## TRANSMITTALo f

OMAH ALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : \b\i\ \Date : 

# JiU A Address : I ^^ ^ 4 \t ^ ^ < Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200 O SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o o f property (DVD ) 0 Executiv e Summary 0 EPA-provide dproperty sketc h I ZSigne dAcces s Agreemen t for subjec t property ^B ' Signe dAcces s Agreement(s ) for adjacent property 1 0 Restoratio nAgreemen t J ^ Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. )

• B - Confirmatio ndat a DO / Photograph s 7^ ^ V?i^ W> r (?^tAv|/m ^ y 'h^6?^^^rig ^ 0 As-buil t sketc h U Satisfactory restoratio nsigne db y Property Owne r w Property close-ou t chec k lis t signe db y EPA •& • Descriptio no f area s no t meetin g RO D cleanu p criteri a a /

Utility clearance s \ 3 Property informatio nfromDougla s Count y Assessor' s Offic e D

3005445 9 

# • l i Superfun d• • ^ «


## Propert yAcces s Checklis t Property ID : \^{^\ ^ PropertyAddrcis ; | O^g^f e < ^ \ ^

^fj " n D

WOR K STARTE D WORKCOMPELTE D ON : __/__/ _ ON:__/__/ _ Owner : 

# Thirh f /X C Afldrcss : 

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Fax : ^ 

# 5n
- ^^.!^ ^ Rente r Phone : Fax : Cell/Page n Additioaal Information : Cell/Page n 

### D Notfflcatlo nLetter £ 1 Access Agreemen t J 0 Restoratio nAgreemen t D Topsoi l Samplin g (i f applicable) D Disposa l Samplin g (i f applicable) nGarde nSamplin g (i f applicable) aUtilit y Clearanc e ^ Video/Photos (Before ) O Video/Pbotos (Daring) D Video/Photos (After ) D Video/Photos (30-Day )
' HS»«)pcrt y Completio nAgreemait It ] Fina l Repor t Sent : / / Signed : ^/Xi^0 9 Signed : ^/IU/0 9 / / / / / / Called : / / On:9_/J^/0? l On : / / On : / / On:__ / / Slgncd((Z/^/g ^ Issued : / / [ By : By : By : By : By : By : By : By : By : By : By : By : By : Ai r Monitorin e (as applicable O Communit y QCre w Results : On : / / By : 

# 1
O Communit y ResuHs : D Cre w On : / / By :
.
nCommunit y Results : D Cre w | On : / / By :

Omah a Lea d Sit e• • 

### Dougla s Cotmty Accoun t L|tfuT|^io n Pag e 1 of 3

Dougla s County , Nebrask a Propert yRecor d - R152206000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e ( 9 scal e 0-5 0 n wes t o f 52n d S t - ViewO H Ma p Informatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e -*•*• * Aut o Sale s Searc h Owne r THIRTYLL C 351 0 DODG E S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 220 6 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 152206000 0 Parce l Address : 193 8 S 1 2 S T OMAH AN E 68108-000 0 Lega l Description : KOUNTZ E 4T H AD D SUP P LO T7 BLOC K6 N 1/ 2 3 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $3,800.0 0 $3,800.0 0 $3,800.0 0 $3,800.0 0 $3,800.0 0 $3,800.0 0 $69,800.0 0 $69,800.0 0 $69,800.0 0 $37,200.0 0 $37,200.0 0 $37,200.0 0 $73,600.0 0 $73,600.0 0 $73,600.0 0 $41,000.0 0 $41,000.0 0 $41,000.0 0 Sale s Informatio n Sale s Date : 2007-10-3 1 Dee d Type : 

## W D 

## 1 Book : 200 7 Pago ; 12762 1 Price : $35,051.0 0 Grantor : Ban k o f NewYor k Grantee : Thirt yLL C Valid/Invalid : Invali d Exclusio n Reason : Ban k Sal e Sale s Date : 2007-04-2 5 Dee d Type : TR D Book : 200 7 Page : 05246 2 Price : $0.0 0 Grantor : HAW KCAMILL E R 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15. . . 8/22/200 9

### Dougla s County Accoun t L^rn^^o n Pag e 2 of 3
Grantee : BAN KO F NE W YOR KA S T R Valid/Invalid : Exclusio n Reason : \ invali d '• Sal e t o Mortgag e - Ban k Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : 2006-03-0 9

\ W D ! $84,000.0 0 ] Cha d Allingto n

Debra Mclntyr e Vali d Book : 200 6 Page : 

### 03943 6

Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : 2005-05-1 6 W D $60,000.0 0 Jerr yMainell i Eta l Cha d Allingto n Vali d Book : 200 5 Page : 05748 6

Lan d Informatio n Acre s 0.0 8 S F 3750. 0 Unit s 1. 0 Dept h 

### 125. 0 Widt h 30. 0 Vacan t N o Improvemen t Informatio n Buildin g 1 

# • 1 pp^n^ m ^^^^S j 

# 1 =^=^ 1 W M 

# W t 1»3eS12S T

EMIS H 2S0S I •? - FWltFlDa r SS1ASq.F l Mi r*i o
ijir'iVlfVtr " Ranc h Birwaiot k B I f 7M. 0 Sq
. n

1 CLIC KT O ENLARG E IMAG E j CLIC KTO ENLARG E IMAG E Squar e Footage : 856. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Fai r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15. . . 8/22/200 9• • 

## Douglas Count y Accoun t I:

lArmatio n Pag e 3 of3
Uni t Type :

Buil t As : Ranc h

HVAC : Centra l Ai rt o Ai r Exterior : Fram e Viny l Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 190 0 0 0 % Physica l Ag e Buil t 

# m m Averag e 0. 0 5. 0 1. 0 1. 5 2. 0 1. 0 Bloc k 0. 0 Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r 190 0 10 9 Unit s 1. 0 736. 0 400. 0 1. 0 1. 0 1. 0 1. 0 28. 0 Detai l Typ e Applianc e Basemen t Basemen t Fixtur e Fixtur e Fixtur e Fixtur e Porc h Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 ft Finishe d Additiona l Fixture s Bas e Fixture s Bat h Ful l Bat h Hal f Enc l Scree n



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 5.. . 8/22/2009• •



## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Final Contact ; Final Action :

Comment : Owner Comment (s) : Site Coordinato r Comment (s) : CONTACT FOR M 

## \%\o\ \
\^^ ^ % 

## 1 ^ S V Date : Date : Date ; Time : Time : Time : Transmit t

o EP A D Action : Action : Action ; Other Action : D

### • • 

## Pag e 1 of 2

" > Create Anothe rTicke t fBac k t o Irt h internet Sen d Emai l |



## • YOURTICKE T NUMBE RI S 2367937 . Origina l Cal l Date : 9/20/0 9 Time : 4:3 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/23/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 193 8 Street : S 12T H S T Twp : 15 NRng : 13 E Sect-Qtr : 27-NE-S E Tv/p : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X 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 Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F

Servic e Are a Contac t 

### Phon e Nuniber Utilit y Typ e
ATTNEBR l ATT/T 

### Day : 8002413624 9 Alt : Emerg : 8002413624 9
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Ah : Emerg : 877366834 4
MCINE B MC I N O CAL LPE RMEMO 

### Day : Alt : 800289342 7 Emerg : 800289342 7 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/20/2009• • 

### Pag e 2 of 2

MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO F CIT Y O FOMAHA
TRAFFIC.SEWE R RO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 6 OMAH A PUBLI C POWE R DISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
PAETE C PAETE C COMMUNICATION S N O NEE D T O CAL LOU T EMERGENC Y 

### Day : Alt : Emerg : 800289190 1 800289190 1 QLNN E1 FQWES T LOCA LNETWOR K N A 

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



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/20/200 9

# • A
. 1861 1 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : JERR YW MAINELL I 

### Sit e SIcetc h • Goo d
• Poo r Ef^No t pain t

Omah aLea dSite 4613 0

# m xq??"! ) S 1861 1 Omah a Lea d Sit e Owne rName : JERR Y\AnyiAINELU
_ 

### Sit e SItetc h Address : 193 8 S 12_S T Phone : .^Jlc:^iJ X 5^ 1 Lea d Sampl e Sampl e Numbe r LA B Concentratio n Collecte d RYASCPXA-1861 1 

# D D RYBSCPXA-1861 1 pp m 

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# 1861 1 Nortt i Arro w 

### Omah a Lea d Sit e Exterio rPain t Owne rName : JERR YW MAINELL I • Good 

### Sit e Sl(etc h Address : 1938 81 2 S T D Poo r Phone
. »S90'ioiJ y^ |2f^No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Finn : ^ ^ ^ RYASCPXA-1861 1 

# n Date : 

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INVIROMniNTA l t • O U r . IH C 

## Consen t Fo rAcces sTo Propert y RIGH T OF ENTR Y TO PREMISE S 

### Granto r(th e propertyowner) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

Owner' er' ss Name : , Daytim e Phone :

Addres s of Propert y covere d bythi s Aflreement : PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A

is requestin g acces s to collect soi l sample s an d remove soi l tha t contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remove contaminate d soil
. Th e remove d contaminate d soi l wil l be replace d wit h clea n material s an d th e are a wil l be restore d to it s origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ eof Coasta l Environmenta l Group , contracte d byUSEPA
. wil l contact th e Granto rin-perso n to discus s th e wor k tobe performed , th e Granto rwil l hav e an opportunityto revie wan d approv e th e planne d soi l removal , an d restoratio n v^r k befor eit begins
. Onc e th e wor k Is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha t it is 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 EP Athat th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractors an d subcontractors th e righ t to ente rth e property , at al l reasonabl e time s an d wnt h prio rnotice , fo rth e sol e purpos eofperformin g th e work
. Thi s acces s shal l remai n in effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of 2rf*^'^, 

# ^ 1 COASTA l 6 • 0 U r . lh 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 f th e propert yi s rented , assis t EP Ai n obtainin g tenant 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 f th 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 f th e wor k done , o rwi 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 pntpert yv^ic h woul d ten d t o endange rth e healt h 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 yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (712 ) 352-018 8
I gran t acces s t o mypropertie s D I d o no t gran t acces s t o m ypropertie s 

# W g ^ Signatur e Dat e Signatur e Dat e
QI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.#

COASTA L 

## RestoratioF i Agreemen t Th e purpos e ofthl 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 . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : 

# fd^j / Propert y Address : M ? < ^ 5~7 ^ "^ ^ (Owner : -^^^ ^{1.-\L ^ Ujy ^^^'^^ ^ O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e propert y an dth e basemen t i f necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e lenoval
. stora.qe . disposal
. :and/o rretur n o f thes e item s i s th e Owner s responEibiiity
.

Item : Item :

Item s t o b e Remove d b yth e Contracto rDurin g Rejgiediatio n an d IVJo t Replace d Item : ^ > ^- J " - /

. T^--vap-v^Z - ^ ttem : Item : Item :
Page l o f £_COASTA L 

### Item s t o B e Remove d B yContracto rDurinf i Remediatio n an d R6placed
_ Item : 

# ^X)\\^ ^ h \, 6 ^ I ^ ^ 

# - ¥ item : 

# ^^ h X A ]^ l . P' ^ Kem : Item : 

### l^andscap e Inventor y 

## Item Conditloii/Type/Specie s Pre-existin g propeit y area , Quadrant s tha t wil l b e excavated , tha t i s covere dvrit hgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Aiiat h n sKeic h o l th e '•rr'i'klv.' i iiniui ; Numbe r o f an dsiz e o f eac hgarden / flowe r be d Eacf a area . Squar e Fee t AlliR h; i skclc ho l rL-!:iliv c M/fS.nn dloc;iiiivi- . Agree dupo nvalu e o f plan t material s no t t o b e replace db y contractor . Ncl» ' Ihi ' > Hlii c»MI I n t USI'L ' 1 0 i5;u < . ! n\-A\y \ »QiJi:Iio ; (( ' th e iiropcrl \ ()>wn;r
. Easemen t Area , t o b e / ? ^ excavate d 

# M y Pag e 2 o, ^

# u ^ C O AS 1 AL C » O U r, IN C
! Additiona l Comment s / Instructions :



# L
. [ J Chec k th e bo xI f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n walls an d possibl e pre-existin g damage
. 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 f house , includin g foundatio n crack s o rfissures
.

d ] I d o no t agre e 

## '(MMJ ^ 

# Mulo f Owner' s Signatnr e CoiUractor' s Signature Date Pag e 3 o f 

### \BVID # /^(B.! ! 

### XR F PROPERT Y SAMPL E SHEE T Dat e Projec t XRFID # __Shot # 

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# ^B3h ^ Addres s 

## 1^3 ^

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. 

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3 S"- ^ <^i f Averag e 7.A^^2^ I Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h Dept h Averag e
RETES TAREA S Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h Dept h Averag e La b resul t Sampl e are a XR F Avg
. Signatur e 

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By : 

## Certificat e o f Verificatio n

1 4 SOI L 2009-11-2 5 10:4 4 122.4 5 Fina l Av g of 10-1 3 193 8 s 1 2 s t B 2 13 " R
. VENTR Y clearenc e ngn c

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

XL3t-3902 2 Readin g N o Mod e Tim e Duration
. Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 245.95 3 Supervise d By : 

## Certificat e o f Verificatio n

1 0 SOI L 2009-11-2 5 10:4 2 30.6 3 Fina l 1861 1 193 8 s 1 2 s t B 2 13 " R
. VENTR Y clearenc e ngn c

± Erro r ± 20.55 0

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 277.42 8 Supervise d By : 

## Certificat e o fVerificatio n

1 1 SOI L 2009-11-2 5 10:4 3 30.6 0 Fina l 1861 1 193 8 s 1 2 s t B 2 13 " R
. VENTR Y clearenc e ngn c

± Erro r ± 21.57 6

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRANT DEPHT XR F TEC H MIS C NOTE
pp m P

b 293.10 1 Supervise d By : 

## Certificat e o fVerificatio n

1 2 SOI L 2009-11-2 5 10:4 3 30.6 6 Fina l 1861 1 193 8 s 1 2 s t B2 13 " R
. VENTR Y clearenc e ngn c

±Erro r ±22.06 8

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 284.04 6 Supervise d By : 

## Certificat e o f Verificatio n

1 3 SOI L 2009-11-2 5 10:4 4 30.5 6 Fina l 1861 1 193 8 s 1 2 s t B 2 13 " R
. VENTR Y clearenc e ngn c

± Erro r ± 21.72 7

## i ^A 7 % Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta i Grou p Inc
. 

# m

^

www.coastalhazmat.co m '•"tpRoi* ^ COASTA L illVIIOIIHINTA l S IO U P
. IN C 

# EXECUTIV ESUMMARY : BVID #18611-(193 8 S 1 2 ST ) No Issue s o r Concern s Q Issues/Concern s Detai l Explanation :

### 4 ^ 

# E i l EP A Propert y Clos e Ou t For m Propert y # : \Z)\ol i . . Propert yAddrvss : l^?>f i V U 

# ^ d- DatcH'Imc : Owner' s Nane:
. .fLl3n^tyi)^'-^x'
. Contracto rGrou p /Tt/mf^ A Quad s Excavated ; g> ) j fi7^ y ^ Ye s N o Excavatio nGenera l I . If necessaiy , were th e correc t qiiadrant(s ) excavate dandrestored ? 

### CX ' 2 . If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

## cy ' Ye s,N o Gmdln g So d an d Vegetatio n 1 .Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y 

# TT T fromth e house ? 2 .Ha s so dbee nlai dinal l area s tha t wer e excavated ? 

# 17 ' 3 .Doe s th e so dappear t

o b e generall y healthy an dgrowing ? (Onl y evaluate i f inspecte da t a3 0 

## 1 / day time period ) 4 .Are soddedarea s generally fir man devenly graded ? 

# 17 ' 5 .

Ar e th e joint s betwee nth 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 dsuchtha t wate r wil l no t poo l o nth e propert>' ? 

# l y 7 .Wa s danug e t o landscapin g o r plan t malerial s avoided ? 

# P "
Gates , Fence s an dRetainin g Wall s Ves /i o 1 .O o gate s ope nan dclos e freely? (Ifapplicable ) 2 .Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# 17" 3 .

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

# IP' ­ 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) ( / Foundation , Sidin g an dGu»er » Ye s N o t .Wa s damage t o th e sidin g o r trimavoided ? 2 .Wa s damage t o th e foundationavoided ? 

# 17 ^ Wa s damag e to window s avoided ? 

# 17 ^ 4 .Wa s damag e to window s or doo r sCTeen s avoided ? 5 .Wa s damage t o downspout s or downspoul extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ycs ^ N o 1 .Wa s damage l o drivewa y surface s avoided ? 

# 1 / 2 .Wa s damage t o walkwa y surface s avoided ? 

# -7
­

## Owner s comments :

iDspectionnotes :

Remova l an dresloratio nactivate s complet e includin g th e 30-da y so dvyarranty : EP A Representativ e / /7 K .lj/;//i ^ ^ Date:/ Q

## Propert yCompletio n Agreemen t riii s agrcemen i document s th e complclio no f remedial activilie s perrorinec i onm y properly . My sigi«ilure will designat e lha t I a msalislie dwil hth e restoratio no f m y properly , an dthai no item s ar e i nqucstion.s , now , o r a

t any tim e i nth e future , excep t thos e ilem s liste dbelow , ifany . PiopcityU) : 1<S(^[ \ Proprrt y Address : |<?3 ? S 13 ^ ^- f Owner : -tV
. f-4-V | UU L 

### Phone : *^o3i-S^)o-<445 4 Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : 

# Z J
Additiona l Comments :



# . J

I agre e rr.storatio ni s complded , excep t a s note d I no l agre e rejiUnrntio nis ; complete d

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