# TRANSMITTALo f

OMAH ALEA D SITE SOILREMEDIATIO NFILEFOLDER SAlD#:JtO_tl_

_. . Date : _Jltii[l ; Address : %<^ \^\^ ^ ^ T Remediatio nContractor : Coasta l Environmenta l Group

_Year : 2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y EPA-provide dpropert y sketc h' ^ Signe dAcces s Agreemen t for subjec t propert y ; Signe dAcces s Agreement(s ) for adjacc'n t propert y 

# y Restoratio nAgreemen t ' '' • J^r " Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) -C

- Confinnatio ndat a 0 Photograph s \\ t Cy?(^t ^ rv ^ ^ Cy=-<^tAV H V^> ^ X ; f a ^ U As-buil t sketc h B Satisfactor y restoratio nsigne db y Propert y Owne r ' ' : u Propert y close-ou t chec k lis t signe db y EP A -B ^ Descriptio no f area s no t meetin g RO D cleanu p criteri a 0 Utilit y clearance s u Propert y iafomiatioi/fron i Dougla s Count y Assessor' s Offic e



# - 2 f < /, Dat e 3021872 9 Superfun d

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# Propert yAcces s Checklis t

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. 

### D D WORK STARTE D WORK COMPELTED .ON : ON : / // /
Owner : jS/lQV^y ^ WrAoe S Address :

Phone : Ho3L-y>\-cr>g>9 ^ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

nNotificatio nLette r V f Acces s Agreemen t 1 1 Restoratio nAgreemen t Q Topsoi i Samplin g (if applicable ) O Disposa l Samplin g (i f applicable )

• Garde nSamplin g (i f applicable ) S Utilit y Clearanc e nVideo/Photo s (Before ) nVideo/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (30-Day ) O Propert y Completio nAgreemen t D Fina l Repor t Sent : / / Signed : I il l ij^ ) Signed : / / / / / / / / CaUedO~ V /O b / \ o On : / / On : / / On : / / On : / / Signed : / / Issued : / / By : By : By : By : By : By : 

## By

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# 1

Omah a Lea d Sit e

## Dougla s County Accoun t InfoaB^io n Pag e 1 of 2 % Dougla s County , Nebrask a Propert yRecor d - R132091000 0 Prin t Repor t NE WFnatiir n - Pame l Dimfinsinn s availahlf i iH ) sralf i O-S d f t wes t o f.')2n d S t - ViO WO H Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->-»- » Aut o Sale s Searc h Owne r HODGE S MAXIN E
130 8 SUNSHIN E BLV D BELLEVU E N E 68123-000 0 Propert yInformatio n Ke yNumber : 2091000 0 1 3
. , Accoun t Type : Residentia l Parce l Number : 132091000 0 Parce l Address : 360 4 OHI O S T OMAH AN E 68111-000 0 Lega l Description : HITCHCOCK S 1S TAD D LO T1 9 BLOC K1 0 5 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $1,000.0 0 $0.0 0 $1,000.0 0 200 8 $1,000.0 0 $0.0 0 $1,000.0 0 200 7 $1,000.0 0 $0.0 0 $1,000.0 0 200 6 $1,000.0 0 $0.0 0 $1,000.0 0 200 5 $1,000.0 0 $0.0 0 $1,000.0 0 200 4 $1,000.0 0 $0.0 0 $1,000.0 0 Sale s Informatio n Sale s Date : 2006-03-2 0 Dee d Type : Q C M Book : 200 6 Page : 04225 0 Price : $ 8,000.0 0 Grantor : Steve n Kin g Eta l Grantee : Maxin e Hodge s Valid/Invalid : Invali d Exclusio n Reason : No n Bon o wit h Do cStamp s Sale s Date : 2002-11-0 8 Dee d Type : SW D Book : 200 3 Page : 15384 7 Price : $300.0 0 Grantor : LR C


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/23/200 9

## Dougla s County Accoun t Inft|ja^io n Pag e 2 of 2 h^jH^ K
Grantee : Steve n Kin g Valid/Invalid : Invali d Exclusio n Reason : Sal e b yGov t Agenc y Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 0. 0 120. 0 50. 0 Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RL.
. 10/23/200 9

## Pag e 1 o f 1
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# "A"^^ ^ Great e Anothe rTicke t Bac k t o Irt h Interne t ! Sen d Emai l



### . YOU RTICKE T NUMBE RI S 2536833
. Origina l Cal l Date : 7/06/1 0 Time : 4:2 5 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/08/1 0 Time : 5:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 360 4 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 08-SE,09-S W Twp : 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 : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . 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 : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F OPPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T EL M LOCATING Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3



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. . 7/6/201 07206 2 

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e ENVmONHENTA L C KO U r, INC

. OLS# : 7206 2 Dat e Excavated : 7/10/201 0 Dat e USEP ASigne d Off : 8/26/ j Are a Sodden : 396 0 s q H Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h
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COASTA l [NvmoNn rKTA I " ' PBO""*- ^ C K O Ur . IN C 

# Cortsen t fo rAcces s T © Prapgrt y RIGH TO F ENTR YT O PREIVJISE S 

## Granto r(th e property ' owner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agency(EPA ) o rit s authorize d representatK'es , 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 : ^7ACn ^ Daytim e Phone : ^^Cjl-Oj^ ^

Addres s o fPropert y 

# Mb 4 DhfoSJ

­ covere d b ythi 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 its 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 perfonned , 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 y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

## Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s 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 fperformin 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 f2„lt D S>4, , 

## fv.^ % COASTA L irtYiKONHtKrA i C I t O U rI wc


### cRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma yw t o save ; is h

cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; fAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; e I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s th e propert yt o perfor m th e work
. t o
cAllo 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 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 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 (402 ) 991-119 9

^ i gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s 

# Si/^/d Signatur e Dat e

Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f2COASTA L ENVinONHENTA L C » O U P , IMC

.



### Th e purpos e o f thi s agreemen t i s to provid e amutual agreement a s to condition s o f th e property prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dto th e satisfactio no f th e property owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : '^Q.O^gi ^ Property Address : >^^Q ^ Q\r^ \Q SV
. Owner : V\x - V * ng . 

## Jt^ ^ 

# I T Phone : C'A.Oa^ 3L*\\ - Q- ^ 

### Onth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s an dlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y document th e existin g condition s ofth e propert y andth e basement if necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s I s th e Owner' s responsibll h Item :

Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Item : , Item :
item : Item :

Pag e 1 o fCOASTA L fNVtflOMHCNTAL

. ca o u p . INC

. 

## Item s t o B e Remove d B yContracto rDurin g Remediatio n aci d RepBace d



## Landscap e Inventor y Ite m Pre-existin g property area , that wil l b e excavated , tha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trunk diamete r Numbe r o f tree s < = 2 inch trunk diamete r Numbe r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r o f andsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. Agree dupo nvalu e o f plan t material s no t to b e replace db y 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 . Easemen t Area , t o b e excavate d 

## Quantit y 

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Pag e 2 o fCOASTA L ENVIRONMENTA L CROUP

. INC

.


### Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. [^Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

[^Chec k th e bo xi 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 bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
.



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± 36.09 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 600.96 3 Supervise d By : 

## Certificat e o fVerificatio n

28 0 SOI L 

### 2011-02-0 7 16:1 4 30.6 5 Fina l 7206 2 360 4 OHI O S T B 2 

### 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 36.16 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 XRFTEC H MIS C NOT E

pp m P b 632.20 8 Supervise d By : 

## Certificat e o fVerificatio n

28 1 SOI L 

### 2011-02-0 7 16:1 6 30.7 0 Fina l 7206 2 360 4 OHI O S T B 2 

### 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 38.15 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 B y 

## Certificat e o fVerificatio n

27 8 SOI L 

### 2011-02-0 7 16:1 2 9i:6 5 Fina l Av g o f275-27 7 360 4 OHI O S T 

### B l 13 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 172.29 6 Supervise d By : 

## Certificat e o fVerificatio n

27 5 SOI L 

### 2011-02-0 7 16:1 0 31.2 4 Fina l 7206 2 360 4 OHI O S T B l 

### 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 17.77 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 173.96 1 Supervise d By : 

## Certificat e o fVerificatio n

27 6 SOI L 

### 2011-02-0 7 16:1 1 30.2 0 Fina l 7206 2 360 4 OHI O S T B l 

### 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 20.90 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 27 7 Mod e SOI L Tim e 

### 2011-02-0 7 16:1 2 Duratio n 

### 30.2 1 Sequenc e Fina l Flag s BVI D 7206 2 ADDRES S 360 4 OHI O S T QUADRAN T B l DEPH T 

### 13 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r P b 177.23 5 ±21.12 1 Supervise d By :

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. '"t PHO-tt'= ' .<P

* www.coastalhazmat.co m COASTA L ENVIRONnENTA L C R 0 U r, INC

. 

# EXECUTIV ESUMMARY : BVI D #72062-(360 4 OHI O ST )

X 

# N o Issue s o r Concern s I I Issues/Concern s
Detai l Explanation : -DANGARVE Y WALKE D TH EPROPERT Y O N8/26/10
.

# EP APropert y Clos e Ou t For m Propert y ft : ~] ^ C>ii>^ ^ , Propert y Address : Date/Time : Name: , > ^
­ ^^E^UiOiSrSOaQ^ Owner' s s Name : /,^__—-.^^ Quad s Excavated : Contracto r Grou p ^j^'^C\\ Ye s No Excavatio nGenera l 1. If necessBiy , wer e th e correc t qiiadi3nt(s ) excavate dan drestored ? 

# y 2. If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# y Gradin g So dan dVcRctatio n Ye s No 1. Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavaieri area s generall y slop e awa y 

### / fromth e house ? 2. Ha s so dbeenlai d inall area s tha t wer e excavated ? 

### / 3. Doe s th e sodappea r tobe generall y health y andgrowing ? (Onl y evaluat e if

inspecte d at

a

30 

### / da y tim e period )
_ ^ -^ — 4. Ar e sodde darea s generall y firmandevenl y graded ? 

### / 5. Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if

inspecte d at

a

30 da y 

### / tim e period ) __. . 6. Wa s th e property grade dsuc htha t wate r will no t poo l onth e properly ? 7. Wa s damag e to landscapin g or plant material s avoided ? Gates
. Fence s an dRetainin g Wall s \ K NU 

# r Do gate s openan dclos e freely? (Ifapplicable ) 

# V 2. Wer e all gate s or fence s take ndowndurin g restoratio nactivitie s reinstalled ? (If applicable ) 

### / 3. Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) 

# y 4. Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) 

# .y Foundation , Sidin g an dGutter s Ve s .N o 1. Wa s damag e to th e sidin g ortri m avoided ? 

### / 2. Wa s damag e to th e foundatio n avoided ? 

### / I Wa s damag e lo window s avoided ? 4 Wa s damag e to window s ordoo rscreen s avoided ? 

# y « Wa s damag e to downspout s ordownspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ve s No 1. Wa s damag eto drivewa y surface s avoided ? 

### / 2. Wa s damag e to walkwa y surface s avoided ?

### # 

## O^'ner s comments :



# iln.« ; pectio nno<es :

Removal andresloratio nactivate s cornplel e includin g the 30-da y sodwarranry : EP ARcpreseniaijv e %o ^ ^ 

## Date : 

# ^\ti\ ^

## Propert yCompletio n Agreemen t
Ihi s agreemen i docuinenl s th e complclio n o t remedia l acliviiie s perloime d o n m ypioperty
. M ysignatur e wil l designat e iha i I a m salisfie d wi( h (li e resloralio n o fm yproperly , an d tha i n o ilein s ar e i n queslion.s
. now , o ra l an ylim e i n th e future , excep i thos e item s liste d below , i fan y

P.opcrtym:-|.^^^- ; Propert yAddr».:0^^^ ^ ^^^^ ^ ^^
. Ownei' : 

# Maxi m\-^C)d^ ^ Phone : 

## ^ i m . ^q/

. D-iFv ^ Restoratio n Item s i n Question :

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

u / ] 1 ayrc crc.^toriilio n i s complcled , riccp l a s note d
U ' fl o "o ( a^^re crestoratio n i s complelcr l 

# < 2 

# m,/ o Dat e (oj' s Signadii t Dal e

# Propert y Owne r Assessmen t of Performanc e For m America nRecover y an dReinvestment Ac t (ARRA ) OmahaLea dSuperfundSit e 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-Q9-0 6 Propert y Identifie r Number : 'H^i'O i f ^ Propert y Address : ^^yy- A<OV l iC i Propert y Owner' s Name ; MoVmo
. V\rAOj2 3 Instruction s t o th e Property ' Owner : Thi s for mserve s t o recor dth e Propert>

- Owner' s assessment of perfonnanc e (Incentiv e 1

- Qualitj ' Assuranc e Surveillanc e Plan ) involvin g the liste dremediatio ncontractor , as applicabl e to the Omah aLea dSite
. Thi s for mdocument s th e timelines s of punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y of work
. I f needbe , the Propert y Owne r ma y utiliz e thi s for mt o recor dproblem s and/or issue s not specifically tie dto a nassigne d address , fo r example , busines s relation s tha t generally don' t follow the guideline s set fort hi nthe Performanc e Wor k

Statement
. "" ^ Th e Propert y Owne r wil l indicate his/her assessment o f performanc e wit hth e contractor' s wor k

b y checkin g anumerica l ratin g onth e tabl e belo w usin g th e numerica l definition s fro m the ratin g scal e below , the nsig n& date th e form
. 9-1 0 "excellent " ^^CElVE D 7- 8 "ver y good " 5- 6 "acceptable " AU G2 3 201 0 U "ve^'poor " SUPERFUN D DIVISIO N Property ' Owner' s Assessment o f Performanc e Regardin g th e Contractor' s Wor k 1 0 n / 5 9 ' ' 4 8 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional; , continu e onbac k pag e i f needed l
Propert y Owne r Signature : / \//i},u.S-y7Kb~fjJ ^ Date : I' i Aua ^ 

# 0