## TRANSMITTALo f

OMAH A LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R 

# SAID

- _'^ki'}__
. Date
- 

# _^yj^jj_ v Addres.s
. UU 0 H Reniediatio nConlraclor
. Coasta l Environmenta ) Grou p Year : iOJOARRA
SOILREMEDIATJO N PROPERT V FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# y Executiv e Summar y 

# y EPA-provide dproperty sketc h Signe dAcces s Agreement fo r subjec t properl y 

# y Signe dAcces s Agreement(s ) fo r adjacenl property Restoratio nAgreement 

# Y Settlemen t document s (i.e. , fo r damag e or t

o replac e plants , elc. ) Confirmatio ndat a p 7 Photograph s 

# y As-buil l sketc h 

# y Satisfactory restoratio nsigne dby Property Owner 

# y Propert y close-ou t check lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanu p criteri a Utilit yclearance s ^ 

### Propert y informatio nfro mDougla s County Assessor' s Offic e

Superfun d

# v v Propert yAcces s Checklis t Propert y ID : Hi^ B - H D WOR K STARTE D ON : / / D WOR K COMPELTE D ON:
. / / PropertyAddress : \^Z ^ / O ^S-/ " Owner : Renter : • ^WT ^ Address : Phone : Fax : Ceil/Pager : Phone : Additiona l Information : 

# ^W ^i < Fax : Cell/Pager : D Notificatio nLette r Sent : / / By : ^ Acces s Agreemen t Signed : pl/i
. I f O By : U:c V [ ^ Restoratio nAgreemen t Signed : 4^^/ ^ By : w-,c X D Topsoi l Samplin g (i f applicable ) / / By : O Disposal Samplin g (i f applicable ) / / By : Q Garde nSamplin g (i f applicable ) / / By : 1 3 Utility Clearanc e CaUed : \\/ " 5 / \ o By : vv./<v/i o VJ^^IM.. ^ 1 ^ Video/Photo s (Before ) 

### On : 1 0 

### /Z\ , 1 / o By : K...V L D Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : O Propert y Completio nAgreemen t Siened : / / By : GFina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable )
• Conununit y • Cre w On : / / 

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• Conununit y • Cre w On : / / By : Results :

• Communit y • Cre w On : / / 

### By : 1 Results :
Omah a Lea d Sit e

## Dougla s Count y Accoun t ^|^|atio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R041414000 0 Prin t Reoor t Vie winteractiv e Gi S Ma o Informatio n i s vali d a s o f 2010-8-3 0 Treasurer' s Ta xRepor t Ne wFeatur e «t'^ ^

Subdivisio n Sale s Searc h Owne r CHAVF7JUA N 493 2 S 1 9 S T OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumtter : 141 4 000 0 0 4 Accoun t Type : Residentia l Parce l Numlier : 041414000 0 Parce l Address : 182 2 OS T OMAH AN E 68107-000 0 Lega l Description : SOUT H OMAH ACITYLOT S LO T 1 1 BLOC K10 8 W 4 0 FTLT1 0 & W 4 0 S 2 5 FT 40X7 5 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota i $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 6 3000. 0 0. 0 75. 0 40. 0 Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R04..
. 9/15/201 0

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t ] Bac k t o Irt h Inteme t ] Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2635799
. Origina l Cal l Date : 11/05/1 0 Time : 12:1 5 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : ll/09/l O Time : 12:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 182 2 Street : O S T Twp : 14 NRng : 13 E Sect-Qtr : 03-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 : FA X 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 Come r Lot : N Front : Y Rear : Involve s Tiinneling o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C 

### N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/5/201 0

## Pag e 2 of 2

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS..
. 11/5/201 0

# ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 4858 7 Dat e Excavated : 11/9/201 0 Dat e USEP ASigne d Off : 12/9/201 0 

### 4858 7 Are a Sodden : 87 0 s a f t Omah a Lea d Sit e Exterio rPain t NcMt h Arro w Owne rName : JUA N CHAVE Z D Goo d Sit e Sketc h Address : 182 2 OS T • Ppo r (

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Omah a Lead Sit e 4613 0



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are a replace d wit h Rock/Mulc h Are a lef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

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# ENTERE D iSE P 1: 3 200 5

Omah aLea dSit e 4613 0

### >*—* *

COASTA l iNVmONHfHIt l cI t 0 u rI * t c 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO 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 rits authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e aotiyitie. s jjpQ n th e followin g describe d premises :

Owner' s Name : Daytim e Phon e 

# 7
. y > So ^ 

# I { A^c^O h (K.VQ

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# / yr^[ f
Addres s o f Propert y covere d b ythi s 

# j/-^ ^ 

# o y 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 that contain s elevate d concentration s of lead an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove 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 work i s bein g performe d unde rth e Omah a Lea d Superfun d Site remediatio n program . Arepresentative 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 perfomned , th e Granto rwil l have a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Onc: e th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive writte n documentatio n fro m EP Athat th e propert y has 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 , its 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 of performin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f 2

### > »'<v
. COASTA L 

### \ IftVIHOHHEKTA l

'^ l PROt* ^ C H O U P t KC 

### ( Remov 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 ywis h t o save ; cWate 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 ; f 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
. c

Allo wvideotapin g and/o rphotographin g o f th 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 f th 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 (402 ) 991-119 9

dlgr a D I d o no t gran t acces s t o m ypropertie s I gran t acces s t o m ypropertie s 

# /(P'^l^/ O Signatur e Dat e
DI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f 2COA S T AL • HVinOMMIMTA L a • O U P
. IMC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s t o condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r the purpos e of assuring tha t restoratio n activitie s ar e completedt o th e satisfactionof the propert y owne r andthe UnitedState s Enviromnenta l ProtectionAgency (EPA)
.

Propert y ID : ^ / ^f ^ Propert y Addres s 

# O S T Owner : ^ UCK ^ Phone : 

# r/ yry/j T O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y dociunen t the existing condition s ofth e propert y an dthe basemen t i

f necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretu m o f thes e item s i s th e Owner' s responsibiiity
. Kem : 

## AyZ 7 -770
. Item : Kem : Kem :


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

# y i y

# z > /y(^ — Kem : Kem : Kem : 

# 7 Pag e 1 of
.COA S T AL • NViaONMSHTA L O M O U P
. INC
. 

## Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d Kem : 

# r^ 

# A Hem : 

# s o 

# i Kem : Kem :



## Ite m Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r o f tree s > 2 inc h trun k

diamete r Numbe r of tree s <= 2 inc h trun k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r of an dsize of eachgarden / flowe r be d area . Attac hasketc hof relative size s an dlocations
. Agree duponvalue of plan t material s not to b e replacedb y conttactor . Not e thi s valu e will b e usedt o issu e aplan t voucher t o th e propert y owner . 

## Landscap e Inventor y Quantity 

# y ­ / 

# ro .^0 ^



# y y 

# y

' 

## Unit Condition/Type/Specie s Quadrants
Eac h Eac h

Eac h

F.ac h Squar e Fee t

$

Easemen t Area , to b e Eac h 

# f^fl^'^ g ^^s o 

# y excavated 

# 2 Pag e 2 of
.COA S T AI
. • MVmOMMaNTA L O B O U r. INC
.
AddKiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohib Kyo 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 underiyin 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 f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi 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 cKe d b yth e cKyi f yo u us e a grave l o rdir t are a s » a drivewa yo rparkin g area , no t wKhstandin g an yremova l o rreplacemen t o f soi l b yth e EPA
. I f yo u hav e an yquestio n abou t legalK yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cKyo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. n Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. 

# ' C/^
. 

# ' 

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D Chec k th e bo xi 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
. 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 f house , includin g foundatio n crack s o rfissures
. 

### nI d o no t agre e 

# i ^ pTiSu.^^ ^ fOl^h/ ( Date Contractor' s Signatur e Date Page s 

# .' }

### 1 

# 48^-^ 1 BVID # 

### XR F PROPERT Y SAMPL E SHEE T Dat e Projec t 

### XR FID # 

### shot # 

## X^ o Vd \ '^'ffl A Averag e

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## 2^ H 

## T.eS ' ^"d ^ Averag e

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## H: ^ ^V 3 \ " 

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# \ 3 / Averag e Readin g Sampl e are a Shot # Dept h Averag e
RETES TAREA S Readin g Sampl e are a Shot #

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. Sampl e are a Dept h

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Readin g Sampl e are a Dept h

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 f Verificatio n

28 3 SOI L 2011-02-2 2 19:5 4 90.7 6 Fina l Av g o f 280-282 1 182 2 O St ^ F 2 4 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 1

XL3t-3902 2 Readin g No 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 192.73 3 Supervise d By : 

## Certificat e o f Verificatio n

28 0 SOI L 2011-02-2 2 19:5 3 30.2 8 Fina l 4858 7 182 2 O S T F 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.10 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 193.28 2 Supervise d By : 

## Certificat e o f Verificatio n

28 1 SOI L 2011-02-2 2 19:5 4 30.2 4 Fina l 4858 7 182 2 O S T F 2 4 " C.PADILL A CONFIRMATIO N CLEA R

Erro r ± 21.89 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 194.11 4 Supervise d By : 

## Certificat e o f Verificatio n

28 2 SOI L 2011-02-2 2 19:5 4 30.2 4 Fina l 4858 7 182 2 O S T F 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.59 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 f Verificatio n

28 7 SOI L 2011-02-2 2 19:5 7 90.1 1 Fina l Av g o f 284-28 6 182 2 O S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 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 51.70 7 Supervise d By : 

## Certificat e o f Verificatio n

28 4 SOI L 2011-02-2 2 19:5 6 30.0 2 Fina l 4858 7 182 2 O S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±13.59 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 53.29 3 Supervise d By : 

## Certificat e o f Verificatio n

28 5 SOI L 2011-02-2 2 19:5 7 30.0 5 Fina l 4858 7 182 2 O S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 13.75 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 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 45.41 2 Supervise d By : 

## Certificat e o f Verificatio n

28 6 SOI L 2011-02-2 2 19:5 7 30.0 4 Fina l 4858 7 182 2 O S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r ±

13.37 3

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta i Grou p Inc
. www.coastalhazmat.co m COASTA L IN«l>ONMiNTA l G > 0 U P , IN C 

# EXECUTIV ESUMMARY : BVID #48587-(182 2 O ST ) No Issue s o r Concern s I I Issues/Concern s Detai l ExplanationSti! ^ 

## EP A Propert y Clos e Ou t For m ^I ZO'TT T Propert y # : 

# . t Propert y Address : Date/Time : Owner' s Name: . / ^ 

# 1 2 

# m ,73^L Quad s Excavaled : 

# P E Contracto rGrou p (^'ft* ^ ^ & Excavatio nGenera l Yes N o 1
. i r necessaiy , wer e th e conrec t quadrant(s ) excavate dan drestored ? 

# y 2
. I f necessaiy , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradlo e So dan dVcuctalio a Ye s N o 1
. Doe s th e gndin g aroun dth e perimete r ofth e hous e i nexcavate darea s generBlly slop e awa y / fromtb e house ? 2
. Ha s so dbee nlai dmal l area s that wer e excavated ? 

# y 3
. Doe s di e so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e if inspecte da t a3 0 

# y da y tim e period ) 4
. Ar e sodde darea s generall y firman devenl y graded ? 

# y 5
. Ar e di e joint s betweett th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

# y tim e period ) 6 . Wa s th e property grade dsuc hthat wate r wil l no t poo l o nth e property ? / 7 . Wa s damag e l o landscapin g o r plan t material s avoided ? 

# 7 Gates
. Fence s ant l Retafailn g Wal b Vt s .N o I 1
. D o gate s ope nan dclos e freely? (I f applicable ) 

### y 2
. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

## 7 3
. Wa s damag e t o gate s o r fence s avoided ? (t f applicable ) 

## 7 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## 7 Foundation , SidiB Ran dGulttr s Ye s .N o I . 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 ? 

## y Wa s damag e t o window s avoided ? / A Wa s dainag e t o window s o r doo r screen s avoided ? / S
. Wa s damag e i o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o I . Wa s damag e t o drivewa y surface s avoided ? / 2 , Wa i damag e t o walkwa y surface s avoided ? 

# T

## Ort'oer s comnieiits :

I 

## pjinspectio nnotes :

Removal andrestoratio naclivale s coinpiel e includin g th e 30-da y so dwarranty : EPA Representativ e fto^ A^' y Date : »*M'£
_I 

## Propert yCompletio n Agreemen t Thi s agreemen t documenl i lh e completio n o l remedia l activitie s perlbime d o n m ypioperl yM ysignature wil l designat e tha i I a m satisfie d wit h (h e restoralio n o f m yproperly , an d tha i n o item s ar e i n queslions
. now . o ra l an ylim e i n th e future , excep l thos e item s liste d below , ifan y

Propert y ID : 

# ^/5^ ^ PropertyAddress : \^l^Z^{ ) %f " Owner : -g^jQU ^ 

## Phone : 7/^

- U/<y 

### 0 

## S^7. ^
- Restoratio n Item s i n Question :

Item : Item : item ; Item : Item : Item :

I I agre e rKtoralio n i s completed , rxccp t a s noler i I d o no l ii|>rt crestoratin n i i complete d

Contiactor' s Signalur e