TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FIL E FOLDE R 

SAID#: _ 223 ^ Date: 3^/l3loe > 

Address 34lC^ T\..V^ A/g. 

Remediation Contractor: Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

^ Executive Summary 

K4 EPA-provided property sketch 

^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

^ Restoration Agreement 

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

I5t Coniirmation data 

^ Photographs 

1^ As-built sketch 

j ^ Satisfactory restoration signed by Property Owner 

"^ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D . 

D • • ' • . • ' 

^ ^ 

40317755 

iiiiin 

Superfund 
Final Report Property Check List (piease place with each fiieX cP'p~6<^^ 

Jtar d Copy Information (^^^^4j^_-p^_t^ ^ 

\ Property Check Li.st ^ "TN |W ^ 

2. Site Working Drawing Map 6^l U -Dx^^^ ^ "^ ^ 

3. EPA originaLs Map 

v4. Douglas County Assessor's Map 

o^^ Property Contact Sheet 

Agreement 

J .-yX-ccess Agreement 

2\R.estoration Agreement 

C 1VI1S Miscellaneou ( s Documents 

rsF^ina i l Map from the Field 

V Change Orders 

VXRF Data 

4. Any emails or PO airrespondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

N^Property Completion Agreement 

4. Any buyout info or reimbursement info 

'X Check or money order copies 

cV EPA Property Close Out Form 

XAttached Begin Video 

Electronic Documentation 

Drawings 

N.^ EPA original 

zs^Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

* Final Documents 

2 Executive Summary 

0 Videos 

' Begin Video 

2 . My Movie 
Property Access Checklist 

Property ID: ^B?jy\ D WORK STARTED ON:

Property Address n WORKCOMPELTED ON: "-•• .3V/<^ Diyfjj h y 

Renter: "^''''^'••DyMM M'^i yariaii^\ 

Plione: "'"^•^•^=B^A/.V^^ci/. Fax: 

Cell/Pa^er: 

Additional Information: 

''""- 7j7^-y/yi 

Fax: 

Ccll/Piifrer: 

n Notilication Letter Sent: / / By: 

1^4 Access Aj^rccincnt Signed: ^//2/J 7 B.v: i2jCy 

rSc Restoration A);rccnicnt Signed: b l 1^1 0 1 y^ryVyix 

n Topsoil Samplin;; (ifapplicable) 1 1 By: 

n Disposal Sampling (ifaiiplicable) 1 1 By: 

Q Ganlen Sampling (if applicahle) 1 1 By: 

\01 Utility Clearance Called: [^ / \'^ 1 (71 By^-^iK^^ 

^ Vi(leo/Pliot(»s (Before) On: y i iy_i y i ^T7a0y 

n Vidco/Photos (During) On: / / By: 

D Vidco/Photos (After) On: / / By: 

n Video/Photos (3()-Day) On: / / By: 

Signed: / / By: 

1 1 Properly Coinplction Agreement 

cn Final Report Issued: / / By: 

Air IVIonitoring (as applieahle) 

n Community n Crew On: / / By: 

Results: 

f~1 Community [ H Crew On: / / By: 

Results: 

n Community D Crew On: / / By: 

Results: 

Omaha Lead Site 

/ /_ 

/ / 
Total( Ifant Square Footage to be Excavated = 1178> 

Property Classification: 800 Tot! ) Zone Linear Footage to be Excavated = 90(l 

'&»'g^ 

Dewey Avenue-^s ^3 ^ 7 

Legend 

Concrete 

Northj^i rrow Omaha Lead Site 

Omaha, Nebraslo 

-3 -

——, Excavated Area 

Existing Structure 

Permanent Landscaping 

Fence 

Scale 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

Property Number OLS-22821 

Property Address 

3416 DEWEY AVE 

Quadrant Boundary Post Excavation Concentrations (ppm) 

F1 . B2 Play Area Street Boundary F2 DZ Easement o Tree/Stirub ./PTM»* ' B1 Garden Other 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

D2, drip zone (1-3 foot area of soil around the foundation of the house). 
0 

=*?!». . 

% \y0. 

Property Classification: 800 

l^i^-l ^ .1. 

(oKS^^NH i. 

<^vg:-^g \ 

Description ol post excavation areas Fl , front yard left-hand quadrant; F2, front yaM rfght-hand quadrant; Bl , backyard lefl-+iana quadrant; 92, backyard riflht-'iand quadrant: 

DZ. drip zone (1-3 foot area of sOil around the foundation of Ihe house), '. , - • "• 7'.' ' 

7\.- •^vJ'Ti;^.:.^r»!Es^v;. _^- ^:y.y0v,^»; 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2112840000 

SARTAIN 

DWAYNE 

3416 DEWEY 

AV 

OMAHA 

68105 

3325 N 48 ST 

OMAHA 

NE 

68104 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

21-15-13 

REEDS 5TH ADD 

4 

15 

50X103.2 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R2112840000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 82 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/9/2007 
CONTACT FORM 

Property ID # 

Property 

Address: 

99?)^^ 

3^/(/> OiiTJUi f}\/i. 

Initial Contact:

^e^nrwi A ^r\nfci/->t - Second Contact:

Final Contact:

Final Action:

 Date: t\{thT Time: /f57>

 P^cito ' Tii->nc»­ Date: Time: 

 Date: Time: 

 Transmit to EPA D 

 Action: y y /^7^-,s-.^ ?. /4(-^^^ ^'^ 

 A/-"f irtt r ^ ' f(Jl.<y Action:_ 

Action; 

(<4iyfuy^ 

Other Action: D 

Comment: 

Owner 

Comment (s): 

\\uy y 7k.<^yyy^ 

Site 

Coordinator 

Comment (s): 
,,to sr<. - * 

COASTA L ENVIRONMENTA L 

CROUP . INC . 

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 environmentai response activities upon the 

following described premises: 

Owner's Name: Davtime Phone: 

'T­ ?yj'-c^f<5>7 jyi^a/Th/ i- ry/ZL^. vi^^^^' 

Address of Property 

covered by this 

Agreement: 

3y/V tVJ ^ 

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 ivseets 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 
COASTA L ENVIRONMENTA L 

GROUP . INC . 

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 (877) 234-6270. 

Q I do not grant access to my properties rant access to my properties 

Ly-o/ 

Date Signature Date 

nn I would like to be present during any sampling that is required. 

Page 2 of 2 
, ( ^ 

Restoration Agreement 

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

remediation acii\iiies. This will also ser\e as decontamination for the purpose of assuring that 

restoration activities are completed lo the satisfaction of the propen\ ouner and the L'nited States 

Environmental Protection Agency (EP.A). 

Property ID: ^^^^ t 

Propertv Address: ^ ^ . , V •- 3-ilL . 0?,v.\f> 

Owner 

'- C ( ^A SA/7-A-A I' M 

Phone: ^[- b g-Sfe^ 

On the attached diagram(s) indicaie area(s) lo excavated and depth of excavation, location of all knov^ii 

utilities, subsurface features, surface structures and landscaping features, access loca;ion(s) !o be used bv 

contractor, and ilie direction of No.nli. Indicate distances, depths, material rxpes. e;:. !;i.iic;i;e ci:g:'.:-.l p'v ;.-> 

bv refcrc'iC'i^g tlie photo-log niiriiber v, ith aii nrro'^v indicatii'g direc;ic;i cf \ iew. 

Iterr.s To 55 Ramcved By Owner Before Sta.-t Cf Ri 

(Use additional sheets as necessary) 

'hs rer^.ovai, storage, disposal, and/or rstjrn cf tbess iterrs is :be C^^-

Item: 

V^-^'T^VI_ , clt-4 , lA^^ y \ -O-cv-C-U- vlyQ^^ c

Item: 

A^^\ Al l \(/(hJ ^ 4i^tr i/)^^Jr hr^^^i^^"''"'' ^ 

Item: 

^ ^ ^ 

Item: y ^ 

Item: y 

1 0 

Item: / 

Item: / 

Item: y 

Paqe lo f \§ 

 i 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use addrtional sheets as necessary) 

Item: 

A\I ^^u,^ -V ^ A^Ah> .Uc.^w^c^c^i_ IV So^c,y\t _ Item: 

(>^ ^ 0.^^-(-ga^ll'c ^ ^<^^S A 

Item: 

^ yvyeoi r\g.A^ \ rf^v>CL-^r >'rN ^ 7 b ^ 'ba. Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of U 
(P> 

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) 

K^^^v.-.c (2,c>cJ^ iofU;^.S. G^/iA^ ^ /^-IAS Sf 

Uv/v:^ l^AC y /yPW A JQA.C-\-^a \ . 

Page 3 of l^ 
•• 

Unit Condition/Type/Species 

Square feet 

I'ach 

1 iach 

; 

luich 

blach 

Si]uare bccl 

Item 

Pic-exi.sling ]Mopcrlv arc;i 

lh;il IS cov'crctl Willi grass. 

Nmiihcr o\' lives ^ 2 inch 

Inink liinmclci 

Niinihci' of liecs <= 2 inch 

Irunk (.liamclcr 

Numbei- ol' .Sprinkler 

/ones. Coiilrc^l Vahes. 

Tiiiici s. I leads, olc 

• i.. , i , ., 1,1. 1 •; ••], . 

|,-P, I 1. i 1 •• ,.l! l 

Number cl' :iini si/e cl' 

each garden/ flower bctl 

area 

•• i : -1 l l . . ,1 , 1 , l l , •' 1 1 I.I' : , 

1 . ,11, 1 \ i •> ill , •I!- . 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity 

IJoo 

i 

4 

f 

4 

Page 4 of (7 
(i 

Item Quantity Unit Condition/Type/Species 

Agreed ii|-ioii value of 

planl nialerials nol lo be 

replaced bv eonlraelor, 

• ..1 , li. i . •, .hi . ••' il l 1.. . 

M-. . , 1 i . • 1 -II I 1 1 .1,111 1 

1 •> . .li> |i..1 i. . ill.. PI. .|.. 1 l\ i $ 

Agreei-l upon list of planl 

nialerials lhal will be 

replaeei,! by contraclor. He 

vcn specific and delailcil 

111. Ir.' . : .1 . 1, ll •' '.'. I 1 . 

.. 1. ll |.!,i;i l •• rl l |. . p l 1. .-, 1 

^ 

i;ach 

i

Agreed upon area of 

piopcitv io be replaeeil 

Willi grass sod. 

 111 . ll'..;. . 1 ,1.1.! . .. i •• 

,i!.M . .I'l' . i . |. | 1 . . i •' ,;| i 

(3co Sh 

1 

1 

Aie;i of Cilv or Coiiiilv 

proiieiiv l(> be laiulscapcd 

per llieir reciuirenieiiis 

i" . liM . i . ' :i .1 ' is-b 

Sh' 

1 

Page 5 of (^ 
Additional Comments / Instructions: 

2 ^ ho^ floWot, ^,-^ 4^taA/^ ^ 

A^./dt-SV^'^-^ 

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. 

n I do not agree im I agree I I I do not agree agree 

o 

yiy^y ^ sC//i 2 67­ 0«<ifr"sSij>na<ure Date . CtVnlrattJu-VSrgnaturc Date 

Page 6 of \ / 
Totalr 'ant Sq igi^MrFootag - e to be Excavated = 1178> 

Property Classification: 800 Tot, p Zon. ' r Footage to be Excavated = 9o(\ 

&b..UC. 

^y^^^ ^ 

.^..._^. 

.^.... •hzjKy 

no 

/ HI . Z^ 104-sqn it,kL. iocxi v 1:\ o'-^ feiofv 

u. \ofe 

Dewey Aventie^^^ri I 11^1 < 

Legend NorthArrow Omaha Lead Site zr 

f , t j Concrete 

Excavated Area 

Existing Structure A 

Scale 

Omalia, Nebraska 

Property Number OLS-22821 

Permanent Landscaping 

Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft 3416 DEWEY AVE -• Fence 

y " ^ ^»i. 

- Quadrant Boundary Post Excavation Concentrations (ppm) 

— Fl . B2 Play Area Street Boundary 

© V HG L 

F2 D2 Easement o Tree/Stirub 

Bl Garden Other 

Description of post excavation areas: F1, front yard left-fiand quadrant; F2. tront yard nght-hand quadrant: B1, backyard left-hand quadrant: B2, backyard nghl-hand quadrant: 

DZ, dnp zone (1-3 foot area of soil around the foundation of the house) 
n. 

t^RCFERTY CL£.^R"NCt AL.h«.:-i:=: 

Date nc\?zjr)-^ Property ID - ^E?OT 

Property Project Omaha Lead -- Fixed Price Address Mis yjujcy fy 

Measurement XRF ID 0\cn'S\ Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

lol ^ \ L . t'-A-s 

in^\ P I ^-\/ y 

-ly f PZ )?-/^4'* 

-TV^ ^ 1 Pflr,0i-' 

y ^ 99 71 n-iU'^ 

Sample Area rTVs Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 i. (Bag) Sieved) 7

2 1 '^ 3 1 

• ( i i \i . ^ 1 ' ^ ^ , ! 1 ' 1 ' l < 1 

XRF Corrected Value —> 

1

: ,;u»e cilibratlo n chart or iC d i q • i i 

.i 20" ^ to value) 

Sample Area 1 Pass/Fail ? "ri ^-lO" 

{ I n Situ Composite Composite Analytical 

tliqjc t Ccrpcsit e Reaiir.c s 1 Analytical 1 Reading Average (Dried & SDilt Sent ^, ^^°_ (Bag) Results 

1 (Bag) 1 Sieved) 

^ i o n 

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.; i ! . -7 ^ 1 ' ^ u 2^ ; - 1 1 ^ i 41 59 . XRF Corrected Value " > j 1 1 31 i 1 35 t 

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Sample Area Pass/Fail ? j?2_ym" __ 1 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent 1 (Bag) Number Results i ; (Bag) Sieved) 

2 1

i 1 ^^^^ 1 

3 \ 1 ^ > 

4 i 1 ^n 

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I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) Number Results

1 (Bag) Sieved) ( P ^ 

Confidential : , ^i'-J ' cece : 
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XRF Techric'an s S'critu'e 

Confidential : = :£ 2 c.f 2 
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1 
vfiL, \ Omaha Lead Site—Fixed Price EP-R7-07-05 ^^^7 I Coastal Environmental Group Inc. 

iv^^^T ^ wvvw.coastalhazmat.com 

^"twiott^ COASTA L ENVIRONMENTAL 

C R 0 U F , IN C 

EXECUTIVE SUMMARY: 

22821—3416 DEWEY AVE 

I I No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

PO was issued two money orders #R10064617764 & R10064617765 in the amount of $500.00 each 

for a total amount of $1000.00 for concrete driveway cracks after remediation activities were 

conducted. The property owner will repair or replace at their leisure. 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

ititai Quadrant Square Footage ID be Excarfated- 117B 

Wnierty cnsancadon: 800 Total onp Zone Linear Fixita(ye to De Excavated - 90 

B2 concrete wall scrap rock and 

put back. F2 has a bad wall stay 

away from it. All plants go, 

bushes to be determined by 

foreman. Metal fencing remove 

and trash. Driveway and wall are 

bad. There is new concrete no 

damage to sidewalk. F1 retaining 

wall all plant life must go. 

—tk^ftui w iM<iiiiii»iMn aa, tmi*tmt rtawjij oniw •. 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
Property Completion Agreement 

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

signature will designate tiiat 1 am satisfied with the restoration of my property, and that no ilcms arc in 

questions, now. or at any time in the future, except those items listed below, if any. 

1'n.portylD: ^20^ / 

Property Adtlrcs..: ^C//( ^ 7))fri^ei y AUe ^ 

Owner: l>Li/yP7A7y - Osy i ''"Sy^77h7yy 

Phon 

- ^/^-^^yjy 

Restoration Items in Question: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Additional Comments: 

l_rI iifircc restofsitioii i.s compieteil, except as nntcd 

 I I <lo not ii(;n» I'ostorHtioii is completed 

y ^ - -y-'i-o? /- y yyi y y,<,0G., 

OwncrVsignalurc Date Contractor's Stgnature bfitc / 

I
Property Damage Settlement 

Property ID 22821 

Property Address 3416 Dewey Ave 

Owner Dwayne Sartain 

Phone 402-813-2987 

I have received from the contractor. Coastal Environmental Group Ine. (Coastal), a sum of $ 1000.00 as 

compensation for miscellaneous property damage in lieu of further repairs or replacement of the damaged 

property, which is described below, that occurred during the removal of lead-impacted soils from the 

adjacent property. 

Money Order Number 10064617764 & 10064617765 

Value of Money Order 500.00 ea (total amount $1000.00) 

Made Out To Dwayne Sartain 

Description of Miscellaneous Propertv Damage 

Coastal accessed the property at 3416 Dewey Ave from the public access unto the property's concrete 

driveway, per owner's written permission. The concrete driveway did not have any pre-existing cracks tsefore 

work commenced. Additional cracks were developed in small one area of the driveway due to excavation 

work. 

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be ^i r compensation for the miscellaneous property damage described above and 

release Coastal Environmental Group Inc from further obligations or liability related to this property 

damage. 

Uy n-n-oi TyTJL 

Signature Date Contractor's Signature 

Page 1 of 1 
Tin-. l-RONT OI- THI' IXK'UMl-NT HAS A MICRO-PRINT AMOUNT BOX AND THF'iRMOCHROMK". Ali.SiiNCI-. 01- THIiSli I-T;ATIIRI-;,S Wll.i. INniCATI'; A COPY. -r i MoneyGram. ^ -^ ^ Money Orders ^*^ ' 

NATIONAL MONEY ORDER 

KEEP A COPY OF THIS STUB 

rOR YOUR RECORDS/ 

MANTENCA UNA COPIA OE 

ESTE RECIBO PARA SUS ARCHIVOS 

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SEPA 

^P A Property Close Out Form 

Property #: 'Z'7BZV7 

Property Address: 3f ^ Tj^open^ /h y / / ^ 

Dmtc/Tinc: Owner's Name: l^y^J^Je'- l/F^yt- "^^^^he-XAiA/ 

Quads Excavated: Contractor Group 

Excavation General 

Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? L^ ^ 

2. If ncccssa-fy, were the correct a-tas ofdrip zone excavated and restored? 

Grading Sod and VetctotioB 

Yes No 

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

from the iiouse? 

2. Has sod been laid in all areas that were excavated? 

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

day time period) ^^ 

4. Are soddtd areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only e\ aloate if inspected at z 30 day 

time period) 

6. Was the property graded such that water will not pool or the prope'T> ^. i^ ' 

7. ^'as damage to landscaping or plant materials avoided? -y 

GMICV Feoccs ana Retaipint nalis Ves No 

Do gates open and close S-eely';' ^If appiicable) r\o 

d-7(JL £2. 

2. Were ail gates or fences laken down during resloration acti\ ities .-einstanec? .if applicpie) 

3. Was damage to gates or fences avoided? Mf appiicable) 

Was damage tc retaining walls avoided? ^!f applicable! 

Foundation, Sidiii and Gutters >.ei Nc 

1. Was damage to the siding or trim avoided? L y 

2. Was damage to the foundation avoided? L / 

3. Was damage to windows avoided? y 

4 Was damage to windows or door screens avoided? 

y 

5. Was daraage to downspouts or dovk-nspout extensions avoided? \^,,^ 

Sidewalks and Driveways (Concrete) 

Ves No 

1. Was damage to driveway surfaces avoided? y 

2. Was daraage to walkway surfaces avoided? M 

1 
Owners comments: 

iDjpecticn nctes: 

QAA/1€ , yCyf Q0Ui^ ^ le^-pi^ 

Remc\-al and restcraticnsactix ates ccrr.rl jdir.g ".he 30-dEv ?od •>-».£rranrv': 

EPA Representative \J(T \ / J <, Date: 7/W^ 7