### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 

# 2J24 3 Date : 

# ,^//4(o e Address : 4^X5 0 /AT^SO A S^T^J ^ 

### Remediatio nContractor : _Coasta I Environmenta l Grou p Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property D 

### Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio nAgreemen t D 

### Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Coniirmatio ndat a Photograph s • As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r / 

### Property close-ou t chec k lis t signe db y EP A D 

### Descriptio nofarea s not meetin g RO D cleanu p criteri a D 

### Utility clearance s D 

### Property informatio nfromDougla s County Assessor' s Offic e D D D

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## Fina l Repor t Propert y Chec k Lis t (Pleas e plac e wit heac htiie) Har dCop y Informatio n 'ropert y Chec k Lis t Sit e Workin g Drawin g Ma p ^ EP Aoriginal s Ma p ^<^Dougla s Count y Assessor' s Map Propert y Contac t Shee t Agreemen t jTA^ca s Agreemen t x^n^estoratio nAgreemen t Miscellaneou s Document s ,-^^ina l Ma p fromth e Fiel d K^^iang e Order s ATHKV Dat a i,^i|py\n y ernail s o r P O correspondence s Propert y Compietio n 1 . Executiv e Summar y 2 . A S BUIL T .--^Propert y Completio nAgreemen t YJpAn y buyou t inf o o r reimbursemen t inf o ^,-5 T Chec k o r mone y orde r copie s Jr<^?APropert y Clos e Ou t Form 7 . Attache dBegi nVide o Electroni c Documentatio n Drawing s 1 . EP Aorigina l 2 . Workin g Drawin g .3 . A S Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s During/Excavatio nPhoto s So dPhoto s 30-Da y So dPhoto s Scanne dDocument s Fina l Document s Executiv e Summar y Video s Begi nVide o M y Movi e I

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# 1 Renter : Address : Phone : Fax : Ccll/Pajjcr :| | Phone : 5feC|<» . j^^^^ Additiona l Information : Fax : Cell/Pajier : D Notitlcatio nLette r Sent : / / By : r x Acces s Agreemen t Signed : ^//^/0Z_ By : l2 i Restoratio nAgreemen t Signed : _£,/i2/(yZ By : 1 1 Topsoi l Sam|)lin g (i f applicable ) / / By : mi Disposal Samplin g (I f applicahle ) / / By : 1 1 Garde nSamplin g (i f ap|)licable ) / / By : ^ [ ^ Utility Clearanc e Called : 5 lai O l 6 7 

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# r ^ 5 ^ Video/Photo s (Before ) On : / / By : nVideo/Photo s (Dunng ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (3()-Day ) On : / / By : E ] Propert y Completio nAgreemen t Signed : / / By : nFina l Repor t Is.sued : / / By : Ai r IVIonitorin g (a s applicabl e » • Communit y C H Cre w On : / / 

# 1 Results : 1 Q Communit y [ 3 Cre w On : / / Bv : Results :j L J Communit y C U Cre w On : / / 

## By : 1 Results : 1 Omah a Lea d Sit eladran t Squar e Footag e t o b e Excavate d = 79 1 Propert yClassification : 80 0 W. Dri p Zon e Linea rFootaq e t o b e Excavate d = 5 6

Descriptio n o fpos t excavatio n areas ; Fl , fron t yar d left-fian d quadrant ; F2 , fron t yar d right-hand quadrant : Bl , backyar d left-han d quadrant ; B2 , backyart i right-hand quadrant : DZ , dn p zon e (1- 3 foot are a o f soi l aroun d th e foundatio n o fth e house) .

## 1 Quadran t Squar e Footag e t o b e Excavate d = 79 1 PropertyClassification : 80 0 ^^ ^ a l Dri p Zon e Linea rFootaq e t o b e Excavate d = 5 6 

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# A OLS-2124 3 txisiin g isirucTur e Scal e Propert yAddres s ra Permanen t Landscapin g 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f

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## 2124 3 Owne rName : STEVE N F BREAZEAL E 

### Omah a Lea d Sit e Exterio rPain t North Arro w Address : 423 0 MASO N ST 

### Sit e Sketc h • • Goo d Poot^- - 

# A Phone : H : W : [g'l^Jo t pain t Lea d Sampl e Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-2124 3 F l 

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### fASibX ) s^ OmahaLeadSite 4613 0 

## IParcell D 161846000 0 Parce l Cit yOmah a PareelZi p 68105-000 0 Owne r Nam e Breazeal e Steve nFEta l Owne r Addres s Owne r Addres s 2 423 0 Maso nS t Owne r Cit y Omah a Owne r Stat e N e Owne r Zi p 68105-000 0 Additio nLeaven-wort hHeight s Acre s Oi l

### Dougla s County Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d ­ R161846000 0 Informatio n i s vali d a s o f2007-7-1 9 Value s no t finalize d unti l afte rBoar d o fEqualizatio n Prin t Repor t Vie wo n Ma p Owne r BREAZEAL E STEVE N F ETA L 423 0 MASO N S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 184 6 000 0 1 6 Accoun t Type : < Residentia l Parce l Number : 161846000 0 Parce l Address : 423 0 MASO N S T OMAH AN E 68105-000 0 Lega l Description : ' LEAVENWORT H HEIGHT S LO T20 4 BLOC K0 4 5 X 10 8 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $5,600.0 0 $5,600.0 0 $5,600,0 0 $5,600.0 0 $5,600.0 0

$0.0 0 Improvemen t $100,300.0 0 $100,300.0 0 $73,200.0 0 $73,200.0 0 $73,200.0 0 $0.0 0 Tota l $105,900.0 0 $105,900.0 0 $78,800.0 0 $78,800.0 0 $78,800.0 0 $0.0 0 Sale s Informatio n Dat e Typ e Boo k Pag e Pric e Lan d Informatio n Acre s 0.1 1

S F 4860. 0 F F 45. 0 Unit s 1. 0 Dept h 108. 0 Widt h 45. 0 Vacan t N o Lan d Attribute s Attribut e Attribut e Descriptio n Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161. . . 8/3/200 7

### Dougla s County Pag e 2 o f 2

M O M O ?if f

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

. . 0 10 * t o o r Clic k t o Enlarg e Imag e Clic k t o Enlarg e Imag e Squar e Footage : 1284. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e Cond o Squar e Footage : 0. 0 Buil t As : 1 1/ 2 Stor yFi n Rooms : 6. 0 HVAC : Centra l Ai rt o Ai r Units : 1. 0 Exterior : Fram e Sidin g Baths : 2. 0 Interior : Drywal l Bedrooms : 3. 0 Roo fCover : Compositio n Shingl e Stories : 1. 5

Roo fType : Gabl e Foundation : Floorcover : Allowanc e Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Physica l Ag e 

### Yea r Built Remodele d Remodele d Buil t 191 6 0 0 % 191 6 9 0 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 864. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 480. 0 Porc h Sla b Roo fCei l 192. 0 Use r Atti cFul l Finis h 396. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 61.. . 8/3/200 7

## Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Final Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : CONTAC T FOR M 

# Z\2^ S +2^ 0 tAcKSO A Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t to EP AD Othe r Action : D.it o sr., , % • A ^ 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www . coasta l haz m at . co m COASTA L ENVIItONMENTA L G K0 U P . IN C 

# EXECUTIV ESUMMARY : 21243^23 0 MASO NS T I I N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation: P O was issue dagif t certificat e fromIndianCreek Nursery inth e amoun t o f $200.0 0 fo r flowers an d to p soi l that wer e remove dfromth e property durin g remediatio nactivities .

# As-Buil t Drawin g ^ COASTA L 

# Omah aLea dSuperfun dSire

Tota l Quadran t Squar e Footag e l o b e Excavate d - 79 1 Propert yClassiHcalio n 80 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 5 6

Dwqctlo n C pos t vircavalia n area s r1 Iron t yar d latt.han d quadran t F2 . rron l yar d nght-rian d quadran t Bl . Dadtyar d laft.han d quadtant ; B 2 backyar d nght-iiatx l quadrant . (3Z . < ^ zon e ( t . 3 tool ai« a o ( se a afoum J th e fDuftdatio n (tftt whouaa ) 

### Legen d Are ano t Excavatei d Dripzon e Excavate d Quadrcint s Excavate d 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

### SIK . 

# EP A EP APropert y Clos e Ou t For m Propert y # : _ 

# ^/^^ ? Propert y Address : J/'7'3^/^A^fJ ^ "T ^ Date/Time : _ Owner' s Name : /^O.Ap/^.A/f ^ /^/-^^7^e^^ , Quad s Excavated : 

# ^ A 7 Contracto r Crou p Aou^^f ^ Excavatio nCenera l Ye s No I .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio n Ye s No I .Doc s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y 

### L ^ fromth e house ? 2 .Ha s so dbeenlai dinal l area s that were excavated ? 

# y 3 .Doe s th e sodappea r t o b e generall y healthy andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s generall y fir mandevenl y graded ? 

# y ^ 5 .Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 6 .Wa s th e property grade dsuc htha t water will not poo l o nth e property ? 

# A 7 .Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s openandclos e freely? (Ifapplicable ) 

### 1 / ' 2 .Wer e all gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# ly ^ 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# u-" Foundation , Sidin g an dGutter s Ye s .N o 1 .Wa s damag e l o th e sidin g o r tri mavoided ? 

# \X ^ 2 .Wa s damag e to th e foundatio navoided ? Wa s damag e to window s avoided ? 

# A 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 5 .Wa s daraag e t o dowTispout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Yes , /N o 1 .Wa s damag e t o drivewa y surface s avoided ? 

# y / 2 .Wa s damag e t o walkway surface s avoided ? 

# • v/ 1

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentativ e 1^(7^/)^^/ ^ Date : f/^l/o' Y^ 

## Propert yCompletio n Agreemen t Thi s agreemen t documenl s th e completiono f

remedia l activitie s performe do n m y property . M y signalur e wil l designat e lha l 1 a msatisfiedwil hth e restoradono f

m y properly , an dlha l no ilcms ar e i n quesUons . now , o r

a

t an y tim e i nth e future , except thos e items listedbelow , i f

any . PropertylD : 2/^y 3 Propert y Address : ^^'J ^ TT^JTJS^ H 

### 5 ^ 

## ^"- ^ /6/ht/^yhey7T^^^^T^A^A ^ Phone : 

## S-T9 ' 7^^A ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

agre e restoratio ni s completed , excep t a s note d d o no t agre e restoratio ni s complete d 

## r,f/;?g/^ 7 Owner' s Signatur e Contractor' s Signatur e Dat e

## Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r Steve nBreazeal e Propert y Addres s 423 0 Maso nS t 

### Propert y Identificatio nNumbe r 2124 3 Materia l Remove d Replacemen t Valu e Flowe r be dare aan d $200.0 0 to p soi l

Tree s Itemize d shrubs/bushe s • 

### Tota l $200.0 0 Th e acceptanc e o f th e replacemen t certificate andth e signatur e belo w i s fiill acknowledgemen t b y th e property owne r that thi s i s afai r an dreasonabl e compensatio n fo

r plan t material s remove ddurin g remediatio nactivities , bu t not plante do r installe db y th e governmen t o r it' s contractors . Th e tota l amoun t o f $ 200.0 0 ha s bee nreceive db y th e owne r inth e for mo f agif t certificate , #256 0 , to b e utilize da t IndianCree k Nursery . 

# '/A ^ f y Property Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

### INDIA NCREE K NURSER Y 

# 256 0 Omaha' s Bes t Kep t Gardenin g Secre t 30 3 Nort hSaddl e Cree k Roa d Omaha , Nebrask a68131-222 9 (402 ) 558-590 0 

# Gif t

Certificate DATE : ^^^^-O ^ I NTH EAMOUN T O F 

# ^^£c^rLjU^^-y~a^^< ^ /to o I%tljDO-*^ ^ ISSUE D TO : 

### D - Mi2Ji ^ 

# a£e . COMPLIMENT S O F 

# &ta/7kl Al/d i q^:x^^a ^ EXPIRATIO NDATE : 

# 4 ^ Authorize dSignatur e 

# J 1^0 - 

# ^^3 0 ^^-^ ^ ^PROPERTYCLEARANC E WORKSHEE T

Dat e Propert yi p 

# nQ777/0 7 y?j<7?4i > Propert y Projec t Omah a Lea d — Fixe d Pric e Addres s 

## y^TS Q /i77f£7r7 1 Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d Sliot s Sho t # Readin g Sampl e Are a Sho t # Readin g Sampl e Are a 

# 77/(7' ' : ^ 

## A'^-^ ' <sst 

## >o;^^ ^ Sampl e Are a 

# 7^:^77^ ' I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 ^^< ^ 

## H

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o 4 3 1 

# 1 7 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# U Sampl e Are a 

## tA^- y Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 ^ ^ 3 •^c ^ 

# 40 ) 4 

### 3 R 

# ^ r XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) Sampl e Are a Pass/Fai l ? 

# y/^^ i I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) 7 Numbe r Result s 1 (Bag ) Sieved ) 

# W­ 7W­ ^ : 

# 6 5 liz : ^

(a 5 XR F Correcte d Valu e —> (us e calibratio n char t o rad d 20 % t o value ) 

# l l Sampl e Are a Pass/Fai l ? 

## /-xz-^ - I n Sit u Composit e Composit e Analytica l Aliguo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 ^ • (Bag ) Sieved ) 7 2 ^ A.> < 3 4 

## Ch i Ti y 

# 5 0 ^ f ^ XR F Correcte d Valu e —> 5 

## 3Z (us e calibratio n char t o rad d 20 % t o value ) 

# ^ D Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 3 4 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# 1

US E ADDIIIOHA I SHCII S I F XR F Teclinician' s Signitur e HEEDE D

### ^ quj<.<d'S:= ^ i t Squar e Footag e t o b e Excavate d =79 1 iJ^Bit s Propert yClassification : 80 0 D^^on ( :on e Linea rFoolag e t o b e Excavate d = 5 6 

# ~ J ^

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### Maso n Stree t Legen d Nort h Arro w Omah a Lea d Sit e I . - , I Concret e N Omaha . Nebrask a Excavate d Are a Propert yNumbe r OLS-2124 3 

# n Existin g Structur e Scal e Permanen t Landscapin g Propert yAddres s 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft 423 0 MASO N S T * Fenc e Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) F 1 . B 2 PlayAre a

- Stree t Boundar y 

### s -y^ f ? V HCaL . D Z Easemen t F 2 /"•- , Tree/Shru b B l Garde n Othe r Descriptio n o f pos t excavatio n areas : F1 , fron t yar d left-han d quadrant ; F2 , fron t yar d right-han d quadrant ; B1 , backyar d left-han d quadrant ; B2 , backyar d nght-harx j quadrant ; DZ . dri p zon e (1- 3 foo l are a o f soi l aroun d th e foundatio n o f th e house) .

# n

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- 

# RESTORATIO NCHANG EORDE R OMAH ALEA D Propert y I D # / ^ ^ 

# Propert y Addres s ^Z37 } ^A9'.'SO* 1 

# Sy Owne r Nam e n/?^/h7bM S^^/P'^tr7l7. y Dat e Comment s FC ^ U7// / j^t^C6 7 {/ ^ ^ cy}0CA7^y f 7=^^ ^ ^^77/ 1 ^ /^; ^ ^e//ii7^//jeSrE^A^€^ 7 y^y'7AUyA3 '

Owne r Signatur e Contracto r Signatur e

# mmm- ^
i m ii. T4 m ^ ^ ^ ^ P COASTA L 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorizecd representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : Owner' s Name:pt^^^ / b(UrhiU(K ^ Daytim e Phon e 

# (i|oz ) ^^<^^Wfc ' fh^tiyiuiQ- ^ • Addres s o fPropert y covere d b ythi s 

# ^V P r(^a.^r ^ S- . Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard . Th e area(s ) wil l b e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition . Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s 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 Atha t th e propert yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work . Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :

Pag e 1 o f2o _ \ ~

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

' •"BO^' - C » 0 U f. IN 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 necessarysubsequen 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 fth e propert yi s rented , assis t EP Ai n obtainin g tenan t 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 fth 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 fth e wor k done , o rwit h th e equipment use d o n his property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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 (877 ) 234-6270 .

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1 gran t acces s t o m ypropertie sC H I d o no t gran t acces s t o m ypropertie s

signatur e ~ J 6«^ 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 .

Paqe 2 o f2

# , 1 ^ COASTA L 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s to condition s ofth e property 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 that restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Property ID : ^ t 7 (J ^ 

### Propert y Address : Lj^Z^C ^ fTl/JA^^/ AS T Owner : ^f^ ^ T^A^t^J^. ^ AhA^k > BTHU^MA I

### E/^r^ZTTj- ^ Phone : ^S^ , J^i^T ' O nth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f excavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to be usedb y contractor , an dthe directio no f North . Indicate distances , depths , material types , etc . Indicate digita l photo s b

y referencin g the photo-lo g number wit ha narro w indicatin g directio no f view . 

## Item s To B e Remove d ByOwne rBefor e Start O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility . Item :



# 7^^07 3 ~T ^ y>/^^r ^ -T ^ Item : ^_ ^ Item : Item : Item : Item : Item : Item : Pag e 1 of .COASTA L ENVINONnENTA L CROU P IN C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s 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 :

Pag e 2 of .

# m ^ Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

### < 0 ^ Item : <D\,'L^ Item : Item : Item : Item : Iten : Itsm : 'te'Ti : Ite r Item : Item : Item : Item : Item :

Pag e 3 o fCOASTA L C R O U f > . IN C 

### Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

## Ite m Quantit y Uni t Conditlon/Type/Specie s

Pre-existin g property area , that wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trun k diamete r

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r lavout . Numbe r o f an dsiz e o f eac hgarden/ flower be d area . .Attac hasketc ho f relativ e size s an dlocations . 

# ^4 7

{-',4S"<fAAJ£<^ A 

# 0

^ 

# 0 Squar e feet

Each

Each

Eac h

Each Squar e Feet

Pag e 4 of .

### Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plan t material s tha t wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Eac h Includ e asketc ho f wer e eac hplan t v^ill b e place d b v th e contractor . .Agree dupo n are ac f propert y t o b e replace d sNJt hsras s sod . Includ e askeic hot" th e 

# % y S F area(s ) t o b e replace dwit h aras s sod . 

## -T O ?t : Are aofCit v o r Count N propert ) t o b e landscape d 

### ]>ejtsr\A7U ^ pe r thei r requirements . S F Includ e asketc ho f th e are a(s )



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

Pag e 5 o fCOASTA L C KO U P IN C Additiona l Comment s / Instructions : 

### yW4 ^ ^^T ^

Chec k th e boxi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . B ycheckin g thi s boxCE 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 cracks o rfissures .

I agre e LJ I d o no t agre e 

# tuA . illi6 1 •S//7/ 0 y Owner' s Signatu r Dat e Contractor' s Signatur e Date ' 

### Pag e 6 of .