## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # 

# , 1'2-lH' l Date : ly 

## \ 0 I P Address : ^V A le^(V^^^Q ^ ^ T Remediatio nContractor : _Coasta l Environmenta l Group _ Year ; 20 i 

## 05j _ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S 

# d 

# d -0

- Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreement Settlement dociunent s (i.e. , fo r damag e o r to rqilac e plants , etc. ) Confinnatio ndata Photograph s As-built sketc h



# - s Satisfactor y restoratio nsigne db y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Office 

# irv// / signatur e )ate 3005484 3 Superfun d

# M # •


## Propert yAcces s Checklis t 

## -707 ' ^^ ^ Property ID : 22m Q ''""^'^•'"^'"'•^^M^^VStMVPr^u^r-t U .S4
­ n D

WORKSTARTE D WORKCOMPELTKD ON : ON : / / / / 

## 0""«'" = Ja nft icrK-,iE PEwirt^i^iiE : Address : 

## T O aSD C 6M0ti3 2 OM^«A,NEl(?8V5 M Phone : Mo2'-758.2e)^U ? F« = ^02.3^o.v'5qtJ Q CcJMPage n Rente n Phone : Fax : Cell/Page n Additional Information :

D NotificationLette r Q Accea aAgreement

^ Topsoil Samplin g (i f applicable ) D Disposa l Samplhi g (if applicable ) D Garde nSamplin g (if applicable ) j3^Utillt y Clearanc e 0 ' Video/Photo s (Before ) D Video/Pboto s (Daring ) D Video/Photo s (After) D Video/Photo s (30-Day ) D Propert y Completio nAgreement D Final Report Sent : / / Signed:' ^ /2//rl 9 Signed : 9_/^/Q 3 / / / / / / CMti:Q_f2Alt£ i



## On:^/iy/I ^ On : / / On : / / On : / / Signed : / / Issued : / / By : 

## By-octav/o ByjrtckivJ o By : By : By : 

## ^y-Q^lz? ^ By : By : By : By : By : By : Ai r Monitorin e (a s apDlicable ] D Communit y QCrc w Results : On : /_/

_

By : j O Communit y ResuHs : QCre w On : 

## /_/

_By : 1 D Commnnit y Results : QCro w | On : 

## / / iBy : 1

Omah a Lea d Sit e• • 

## Dougla s Count y Accoun t ^^na^o n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R161662000 0 Prin t Repor t NE W Featur a - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - ViewO 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 PUSC H JA N E 

# K^- ^ KMUJ U 

# vu^^ ^ P O BOX 54043 2 OMAH AN E 68154-000 0 Propert yInformatio n Ke yNumber : 166 2 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 161662000 0 Parce l Address : 433 5 LEAVENWORT H S T OMAH AN E 68105-000 0 Lega l Description : LEAVENWORT H HEIGHT S LO T1 8 BLOC K0 4 5 X 111. 7 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d Improvemen t $5,700.0 0 $60,700.0 0 $5,700.0 0 $60,700.0 0 $5,700.0 0 $60,700.0 0 $5,700.0 0 $60,700.0 0 $5,700.0 0 $45,000.0 0 $5,700.0 0 $45,000.0 0 Tota l $66,400.0 0 $66,400.0 0 $66,400.0 0 $66,400.0 0 $50,700.0 0 $50,700.0 0 Sale s Informatio n Sale s Date : 

### 2006-06-2 6 Dee d Type : Price : TRD M $0.0 0 Book : 200 6 Page : 07529 4 Grantor : Pusc h Ja n E T R Grantee : Pusc h Ja n E Valid/Invalid : Invali d Excl Reason : usio n Famil ySal e Sale s Date : 1991-09-1 0 Dee d Type : Price : W D $0.0 0 Book : 200 6 Page : 06430 2 Grantor : Pusc h Ja n Eta l 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accotmtno=Rl6.. . 9/17/200 9

### Dougla s County Accoun t Ia£3rja|tio n Pag e 2 o f 3 Ij^rjaat i
Grantee : Pusc h Ja n T r Valid/Invalid : Exclusio n Reason : j invali d
Lan d Informatio n Acre s 0.1 1 S F 4995. 0 Unit s 1. 0 Dept h 111. 0 Widt h 45. 0 Vacan t N o Improvement Buildin g 1 Informatio n

3 V SWisq. " jt r Ali i 

### i'*"f4§ifi r

1 i n STOR * FIMSHE O Bimn i eio a t * » M 0 t q • CLIC KT O ENLARG E IMAQ E CUC KTO ENLARG E IMAG E Squar e Footage : 946. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : | Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : ; 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : I 5. 0 Exterior : Fram e Sidin g ' Units : • 1. 0 Interior : ' Drywal l Baths : 1. 0 Roo f Cover : ! Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : [ Gabl e Stories : : 1. 5 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 6 0 % 191 6 9 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 624. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16. . . 9/17/200 9• • 

## Dougla s Count y Accoun t I

:^|nn|do n Pag e 3 of 3
Porc h En d Scree n 160. 0 Use r Atti cFul l Finis h 302. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16.. . 9/17/200 9

## Pag e 1 of2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t j[\:Sen d EmaN_ ^

J



## • YOURTICKE T NUMBE RI S 2369313 . Origina l Cal l Date : 9/22/0 9 Time : 8:1 2 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/24/0 9 Time : 8:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 433 5 Street : LEAVENWORT H S T Twp : 15 NRng : 13 E Sect-Qtr : 20-S W Twp : Rng : 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 : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Txmnelin g o r Horizonta l Borin g : N Explosives : N ALT87 2 BSHPCLK S CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C UNITEO M UNOTE L

Servic e Are a Contac t Phon e Nunibe r UtiUty Typ e ALT87 2 WINDSTREA M COMMUNICATIO NN A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 BSHPCLK S NEBRASK A HEALT H SYSTE M 

### N A 

### Day : 402552346 0 Alt : 402552334 7 Emerg : 402559511 1 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITANUTILITIE S DISTRICT SAND Y 

### Day : 402504782 3 Alt : 

## Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/22/200 9• • 

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A
QLNNEI C QWES T LOCALNETWOR K 

### N A

UNIT EPRIVAT ENETWORK S LL C UNITEO M OMAH A
ANDREW UNOTE L UNIYERSIT Y O FNEBR/OMAH A TAYLO R 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 402554359 9 Alt : 402554303 6 Emerg : 402554264 8

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/22/200 9OLS# : 2214 9 

# As-Buil t Drawin g Dat e Excavated:9/30/0 9 Dat e USEP ASigne d Off : 10/19/0 9 COAST AL 

# Omah aLea dSuperfun dSit e Are a Sodden : 91 8 s q f t 

## 2214 9 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : JA N ERI C PUSC H [2^Goo d Sit e Sketc h Address : 433 S LEAVENWORT H S T • Poo r

Phone : H : W : I I No t pain t

Omah aI^a dSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d^ ' Are areplace dwit h Rock/Mulc h Are alef t bar e 

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

# l l ^ h • • 

# 2214 9 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : JA N ERI C PUSCH [0^Goo d 

### Sit e Sketc h Address : 4335 LEAVENWORT H S T • Poo r Q No t pain t

OmahaLea dSit e 4613 0

# rAi^lk)6^rf i ^ u- 1 2214 9 Exterio rPain t North Arro w Omah a Lea d Sit e Owne rName : JA N ERI C PUSC H [g^Goo d Sit e Sketc h Address : 433 5 LEAVENWORT H ST Q Poo r W : Phone : " Q No t pain t 

# i
Sampl e Numbe r Lea d Concentratio n B^rajj . Sampl e Collecte d LA B Firm : Sample s Collecte d fVl^ S A^.// ) •/ 4 RYASCPXA-2214 9 RYBSCPXA-2214 9 RYCSCPXA-2214 9 RYDSCPXA-2214 9 F 1 F 2 B l B 2 \ > ^ ypp m pp m 

# 1353 ; 

# P I J i ppm 

## \S A D D D D Dat e Tim e 

## ///3>>/0 H 

## 5: Q Sample s Analyze d RDZSCPXA~2214 9 D Z D XR F Unit : % \ \ Book : ^ ^ ^ ROZOCrXA-2214 0 G2 > pp m 

## D D Dat e RPZ3CPXA-2214 9 P2 ­ pp m 

## D Numbe ro f Sample s = | 5 i D O Tim e Staff : 

# B B : 

# £ ^al ^

Omah aLea dSit e 4613 0

## 2214 9 Exteiio rPain t NorthArro w 

### Omah a Lea d Sit o Owne rName : JA N ERI C PUSC H [B^oo d 

### Sit e Sketc h Address : 433 5 LEAVENWORT H S T D Poo f Phone : H i WL _ Q Not pain t

Omah a Lea d Sit e 4613 0

### #37 1 P.002/DO B 

### Fron:COASTA L ENVIRONNEHT / B7 7 66 2 421 1 h/200 9 10:4 1

j'''l!'*'« , 

# i ' COASTA l rirna»ii M «1« i & ».D « r• » c *^.«*t ^ 

### Consen t fe i Acces s T o Properl y RjtSM TO F EhfTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectia n Agenc) ' (EPA ) o rtts authorize d representatives , collectivel y th e Gfantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e fcltowin g describe d premises :

Owner' s Kama ; Daytim e Phone : 

### T o n R . PuSc/ i 

# 7.^^-^?^ C /3/2-9^ 7 9 Additts a o rPropert y covere d b ythi s ABToemant : 

# i 33 S heoL/enuACrih . PuRPDs g 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 rentov 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 t> e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l b e replace d wtt h dea n material s an d th e are a wti i b e restore d t o it s originB l condition . Thi s wor k i s liein 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 Grotip , contracte d b yUSEPA , wil l contac l th e Granto rin-perso n t o discus s th e wor k t o b e perfonned . th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d so M removal , an d restoratio n wor k ttefor e i t begms . Onc e th e wor k 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 meat s wit h th e Grantor' s approval . Upo n completion , th e Granto rwril l receiv e writte n documentatio n from EP Atha t th e propert y ha s bee n remediated . ENVIROWMEHTA L RESPONS E ACTION S 

### Bys^in 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 , fb rth e sol e purpos e o f performin g th e wor k Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfsctoril ycompleted . Th e Granto rals o agree s to :
Pageiof S



### J O Bfie d) i :a i B^ouie s a#37 1 P.003^00 6 

### FroaiCOASTA L ENVIRONNEN T 

# H i 87 7 66 2 421 1 /200 9 10:4 1 < #
.* ­ ^ C&ASTA L 

# \'.y' ^ Renrtov 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 Gr a itor' s tenan t ma ywis h t o save ; Wate ran d maintai n replacemen t vegetation , includin g fi^rlilize rapplx:ation . a s necessar ysubsequen t t o a n initiB i M.*aterin g perio d b yEP A Abid e b yhealt h an d safet ygiidsnc e provkle d b yEPA : I f th e propert yi s rented , assis t EP Ai n ot}tairur) g tenan t ipprove l (o racces s t o th e propert yt o perfor m th e work . Allo wvideotapin g and/o rphotographin g o f th e property . AGREBXEN 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 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 f sai d propert ywhic h wouk f ten d t o erxfange rth e healtt i 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 yquestkin s idiou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9 

# (S i gran t acces s t o m yproperti m D t d o no t gran t tceea a t o rn ypropertie s ' ) 

# (^ILM . Dat e Siflnatuf o Dat e

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

Pag e 2 of ?



### i o Bfie dH >a i a:;ou»] i a

### n/200 9 1C:4 1 #37 1 P.004/00 6 FroB:eOASTA l ENVIRONHENT i 87 7 66 2 421 1



## R«©torat50!" i Agreemsrt t Th e putpos e of thi s agceeme mi s t o provid e amutaa l agreement a s t o condition s of th e propenj ' prior l o reraediatio nactivitieB . Thi s will als o serv e a s documentatio nfbr th e prnpos e o f assurin g tha t restonttio n activitie s ar e complete di o tli e satisraaio nofth e property owner an dth e Unite dState s Envirorvnental Proieetio nAgenc y [E?A) . I Prapert y n> : 

# i q

. Ow««r : -r^> t Pu-ir. k O ntlt e attache ddiagmn(s ) indicai e aru(t ) t o excavate , snrfae e stnicfjic s an dlandscapin g raature s an d acces s kxiition(s } n o b e nse db y th e coatracUns . Indicai e distances , depths , material lypes , etc . Photographican y andVideographicall y docunwnt th e existin g conditian s ofth e proper ^ an dth e basement if necessary . item a to b e R«move d b yth e Owna rbefor e Star t o f Rennediation : rr>e fafnoval.stofa!;e.i>g>potei , anri/o i r^Witt xo f tHespitom s i s ;h«>Owner s '•esponeibilii y 

## AwStA/y^l ^ V^Uh/vV s I Kem :

Item : ItBm :

ttam a to b e Remove d b yth e Contracto rDurin g Rernediatio n an d Wo t I 

# ^wSu-JlPy^ ^ L.«p> t

€«8HtKi O Itent : jltam :

, ^ Pag e 1 of ,

J O Bfie ds ta x e^ooio H a

### From:COASTA L ENVIRONHENT i B77 66 2 421 1 

# m U200 9 10:4 1 #37 1 P.005/00 6

COASTA L 

### ttem e to B aRemove dB y Conbacto r Durin g Remediattg nandBgBJa.cg d J Item :

• - ^ ^ ^ ^ ­ • itsm : 

# ;^ D 

# " i ttenr :

Itom : 

### Landscap e Inventor y Item Quantit y Uni t Condition/Type/Specie e Pre-existin g ptopen y area , Quadrant s tha t wil l b c excavated , ihat i s coven dwit hgn» . Numbe r o f

tiec t > 2 inc h Ead i trun k diamete r Numbe r « f tree s <• = 2 inch Eaeh tmn k diamde r Numbe r o f Spritdck r Zones . Contro l Valves . 

# ^n. ^ c^ ^ Eac h Thners . Heads , etc . • Mc,-!!.! * ; i slrir' " u l llit f Nsnbe r o f aa dsiz e o f eac hgarden/ flower be d eac h area . Square Fbe t Agree dupo n>«]ii e o f plan t materia k oa l j o ^ ceplac^b v contractor . 1 '•er r i.'-.f iHJiic «il i H i

• Oin:'!.' . ll
- -li t i;-.;'K-: \ 

# i 0 ' •1' • : 1* . 

### t Eascme mArea , t o b e 

## 1 • • 1 excavate d > BMtt t j 

# 1 1 I Pag o 2 of .

3 0 ete ds iQ I B:)C)a]e 8 aFron:COASTA L ENVIR0NMEN 1 87 7 66 2 421 1 Aei/2O0 9 10:4 1 #37 1 P.006;00 6

C O • . I . - I At . Addittena l Comment s rinstmetionB : 

# e -pErJw^rr s wMfo ; Voconj '

Q CtiBG k tvn a hn » » r>iM^«| - ni ^ rip « ifflp t qg ^ t o dotynen t interio rfoundatio n wall s an d possibl e pre-existin g damage . B ydhstMn g thi s ta xCE G i s nb t reaponsifaltflD ren ydameg e don e t o th e interio ro f house , indudiri s foundado rcrscit t o rfissures.

fagre e O i d o no t agre e 

# \)g^^ ^ CSIC L

# \p\tA' ^ ^raceQ?>r > ^i^iln ^ OttoirVSigMtar e USt e dbsiractor'sSlgDatur e Sat T PageSof .



### JO a£B ds <a i o^ouis s a

### BVI D # S^/H ^ XR F PROPERT YSAMPL E SHEE T Dat e Projec t XRFID #

Shot # ^^^2^2S Z 

# 2 ^

Averag e 

### ^/.b£>7o f Omah a lea d F P 2n( 1 yea ropilo n Readin g 

# 3r . 

# ^ ^ lo f ^A t Sampl e are a 

# iS Z

Dept h {i^^j Q Addres s Sampl e tim e sampl e lengt h Shot # -/^G ^ ^ 

### /?A2 y /KMotag e f^^Zy r LeA\f£j/ \tti/nti L am/p m 

### 3 0 se c Readin g 

### ^j i ^ ll ? //?^->^/ 3 

## A^^.- i IT Sampl e are a 

# 2 F Dept h 

# 1I± . ADT p Jy/ y A ^ f

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

ShGt # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

Shot # Readin g RETES TAREA S Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e

la b sampl e # La b resul t Sampl e are a XR F Avg . Averag e Signature . 

# ^/m m Prin t Z^Kh^ti ^

C(^rp^ s

## iJSkLj \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^ ^

I ^%y^y A Coasta l Environmenta l Grou p Inc . www.c6a8talhazmat.co m M ^^y ^PBoT*" ^ COASTA L INVIIONHtNTA l C a o U P . IH C 

# EXECUTIV ESUMMARY : BVID #22149-(433 5 LEAVENWORT H ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : • ^^ ^4 

# P 'SS t 

# EP A EP A Propert y Clos e Ou t For m Propert y# : 9_X\'-\ ^ . . Datc/Tlmc : Owner' s Name: . iJ6.>YA'U . Quad s Excavated : ftt -V V^ T Contracto r Grou p C 

## 'Y\V) t ^onirien f Excavatio nGenera l 

# rf ] 1 .I f necessaiy , were th e correc t quadnuit(s ) excavate dan drestored ? 

# r ^ 2 .i f necessary , were th e cone aarea s ofdri p zone excavate dandrestored ? Ye s No Gradin g So dan dVegetatio n 1 .t3oe s di e gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

# r r fiomth e house ?^_____ _ 

# r ^ 2 .Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3 .Doe s th e sodappear to b e generall y health y an dgrowing ? (Onl y evaluate if Inspecteda t a3 0 day tim e period ) _ ^ 

# y 4 .

Ar e soddedarea s generally fir man devenly graded ? 

# y 5 .

Ar e th e joint s Iwtweenth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y ^ tim e period) 6 .Wa s th e propert y grade dsuc htha t wate r will not poo l o nth e propert}'* ] 

# \ y 7 .Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s aa dRetainin g Wall s 1 .D o gate s ope nan dclos e freely? (If applicable ) 

# z A 2 .Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinsulled ? (If applicable ) 

# y 3 .Wa s damage t o gate s o r fence s avoided ? (Ifappiicable ) 

# Z ^ 4 .Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) 

## y Foundation , Sidia g an dGntler s Ye s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# A 2 .Wa s damage t o th e foundationavoided ? 

# y 3 .Wa s damag e to window s avoided ? 

## y

Wa s damag e t o window s or doo r screen s avoided ? 

## ry" ­ 5 .Wa s damage l o downspout s o r downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damag e l o driveway surface s avoided ? 2 .Wa s damage t o walkwa y surface s avoided ?

# • P- Ovvner s comments :

Inspectio nnotes :

Remova l an drestorationaclivale s complete including the 30-da y so dwarranty : EP A Representativ e Uh ^ [jAlyLP-tAt : l<^//f/(^ f10/16/200 9 11:0 2 P.002/00 3 Frcm:COASTA L ENVIRONNENTAL 87 7 66 2 42 n 

## leTSo i #43 6

^ 

### Propert yCompietio n Agreemen t Dil i Bijiccmer. i bocumcnJs . th e compkSiO n o t rcmedw l acliwiic s perlOtme d n n m yproperl yM ysmnaiui t wi n rtejignale tha i 1 a m satisfie d wit h th e roeioralio n o f m yproperLy . an d tha i nt > item s ar ci n qucsiio« « now . o r» t an y!un e i n Ih cfuture , cxccp i thos e iiein s Ittte d below , ifan y

Pinpcit yID : J.3 . I H O j Propert y AcMrc^r ^ 7,-.>« r Ce<^V>e^-x<.>t.'Ai k 5 V Owner : ^a. ^ (? , Ph^ie : Ato>>n-$'f - JLtfLt o Restoratio n lt«in s i n Question : ItBin : hem : Item : (tatn : Hem : 1 Item : 

# 1 AtfdiMona t Conrunonis :

Cr^^CA . P^ J m-rc rI rirorklio n l > comprcictf , occp f • » >"»•»< • 

# n I it a « M iKrc crftfpraiii m i t compklct i

OwiieVJ f SiBn»fiij rDat e Conttarlar' s Siritaiwr cOrZ *

3 0 efia d H sa i ettoue a a