# r

TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID^ : ^/T^ a Date : 

# yii/o^ Address : ^^2: ^ P/Zll^Pl J ^ l Remediatio nContractor : Coasta l Environmenta l Grou p Year : 2007 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o of propert y (DVD ) Executiv e Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D 

## SignedAcces s Agreement(s ) fo r

adjacen t propert y Restoratio nAgreemen t Settlemen t document s (i.e. , fo r

damage o r

t o replac e plants , etc. ) Coniirmatio ndat e Photograph s 

# a / As-built sketch Satisfactor y restoratio nsignedby Propert y Owne r Propert y close-out chec k

lis t signedby EP A Descriptio nofarea s no t meeting RO D cleanu p criteri a Utilit y clearance s Propert y infonnatio nfromDouglas Count y Assessor' s Office 

# s 7
u u u 

# 3//7A g ^Datf e 

## u 4031777 9 

### D , D Superfun d% 

## Fina l Repor t Propert y Chec k Lis t (pieasc plac e wit heac hnk) ^ /

77 e ^ C L ^ Har dCop y Informatio n^ ^ _^ 77 . i y 1 . Propert y Cliec k Lis t I ^-51)7 7 /^A< ^ 2 . Sit e Woricin g Drawin g Map ! | 

# 0 3 . BPA original s Map ' | 4 . Dougla s Counl y Assessor' s Map \ 3 . i'ropcil y Contac t Slicc i | Afirccnicn t : | 1 . Acces s Agfccmcn t : | 2 . Resloratio nAgreenieii l | 

# I it ' 

### Miscellaneou s Document s l l i,| t 

### 1 . Final Map fromth e Fiel d '( 2 . Chang e Order s I f 3 . XR FDat aj 4 . An y email s o r P O correspondence s •' ; Propert y Compleliot i [ 1 . Executiv e Summar y 2 . A S BUiL T \ 3 . Propert y Completio nAgreemen t [ 4 . An y buyou t inf o o r reimbursemen t int o % 5 . Cliee k o r mone y orde r copie s !| 6 . EP A Propert y Clos e Ou t Form; 7 . Attaehe dBegi nVide o 

## Electroni c Documentatio n Drawing s 1 . EP A origina l 2 . Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s During/Elxcavatio nPhoto s So dPhoto s 30-Da y So dPhoto s Scanne dDocument s Final Doeumeni s J ? 

### Executiv e Summar y Video s Begi nVide o M y Movi e 2

### % 

## Propert yAcces s Checklis t Pro.,ei-ty ID : ^/^/^ ^ D WOR K STARTE D ON : / _/ _ P.«pci-t.v.A.hl.es.s : ,^^50 ^ ^,^?>^.. ^ nWOR K COMPELTE D ON : / / ~ 

# f Owner : Renter : 

## yy,djy^^Tr \ Address : Phone : Fax : Cell/Paser : Additiona l Infoimatioiv . 

# pj--(4oi ) _^£ 5 r-^6 3 Fax : Cell/Pajier :

^ Notificatio nLette r Sent : ^1^ 1 d:7
- Bv : 

# IU , \SJ: ^ l-S ' Acces s Agreemen t Signed : ^/^/ ^ Bv : 

## CU-^^ s Restoratio nAj;reeinen t Signed : ^ /g ^ 1 ^ Bv : 

# CMi ^ r~ l Top.soil Samplin " (i f applicable ) Bv : I i Disposal Samplin " (i f applicable ) Bv : r~ l Garde nSamplin< > (i f applicable ) Bv : ^ Utility Cleaii i nic e Called : ) 0 / 2

L/o 7 ^y\0f A Z . ..^^Video/Photo s (Before ) 

## On : 4./^/! ^ Bv : K<5l£flilcCZ/ ' D Video/Photo s (During ) On : Bv : nVideo/Photo s (After ) On : By : nVideo/Photo s (30-Day) On : / / Bv : r~ 1 Pro|)ert y Completio nAfjreemen t Siuned : Bv : nFina l Repor t Issued : Bv : Ai r IVIonilorin< > (a s a|)|)licable ) • Communit y • Cre w On : / / 

# 1 Results : Q Communit y [ U Cre w On : / / By : Results :

• Communit y Q Cre w On : / / By : Results : Omah a Lea d Sit e

# % (yi(x7 b ([(775 6 Name ; f7i\7 q hn/7{XJor ^ Omah a Lea d Sit e Dat e Nort h Arro w— i Sit e Sketc h Tim e Phone : (4if? J ^^'3-^/// y 

# t Tea mpf)i'U^I^ / 1^0Diy ZBVID #3 ! 7l^ f XR F Cod e 

# 180 ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e pYe s n N o pp m fTYe s a N o pp m 6/Ye s a N o 

### B>lYe s C D N o ^ No) s ^:Ye s ^ 

# 1)7 ^ (n2,oc^ ) pp m Ye s n N o C D pp m Ye s • N o • 

# \..7Lill.7t.\MMM . 

# r ^ 7yyyyy7yy7M..k777.-:y i pi ' 

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St ^ Omah aLea dSit e 4613 0

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### Name : f^ll/ q 7^71/ 7 {/J0/ ^ Omah a Lea d Sit e 

## Date: ^^A?7 ^ Nort h Arro w Address : 760 ^ fihlCy^y y Sit e Sketc h Time ; \ Z o. € Phone : (407. ) ip^-^yiy ^ 

### Tea m^ 6^UJl O /U o Diy ZBVID#_iJ_ZM _ XR F Cod e 

# ISO ^ Sampl e Numbe r LeadConcentratio n Confirmatio n Sampl e 

# tax , pp m P|Ye s a N o FTYe s a N o pp m 6 ) Yes n N o )f - "5 ^ pp m g.ZYe s n No rr No) S 

# y/'/Kt^^Z ^ i^^Ye s • N o O Ye s • pp m No • Yes 1= 1

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# i \^^^\ \ 6y \ .k)../B...L . 

# -wz^y pIlOKney St . Omah aLea dSit e 4613 0

### Dougla s County Accoun t 1Q^nnatio n Pag e 1 o f 2 Dougla s County , Nebrask a Propert yRecor d - R210100000 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 ANDERSO N ELVA V ETA L 250 8 PINKNE YS T OMAH AN E 68111-000 0 PropertyInformatio n Ke yNumber : 010 0 000 0 2 1 Accoun t Type : Residentia l Parce l Number : 210100000 0 Parce l Address : Lega l Description : 250 8 PINKNE YS T OMAH AN E 68111-000 0 REDICK S -CLARK-AD D EX T LO T4 BLOC K2 4 6 X 10 0 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0

$0.0 0 Improvemen t $65,100.0 0 $65,100.0 0 $65,100.0 0 $15,400.0 0 $15,400.0 0 $0.0 0 Tota l $67,400.0 0 $67,400.0 0 $67,400.0 0 $17,700.0 0 $17,700.0 0 $0.0 0 Sale s Informatio n Lan d Informatio n Acre s 0. 1 S F 4600. 0 F F 46. 0 Unit s 1. 0 Dept h 100. 0 Widt h 46. 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/accountinfojsp?accountno=R21. . . 9/27/200 7

### Dougla s County Accoun t IiAcnatio n Pag e 2 of 2

n^tr m

Tw o Story 250 8 Pinkne y

1* 0 ISO ! 19 0 1 3 0' to r n v M.t r 1 9 0' Fk-sinoo r Secon d Floo r 2: 0 874. 0 Sq . n . i . • 22 0 830. 0 S q F t i J 80* 1 . ' l.- » 1 4 0 1 ' Ja l Mt r nn -

BO SlabRorJCwhn. ; 9 8 S

O ft BsmnlBIO'.k^f t 830CiS q F C I ic k t o Enlarg e Imag e Clic k t o Enlarg e Imag e Squar e Footage : 1704. 0 Percen t Complete ; 100.0 % Perimete r 0. 0 Quality ; Fai r Uni t Type : Condition : Goo d Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : 2 Stor y Rooms : 8. 0

HVAC : Centra l Ai rt o Ai r Units : 1. 0 Exterior : Fram e Sidin g Baths : 2. 0 Interior : Drywal i Bedrooms : 4. 0 Roo f Cover : Compositio n Shingl e Stories : 2. 0

Roo f Type : 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 191 5 0 0 % 191 5 8 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 830. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h Sla b Roo f Cei l 88. 0



### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21. . . 9/27/200 7• 

## CONTAC T FORM Propert y I D # Property Address : Initia l Contact : Secon dContact : Fina l Contact : Final Action :

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

# mu L yyTT^^y ­ Date : Time : Action :

Date : Time : Action : Date : Time : Action : Transmi t to EP A D Othe r Action : DX 

### i^JJL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 o J^^^ L I Coasta l Environmenta l Grou p Inc . \^^^T< ? www.c0astalha2mat.co m

%PBo->«^ ^ COASTA L ENVIRONMENTA L CROUP , IN C 

# EXECUTIV ESUMMARY : 31768—250 8 PINKNE Y S T N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation:

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

ttW i Arro w Omah a Lea d Sit e Date , ^f^y ^ ^/Z7Z^ ^ 

### Name : r ^

/r; , f^ydiH^c N Sit e SHttc h Tnr» ; I j y^- g 

# t

Tea m Jjliti^y^ '^^^ ^ '>:^?

_ BVI D » pr7i^)f XR F Code . 

# ZS ^ Loa d CocKienlratlo n Connmftanio n Sampl e 

### yJl^i:.<3 a ppo n pp m pp m 

### '^ F'Ye s F"^Yo t t5. ' Ye s fc-iYes 

### a u u u NO ! ^ 

# .T^S^^p m ppc n Ye s Ye s 3 n N o ,& 3 N

o a N o O 

### B 2 di g aroun d tree s an d sav e ros e bushe s an d roc k replac e wit h whit e roc k i n F2 . Sav e ros e bus h i n DZ . 

# i >1 < ^ "S i r± ^ ^/Zllpi' O 

# i^^i,mLk . /ii_y77- ^

: ^— 1 — 

# '^^^'^A.L.J^L.t..U ^ I 0LS# : 3176 8 

# pifoKi-,^ / <7 . C«r-i a Dat e Excavated : 10/25/0 7 46J3 0 Dat e USEP ASigne d Off : 12/13/0 7 

### Legen d Are ano t Excavate dyyy j Dripzon e Excavate dg2S ^ Quadrant s Excavate d 

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

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

# 3/7^ ^ Date/Time : Quad s Excavated : Excavatio nGenera 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 dri p zon e excavate dan drestored ? Gradin g So dan dVegeUtio n 1 .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 fromth e house ? 2 .Ha s so dbeenlai dinal l area s that were excavated ? 3 .

Doe s th e so dappea 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 man devenl y graded ? 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 wil l not poo l o nth e property ? 7 .Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Fence s an dRetaininf > Wall s 1 .D o gate s openan dclos e freely? (If applicable ) 2 .Wer e all gate s or fence s talte ndowndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 3 .Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 .

Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundatio navoided ? 3 .Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkway surface s avoided ? Ye s No 

### y y Ye s N o ^ y ^y 

## y y 

## y y Ye s N o 

## ^t

^ y 

### y y Ye s N o
i ^ y y y y Ye s N o y y

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representati y^^-^^^^^g, ^ ;^^^^^y,X ^ Date: Z^Z^A z

# (i Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n of remedia l activitie s performe d on my property .My signatur e wil l designat e that I

amsatisfie d v\it hth e restoratio n of my property , andthat no item s are in questions , now , or at any tim e inth e future , excep t thos e item s liste dbelow , ifany . Propert y ID : 

# ^/^g ^ Propert y Address : ^ ^ ^ /^yU/ ^ /U/ ^ T Owner : fy^__^y/ l /7yV/\-77 ^ O7J Phone : C/^^,^/^ ^ Restoratio n Item s in Question :

Item : 

# /l/ld-(A.i4oig
- S^ 5 t ^ 4-l/U ^ ^PglK/-6i^iA>ie ^ Item : Kern : Item : rtem: Item : Additiona l Comments :

ly f I agre e restoratio n is completed , excep tas note d II do no t agre e restoratio nis complete d 

# 7/j y /±j^ 

# _y jct ' Owner' s Signatur e Dat e Contractor' s Signatur Signatur e e Dat e IPROPERTYCLEARANC E WORKSHEE T Propert yI D Propert y Dat e 

## 7D!y37Q> ^ 

# 3/%. ^ Projec t Omah a Lea d —Fixe d Pric e 

# ^yp y HyJz/T^^ ^ Addres s Measuremen t XR

FI D 0107-5 1 Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Shot # Readin g Sampl e Are a 

## 553 : 

# 17 ^ ihi^" ' 'fit y. ^ 

### ^ . 

# 'W - M L r- y" L . 

### ^ 

## -kr 

## tu - '9 . 

## ^'^ " Sampl e Are a 

# 7^ ^ 1^
- 

# n . r 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 (Bag ) Sieved ) 7 

# j y XR F Correcte d Valu e - > (us e calibratio n char t o rad d 2 0 % t o value ) 

# m Sampl e Are a Pass/Fai l ? 

# 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 (Baq ) Sieved ) 7 2 

# 1^' ^ 3 4 

# 5 V 

# 5 3 XR F Coi^cte a Valu e 

# ^ 9 - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# y Sampl e Are a Aliquo t 1 I nSit u Reajjin q Rea d 

# m e> i 

## /^- ^ r r Composit e Reading s (Bag ) 

# s x Composit e Averag e

(Bag ) Composit e (Drie d & Sieved ) Pass/Fail ? Analytica l Spil t Sen t La b Numbe r Analytica l Result s 

### ^ ^ 

### l ^ 

# ^ s 

# m- XR F Correcte d Valu e -- > (us e calibratio n char t o rad d 2 0 % t o value ) 

# i ^ 

# n i_
- Sampl e Are a 

## P5 ^ s^-^' ^ Pass/Fai l ? Aliquo t 1 2 3 4 5 I n Sit u 

## Z ^ y

j ' ' \t l 

## y i ^

/ Composit e Reading s (Bag )



# 7 b 4 9 

# 1 y y XR F Coi^ecte' d Valu e ­ > (us e calibratio n char t o rad d 20 % t o value ) Composit e Averag e

(Bag ) 

# iiL e 

# \ y Composit e (Drie d & Sieved ) Analytica l Spil t Sen t 7 La b Numbe r Analytica l Result s

Sampl e Are a Pass/Fai l ? Aliquo t 1 I n Sit u Readin q Composit e Reading s (Bag ) Composit e Averag e

(Baq ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t 7 La b Numbe r Analytica l Result s 2 3 4 XR F Correcte d Valu e - > (us e calibratio n chart o rad d 20 % t o value ) li% t ADDIIIOHA i SHtfI S I F XR F Technician' s Signitur e Hirin n 5tt . 

# ^ , l^o?)q^4 8 Name : f^U/ a 7\n/7{/Jor ^ Address"^Z^o g fihICmy Phone : ^4^.^ J ^y^y-'-Jty j 

# 1 C^/S5 ' y(yu-'^y^ — Omah a Lea d Sit e Site Sketc h 

### Date : 77/7( 3 ^7z7o' > Time : /2^^.5 " .CX ^ 

## y 

# P.2-/ ^ /< ^ Nort h Arro w 

# t Tea m ^/^J^^A ^ /^/J(JU( ? BV1D # 3 i 7^ ^ XR F Cod e 

# IM i Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## pYe s n N o 

# 7'y7)fz:f&i p 7>in(p ^ ,.( - ^j» y• pp m pZYe s 6 ) Ye s g>ZYe s a a ^ N o ^
- 

## N

o M No m No/ S (;/l2.ggy > pp m Ye s n 

### N o n pp m Ye s • 

### N o •



# j^i?g ^



# p I ^ ) Kni ^ OmahaLea dSite 4613 0V*"***^' ' COASTA L ^ , _«C . EHVmONMJNTA l

' »*Ol * C < O U » . IN C 

## 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 : 

# euz/ ^ Owner' s Name : - ,> . ^.^ ^ ^ , 

### Daytim e Phone : 7J^3'^/Ci' ^ 

# A7^T7>e^S07 U 

# z^o s /^AJ/eiV ^ Addres s o f Propert y 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 f lea 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 f Coasta 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 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 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 f 2S^^^ / COASTA L CROUP , INC .



### •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 an d safet yguidanc e provide d b yEPA ; • I f th 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 f th e property . AGREEMEN TNO TT O INTERFERE 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yofth e wor k activities , o rwit h an y o f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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 ^

I gran t access t o m ypropertie s D I d o not gran t acces s t o mypropertie s 

# 777, ^ y /yyiyUy y yy^^^My ^ Signature Dat e Signatur eDat e

,

^

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

# 1 Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o 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 tha t restoratio n activitie s ar e complete dt o th e satisfactio nofth e propert y owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert y ID : ^(7<^g , Propert y Address : 2.^5^3 ^ T^V^^/gy Owne r 

# GLj/ A z^ub-e/esai ^ Phone : </5-3.<9r/^ 3 Onth e attache ddiagram(s ) indicate area(s ) t o e.xcavate danddept ho f e.xcavation . locatio nof al l Icnow n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e usedb y contractor , andth e directio no f North . Indicate distances , depths , material t>'pes . etc . Indicate digita l photo s b

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

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

### Th e removs! . storage , disposal , and/o r retur no f thes e item s i s th e Owner' s 'esponsibiiitv' . Item : 

### ^/l^yT i 

# / / P c C/lAJI S Ite m 

# UMt ^ i^-ry ^ 'D/zi\7eoJA( / Item : Item : Item : Item : Item : Item : Pag e 1 of ^COASTA 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 : 

# L)o/o € Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 of .COASTA L P . I n ^ 

### 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 : 

# 5o h Item : 

# SOI L Item : 

# vu^x € TQCK
- Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of .COASTA L



## 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 inch trunk diamete r

Numbe r o f tree s < = 2 inch trunic diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves . Timers . Heads , etc . AUUL-I I i l skeicl : o! ' I'-' e sprinkle r iavout .
Numbe r o f an dsiz e of eac hgarden/ flower bed area . Auacl i .nskeic no \relativ e <i;'e
- an J locaiioni . 

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

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

Squar e fee t

Each 

# '^4V t 4/ / 

# f^5e.6t7S^ ^ Eac h

Eac h

Eac h Squar e Fee t

Pag e 4 of .

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e of plan t material s no t t o b e reolace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t \ouche r t o th e propert y o\>ner . Agree dupo nlis t o f plant material s that wil l b e replace db y contractor . B e very specifi c anddetailed . Includ e asketcl i o f wer e eac hplan t will be place d b_

\th e coniracior . Agree dupo nare ao f properr> ' t o b e replace d wit hgras s sod .

• iiclud e a^keu: ho f ihc area(s ) l o b e repl'jccc ! w ;ii i yras s >c.d . .Are ao f Cit y or Count y propert> ' t o b e landscape d pe r thei r requirements . liKluLi e <- . -keu-ii of ;hc ' 1 rive ais )

Easemen t Area , t o b e excavate d 

# 0 $



# l/Ji/iv e Each 

## ^^.^<,Cd ^ yy^^i p

S F 1



### SF

S F

Pag e 5 o fCOASTA L ENVIRONM C NTA L 

### Additiona l Comments / Instructions :

• Chec k th e boxi f Owne 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 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 . j 2 I agre e O I d o no t agre e 

# ^_?i^:a 7 Owner' s Signature Date Contractor' s Signatur e Date Pag e 6 of .