TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SA1D#: 

^ S t^^ Date; 

1 n 11

Address: foi'? WitMV t\i ^ 

Remediation Contractor: Coastal Environmenia) Group Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

7 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject properly 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs \ k ty"^hl(M ^c (^<^^ ^ )( ^ ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

:£/ Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

t/ Utility clearances 

Property information from Douglas County Assessor's Office 

Signature Date 

30218822 

PHil 

Superfund 
^v 

Property Access Checklist 

PropertylD: ^,^^Z > D WORK STARTED ON: / / 

Property Address: 2ZM ^ iQ f I ll^S 4/^' ^ n WORKCOMPELTED ON:__/__/_

Owner; ^Q^rrsp ^ W>i\c}t^SU^ Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

SvjVccess Agreement 

Signed: ^/^^//L O ^y- u>o\c 

I " Restoration Agreement Signed:/(9l 3^1 J ^ ^y-

 vj^ov^ 

E Topsoil Sampling (if applicable) I I By: 

Q Disposal Sampling (if applicable) I I By: 

G Garden Sampling (if applicable) I I By: 

H UtiUty Clearance Called: vi /<?, / Vo y ' U /v,3 1^1-, VAJL^IML . 

QL Video/Photos (Before) On: Xo I "hO 1 . \j By: V»>a- ^ 

D Video/Photos (During) On: / / By: 

n Video/Photos (After) On: / / By: 

n Video/Photos (30-Day) On: / / By: 

Q Property Completion Agreement Siened: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

• Community • Crew On: / / By: 1 

Results: 

Q Community D Crew On: / / By: 

Results: 

• Community • Crew On: / / By: _ 

Results: 

Omaha Lead Site 
Douglas County Account In: ^Mio n Page 1 of2 

Douglas County, Nebraska Property Record

Information is valid as of 2010-8-30 

­ R1408910000 

New Feature •^ ^ ^

Print Report 

View Interactive GIS Mao 

Treasurer's Tax Reoort 

 Subdivision Sales Search 

Owne r 

WITCHER JAMES M 

0/0 CYNTHIA WITCHER 

3315 N 37 ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0891 OOOO 14 

Account Type: Residential 

Parcel Number: 1408910000 

Parcel Address: 

Legal Description: 

2219 WILLIS AV 

OMAHA NE 68110-0000 

IDLEWILD ADD LOT 12 BLOCK 2 50 X 127 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6350.0 0.0 127.0 50.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R140... 9/3/2010 
"> 

Page 1 of 1 

Create Another Ticket Back to Irth Intemet Send Email ] 

• YOUR TICKET NUMBER IS 2637696. 

Original Call Date: 11/08/10 Time: 5:46 pm Op: ELIZABETH18790 


Work to Begin Date: 11/10/10 Time: 6:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2219 Street: WILLIS AVE 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/8/2010 
< ^ 

COAST A L 

As-Built Drawing 

Omaha Lead Superfund Site 

OLS#:28242 

Date Excavated: 11/11/2010 

Date USEPA Signed Off: 12/14/2010 

Area Sodden: 2300^sq ft 28242 

Exierior Paint IvlorUi Arrow Owne Omaha Lead Site r Name: -iMAE&M wrrCHER • Good Site Sketch Address: 2219 WIU-IS AV • Poor Phone: « 402.453-1508 w Q Not paint y

Sampl Lead Sample Samples Collecled e Number LAB Concentration Collected Firm: 

RYASCPXA-28242 Fl /WiQ ppm D Dale. M-H - ^ 

RYBSCPXA-28242 F2 ^^ 1 ppm Time; '^.QQ 

RYCSCPXA-28242 Bl n ^g ? ppm Samples Analyzed RYDSCPXA-28242 B2 Wtf7 ppm I D

ROgOCrXA-20242 B2- POT D XRF Unit: l03 1 Book: /a 9 

RG25CPXA-2e24a -e2 - ppm n D Oate 9-3-0 ^ 

RPZOCPXA'20241! ppm n D Time: _Sm- Staff Number of Samples A ^ -T D D 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Rigfit DZ = Drip Zone, GZ = Garden, PZ = Play Ail quadrants are as viewed from the street, facing property 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
28242 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: JAMES M WITCHER Q Good Site Sketch Address: 2219 WILLIS AV • Poor 

Phone: H: 402-453-1508 W: ; Q Not paint 

Sampl Lead Sample 

Samples CollecJed e Number 

i

i 

LAB Concentration Collected Firm: F M NT / /glJ 

RYASCPXA-28242 Fl l^i/L ppm D Date: ^-j^ - S 

RYBSCPXA-28242 F2 AM. ppm D Time ^-O O 

RYCSCPXA-28242 Bl 2.S^ ppm 

D Samples Analyzed RYDSCPXA-28242 B2 

ML 

ppm D •RDZOCPXA-202-12

 B2- ppm D XRF Unit: lO^ l Book: IZ-' J 

RGZ5CPXA-2e2'<2 62 - ppm D D Date; 9'(i-0^ 

RPZOGrXA-20242 P^ . ppm D D Time: AjTI 

T Staff: LJ ^ 

Number of Samples 

Legend: Fl = Fron Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

y 

y/A//^/^^^/A/// V y 

V^iixis feJ Rev Ji 

G46I41.0I2.1 

/ < m (/t \ 
28242 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: JAMESM yviTCHER 

Sit • Good e Sketch Address: 2219 WILLIS AV • Poor 

Phone : H: 402-453-1508 W: ^ 

\~\ Not paint 

Sample lecie 

Concentration Collected Sample Number Lead LAB Samples Collected 

Firm F M MT//gu^ I 

'-1 RYASCPXA-28242 Fl HO ppm D Date 

RYBSCPXA-28242 F2 ^kkL. ppm n Time 

RYCSCPXA-28242 Bl 2^1 ppm n 

Samples Analyzed RYDSCPXA-28242 B2 ^01 ppm n 

RDZ0CPXA-2Q242 9i - ppm n 

n XRF Unit: J03 l Book: /2.9 

RGZSCPXA-2a242 62 - ppm n D Date: _ 9'a-osr 

RrZClCnOV20242 P2­

? 

ppm D D Time: /}/71 

Staff: Number of Samples = AA. 

Legend: F1 = Front Left, F2 Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie street, facing property 

CiZAA) 
28242 

Omah Exterior Paint NorthArrow Owne a Lead Site r Name: JAMES M WITCHER • Good Site Sketch Address: 2219 WILLIS AV • Poor 

Phone: H: 402-453-1508 W: • Not paint y

Sample Number Lead Sample Samples Coilec^ LAB Concentratian Collected Firm: F M MT/ig> J 

RYASCPXA-28242 F1 UilL ppm n Date: ^-K ~ S 

RYBSCPXA-28242 F2 

ppm n Time: '^IQ O 44i_ RYCSCPXA-28242 81 ppm n 

Samples Analyzed 

RYDSCPXA-28242 82 ppm I n

RD200PXA"£Og42 BS» ppm a XRF Unit f03 l Bool<: /2.9 

RGZSCPXA-2fl24Z 82-' ppm D D Date: ^'3-0 ^ RPZ0GPXA"2024a PZ- ppm D D Time: AutL D Staff: Numt>er of Samples = I _4A. 

Legend: F1 = Front Left F2 = Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

All quadrants are as wefwed from the street, facing property 

AiXev^ 

HOI 2 / 

W­

(a 

+ 

2iJ ^ WiU-iS .As/ 

.P. 

I'iO 

Q 

IMS Rev 4' Wijfis /?v 046UI.012.1 
.•^^'O *'"'» , 

C0AS 1 A l EHVItONHf KTAI 

C I 0 U r Ih c 

Conseii l for Access- \ o PropfeKy 

RIGHT OF ENTRY TO PREMISES 

Gfantor (the property owner) consents to and aulhorizes the United Slates 

Environmental Protection Agency (EPA) oi its aulhorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: ^ ^ y ( j 

Owner''ss Nam Namee : / / Daytime Phoney

r^Y^ 

Address of Property 

covered by this zz^y uJiHu Zy. 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 wili be restored to Ks 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 perfonned, 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 confinn 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 
..*^*""v.. 

v: C0AS 1 A l 

[NrikONhfKTi l * i pno^v*- C R 0 U r ) h C 

t Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

I Water and maintain replacement vegetation, including fertilizer application, as 

necessary' subsequent to an initial watering period by EPA; 

« Abide by heallh and safety guidance provided by EPA; 

« If the property is rented, assist EPA in obtaining tenant approval foi access to 

the property to perform the work. 

t 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 (402) 991-1199 

D I grant access to my properties D I do not grant access to my properties 

z^^y^-JlF 

Date Signature Date 

G i would like to be present during any sampling that is required. 

Page 2 of 2 
C OA S T A L 

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). 

PropertylD: ^-/^^ C 

Property Address; y? Z I ^ \A J U J f ^ -AxfZZ 

Owner; J c^ , ^ .^3 ^ ? j-t k-^A^ 

Phone: yUo f h^j^-jy^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Stert of Remediation: 

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

Kem: 

yZouQ— 

Kem: 

Kem: 

Kem: 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Kem: 

I V £> AJl ^ 

Kem: 

Kem: 

Kem: 

Page IM - 3 
 1 

^^^' COASTA L • MVmONMINTA L OROUP . INC . 

items to Be Removed By Contractor During Remediation and Replaced 

1 Kem: 

5 z)'i 1 

Kem: 5^i 

Kem:

Kem: 

Landscape Inventory 

Item Quantity Unit Condltlon/Type/Specles 

Pre-existing property area, f7Z fZ. Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each ^ 

trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Attach a sketch of relative 

sizes and locations. 

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. 

Easement Area, to be 

excavated ( ^^ n 

Each if en ^''' 3 4^^'"^'^^ 

^ 

Page 2 of. 3
COASTA L eMVmOMHeMTAL o n o u p . INC . 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibK you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removai orreplacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the cKy of Omaha's Planning Department at (402) 444-5150. 

Q Please check this box if you underetand the information outlined above. 

ylu. / 

G 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. 

IZflaI agre s e G I do not agree 

zzy^zA^^z^ PCmMzr- fO\^&lii) 

"^Owner's Signature ' Dite Contractor's Signature Date 

Page 3 of -Z 
BVID# ZQZ4Z 

XRF PROPERTY SAMPLE SHEET 

Date ( - I B - 2X?(0 Address ZZ^ n UAu.is A u 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# ^°I0LZ, sample length 30 sec 

Shot # 1 Reading Sampie area Shot # Reading Samplearea 

/ zm i Z5- 6^ 

L ZSlt L3 Depth Depth 

3 Z^Q> t 2 3 4. 

Average Z(.S i Z4 / Average 

Shot# Reading Sample area Shot# Reading Samplearea 

304 ^ Z6 FL 

Z°(L i Z6 Depth Depth 

z e e i 25" 

Average zm

f Average t ^5 

Shot# Reading Sample area Shot# Reading Samplearea 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth //^ 7 

Average Average 

Signature 

Print 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 4 

Mode SOIL 

Time 2011-01-18 16:06 

Duration 90.67 

Sequence Final 

Flags 

AVERAGE Avg of 1-3 

ADDRESS 2219 WILLIS AV 

QUADRANT B2 

DEPHT 4" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm 

Pb 265.035 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 287.389 

Supervised By: 

Certificate of Verification 

1 

SOIL 

2011-01-18 16:04 

30.18 

Final 

28242 

2219 WILLIS AV 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 25.105 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Tumpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 251.488 

Supervised By: 

Certificate of Verification 

2 

SOIL 

2011-01-18 16:05 

30.22 

Final 

28242 

2219 WILLIS AV 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 23.667 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 3 

Mode SOIL 

Time 2011-01-18 16:06 

Duration 30.27 

Sequence Final 

Flags 

BVID 28242 

ADDRESS 2219 WILLIS AV 

QUADRANT B2 

DEPHT 4" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 256.228 23.950 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

8 

SOIL 

2011-01- 18 16:09 

90.78 

Final 

Avg of 5-7 

2219 WILLIS AV 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 304.856 

Supervised By: 

Certificate of Verification 

5 

SOIL 

2011-01-18 16:07 

30.24 

Final 

28242 

2219 WILUS AV 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.100 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 292.107 

Supervised By; 

Certificate of Verification 

6 

SOIL 

2011-01- 18 16:08 

30.28 

Final 

28242 

2219 WILLIS AV 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 25.595 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 268.081 

Supervised By: 

Certificate of Verification 

7 

SOIL 

2011-01-18 16:09 

30.26 

Final 

28242 

2219 WILLIS AV 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 25.044 
.*'^* % 

i jOk^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I Coastal Environmental Group Inc. v\ 

^ www.coastalhazmat.com 

'"tPHOi** COASTA L • NVIIONHINTA l 

e no u r, INC 

EXECUTIVE SUMMARY: 

BVID # 28242 - (2219 WILLIS AVE) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: __ ^ 
% 

EPA Property Close Out Form 

g^ ^ Wjitii.^ Property #; 

2#Af/^- Property Addrcss:v 

Date/Tine; 

OwDcr'a Nane:. / ^ uuj v I line:

 /• Contractor Group (^> Quads Excavated; 1^1 \r Y ^ 

ExcavatioD Yes No Genenl 

1. ir necessuy, were the correct quadi3nt(s) excavated and reslored? J 

2. If necessary, were the correci areas of drip zone excavated aod restored? / 

Grading Sod and VcKctotkiB Yes No 

I. Does the grading around the perimeter ofttie house in excavated areas generally slope away zy fix>ni the house? 

/ 2.

 Has sod been laid in all areas that were excavated? 

3. Docs the sod i^ipcar to be generally healthy and growing? (Only evaluate if inspected ai a 30 ~7 

day time period) 

4. Are sodded areas generally flmt and evenly graded? ~7 

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

tinie period) 

-y 6.

 Was the propeity graded such that water will not pool on the propern*? 

7. Was damage lo landscaping or plant materials avoided? y 

Gates, Fences and Rctainlos Walb Ves No 

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

2. Were all gates or fences taken down during restoration activities reinsulied? (If applicabk) y 

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

^. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, SidioK and Gntlers 

I. Was damage lo the siding or trim avoided? 

Yes 

/ 

.No 

2. Was damage to the foundation avoided? 

?. Was damage to windows avoided? 

y 

y 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoui extensions avoided? 

y 

y 1 

Sidewalks and Driveways (Coacretc) Yes No 

I. Was damage to driveway surfaces avoided? yy 

- ^ 2. Was damage to walkway surfaces avoided? 
% Ort'ners comments: 

[inspection notes: 

Removal and resloration activates complete including the 30-day sod warranry: 

EPA Represenlaiive ^ ^ )S<^ Date: iliHl!o_ 
t 

Property Completion Agreen^ient 

Ihis agreement documenls the tomplchon ol remedial aclivmes perloimed on my properly My signature 

will designate that i am satisfied with the restoration of my properly, and thai no items are in questions, 

now, or al any lime in the fulure, excepl ihose items listed below, if any 

Property FD: jg^ ^ ^ 

Property Address: 2^Z \ (JJf(ll'^'5> /h ^ 

Owne r '"

• ^^^-m ^ Ufi-hcJAM^ 

Phone: ^ko. tJury-JL^ 

Restoration Items in Question: 

Item: 

ttem: 

Item: 

Item: 

Item: 

=,= Item: 

l|ri I Agree restoralion is completed, except as noted 

[_J I rto nol aifrec restoration is completed 

iwner' s Signature Date Cunti arlor's Signature Dale