TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: , ^BS-^^

 Date: 3/72y/o& 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

M EPA-provided property sketch 

•iZ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

M Confirmation data 

y Photographs 

B^ As-buih sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D , 

D 

W/» 

T55 
30^ ^1 

n I 

'^^ 

^ 

Final Report Property Check List (piease place with each tiie) ^5 " ^5 / ^ 

Har d Cop y Informiation ,^ ^ $iyyclyt

jyfl . Property Check List 

,0-2 Site Working Drawing Map 

EPA originals Map 

Douglas County Assessor's Map 

Property Contact Sheet 

^Agreement 

,Hi I. Aeeess Agreement 

J^2 . Restoration Agreement 

Miscellaneous Documents 

J ^ I. Final Map from the Field 

X l 2. Change Orders V ^ 

XRF Data 

''4. Any emails or PO eorrespondenees ^YYY^MJ( 

Property Completion 

D 1. Exeeutive Summary 

n 2. AS BLJILT 

py7^- Property Completion Agreement 

y ^ 4. Any buyout info or reimbursement info^O—^ 

j2l 5. Cheek or money order copies ^(y J 

^6 . EPA Property Close Out Form 

IU 7. Attaehed Begin Video 

Electroni c Documentatio n 

Drawings 

Q I. EPA original 

Q 2. Working Drawing 

iZl. l AS Built.vso 

n 4. AS Built.jpg 

Photos 

1 Begin Photos 

2 During/Exeavation Photos 

^ Sod Photos 

4 30-Day Sod Photos 

Scanned Documents 

Final Documents 

Exeeutive Summary 

Videos 

Begin Video 

My Movie 
M 

m 

Property Access Checklist 

Property ID: (^5^^ ^ 

n WORKSlARTliD ON: / / 

Properly n WOKKCOIMFELTED ON: / /_ Addrc.s.s: -^^<L ^ ^£ULa 

Renter: '"'y'yiliTiy 07- QM^JL.- ^ 

Addres.s Plione: : (J f\ 

{"^{^TTbuxa.^.. ty^<s7^yaj^ Fa\: 

Ccll/Pawr: 

Phone: Additioiiitl Information: -l^ y T^T^-^Si^o 

I'ilX 

Ccil/Paircr 

Notification Lcttci" Sent: XL/^/_^ ^ ^iGJ^ : 3_ 

H Access Aj»rccnK>nt Si;4ned: ]±_ /S i / -47 ' ^ y QjTei S 

u 

Kcstoiafion A"rccnicnt Signed: IL/^/^2 - ^7QJyyy 

D Top.soil Sani|)lin<; (if applicable) By: 

7 Dis|)osal Saniplins; (if a|)|)lical)lc) Bv: 

Garden Sainplin" (if applicable) Bv: 

Utility Clearance 

Called:/Z-/^42 : ^yiy^jlh(^23rcy^jBA7^yy'/ 

^P " Video/Photos (Bcfoic) o».JiiS7i63- ^y-yju/s 

D Video/Photos (Durinj;) On: B y : 

n Video/Photos (After) On: Bv: 

D Video/Photos (30-Day) On: / / Bv: 

Pr()|)crty Completion Aj>iccmenf Sijjncd: / / By: 

Final Report Issued: / / Bv: 

Air IVlonitorint; (as ap|)lical)lc) 

jj n Coninuinify D Crew On: / / By: 

ResuKs: 

1 1 Community JH] Crew On: / / Bv: 

Results: 

1 L J Community [H Crov On: / / By: 

Results: 1 

Omaha Lead Site 
I 

IA7fi)c777pEy7 g^^6-.q —t— Omah Exterior Paint North Arrow a Lead Site 

Own« Site Sketch r Name: dlJ-^ J o P Omah a • Good 

iAddress • Poor 

Phone: H w: vW- cryx/ \ 

[ J Not paint 

Sample Number 

RyASCPXA- 25'553F i 

RVBSCPXA-^^y^ ^ F2 

RrCSCPXA-25g5^ B1 

RrDSCPXA-25-35-5 B2 

RDZSCPXA SffSfTS DZ 

RGZSCPXA SirSS9 Q^ 

Legend: Fl = Front Left, F2 

Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm; Asvo \ R^ \ C>v=-» 

g 35 " ppm ET D Date: iq - \ 2 -£>C. 

<STn ppm 0- D Time: ji-.^ n 9^^ 

33 3

33( 3

 ppm 

 ppm 

0- D 

D Samples Analyzed 

-

ppm 

 ppm 

D 

D 

D 

D 

XRF Unit:

Date:

 I QO T Book: 

 /-/T~0 7 

JZI 

" ppm D D Time A M. Number of Samples = 4 - I Staff: t^ATIL 

Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 
y'"^^. 

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY l3Si 

'"-"PKO''*'.<-" ' REGION Vl l 

901 NORTH 5TH STREET 

KANSAS CITY, KANSAS 66101 

October 3, 2007 

CITY OF OMAHA 

C/O CITY FINANCE 

1819 FARNAM ST 

OMAHA NE 68183 

BVID: 25859 

Dear Owner/Resident: 

Yard soil on your property located at 3859 SEWARD ST in Omaha, NE was recently tested by the U.S. 

Environmental Protection Agency (EPA) for lead contamination as part ofthe Omaha Lead Superfiind Site 

investigation. A sketch ofyour property with the results ofthe soil testing is enclosed with this letter. 

In order to conduct the soil sampling, your yard was divided into a number of sections. A representative soil 

sample was then collected from each section. A typical yard is divided into two front yard sections (Fl and F2) and 

two back yard sections (Bl and B2) In addition, a fifth sample is collected near the foundation (drip zone or DZ). 

Additional samples can be collected from children's play areas (PZ) and from gardens (GZ), if present. The actual 

number of samples collected from your property depends on the size ofyour yard and whether play areas or gardens 

were identified and sampled. 

The samples collected from your yard were analyzed for the presence of lead contamination. Exposure to lead 

contamination can adversely affect the development and behavior of young children. Also enclosed with this letter is 

a Lead Fact Sheet from the Douglas County Health Department that provides information about lead exposure. If 

children six years of age and younger are living with you, orfrequently spend time in your home, we recommend you 

follow the suggestions contained on the fact sheet to Project your children from lead exposure. Following these tips 

will greatly reduce a child's risk of having elevated blood-lead levels. If you have children six years or younger living 

in your home, we strongly recommend that you contact your doctor or the Douglas County Health Department at 444­

7825 and arrange to have their blood tested for lead, if you have not already done so. 

The EPA is currently excavating and replacing yard soil on residential properties with lead concentrations 

above 800 parts per million (ppm). The attached results will be used by the EPA to determine if your property is 

eligible for a soil cleanup at this time. Ifany portion ofyour property, excluding the area immediately around the 

house (drip zone), is above 800 ppm, the EPA will contact you in thefijture to arrange for removal ofthe 

contaminated soil. Excavated portions of yards will be backfilled to the original grade with clean soil and lawns will 

be re-established with sod. This work is being conducted by the EPA at no cost to the homeowner or occupant. 

In general, the EPA is concerned about soils in residential areas that exceed 400 ppm, but studies on actual 

contaminated soils in Omaha are required to establish a final cleanup level at the Omaha Lead Site. These studies are 

currently underway. In the meantime, the EPA is also excavating and replacing soils that exceed 400 ppm at child 

care facilities and properties where children with elevated blood lead levels reside. At this time, exposure to soils 

containing lead at concenfrations less than 400 parts per million are not considered a significant enough health threat 

to take action. 

If areas ofyour property away from the foundation exceed 400 ppm, but are below the current 800 ppm action 

level, the EPA may include your property in afiiture cleanup action. The EPA will contact you in the fiiture to 

arrange for soil cleanup if the lead levels in your yard exceed the final cleanup level that is determined for the site. 
Page 1 of2 

tsimmons(glkgs.he.net 

From: "NE DIGGERS L" <info(gne-diggers.com> 

To: <tsimmons(gcoastalhazmaLcom> 

Sent: Monday, November 05, 2007 12:15 PM 

Subject: Re: NE-Diggers.com - LOCATE Contractors Request Form 

DIGGERS HOTLINE PRESENTS THE 'NO WAIT' N.I.T.E.S. TICKET ENTRY! 

Avoid lengthy wait time - Immediate ticket number response - User has access to all issued tickets. 

FREE training sessions. Contact Connie or Lisa at 402-330-1866 for further information. 

******************************************************************* 

Ticket #1929724 

Work to begin date: 11-07-07 at 1230pm 

The utilities we will notify are...CITY OF OMAHA TRAFFIC & SEWER, COX, MUD, OPPD, QWEST, mcleod 

If there are any other utilities besides those mentioned above, you will need to notify them yourself and any 

privately owned lines will not be located. 

Original Message 

From: tsimmons(gcoastalhazmat.com 

To: info(gne-diggers.com 

Sent: Monday, November 05, 2007 10:50 AM 

Subject: NE-Diggers.com - LOCATE Contractors Request Form 

NE-Diggers.com - LOCATE Contractors Request Form 

Name: Rita 

Alt. Name: 

Phone:7123520188 


Alt. Phone: 


Email: tsimmons@coastalhazmat.com 

Caller ID: 18790 

Company: Coastal Environmental Group 

Type of work: lead excavation 

For Whom: EPA 

How Deep: Oft. 36in. 

Explosives: No 

Corner Lot: No 

Front of Property: Yes 

Rear of Property: Yes 

Tunneling/Boring: No 

11/5/2007 
Page 2 of2 

County: Douglas 

City: Omaha 

Address: 3859 Seward St 

Directions: 

Where on Property: 

locate entire property 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

11/5/2007 
Douglas County Account Information Page 1 of 1 

Dougla s County , Nebrask a Propert y Recor d - R192512025 0 

Print Report Information is valid as of 2007-10-10 View on Map Values not finalized until after Board of Equalization Treasurer's Tax Report 

Owne r 

CITY OF OMAHA 1 77f t f^dy>:>/ ^ 

C/O CITY FINANCE

1819 FARNAM ST

OMAHA NE 68183-0000 

 <oyr^/yad > 

 "^ ^ 

Propert y Informatio n 

Key Number: 2512 0250 19 

Accottnt Type: Ex Government 

Parcel Number: 1925120250 

Parcel Address: 

Legal Description: 

3859 SEWARD ST 

OMAHA NE 68111-0000

ORCHARD HILL ADD REP 8* LOT 1 BLOCK 0 50 X 138 

| 

Valu e Informatio n 

Land Improvement Total 

2007 

2006 

2005 

2004 

2003 

2002 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00

$0.00 

1 

Lan d Informatio n 

Acres 

0.15 

SF 

6900.0 

FF 

0.0 

Units 

0.0 

Depth^^Of 

'/1138.0 

i l 

li 

Width 

50.0 

Vacant 

No 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 9... 11 /2/2007 
Douglas County NE GIS Map 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment:

Owner 

Comment (s): 

Site 

1 Coordinator 

Comment (s): 

CONTACT FORM 

rG ^5t7>^ J 

x: SQ 

0 

 Date:///4,M'? Time: Action: ^T^^yt 

 Date: ' Time: Action: ' 

 Date: Time: Action: 

Transmit to EPA D Other Action: D 

J 
*•''''"'"*. 

r^fi^' o Omaha Lead Site—Fixed Price EP-R7-07-05 ((ifl & 

i^^^v ' I Coastal Environmental Group Inc. ^'^^^^ F 

v^^^^ * www.coastalhazmat.com 

%PBoTt^ COASTA L ENVIRONMENTA L 

C It O U P . IN C 

EXECUTIVE SUMMARY: 

25859—3320 HAMILTON ST 

^ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

C OAST A L Omaha Lead Superfund Site CNVinONHCNTAL O ft O U P . INC . 

L\,y7>c07ey 

Phrtn*: .-J...-j - yr!-->y 

[ 3 Nol pa rtt ^ 

Srtlllp^e NumDer r::Ciinentr?Tfion Ccillec:Ed Firm: Ag. ^ i ft-s. 1 t^b -

Date: 1-a. — 1.2 -c^c. 

S' wrnf.- J l-l^r - p . 

Rrcscpxv^53j- j Bl I ] 

RVDECPX^ 5535 3 B2 m Z] 

>i;tJ2SC.rX.<V ;gjg5''j-t g 

" 3pm D .XRF Unit: /OQ T DOCK: !T 7 

" 33m U n Date: / -/ T ' O T 

a Tin-«; i^^ l 

NunillOr Cf ^rimpltS = 

LeceriJ : F l = f-"rcn: LE:1 , FI: = Front RJgh^ (3 I - K?ck l.Rrt t57 =: Back RiG'>l DZ = Drip Zone LiZ = (iardfin hV = (Jlfiy 

-r 

0£C :l' B' iii^g 

F2 = 171 PPM @ 6" pi '+^1' '^'' ^ "^* ^ 

WM<I ni; i 

-<^/^ : .;> 0LS#: 25859 

Date Excavated: 11/8/07 

Date USEPA Signed Off: 12/4/07 

Legen d 

Area not Excavated iTZyi Dripzone Excavated K ^ Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
S*L EPA 

EPA Property Close Out Form 

Propert Property Address: 3&5 ^ '5fcWJ<trcl y #: ^(^<^6 ^ 

Dflte/Time: u /a^q Owner's Name: CL>'-fy a f Amo-Kt V 

Quads Excavated: Contractor Croup CWZL ytg*-! 

Excavation Yes No General 

1. If necessary, were the correct quadrant(s) excavated and restored? y ^ 

2. If necessary, were the correct areas of drip zone excavated and restored? 

(^{i 

Grading Yes No Sod and Vegetation 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away UA 

from the house? 

Has sod been laid in all areas that were excavated? 

i ^ 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) ^^_______ 

1. Was damage to landscaping or plant materials avoided? Aif 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (If applicable) / ^ ^ 

2. Were all gates or fences taken dovm during restoration activities reinstalled? (If applicable) /s/ ^ 

3. Was damage to gates or fences avoided? (If applicable) 0^ 

4. Was damage to retaining walls avoided? (If applicable) 

tJA 

Foundation, Siding and Gutters 

Yes No 

I. Was damage to the siding or trim avoided? \JA 

2. Was damage to the foundation avoided? ,J^ 

3. Was damage to windows avoided? A/A 

4. Was damage to windows or door screens avoided? jJA 

5. Was damage to downspouts or downspout extensions avoided? 

fJ(^ J 

Sidewallts and Driveways (Concrete) Yes No 

I. Was damage to driveway surfaces avoided? A/A2. Was damage to walkway surfaces avoided? 
Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representati V Date: 7y/<7/t77 
^ ^ 

Property Completion Agreement 

Tills agreement documents the completion of remedial activities perfonned on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the fiiture, except those items listed below, ifany. 

Property ID: D / ^ g f^C ( 

l^operty Address: >2^^f^C^ 9.fXMO.r l 

Owner: 

Phone: 44 4 C g:^/^^^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

agree restoration is completed, except as noted 

 I I do not agree restoration is completed 

A<^' M-y 

Owner's Signature / / Date Contractor's Siiaiature 

/ 

I
llljyyy> '^y^j))cap^y # ^5<^53^ 

Exterior Paint 

North Arrow Omaha Lead Site OwntffName: CIJ- W o P Omah a ^. ^ ^ , , ^ • Good 

wvddress:_A3Ag_ cyg^arr/ c9/ ^•*^ ^''^*^^ • Poor 

Phone: H: w.y<4<~f7<sis7 

^ 

[ 3 Not paint 

Lead Sample 

Samples Collected Sample Number LAB Concentration Collected Firm: A'SVJ \ R's. \ l:^v=.. 

RrAscpxA- es8S3^ ^ g35'ppm {zr D Date: la - t a -gg . 

__dI Q ppm D Time: '•' i*?Q P* ^ 

RY'CSCPXA-25g5^ B1 33J3 ppm D Samples Analyzed RYDSCPXA-SffQSS B2 33 Q ppm D 

RPZSCPXA QffQSO DZ ppm D D XRF Unit: /QO T Book: JJ Z 

RGZSCPXA S^8S9 ^'^ •" ppm D D Date: /-/T-QT 

RfZCCPXA CiPQffa PZ " ppm D D 

Time: >^/l/ ^ 

Staff: (S7U1L 

I \r7r^^'S>^''77ZS^ f ^ . Number of Samples = [ T 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID jyo^'Oi JZ5SS1 

Property Project Omaha Lead -- Fixed Price Address ^g5 ^ Sgv>^^ ST 

Measurement 

XRF ID 0107-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot * Reading Sample Area 

y»?> 11 n IrZ. 4-(* 

bUla f.A-Ki tfc 

Sample Area FZ ^-(^ 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent 

(Bag) Number Results 1 2 / 0 (Bag) Sieved) ? 

2 n t n l 

3 /«6 

4 ni ni m m XRF Corrected Value --> 

5 21^ (use calibration chart or add 

2 0 % to value) Z\1> 

Sample Area Pass/Fai l ? ^A -^ / 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 

2 ^9 

3 CT 

4 

^7 (eft XRF Corrected Value --> 

5 (use calibration chart or add SO 

2 0 % to value) 

Sample Area Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7 

2 

3 

4 

XRF Corrected Value --> 

S (use calibration chart or add 

20% to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) •? 

2 

3 

4 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

Aliquo In Situ Composite Composite Analytical t Readin Composite Readings Lab Analytical q Average (Dried & Spilt Sent (Bag) Number Results (Bag) Sieved) •? 

XRF Corrected Value --> 

(use calibration chart or add 

2 0 % to value) 

i n i AUDI I IOHA I miii i i, 

XRF Technician's Siqniture nf f III II 

5 
m 

COASTA L 

'•»>• y ENVIRONHENTA l 

C II 0 U f , IN C 

Consent For Acces s To Property 

RIGHT OF ENTRY TO PREMISES 

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: 

i (^//y or Onn^A 

Owner's Name: Daytime Phone: 7^^ ' 5IS O (l/4cc5 cy^ju e 

Address of Property 

covered by this S^^f ^^ity^b ST. Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. 

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

program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-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 written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

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: 

Page 1 of 2 
.T""**^* '

 CCOASTA O A S T A IL IWVmOWMiNTA l 

C • O U P . I t« C 

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. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

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

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the 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 Coastal 

Environmental Group, at (712) 352-0188 

-B l grant access to my properties • I do not grant access to my properties 

7u. ^ ^^y^7 

Signature/ ' Date Signature

 Date

O I would like to be present during any sampling that Is required. 
COASTA L CMVinOMMSNTAi . 

C n O U r . IN C 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: Z.'O S ^5 ^ 

Property Address: ^n. Owner: (Tyitt^ Q ^ yT^^^T/y^ ty/yy/Ayf^ 

Phone: 77 ^ ' S^Z^Q 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known utilities, 

subsurface features, surface structures and landscaping features, access location(s) to be used by contractor, and 

the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos by referencing the 

photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these Items is the Owner's responsibility. 

Item: / 

oy->€:' 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: T 

Page 1 of ^ 
COASTA L • MVIRONM C NTA L 

CROUP . IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

7o^£' 

Item: 

Item: 

^ ^ ^ 

Item: \ 

Item: \ 

/ 

/ 

/ 

Item: / 

Item: 

/ 

1 '*®'"" / 1 

Item: / 

Item: / 

Item: 

/ " 

Item: ' 1 

Item: 

/ 

Page 2 of ^ 
COASTA L KMVIRONMBNTA L 

CROUP . INC . 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

•b 

5 o/C 

7 

Page 3 of. 0 
< ^ 

COASTA L SNVIROMNSNTA L 

CROUP . IN C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

Quantity 

pzy 

^ 

(y 

y 

0 

Unit Condition/Type/Species 

Square feet 

Each 

1 

Each 

Each 

Each 

Square Feet 

sizes and locations. 

Page 4 of _ 
COASTA L KNVIRONNCNTA L CROUP . IN C 

item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon hst of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

y 

$ 

7 Each 

SF 

1 

1 

/y7eysi2u^ye> 

SF 

SF 

Page 5 of. ^ 
COASTA L • NVtRONMSNTA L CROUP . IN C 

Additional Comments / Instructions: 

. \/i^r^r ^ ^ B^i^A^^^ - ^ y ^ C L o^yy)...^^^ 

7Syff7yicf//htt yy ^^yf^yjoa 

-^yr6)y77(£ -T-^p 0-r^~r77^3LdP^ ouy- ^ r7i^A7 ^ze-A^ 

A<ob SZyjo^ 777^^^T ^ jy o y^^^n" Jl^cyT Syfcj^^7ic 

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O Check 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 

interior of house, including foundation cracks or fissures. 

• Q I agree Q I do not agree 

1^ iyYL..,ryK'<^^ C'y - ^yyy.. nkh-? 

Owner's Signature ' Date Contractor's Signanire Date 

Page 6 of <^