TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: Q0?\^ O Date: c^)l\)aC^\Ol 

Address: Ma\ 5 ^>CC).UV\\r\ ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

jA Video of property (DVD) 

JZ' Executive Siunmary 

H' EPA-provided property sketch 

^ Signed Access Agreement for subject property 

V^ Signed Access Agreement(s) for adjacent property 

jA Restoration Agreement 

JB^ Settlement dociunents (i.e., for damage or to replace plants, etc.) 

^ Confinnation data 

^ Photographs prr-e^o, ^o^pv^nVr^^ 

^ As-built sketch 

y Satisfactory restoration signed by Property Owner 

•0^ Property close-out check list signed by EPA 

^ ^ Description of areas not meeting ROD cleanup criteria 

^ Utility clearances 

\A Property infonnation from Douglas County Assessor's Office 

[J 

D 

n 

Signature ' Date * 

30054815 

Superfund 
PL 

Property Access Checklist 

Propirr^ ID ztrrgp" 

Prcpcn.vAddre..:49;^«:^ frAr^M' ^ ^ ^ 

n

D

 WORKSTARTED

 WORK COMPELTED

 ON: 

 ON: 

_/

/

 /_ 

/ 

Ownc: Kcvrtn V/^^Vd e 

Addrc^s:^^ 

T5C\VY\J^ 

Phone ?.l'5-^?^^' S 

Fax: 

Renter 

Phone: 

Fa-v: 

Cell/Pager: 

Additionul Inlnrmnlion: 

Ccll/Pager. 

• Notirication Leitcr 

So Access Agreement 

CS* Restoration Agreement 

D Topsoil Sampling (if applicuble) 

D Disposal Sampling (ft applicable) 

D Ciirdcn Sflmpling (if applicable) 

D Ulility CIcArancc 

D VIdeo/Phofos (Befnre) 

D Video/Photos (During) 

D VIdeo/Pholos (After) 

D Video/Photos (30-D«y) 

D Property Compielion At;recincni 

• Final Report 

Sent: / / 

Signed: Jl/43/jQOj 

Signed:X ' £L ' ^ 

/ / 

/ / 

/ / 

Called; / / 

On: / / 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

^y-£k^rrA^\i> 

»> Vfi^iorv 

^ 

By: 

By: 

By: 

By: 

Bv: 

By: 

By: 

By: 

By: 

Air Monitorint: (<ls upplicable) 

D Community Q Crew 

Rc^iultv: 

On: / / '>: 

D Comraunit;*'

Results: 

D Crew On: / / By: 

O Community

RMUIU: 

D Crv^y On: / / By: 

Omaha Lead Srte 
m 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

LKo \u\v-) 

HZI^ FmnUi n b ^ 

 Date: 7-^^i^-o^Tlme: Z T3 ^

 Date: yj^'bl^ Time: ^^ 5

 Date: ' ' ' Time:

 Transmit to EPA D 

 Action: jgoj^f wf M

 Action:^^/­ ALAt-^

 Action: 

Other Action: D 

 IfoTJ y ^ 

 i cy ^ 
D,ouglas County Account Infoi irn||g^ Page 1 of3 

Douglas County, Nebraska Property Record - R0906700000 

Print Report 

NEW Feature - Parcel Dimensions available O) scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature •*•*• * Auto Sales Search 

Owner 

WECKLE KAREN 

4215 FRANKLIN ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0670 OOOO 09 

Account Type: Residential 

Parcel Number: 0906700000 

Parcel Address: 4215 FRANKLIN ST 

OMAHA NE 68111-0000 

Legal Description: CREIGHTONS 2ND ADD LOT 4 BLOCK 6 LOT 4 

Value Informatio n 

Land Improvement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$6,700.00 

$6,700.00 

$6,700.00 

$6,700.00 

$6,700.00 

$6,700.00 

$56,300.00 

$56,300.00 

$56,300.00 

$56,300.00 

$39,800.00 

$39,800.00 

$63,000.00 

$63,000.00 

$63,000.00 

$63,000.00 

$46,500.00 

$46,500.00 

Sales Informatio n 

Sales Date: 2004-02-27 

Deed Type: WD Book: 2004 Page: 028851 

Price: $64,400.00 

Grantor: Edward D Coleman etal 

Grantee: Karen Weckle 

Valld/lnvalld: Valid 

Exclusion Reason: 

Sales Date: 1997-08-21 

Deed Type: D Book: 2069 Page: 168 

Price: $44,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R090. 7/7/^tK. 
Douglas County Accoimt Info: wa^^n Page 2 of3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Land Informatio n 

Acres 

0.16 

SF 

7200.0 

Units 

1.0 

Depth 

150.0 

Width 

48.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

1

j -a?: 

4tiimiin€mii\ 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1458.0 Percent Complete: | 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Batlis: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1924 0% 1924 84 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 988.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R090... 7/7/2009 
Douglas County Account InformU^ Page 3 of3 rmU ^ 

Garage Detached 352.0 

Porch End Screen 96.0 

Porch End Screen 36.0 

Porch Slab Roof Ceil 24.0 

http ://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.j sp?accountno=R090... 7/7/2009 
m Page 1 of 1 

I::. :--Qrft3!JQAn9?^^?[ JlglSgl_ 11.. - .BacMo jrt^ InjflT'gJiJ-ijI j[. SendErnaiTj 

• YOUR TICKET NUMBER IS 2332209. 

Original Call Date: 8/03/09 Time: 12:18 pm Op: ELIZABETH18790 


Work to Begin Date: 8/05/09 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4215 Street: FRANKLIN ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE ABOUT CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNElC QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/3/200^ 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet {[; Send Email J ][ 

YOUR TICKET NUMBER IS 2357198. 

Original Call Date: 9/04/09 Time: 10:28 am Op: ELIZABETH18790 


Work to Begin Date: 9/09/09 Time: 11:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4215 Street: FRANKLIN ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Urtlity 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 RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/4/2009 
OLS#:26140 As-Built Drawing Date Excavated: 9/14/09 

Date USEPA Signed Off: 3/4/10 COASTA L Omaha Lead Superfund Site Area Sodden: 2580 sa ft 

Name: tPiofiy!(A Omaha Lead Site Date: <a)2o\/j 3 NorthArrow 

Address: 'JP/ ^ /:rAnAAyA Site Sketch Time: l-CsO 

Phone: ^4t? n^ ^ -<:pf C ^ 

Team 3rig>u»3 j'/4at;Q)i BVID# oKalQO XRF Code 5^Z- Sample Number Lead Concentration Confinnation Sample 

fiVA \r.fV 4 - ;^a,f4o n Yes a No ^ 'TiL l '1 PP"' ^ Yes CD No -ea ^y r -SfPv^ - ?.to/Ur7 377 ^ / J PP'" J , Yes K No a g-v(\ Sc^yv% - 7ipiab ^ Yes n No R^ 

% Yes a No l5t^ . ^ ^ 7 ppm Y Yes a No tS^ &CPI "^ g/ ppm g Yes • No "pJC 

RYCSCPLA-26140 

Lab «r« OOO pp m __ 359 ppm =tf 

TK 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated 

Quadrants Excavated 

Area replaced with Area replaced with 

Sod Rock/Mulc Area left bare h 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc , 
^/ 5 f0^AB^L\N 

Name; /^A^A^A^// Omaha Lead Site Date: <2>ho\/lA> North Arrow 

r Address: V^/ ^ A7/^iOAVOA Site Sketch Time; l-CiO 

Phone: Mt2- O?) ^ -^1? C S ^ 

Team 3n^cu J ) i)-\aoeD5 BVID # oJjyNO XRF Code 'zA^ST ^ 

Sample Number Lead Concentration Confirmation Sample 

Yes a No 

Sfl.%J?AtA - jiJii>i(j,o 1</L. Yes n N ^ t 

ppm A o m t C. V ^ - 7.(glUn 

ppm Yes J8C No D

ppm ., Yes D No ^ 

^^•2f<A^PvPt - 7Afmv pjKn 6^^- -Yes a No 51^- Z ^ - 7 ppm P/^Yes n No ^ 

R p? - .^Bc^x:<^ —-z<f>it^ ^ ppm g Yes n No " ^ 5ca. RYCSCPLA-26140 

Lab 

359 ppm __ _ 

'XX 'V VJipH/d-j; 

Omaha Lead Site ~AAAllmdAAWy^^Z 46130 
Name:

Address:

Phone;

 tP^jAO/t{ / 

'-AA/A' PA/Jt^AAyA 

 Mt?_ n?. ^ -^Tg C 

Omaha Lead Site

Site Sitetch

 Date:

 Time:

 <£>l2A)\d3 

 I-(SO 

North Arrow 

si^ 

Team 3nga. O ) i^lJGn 5 BVID# oliylQ O XRF Code 

Sample Number Lead Concentration Confirmation Sample 

6

R.Y C ^^k: A

 ^G-7-rUAS/Pr

 ­

—

 ?Mi^d . 

 lieiit c 

/^71 / I pp;" . -L—­ — Dom 

RYCSCPLA-26140 

Omaha Lead Site 46130 
Name: ^Pt^JAJPc/ 

Address: ^^/ ^ PP^lA/yyA 

Phone: yi^l^-a-hSL -0^)% ^ 

Team 5rt^?a») | ^^USnS BV1D#

Sample Number 

— y i.\ilh i f2-vD ^cem- - 7^gmo 

RP7.<^ya - -'U/f\UrV 

RYCSCPLA-26140 

Lab 

359 ppm 

Omaha Lead Site

Site Sketch

 olbN O

Lead Concentration 

552:^ ^ SSm i l r t L pp^ 

t^T^'-^r pp"^ 

^^• " / ppm 

^CPI-^- Z\ ppm 

 Date: y^hoh^ North Arrow 

 Time 

s/^ 

 XRFCode 5*^2 L 

Confirmation Sample 

n Yes a No 

^ Yes n No ^

A, I Yes M No a 

« ! Yes n 

6 ^ Yes n No ^ ­

??- Yes • No ]5K 

g Yes • No "pa: 

y^m^pW, 

Omaha Lead Site 46130 
COASTA L 

V INVUtONHEKTAl . A CROUP , IN C 

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 authorized representatives, collectively 

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

following described premises: ^ , . 

Owner's Nahfie: Daytime Phone: 

K^A^^gP \jiXly[y 4ol 2(5 Si ^^ 

Address of Property 

covered by this 4715 f^^\w y 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 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 perfomied, 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 
.s*^^"L*'^v, 

^ ; 

COASTA L 

[NVmONHENTAL ^^. Pno-<t^ 

CROUP . IH C 

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

piles, dog houses, etc; 

e 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; 

e 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 (402) 991-1199 

I grant access to my properties 

n I do not grant access to my properties 

^^^ 7- P7-O ^ 

-"Slgriature Date Signature Oate 

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

Page 2 of 2 
COASTA L iNViHOhnrNrA L 

<: R O U V . IM C 

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). 

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 Start of Remediation: 

The removal, storage, disposal, and/or return ofthese Items is the Owner's responsibility. 

item: -A 

AA^^ L \ ^^O/h J^^ 

Item: / ^ 

Item: 

Item: 

items to be Removec Ibyt h e Contractor During Remediation and Not Reoiaced 

Item: 

^ ^ . / Xhv^i. Uy\ i^^u^^ . Item: / 

item: 

item: 

Pagel of. 
COASTA L CM V I HO N I t r NTAI . 

c H o U r . IH C 

Items to Be Removed By Contractor During Remediation and Replaced 

item: 

^iL ^ ya^T\,, bz.-

Kem: 

Landscape Inventory 

item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that "F(,6-^ 

Is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter 2 

Number of trees <= 2 inch Each 

trunk diameter ^ 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 1^ 

Attach n sketch ol' the ^ 

sprinkler layoui. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet - ^ 

Aiiach a sketch ol" relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this ^allle will he 

used lo issue H pliinl 

\oueher lo the propcrt> 

owner. 

Easement Area, to be Each y \ V

excavated 

^ 

Page 2 of. 
% 

C O A S T A 1- • MVinOMnLNTA L a tt O K> f . IM C 

Additionai Comments / Instructions: 

2^- 3 \:^^y \<£>-\\A^ 

o (^ Jy^cj \ ) AT \y>y I )P^ P'4lVT.|'vu.^ 

y 

^ Sr^,^ XA^^^^^^^^ ^^j- e (?>^^k.^ 

Q 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. 

Q I do not agree 

^A7-(^ A £Cj^onp/^^ 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
BVID# dlpf-i O 

XRF PROPERTY SAMPLE SHEET 


Date 

Project ij^/H^oq Omaha lead FP 2nd year opilon 

Address I

Sample time 

 Q^H ^ ^A^p^'Sf -

am/pm 

XRFID# •b2A>^ sample length 30 sec 

Shot# 

3o T 

3/0 

ML 

•=M? 

Reading

yg t-/^ 

S-y ;/­ \0 

9^"^ ± 17. 

8A\ ^. ' ^ 

 Sample area 

^ ^ 

Depth 

I A 

ShQt# 

_2zs: 

:ai 

3 J ^ 

Reading 

5^ 

i?/ / 

my^& 

Sample area 

F/ 

epth 

^ 

Average o A y \A^ Average l/>l^lo 

_Shot # Reading Sample area Shot# Reading Sample area 

-g:t ^ 

.^IL 

}% t

i?>s ^ ^ ^ 

 IS 

/ 

^ 

^ ^ 

Depth W­

'^Z. 3ik2L. 

Mil 

3fc.<r 

N?. t ly /V^ -I-/s- N l t ^ fe 

&AT ^ /V 

^?_ Depth 

Average g ^ J^/g > Average i^" ^ I S -hKT -

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot # Reading Sample area Shot# Reading Sample area 

Depth ' Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature (^OA^QI^Q/ ^ 

Print UWIUJQQJ^ CM^ ^ 
i 

.-^'^'^v. 

iyA.\ Omaha Lead Site—Fixed Price EP-R7-07-05 

o ^^^A I Coastal Environmental Group Inc. V ^ y S^^yy^ www.coa8taihazmat.com 

COASTAL 

IN«l>OIIHIIIT*L C lour . IN C 

EXECUTIVE SUMMARY: 

BVID #26140-(4215 FRANKLIN ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-DAN BAHNKE WALKED THE PROPERTY AND SIGN OFF ON IT 3/4/10 
r\ 

tf^ 

EPA Property Close Out Form 

Property #'. 

Property Addmsrii^ ^ r?l^t.UO 

Date/Time; Owner's Name: J^J^l Q 

Quadi Excavattd; V? - /^ j ^ f^ Contractor Group 

Excavation General 

1. If necessaiy, were the concct qtiadrant(8) excavated and restored? 

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

Grading Sod and VcnetoHon 

I. Does the gnding around the perimeier orthe house in excavated areas generally slope away 

from tbe house? 

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. Ate sodded areas generally firm and evenly graded? 

S. 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 propeny^ 

r 7, Was damage to landscaping or plant materials avoided? 

Gates, Fences and Reufaitng Walls 

I 1. Oo gates open and close freely? (Ifappiicable) 

2. Were all gates or fences taken down during restoration activities reinsulled? (If applicable) 

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

1. Was damage to retaining walls avoided? (Ifappiicable) 

Foundation, SidinKand GnMers 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Coocretc) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surftces avoided? 

y^ 

mup. 

Yes No 

y 

y 

Ves No 

y^ 

y 

A 

y 

y

y" 

Yes No 

y 

y

Z^ 

Z^ 

Yes No 

y ^ 

y 

y ^ 

y ^ 

ZA^ 

Yes No 

y 
I

Ort'Ders comnients: 

 ^^ ^ 

[Inspection notes: 

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

EPA Represenlalive \)[^\\y, L I ^ Date:^/f/^0/p _ 
Property Completion Agreement 

Ihis agiccmeni documenis the completion ol remedial acliviiies perioimed on my property My signaiure 

will designate ihal I am satisfied with lhe restoration of my propeily, and Ihal no ilems are in questions, 

now, or at any lime in the future, except Ihose ilems listed below, ifany 

Property ID: ^ Cg | ^ Q 

Property Address: ijII- 1 5" ^ -fi-.^KLX ^ <( r 

Owner: /C^< ^ -L^^ ^ t „ ^T f-<. 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additionai Comments: 

nyrcc rcstoralion it completed, except as noteri 

I do nnt aijrec resloration is completed 

lyi it.-2,-0<? pUkMAe— /^-^- ^ 

Date Conti ar tot's Signature D»lc