopeit y ID : 'Jif/LfC j Propc-t y Address : ^^^g ^ f j /^^' ^ 5 / n D

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"> Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

# L YOU RTICKE TNUMBE RI S 2078211 . Origina l Cal l Date : 7/09/0 8 Time : 5:4 7 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/11/0 8 Time : 6:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 253 2 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : IQ-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Remidiatio n Locatio n o f Work : ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . 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 ho f Excavation : 4f t Corne r Lot : NFront : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utility Typ e 

### Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S LPTONYAAlt : 

### Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC TEDWINAAlt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0
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### Pag e 2 of 2
Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC TNA 

### Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNNEI C QWES TLOCA LNETWOR K 

### N A Alt : 

### Emerg : 888728934 3

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nfcr r Dougla s County , Nebrask a Propert yRecor d - R160052000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft west o f90t h St - VIe WO H Ma p Informatio n i s vali d a s o f2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -»-•- •Aut o Sale s Searc h Owne r CIT YO F OMAH A PLANNIN G DEP T 181 9 FARNA M S T#111 1 OMAH AN E 68183-000 0 PropertyInformatio n Ke yNumber : 005 2 000 0 1 6 Accoun t Type : E xGovernmen t Parce l Number : 160052000 0 Parce l Address : 253 2 N 1 8 S T OMAH AN E 68110-000 0 Lega l Description : LAK E AD D LO T2 BLOC K1 S 1/ 2 30. 5 X 14 4 Valu e Informatio n Lan d Improvemen t Tota l 200 8 

### so.o o $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $0.0 0 $0.0 0 $0.0 0 200 5 $0.0 0 $0.0 0 

### $0.0 0 1 200 4 $400.0 0 $0.0 0 $400.0 0 200 3 $400.0 0 $0.0 0 $400.0 0 Sale s Informatio n Sale s Date : 2005-09-1 6 Dee d Type : SW D Book : 200 5 Page : 15762 8 Price : $0.0 0 Grantor : LAN D REUTILIZATIO N COMMISSIO N Grantee : CIT YO F OMAH A Valid/Invalid : Invali d Exclusio n Reason : Sal e b yGov t Agenc y Sale s Date : 1998-11-1 8 Dee d Type : SH D Book : 200 5 Page : 15762 7 Price : $0.0 0 Grantor : DOUGLA S COUNT YSHERIF F 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R160. . . 7/2/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 2

Grantee : LAN D REUTILIZATIO N COMMISSIO N Valid/Invalid : Invali d Exclusio n Reason : Sal e b yGov t Agenc y Lan d Informatio n Acre s S F Unit s Deptf i Widt h Vacan t 0. 1 4464. 0 0. 0 144. 0 31. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R160. . . 7/2/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Omah a Lea d Sit e Sit e Sketc h Samplin g Address : 253 2 N 1 8 s r Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-7414 9 F l 

### 21 1 pp m 

### D RYBSCPXA-7414 9 F 2 pp m 

### D RYCSCPXA-7414 9 B 1 pp m 

### D RYDSCPXA-7414 9 B 2 pp m 

### S' RDgOCPXA-74ia 9 -B Z pp m 

## n D RCgCCPX/i i 7414 0 pp m 

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### 414 9 Exterio rPain t •Gooc J n^Poo r [ 3 No t pain t Sample s Collecte d Fir m rpft BliiLlL_ Date : °^W!^ lo > Time : \:\ \ ff ^ Sample s Analyze d XR F Unil : fgS^- fBook : J^J _ Date : /O-ZT-O ? Tim e _£ d Staf fM5H / D Z = Dri p Zone , G Z = Garden , P Z = Pla y propert y

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

# i 7414 9 Exterio rPain t Nortt i An'o w 

### Omah a Lea d Sit e 

## C'^ y ^OMO U Sit e Sketc h •Goo d •Poo r Samplin g Address : 2532 N 18 ST py fNio t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# I LA B Concentratio n Collecte d 

# i Fir m RYASCPXA-7414 9 Fl 

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# I LA B Concentratio n Collecte d Firm : RYASCPXA-7414 9 F 1 

## 2J1 . pp m 

## D Date : RYBSCPXA-7414 9 F 2 

## 33 b pp m 

# n Time : RYCSCPXA-7414 9 8 1 

## I/S 3 pp m 

## D Sample s Analyze d RYDSCPXA-7414 9 8 2 

## 3 Z ^ pp m 

## H ' RDZ3CPXA-7414 9 D f pp m 

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# ,f ^ < # COASTA L ENVtHOHHINTA L C I O U r. IM C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO PREMISE S 

### Granto r(th e propertyowner) 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 ; 4^- "^ M I M * ^
owner' s Name : C^^] ^ ^ Qmo U Daytim e Phone : t. f^If- ^ l ^ D 

# dsiT . u . 1«-^ ^ Addres s o fPropert y covere d b ythi s Agreement : i 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 remov e soi l tha t contain s elevate d concentration s o flea 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 fCoasta l Environmenta l Group , contracte d byUSEPA , 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 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 EPAtha t th e property ha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors th e righ t t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work . 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 of2

# V COASTA L CNVtRONMrNTAt
. 

### %^^- ^ C R O U F . IN C



### •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 necessar ysubsequen 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 fth 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 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 o fth 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 o fsai d propert ywhic 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 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 (712 ) 352-018 8 

## 4^9r ' D I d o no t gran t acces s t o m ypropertie s I gran t acces s t o m ypropertie s 

# -7-/ ' 

# ^ ^ 2 ^ 

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I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

## Restoratio n Agreemen t Th e purpos e o fthi s agreemen t i s t o provid e a mutua l agreemen t a s t o condition s o fth e property ' prio rt o remediatio n activities . Thi s wil l als o serv e a s documentatio n fo rth e purpos e o fassurin g that restoratio n activitie s ar e complete d t o th e satisfactio n o fth e propert yov\ne ran d th e Unite d State s Environmenta l Protectio n Agency(EPA)
.

Propert yID : ^l-j^lU ^ Propert yAddress : 0^^2)3
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. Owner : QJ^ ^ ^ QrmJ ^ 

### Phone : ^1/)^-^W - S^J^ h O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d dept h o fe.xcavation . locatio n o fal l know n utilities , subsurface features , surfac e structure s an d landscapin g features , access location(s ) to be used b y contractor , an d th e directio n o fNorth . Indicat e distances , depths , materia l t\pes , etc . Indicat e digita l photo s b yreferencin g th e photo-lo g numbe ruit h a n arro u indicatin g directio n o fview . 

### Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner s responsibility . Item : Item : Item : Item : Item : Item : Item : Item : ^ Pag e 1 of
.COASTA L 

### 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 : Item : x Item : \ Item : \ Item : \ \ Item : \ Item : \ Item : \ Item : \ Item : \ Item : \ Item : \ Item : \ Item : \ Item :

Pag e 2 of
.

# m ^ ^ COASTA L c • o o » ' Nc 

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# X
Item : Item : Item : Item :

Pag e 3 of
.COASTA L 

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

## Ite m

Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trunk diamete r

Number of tree s -' = 2 inch trunk diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves . Timers . Heads , eic . Aiiac hasketc h^-. l ihc sprinkle : !a. \oui .
Numbe r o f andsiz e o f eac hgarden/ flowe r bed " area . '•.w.i^i . i . sKcici i v' l .c..i:i'. c '•ir'e s :<.nJ . locaiions . 

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## Condition/Type/Specie s 

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Pag e 4 o f

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COASTA L 

### Ite m Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor . Not e thi s valu e nil l b e use d t o issu e a plan t vouche rt o th e propert v owner . Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor . B e ver yspecifi can d detailed . Includ e a sketc h o fwer e eac h plan t wil l b e place d 1\

\ ih e contraclor . Agree d upo n are a o f propert N t o b e replace d vsit h gras s sod . ':u'li:d e L ; sl-eicl i o ; ih c .treats; , ii.- . b e :epijcc a -. ^ 'I' l Li'-.is s >od .
.Are a o fCit yo rCount ) propert yt o b e landscape d pe rthei rrequireinents . h'lLi.nl c. . -r.c'i.T i 1.; ' :! c .•,:c\ , is !

Easemen t .Area , t o b e excavate d 

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## Vaoj^vd rUT [ H Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wail s an d possibl e pre-existin g damage . Bycheckin g thi s t>o 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 cracks o rfissures
.

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# 7-/-^ ^ 7-/-^ ^ Owner' s Signatur e Date Contractor' s Signature Date Pag e 6 of
.

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 76 5 Mod e SOI L Tim e 2008-07-1 4 12:2 6 Duratio n 121.4 9 Sequenc e Fina l Flag s AVERAG E jjAv g o f761-76 4 ' 1 ADDRES S 253 2 nort h 18t h stree t QUAD/ZON E B l INSPECTO R ^MATEU S DEPT H SAMPL E TYP E NOT E

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 723.78 0 Supervise d By : 

## Certificat e o fVerificatio n

76 1 SOI L 2008-07-1 4 12:2 4 30.5 7 Fina l 7414 9 253 2 nort h 18t h stree t 

### 8 1 MATEU S 6

± Erro r ± 33.14 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 807.77 3 Supervise d By : 

## Certificat e o fVerificatio n

76 2 SOI L 2008-07-1 4 12:2 5 30.5 3 Fina l 7414 9 253 2 nort h 18t h stree t B l MATEU S 6

± Erro r ± 34.76 7

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 920.41 7 Supervise d By : 

## Certificat e o fVerificatio n

76 3 SOI L 2008-07-1 4 12:2 5 30.2 3 Fina l 7414 9 253 2 nort h 18t h stree t B l MATEU S 6

± Erro r ± 37.45 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 775.48 9 Supervise d By : 

## Certificat e o fVerificatio n

76 4 SOI L 2008-07-1 4 12:2 6 30.1 6 Fina l 7414 9 253 2 nort h 18t h stree t B l MATEU S 6

± Erro r ± 34.66 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 78 6 Mod e SOI L Tim e 2008-07-1 4 21:5 5 Duratio n 122.1 5 Sequenc e Fina l Flag s AVERAG E fAv g o f782-785 * ADDRES S 253 2 N 18t h S T QUAD/ZON E B l INSPECTO R " 1 MATEU S DEPT H •1 3 SAMPL E TYP E I RETES T NOT E "CLEARANC E @ 1 3 inche s

Supervise d B y

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 78 2 Mod e SOI L Tim e 2008-07-1 4 21:5 2 Duratio n 30.9 2 Sequenc e Fina l Flag s BVI D # 7414 9 ADDRES S 253 2 N 18t h S T QUAD/ZON E B l INSPECTO R MATEU S DEPT H 1 3 SAMPL E TYP E RETES T NOT E CLEARANC E @ 1 3 inche s
pp m ±Erro r P b 477.25 5 ±26.63 7 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-3208 9 Readin g N o 78 3 Mod e SOI L Tim e 2008-07-1 4 21:5 2 Duratio n 30.4 6 Sequenc e Fina l Flag s BVI D # 7414 9 ADDRES S 253 2 N18t hS T QUAD/ZON E B l INSPECTO R MATEU S DEPT H 1 3 SAMPL E TYP E RETES T NOT E CLEARANC E @ 1 3 inche s
pp m Erro r P b 435.28 4 25.73 3 ± Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 981.75 1 Supervise d By : 

## Certificat e o fVerificatio n

78 4 SOI L 2008-07-1 4 21:5 3 30.4 1 Fina l 7414 9 253 2 N 18t h S T B l MATEU S 1 3 RETES T CLEARANC E @ 1 3 inche s

± Erro r ± 38.65 1

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 311.64 8 Supervise d By : 

## Certificat e o fVerificatio n

78 5 SOI L 2008-07-1 4 21:5 5 30.3 6 Fina l 7414 9 253 2 N 18t h S T B l MATEU S 1 3 RETES T CLEARANC E @ 1 3 inche s

± Erro r ± 21.68 0Vltl * ST4 f

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### 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 COASTA L ENVIKONHENTA L GROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #7414 9 - (253 2 N1 8 ST ) IIN o Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : CONTINU ET O MONITO RSO D ESPECIALL Y AREA S REPLACED . WIL LREVIS EI NSPRIN GO F2009 .^ ^ 

# EP A EP APropert y Clos e Ou t For m Propert y M : 3^\M ^ Propert y Address : -r^S^^^^-M- ^ ^ - - Date/Time : OwVer' s Name : £\WCf ^ QUrm ^ . Quad s Excavated : ^\ Contracto r Grou p (W0OiA Excavatio nGenera l \f^^,AiKt r j_OT Ye s No 1 .If necessary , were th e corre aquadrant(s ) excavate dan drestored? 

# y 2If necessary , were th e correc t area s o f dri p zone excavate dandrestored ? 

## fjA Gradin g So dan dVegetatio n Ye s No 1 .Doe s the gradin g aroun dthe perimeter o f th e hous e i nexcavate darea s generall y slop e awa y fromthe house ? ^ 2 . Ha s so dbee nlai di nall area s tha t were excavated ? 

# y 3 . Doe s the sodappear to be generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da v time period ) 4 . Ar e sodde darea s generall y finnan devenly graded ? ^ 5 , Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Only evaluat e i f inspecte da t a3 0 da y tim e period ) 6 . Wa s the properr y grade dsuchtha t water will not poo l o nthe property ? i / 7 . Wa s damag e t o landscapin g or plan t material s avoided ? 

## y Gates . FcDce s an dRetainin g Wall s Ve s Nc 1 .D o gate s ope nandclos e freely ? (Ifapplicable ) Wer e all gate s o r fence s take ndowndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# ~ P 3 .Wa s damag e to gate s o r fence s avoided ? (Ifapplicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , SidiD Kan d Gutter s Ye s N o 1 .

Wa s damag e l o th e sidin g o rtri m avoided ? 1 (fi < 2 Wa s damag e t o th e foundatio n avoided ? ^	 ^ 

## iftfl O

l y v J .Wa s damag e t o window s avoided ? / T ^ 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? 5 .Wa s damag e t o downspout s o rdownspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 .

Wa s damag e t o drivewa ysurface s avoided ? 

# i k 2 .Wa s damag e t o walkwa ysurface s avoided ? 

# fli ­

## Owners , comments :

Inspectio nnotes :

Removal andrestoratio nactivate s complet e includin g the 30-da y so dwarrant)' : EPARepresentalivfr^^^'^^^^^^^^^,^^ ^ Date : 9//0/p S

## Propert yCompletio n Agreemen t fill s agreemen l documeni s th e completio n o f remedia l activitie s performe d o n m ypropert yM ysignatur e wil l designat e tha t I a m satisfie d wit h th e restoratio n o f m yproperly , an d tha t n o item s ar e i n questions , now , o ra l an ytim e i n th e future , excep t thos e item s liste d below , ifany
.

Propert yID : -jjj j l^C j /[ / /

J

J ^ 

# i m Propert yAddress : ^Lj^^ ^ ~^^^S ^ Owner : 

# .C.f ^ 

# o f O l'U\.a.h-0 \ 

# L Phone : ^l ^ i{ . 5- / ^ D Restoratio n Item s i n Question :

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

# 1

I a{i;rccrestoratio n i s completed , excep i a s note d I I I rio no l ai;re crestoratio n i s complete d 

## f^-t^ ^ -<£:^w . Owner' s Signatiiy p Dat e //Contractor' s Signatur e Date