TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 2J243 Date: ,^//4(oe 

Address: 4^X5 0 /AT^SOA S^T^J ^ 

Remediation Contractor: _CoastaI Environmental Group Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Coniirmation data 

Photographs • 

As-built sketch 

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 County Assessor's Office 

D 

D 

D 

40317684 

Illiiiil 

Superfund 
r.*&-­

6 

4 

2 

^

Final Report Property Check List (Please place with each tiie) 

Hard Copy Information 

'roperty Check List 

Site Working Drawing Map 

^ EPA originals Map 

^<^Dougla s County Assessor's Map 

Property Contact Sheet 

Agreement 

jTA^ca s Agreement 

x^n^estoration Agreement 

Miscellaneous Documents 

,-^^inal Map from the Field 

K^^iange Orders 

ATHKV Data 

i,^i|py\ny ernails or PO correspondences 

Property Compietion 

1. Executive Summary 

2. AS BUILT 

.--^Property Completion Agreement 

YJpAny buyout info or reimbursement info 

^,-5T Check or money order copies 

Jr<^? A Property Close Out Form 

7. Attached Begin Video 

Electroni c Documentatio n 

Drawings 

1. EPA original 

2. 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 

Executive Summary 

Videos 

 Begin Video 

 My Movie 

I
-m • 

Property Access Ciieci<iist 

PropertylD: 2.124 5 

n WORK STARTED ON: 

n WORKCOMPELTED 

Property Addrcs.s: 422 ^ MaScir> ^"t" ON: -'-.-1 

/J-^ i ^ a.y f" a l-P 

Owner: ^^^ ^ / f^^^^ b^^^ V 1 Renter: 

Address: Phone: 

Fax: 

Ccll/Pajjcr: || 

Phone: 5feC|<» . j^^^ ^ 

Additional Information: 

Fax: 

Cell/Pajier: 

D Notitlcation Letter Sent: / / By: 

r x Access Agreement Signed: ^//^/0Z _ By: 

l2i Restoration Agreement Signed: _£,/i2/(y Z By: 

1 1 Topsoil Sam|)ling (if applicable) / / By: 

mi Disposal Sampling (If applicahle) / / By: 

1 1 Garden Sampling (if ap|)licable) / / By: 

^ [^ Utility Clearance 

Called: 5 laiO l 6 7 B..iL'!^f^^^T r^ 

5^ Video/Photos (Before) On: / / By: 

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

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

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

E] Property Completion Agreement Signed: / / By: 

n Final Report Is.sued: / / By: 

Air IVIonitoring (as applicable » 

• Community CH Crew On: / / 1 

Results: 1 

Q Community [ 3 Crew On: / / Bv: 

Results: j 

LJ Community CU Crew On: / / By: 1 

Results: 1 

Omaha Lead Site 
ladrant Square Footage to be Excavated = 791 

Property Classification: 800 W. Drip Zone Linear Footaqe to be Excavated = 56 

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

DZ, dnp zone (1-3 foot area of soil around the foundation of the house). 
1 Quadrant Square Footage to be Excavated = 791 

Property Classification: 800 ^^ ^ t al Drip Zone Linear Footaqe to be Excavated = 56 

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IVIaSuii outs e t 

Legend North Arrow Omaha Lead Site 

(Sv:^ Concrete N Omaha, Nebraska 

7 A Excavated Area A Property Number OLS-21243 

txisiing isirucTure Scale 

Property Address ra Permanent Landscaping 1 Inch = 20 feet or 1 grid = 5 x 5 f 

_ 4230 MASON ST 

Fence 

Quadran Post Excavation Concentrations (ppm) t Boundary ,\0 . w HGL Fl B2 Plav Area ouriL d i y 4 ^ hydro-l^: jLoyk. . Ifii. / = F2 DZ_ Ease ment o Tr ^ ­ e ;e/Sh rub Bl Gard e n _ 3ther 

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; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
21243 

Owner Name: STEVEN F BREAZEALE Omaha Lead Site Exterior Paint North Arrow 

Address: 4230 MASON ST Site Sketch •

•

 Good 

 Poot^-- A 

Phone: H: W: 

[g'l^Jot paint 

Sampl Lead Sample e Number LAB Concentration Collected Firm: 

RYASCPXA-21243 Fl ^^ 7 ppm D Date: 

RYBSCPXA-21243 F2 ppm 

& ^ ^fiiZ D Time: 

RYCSCPXA-21243 B1 ^7L ppm 

RYDSCPXA-21243 B2 ppm n 7/7 % ^ 

RDZSCPXA-21243 DZ /^/S ppm D XRF Unit 

RGZaCPXA-21240 ©Z- ppm -H D Date:

RPZSCPXA 21218 P ^ ppm -B- -• Time: 

Staff: Number of Samples =^. ^ O 

I 

h ^ 

^7 fc-l tjA.jjA:(>t: 

^(AJ! ? 

^ : ^ 

WA.11^ * / , -f. 

.117 

&^ 

•c 

.r7Z.'' / 

^ ^ ­

U.3 . T35i 

\J J K E: ^K\K 

^¥7 

^^7 •pi f 

Samples Collected 

Samples Analyzed 

Bock: (_ 

^ - ^ 

T^A^^ 

7::A,77^ 

liNTEREI 

AUG 3 1 2tt0jl 

'^KW . 

fASibX) s^ 

Omaha Lead Site 46130 

I 
ParcellD 1618460000 

Parcel City Omaha 

PareelZip 68105-0000 

Owner Name Breazeale Steven F Etal 

Owner Address 

Owner Address 2 4230 Mason St 

Owner City Omaha 

Owner State Ne 

Owner Zip 68105-0000 

Addition Leaven-worth Heights 

Acres Oil 
Douglas County Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d ­ R161846000 0 

Information is valid as of 2007-7-19 

Values not finalized until after Board of Equalization 

Print Report 

View on Map 

Owne r 

BREAZEALE STEVEN F 

ETAL 

4230 MASON ST 

OMAHA NE 68105-0000 

Propert y Informatio n 

Key Number: 1846 0000 16 

Account Type: < Residential 

Parcel Number: 1618460000 

Parcel Address: 4230 MASON ST 

OMAHA NE 68105-0000 

Legal Description: ' LEAVENWORTH HEIGHTS LOT 204 BLOCK 0 45 X 108 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$5,600.00 

$5,600.00 

$5,600,00 

$5,600.00 

$5,600.00 

$0.00 

Improvement 

$100,300.00 

$100,300.00 

$73,200.00 

$73,200.00 

$73,200.00 

$0.00 

Total 

$105,900.00 

$105,900.00 

$78,800.00 

$78,800.00 

$78,800.00 

$0.00 

Sales Informatio n 

Date Type Book Page Price 

Lan d Informatio n 

Acres

0.11 

 SF 

4860.0 

FF 

45.0 

Units 

1.0 

Depth 

108.0 

Width 

45.0 

Vacant 

No 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161... 8/3/2007 
Douglas County Page 2 of 2 

MO 

MO 

?iff 

" fia^'>r ' t '*'' 

. . 0 10* 

to or 

Click to Enlarge Image 

Click to Enlarge Image 

Square Footage: 1284.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Condo Square Footage: 0.0 

Built As: 1 1/2 Story Fin Rooms: 6.0 

HVAC: Central Air to Air Units: 1.0 

Exterior: Frame Siding Baths: 2.0 

Interior: Drywall Bedrooms: 3.0 

Roof Cover: Composition Shingle Stories: 1.5 

Roof Type: Gable Foundation: 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Yea Physical Age r Built Remodeled Remodeled Built 

1916 0 0% 1916 90 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 864.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Garage Detached 480.0 

Porch Slab Roof Ceil 192.0 

User Attic Full Finish 396.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 61... 8/3/2007 
Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

Z\2^ S 

+2^ 0 tAcKSOA 

Date: Time: Action: 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 
.ito sr.,, 

%• A^ 

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www. coastal hazm at. com 

COASTA L ENVIItONMENTAL 

G K 0 U P. IN C 

EXECUTIVE SUMMARY: 

21243^23 0 MASON ST 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

PO was issued a gift certificate from Indian Creek Nursery in the amount of $200.00 for flowers and 

top soil that were removed from the property during remediation activities. 
As-Built Drawing ^ 

COASTA L Omaha Lead Superfund Sire 

Total Quadrant Square Footage lo be Excavated - 791 

Property ClassiHcalion 800 Total Drip Zone Linear Footage to be Excavated = 56 

Dwqctlon C post vircavalian areas r 1 Iront yard latt.hand quadrant F2. rronl yard nght-riand quadrant Bl . Dadtyard laft.hand quadtant; B2 backyard nght-iiatxl quadrant. 

(3Z. < ^ zone (t .3 tool ai«a o( sea afoumJ the fDuftdation (tf ttw houaa) 

Legen d 

Area not Excavateid Dripzone Excavated Quadrcints Excavated 

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

EPA Property Close Out Form 

Property #: _ ^/^^ ? Property Address: J/'7'3^/^A^fJ ^ "T^ 

Date/Time: _ Owner's Name: /^O.Ap/^.A/f^ /^/-^^7^e^^ , 

Quads Excavated: ^ A 7 Contractor Croup Aou^^f^ 

Excavation Ceneral 

Yes No 

I. If necessary, were the correct quadrant(s) excavated and restored? 

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

Grading Sod and Vegetation 

Yes No 

I. Docs the grading around the perimeter ofthe house in excavated areas generally slope away L ^ 

from the house? 

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

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? y^ 

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

time period) 

6. Was the property graded such that water will not pool on the property? A 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) 1 / ' 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) y 

3. Was damage to gates or fences avoided? (Ifapplicable) 

ly^ 

4. Was damage to retaining walls avoided? (Ifapplicable) 

u-" 

Foundation, Siding and Gutters 

Yes .No 

1. Was damage lo the siding or trim avoided? \X^ 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? A 

4. Was damage to windows or door screens avoided? 

5. Was daraage to dowTispouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes, /No 

1. Was damage to driveway surfaces avoided? y / 

2. Was damage to walkway surfaces avoided? •v/1 
Owners comments: 

Inspection notes: 

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

EPA Representative 1^(7^/)^^/ ^ Date: f/^l/o'Y 
^ 

Property Completion Agreement 

This agreement documenls the completion of remedial activities performed on my property. My 

signalure will designate lhal 1 am satisfied wilh the restoradon of my properly, and lhal no ilcms are in 

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

PropertylD: 2/^y 3 

Property Address: ^^'J ^ TT^JTJS^ H 5 ^ 

^"- ^ /6/ht/^yhey7T^^^^T^A^A^ 

Phone: S-T9 ' 7^^A^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

agree restoration is completed, except as noted 

do not agree restoration is completed 

r ,f/;?g/^7 

Owner's Signature Contractor's Signature Date 
Omaha Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Steven Breazeale 

Property Address 4230 Mason St 

Property Identification Number 21243 

Material Removed Replacement Value 

Flower bed area and $200.00 top soil 

Trees 

Itemized 

shrubs/bushes • 

Total $200.00 

The acceptance of the replacement certificate and the signature below is fiill 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ 200.00 has been received by the owner in the form of a gift 

certificate, # 2560 , to be utilized at Indian Creek Nursery . 

'/A^ fy Property Owner's Signature Date Contractor's Signature Date 
INDIAN CREEK NURSERY 2560 

Omaha's Best Kept Gardening Secret 

303 North Saddle Creek Road 

Omaha, Nebraska 68131-2229 

(402) 558-5900 Gift Certificate 

DATE: ^^^^-O ^ 

IN THE AMOUNT OF ^^£c^rLjU^^-y~a^^< ^ /to o I %tljDO-*^^ 

ISSUED TO: D - Mi2Ji ^ a£e. COMPLIMENTS OF &ta/7kl Al/di 

q^:x^^a^ EXPIRATION DATE: 4 ^ Authorized Signature 

J 1^0 - ^^30 ^^-^^ ^ 
PROPERTY CLEARANCE WORKSHEET 

Date Property i p nQ777/07 

y?j<7?4i> 

Property Project Omaha Lead — Fixed Price Address y^TSQ /i77f£7r71 

Measurement XRF ID 

0107-51 Count/Time 

Field Sliots 

Shot # Reading Sample Area Shot # Reading Sample Area 

77/(7'' 

: ^ A'^-^' 

<sst >o;^^ ^ 

Sample Area 7^:^77^' 

I n Situ 

Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical 

Readinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 (Bag) Sieved) 7 

2 ^^<^ 

H\^o 

4 

3 

1 1 7 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 

U 

Sample Area tA^-y 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) 7 

2 ^ ^ 

3 •^c ^ 

4 

3 R 40) ^r XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 

Sample Area 

y/^^ Pass/Fai l ? i I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readinq 

Average (Dried & Spilt Sent (Bag) 

7 Number Results 1 

W­ (Bag) Sieved) 

7W­ ^ : 

65 liz: ^ 

(a5 

XRF Corrected Value —> 

(use calibration chart or add 

20% to value) 

ll 

Sample Area 

Pass/Fai l ? /-xz-^ - I n Situ 

Composite Composite Analytical Aliguot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 ^ • 

(Bag) Sieved) 7 

2 ^ A.>< 3 

4 Chi Tiy 50 ^ f ^ XRF Corrected Value —> 

5 3Z (use calibration chart or add 

20% to value) 

^ D 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical Reading 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Bag) Sieved) 7 

2 

3 

4 

XRF Corrected Value -> 

5 (use calibration chart or add 

20% to value) 

1 USE ADDIIIOHA I SHCIIS I F 

XRF Teclinician's Signiture 

HEEDED 
^ quj<.<d'S:=^ 

iJ^Bitits Square Footage to be Excavated =791 

Property Classification: 800 D^^on:on( e Linear Foolage to be Excavated = 56 

~ J ^ 

^A^yc r /p7) 

7oki}-^^90 

_L«-><ai cd.y-7'^­ s^y7 

^ 

|C^(NKX30-' 

-tf^^g::^ j«./«.Jl-v.rt 

Mason Street 

Legend North Arrow Omaha Lead Site I . - , I Concrete N Omaha. Nebraska 

Excavated Area Property Number 

n OLS-2124 3 Existing Structure Scale 

Permanent Landscaping Property Address 

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

4230 MASON ST * Fence 

Quadrant Boundary Post Excavation Concentrations (ppm) 

F 1 . B2 PlayArea - Street Boundary s -y^f ? V HCaL . F2 DZ Easement /"•- , Tree/Shrub Bl Garden Other 

Description of post excavation areas: F1, front yard left-hand quadrant; F2, front yard right-hand quadrant; B1, backyard left-hand quadrant; B2, backyard nght-harxj quadrant; 

DZ. drip zone (1-3 fool area of soil around the foundation of the house). 
n 

..y>^'^-'". v 

I.. 

^' fy()-\'-

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # / ^ ^ 

Property Address ^Z37 } ^A9'.'SO*1 S y 

Owne r Name n/?^/h7b M S^^/P'^tr7l7.y 

Date 

Comments 

FC^ U7// / j^t^C67 {/^ ^ cy}0CA7^yf 7=^^^ 

^^77/1 ^ /^; ^ ^e//ii7^//jeSrE^A^€^7 y^y'7AUyA3' 

Owne r Signature 

Contractor Signature 
m m m - ^ 

i m ii.T 4 m ^ ^ ^ ^ P COASTAL 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorizecd representatives, collectively 

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

following described premises: 

Owner's Name:pt^^^ / b(UrhiU(K^ Daytime Phone (i|oz) ^^<^^Wfc' 

fh^tiyiuiQ-^ • 

Address of Property 

covered by this 

Agreement ^VP r(^a.^r^ S-. : 

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 
o _ \ ~ 

__ __ COASTA L ^^A . -eC*'"*' " IHVmONMlNiTA L 

' •"BO^' - C » 0 U f . IN 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 (877) 234-6270. 

[EM 1 grant access to my properties

 CH I do not grant access to my properties 

signature ~ J 6«^e ' Signature

 Date 

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

Paqe2 of 2 
, 1 ^ 

COASTA L 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe 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: ^ t 7 (J ^ 

Property Address: Lj^Z^C^ fTl/JA^^/A S T 

Owner: ^f^ ^ T^A^t^J^. ^ AhA^k> BTHU^MA I E/^r^ZTTj- ^ 

Phone: ^S^ , J^i^T' 

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: 

7^^07 3 ~T^ y>/^^r^ -T^ 

Item: ^_^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L ENVINONnENTA L 

CROU P IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

3 /U 4^ / /^^^ ^T<> >4 ^ ^ g, o^t^^5 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
m^ 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

< 0 ^ 

Item: 

<D\,'L^ 

Item: 

Item: 

Item: 

Item: 

Iten: 

Itsm: 

'te'Ti: 

Iter 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
COASTA L 

C R O U f> . IN C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Conditlon/Type/Species 

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 lavout. 

Number of and size of 

each garden/ flower bed 

area. 

.Attach a sketch of relative 

sizes and locations. 

^47 

{-',4S"<fAAJ£<^A 

0 

^ 

0 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of. 
Item Quantity Unit Condition/Type/Species 

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 list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. Each 

Include a sketch of were 

each plant v^ill be placed 

bv the contractor. 

.Agreed upon area cf 

property to be replaced 

sNJth srass sod. 

Include a skeich ot" the %y SF 

area(s) to be replaced with 

arass sod. 

-TO ?t: 

Area ofCitv or CountN 

propert) to be landscaped ]>ejtsr\A7U^ 

per their requirements. SF 

Include a sketch of the 

area (s) 

^^TtSi^i^-^'-t^^^ 

Page 5 of 
COASTA L 

C K O U P IN C 

Additional Comments / Instructions: 

yW4^ ^^T ^ 

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. 

I agree L J I do not agree 

tuA. illi61 •S//7/0 y 

Owner's Signatur Date Contractor's Signature Date ' 

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