### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 77//>&7 e Date : S/n/O ^ Address : ^^ / DaTO/lJ?/ r

S> h Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f property (DVD ) M Executiv e Summary s 7 EPA-provide dpropert y sketc h S /

Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t propert y y Restoratio nAgreemen t D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) 0 Confirmation^iat a [MPhotograph s j /

As-built sketc h y Satisfactory restoratio nsigne db y Property Owne r y Property close-ou t chec k hs t signe db y EP A D Descriptio no f area s no t 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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4031777 3 

# liillllililll l Superfun d

# Fina l Repor t Propert y Chec k Lis t (pieas e plac e wit heac htiic ) Har dCop y Informatio n ^ \ . Propert y Chec k Lis t • ^Sit e Workin g Drawin g Map

3 ^ EP Aoriginal s Ma p ' 4.\Dougla s Count y Assessor' s Ma p S V Propert y Contac t Shee t -Agreemen t

1 . Acces s Agreemen t XT?.estoratio nAgreemen t Miscellaneou s Document s 1 . Fina l Ma p fro mth e Fiel d 2 . Chang e Order s X^CR FDat a 4 . An y email s o r P O correspondence s Propert y Completio n 1 . Executiv e Summar y 2 . A S BUIL T 3xPropci1 y Coinpletio nAgreeinen t 4 . An y buyou t inf o o r reimbursemen t inf o 5 . Chec k o r mone y orde r copie s V

\ ^ EP APropert y Clos e Ou t Fon n X^ttache dBegi nVide o Electroni c Documentatio n Drawing s ^ . EP Aorigina l \ •- 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 7 • Executiv e Summar y Video s ^ Begi nVide o



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## Propert yAcces s Checklis t Propert y ID : ^ AA , /^ ^ Q WOR K STARTli D ON :

_ / /_ Prop^Ml y Achlrc^^^ ^ / T&Cg^_^"lW^ ^^^'^" ^ COMPELTE D ON : / / Renter : 

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# 1 .AddiTss : Plione : Fax : Cell/Pasie i A<klitional liil'ormatioir . 

# • ^So^cP/^-s?/! : Fax : Cell/P:i«'cr :

• ^ Notificatio nLette r Sent : 7) 0/[^/. ^ 

# ^ytUiy ^ § ^ Acces s Ajjreemen t Siiined:/ 0 I tbiCf } 

# ^ y CJyz\5 H' ^ Restoratio nAgieemen t Sit>ned : //J l IIDIG' ^ I I Topsoi l Sam|)lin< ; (if applicable ) I I By : I I Dis|)osal Sampling ; (i f applieahle ) Bv : I I Garde nSain|)lin< i (if applicable ) Bv : - ^ Utility Clearanc e Called : /O/^/C ^ 

### ^ y 0 ^ /0l^/l3 0 7'7/US^ ^ S 3 ' Video/Photo s (Before ) 

# 0»^/2/^Zl 7 

# ^jiMyzyxU Video/Photo s (Durinji ) On : Bv : D Video/Photo s (After ) On : / / Bv : D Video/Photo s (3()-Day ) On : / / . Bv : I I Propert y Completio nA<j;reeinen t Sijined : / Bv : nFina l Report Issued : / Bv : Aiijyionitorint ; (a s applicable ) 1 m i Conununit yCU CreM - On : / / Bv : Results : 1 L J C(»inmunit. yJ U Cie n On : / / J 

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/ ^/^58 ^ ^6/j h y^ccts 7 yMy^^ ) Name : L^YirXfl ^ rv\t\l^J ^ Omah a Lea d Sit e Date : 6n-VS-C> 3 NorthArro w Ad d ress^yy o - > \ T V rILV^< - & ^ Sit e Sketc h Time : \ b ' . I' S oci> \ Phone : 4^ - '^'^t - \1<=.* Z 

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4613 0

### .Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R194653000 0 Prin t Repor t Informatio n i s vali d a s o f 2007-8-2 4 Vie wo n Ma p Value s no t finalize d unti l afte rBoar d o f Equalizatio n Treasurer' s Ta xRepor t Owne r JACKSO N ANDRE W 

# -f^W=¥=?^fz ^ 242 1 DECATU R S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 465 3 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194653000 0 Parce l Address : Lega l Description : 242 1 DECATU R S T OMAH AN E 68111-000 0 PARKER S AD D LO T4 BLOC K1 2 W 1/ 2 3 0 X 12 8 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $900.0 0 $900.0 0 $900.0 0 $900.0 0 $900.0 0

$0.0 0 Improvemen t $50,600.0 0 $50,600.0 0 $50,600.0 0 $7,900.0 0 $7,900.0 0

$0.0 0 Tota l $51,500.0 0 $51,500.0 0 $51,500.0 0 $8,800.0 0 $8,800.0 0

$0.0 0 Sale s Informatio n Lan d Informatio n Acre s 0.0 8 S F 3840. 0 F F 30. 0 Unit s 1. 0 Dept h 128. 0 Widt h 30. 0 Vacan t No Lan d Attribute s Attribut e Attribut e Desc riptio n Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 10/11/200 7

### .Dougla s County Accoun t Informatio n Pag e 2 o f 2

242 1 DECATU R S T ,y""'. a (5* 1 60 ' " . ^ SO l-fi l FIDO - 4 5' / :. o s o / B»mr t Bio^KS fl

66 8 ( 1 11 0 Ti n En d S«k< l Ws H

t«I O ;(jr r TWO STOR Y Clic k t o Enlarg e Imag e Clic k t o Enlarg e Imag e Squar e Footage : 1344. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : 2 Stor y Rooms : 6. 0

HVAC : Force d Ai r Units : 1. 0 Exterior : Fram e Sidin g Baths : 1. 0 Interior : Drywal i Bedrooms : 3. 0 Roo fCover : Compositio n Shingl e Stories : 2. 0

Roo fType : Gabl e Foundation : Bloc k Floorcover : Allowanc e Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 188 8 0 0 % 188 8 11 6 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 686. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 140. 0 Porc h Sla b Roo fCei l 30. 0 Use r Partia l Basemen t 329. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 10/11/200 7

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

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

# yy^y s yy /

7'^^^^ y^- y Date : /4</ ^ Time : 777 7 Action : '77^/77 ^ 77y^>^yt/ r

Date : Time : Action : Date : Time : Action : Transmi t t o EP AD Othe r Action : n



# ^yz y 7^y^^72 ^ ^7 ^ /^M7^y727 ^ yy7yyy-'y^y^7^^^£f^ ^ y<-^/^i74yy ^

### lfiL, \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 {ttk ^ ^^^ yI Coasta l Environmenta l Grou p Inc . ^^^^ ^ V^^^^ * www.coastalhazmat.co m

^•>i.f^ yCOASTA L ENVIRONMENTA L C H O U P . IN C 

# EXECUTIV ESUMMARY : 26618—242 1 DECATU RS T ^ No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g COASTA L » , 

# mah aLea dSuperfun dSit e

OLS# : 2661 8 Dat e Excavated : 11/12/0 7 Dat e USEP ASigne d Off : 11/29/0 7 Legen d Are ano t Excavate d Dripzon e Excavate d y ^ 

# m Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c 4613 0^ 

# 4EPA EP APropert y Clos e Ou t For m y ^ ^ Tyrr^Ay, ^ Propert ytt : c7^/y,7. , Propert y Address : Date/Time : Owner' s Name: . 77.07^1^yy7
- Quad s Excavated : Contracto rGrou p Ye s No Excavatio n Genera l 1 .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 drip zon e excavate dandrestored ? Ye s N o Gradin g So d an d Vegetatio n 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y fro mth e house ? 2 .Ha s so dbee nlai dinal l area s tha t were excavated ? 3 .Doe s th e sodappea r t o b e generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 l y da y time period ) 4 .

Ar e sodde darea s generall y firmandevenl y graded ? t ^ 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Only evaluat e i f inspecte da t a3 0 da y tim e period ) l y 6 .Wa s th e propert y grade dsuc htha t water will not poo l o nth e property' ! 7 .Wji s damag e t o landscapin g or plan t material s avoided ? 

### y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s openandclos e freely? (If applicable ) y ^ 2 .Wer e all gate s o r fence s take ndowndurin g restoratio nactivities reinstalled ? (I f applicable ) 

### y 3 .Wa s damag e to gate s o r fence s avoided ? (I f applicable ) oy 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

## (7 ^ Foundation , Sidiocan d Gutter s Ye s N o 1 .

Wa s damag e t o th e sid'm g o rtri m avoided ? l y 2 .Wa s damag e t o th e foundatio n avoided ? y 3 .Wa s damag e t o window s avoided ? 

### y 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? • ^ 5 .Wa s damag e t o downspout s o rdownspou t extension s avoided ? 

### y Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 .Wa s damag e to driveway surface s avoided ? 

### z^/A 2 .Wa s damag e t o walkwa ysurface s avoided ? 

## y

## Owner s comments :

Inspectio nnotes :

l^ytz ^ 7)0/^ -

Removal an drestoratio nactivate s complet e includin g the 30-da y so dwarranty : EPARepresentati>^-7^^^^^^^<^^,3,Xigf ' Date : ///^f/^ /^ ^ ^ 

## Propert yCompletio n Agreemen t Thi s agreement document s the completio no f remedia l activitie s performedo nm y property . M y signature wil l designate tha t I a msatisfie dwit hthe restoratio no f m

y property , andtha i no item s ar e i n questions , now , o r a

t any tim e i nthe future , except thos e item s listedbelow , ifany . Propert y ID : ^^ / / g Propert y Address : ^ ^ ~ ^;)^^^^^ ^ ^ ^ 

# Q-'^-- ^ ,7)ndl,y, y U^.^y<l^-^rr ^ ^'^^-^••^d^)yi4y^} 7 Restoratio n Item s i n Question :



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(^{y ^ ^ wihzyi^-'y^ t o\ Vn/yy. h\Uy . ^z ^
' &k y[jChT^ t [yTilhOfy ^ /ZoTL ^ Item : Item : Item : 

# f Item :

li^lTaare e resloratio ni s completed , excep t a s note d I I d o no t ajjic e resloratio ni.s complelc d 

# /iA.r,.^^\nin^ ^ Owner' s Sign^lHr e Dat e Contractor' s Signatur e Dat e I

# 777cc h7^y7es 7 yl^^\ Name : \.r,x\i\o . rAtUeK " Omah a Lea d Sit e Date : 6" l - VS"C^ 3 Nort h Arro w Address^^j^-S AOfrafci^^^<" ^ ^ Sit e Sketct i Time : Vt)' . t ^

o».r>' \ Phone : 4^^ - "^^t - ^ : 2 <=,<; . 

# I

Tea m C^Oo\c^ \ ^U^>e^V<.-J» . BVID # ;^C-U\ ^ 

### XR F Cod e 1 S O ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## oy/^CVYA-2(777.\ B P»Ye s ^ N o 5 0 

## W7B'y=FYiy3^< ^ fiYe s n N o ^ «nYe s a 

### N o g «A'e s ^ N o '- ' 

## \l&0±y 7 pp m Olives a N o ^ pp m Ye s a N o CD pp m Ye s n 

### N o n RYDSCPLA-2661 8 La b 73 8 pp m 

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# M * Xl i . X ! >« • ^ K- r ^14-4—i


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4613 0PROPERT YCLEARANC E WORKSHEE T 

# (p ^

Dat e Propert yI D 

## ll'l2'O l Z(;U ^ Propert y Projec t Omah a Lea d -- Fixe d Pric e Addres s 

## zt/z / /O^^^T Ws r Measuremen t XR F I D 010 7 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 

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## U^ i 3 l o l 

# I9 f 4 

### ^ zot > XR F correcte d Valu e -- > 5 (us e calibratio n char t o rad d 

## W IQV o t o value ) Sampl e Are a 

### b z U-/ V 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 ) ? 2 

## P L 4 3 

## i ? / 

## l o l n z XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 

## 2^ f 2 0 % t o value ) Sampl e Are a 

### F l 1- 6 Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l F^eadin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 

## h 2 S K 

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## f i XR F Correcte d Valu e -- > b (, 1 (us e calibratio n char t o rad d 

# n 2 0 % t o value ) Sampl e Are a 

### V^ z H't ^ 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 70*^ ^ 

### fc7 3 (o O (^( t 4 hi - (^ Y 

# t t XR F Correcte d Valu e —> (us e calibratio n char t o rad d 5 

## y i 2 0 % t o value ) 

# S 5 Sampl e Are a 

### % \ yi M 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 7 

## 353 1 (Bag ) Sieved ) 

## tJX ­ 

# m ZO H 300 . 

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_ XR F Correcte d Valu e —> 

### IH< \ (us e calibratio n char t o rad d 2 0 % t o value ) 

## 3S 0 XR F Technician' s Signitur e

### ( # COASTA L % • y ENVKONtlENTk L C R O U f, INC . 

## 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 authorize d 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 : 

# A^iy e Owner' s Name : Daytim e Phone : r^ ^ ^ 

# jAyso/ u •2/ 7 

# • 5K/ S Addres s o fPropert y 

# zyyT^eyyu ^ s r 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 maypos 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 anc J 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 

### 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 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 f2VT**^^ * COASTA L *^ . ** C ENVI«ONMENT* l ^BO TCROUP . 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 necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h ant 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 INTERFERE 

### 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 (712 ) 352-018 8

y O I gran t acces s t o m ypropertie sD I d o no t gran t acces s t o m ypropertie s 

# T^ZizyjihtTmy y /Signatur e ^ \777 yQate^3^^ ^

Signatur e Dat e iignatur e yy ^

Qate,^..^ ' ^ S
C U I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s to provid e amutual agreement a s t o condition s ofth e propert y prio r to remediatio nactivities . Thi s wil l als o ser\ e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio nofth e property oune r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert yID : ^<^^/ ^ 

### Propert y Address : 2^(/2 y 77^^/^ZV/ ^ ^ ^ Onner : ^^^^ g /y^^^jT^X y Phone : 

# ^7^'^?7 7 O nth e attache ddiagram(s ) indicate area(s ) t o excavate dan ddept ho f e.\ca\ation . locatio nof al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o be usedb y contractor , an dth e directio no f Nonh . Indicate distances , depths , material t}.pes , etc . Indicate digita l photo s b

y referencin g th e photo-lo g numbe r uit ha narro u indicatin g directio no f \iev\ . 

### Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) 

### storage , crisposal . and/o r ret^.- r c

f t!-:es e iter^ s i s th e O-.v^sr s 'espo-sibility . •.

e rerncv i

Pag e 1 o fCOASTA L 

### 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 : 

# 3/774-1 / ?17U^7T S Au S TSUH^ S Item : Item : Item : Item : Item :

' Item :

Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 o fCOASTA L CHOI.* * • • » C 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 : 

# 5a] ) Item : 

# 5, '0) U Item : 

# ^^y>C ^ // ^ ^i7P^y/y b item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of .COASTA L 

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

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

Pre-exisiin g property area , tha t wil l b e excavated , tha t Squar e fee t i s coveredwit h"rass . 

# I Numbe r o f tree s > 2 inch Eac h trunk diamete r

Numbe r o f tree s • = 2 in c :.c h trun k diamete r

i Numbe r o f Sprinkler j ! Zones . Contro l \''a!\'es . j \rimers , i^.eads . etc . Lach

;.. k IL T !.V . Out .
Numbe r o f an dsiz e of eac hgarde nflou e r bed area . Eac h

Pag e 4 o f

### Ite m Quantit y Uni t Condition/Type/Specie s Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor . Not e thi s \alu e wil l b e use dt o issu e aplan t \ouche r to th e propert > o

w ner . Agree dupo nlis t of plan t material s that will be replace db y contractor . Be \er\ ' specifi c anddetailed . Eac h Includ e asketc ho f wer e eac hplant v\ill b e placed b \th e coniracUT . .Agreedupo n propertv to b e wit hiiras s sod . are ao f replace d SF

.A.re ao f Cir_ \o r Count v 

# yg e propen x t o b e landscape d pe r thei r requirements . 

# j)y7^/'^i ^ s F

Easemen t .Area . l o be e\ca\ate d S F

Pag e 5 o f^ COASTA L CNWIROMHINTA L C H O U P . IMC . 

### Additiona l Comment s / Instructions : 

# ^ ^e^ly^ys r ev^y-^^^ y c y JsA7 , yy/r r /^-tp/^^c-^ .

- 7^1 / 4- ^ F^ZJC ^ 

# A-/CDU/7 b T77 ^ T^eT^-rt f .

n 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 . Bycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio rofhouse , includin g foundatio n cracks o rfissures .

I d o no t agre e



# . f o a/o 7 Date ( Dat e