TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Jl/7):7y f Date: ^?/^ ^ 

Address: ^O B /y^pployfOf) 

Remediation Contractor: _Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

H Video of property (DVD) 

M Executive Summary 

m EPA-provided property sketch 

M Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

D Settlement docmnents (i.e., for damage or to replace plants, etc.) 

[ / Confirmation data 

/ Photographs 

M As-built sketch 

M Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D , 

0 • • • • • . ' ' 0 • 

•^7jy7ad 

Date 

40317912 

Superfund 
Final Report Property Check List (piease place with each file) ^/Oyy j 

Hard Copy Information <=y^S(' ioppOi^t^a^ 

1. Property Check List :! ^^ ^ ° f\\ri_ 

2. Site Working Drawing Map ,' 

.3. EPA originals Map ' 

4. Douglas County Assessor's Map ;; 

5. Property Contact Sheet ;| 

Agreement 

1. Access Agreement 

2. Restoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

,1. XRF Data 

4. Any einails or PO airrespondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3. Pro petty Completion Agreement 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

6. EPA Property Close Out Fonn 

7. Attached Begin Video 

Electroni c Documentatio n 

Drawings 

1. EPA original 

2. Working Drawing 

.3, AS Built.vso 

4, AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

3 Sod Photos 

4 3()-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

' Begin Video 

2 My Movie 
I^BB! ^ 

Property Access Checklist 

ProipertylD: ^^\0^< \ 

Property .4ddres.s: ^^ ^ Pcsppl^-Jt A . f^ 

n WORK STARTED

n WORKCOIVIPELTED

/We 

Owner: f^^^] ^ C « Pp f I U n O 

Address: 

6^5 Pcppk-itia 7\^^. 

Phone: %t O -\0^ ^ 

Fax: 

Cell/Pager: 

Renter:

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

ON:

 ON:

 /

 /

 /_ 

/_ 

j 

1 1 Notification Letter 

1^ Access Agreement 

IS Restoration Agreement 

1 1 Topsoil Sampling (if applicable) 

O Disposal Sampling (if applicable) 

1 1 Garden Sampling (if applicable) 

S Ltilitv Clearance 

13 Video/Photos (Before) 

n Video/Photos (During) 

n Video/Photos (After) 

n Video/Photos (3«-Dav) 

n Property Coni|)letion Agreement 

• Final Report 

Sent: / / 

Signed: q / f 0 / 0 7 

Signed: _3:/ji/0 2 

/ / 

/ / 

/ / 

Called: l6 / 2 / 6 7 

On: / / 

On: / / 

On: / / J 

On: / / 

Signed: / / 

Issued: / / 

Bv: 

B­ CjHr.'s 

^y- c7f\(\s. Bv: 

By : 

By:

«>io/ 4 -z-.*

By: 

By: 

By: 

By: 

By: 

By: 

/|«T/-Z«0 5 

II 

j 

Air Monitoring (as applicable) 

1 1 Conununity CU CrcM 

Results: 

On: / / By: 1 

1 1 Communitv

Results:

 CU Crew On: / / By: _ 1 

j 

1 1 Comnuinity

Results: 

CU Crew On: / / By: II 

Omaha Lead Site 
^// 9 f/^/77y 

Total Qi^^ri t Square Footage to be Excavated = 892 (c/7% ^y^y^ 70^ ^ TotalB^r Zone Linear Footage to be Excavated = 0 Property Classification: 800 

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Noilh Arrow Omaha Lead Site 

Omatia, Nebraska 

A 

Property Number 

OLS-2102 9 Scale 

Property Address 1 Incti = 20 feet or 1 grid = 5 x 5 ft 

508 POPPLETO N AVE 

Post Excavation Concentrations (ppm) 

- Streel aounc r •• Fl i^iay ^Arec d i y 

• ' ro( nq c, !i>-

F2 

Eas ;merr 0 — t Tree/ Shrub 

S,.p.^ ^ ^ 

B _

 Garc Othe r 1 

Description of post excavation areas: Fl,front yard left-hand quadrant, F2, front yard hght-hand quadrant; Bl, backyard left-hand quadrant, B2, backyard right-hand quadrant; 

D2, drip zone (1 -3 foot area of soil around the foundation of the house) 
• • 

Total Qt-^Blh: Sqi jare Footage to be Excavated = 892 

• Total W^on e Linear Footage to be Excavated = 0 Propertv ( DIasslficat on: 800 

-

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Legend North Arrow Omah a Lea d Sit e 

p^;-^ Concrete N Omaha, Nebraska 

\ y j \ Excavated Area A Property Number 

OLS-21029 W M Scale • Fence Property Address 1 Incti = 20 feet or 1 grid = 5 x 5 ft 

Permanent Landscaoina 508 POPPLETON AVE ^ 

Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary ?Jt |V HG L Fl B2 Plav Ares ydm<..rol.oglc, Irk: \ J ^ i = t Tr( ;e/Sh rub — O ^<«Pn» y Bl _ Garc Jen_ Othe 

Description of post excavation areas: Fl, front yard left-hand quadrant: F2, front yard right-hand quadrant; 81, backyard left-hand quadrant; 82, backyard nght-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house) 
2/0Z7 

Nanne: Tr-c-^K Cc^ft^ yi^O Omaha Lead Site Date; (MCm S North Arrow 

Addressi "TO^, c^Cfpl^'VoA Site Sketch Time: {1 ! L* 

Phone: 

1 

5f^/;^.' LA Vnte • g-f-cj- n^ne: P/vi 

Team f{] K Gjj(^ M BVID# -2101^ 1 XRF Code /03 7 /?oc?^//9 

Sample Number Lead Concentration Confimnation Sample 

PVCS^>^-£/Q2 1 4

KiO^CPKA-2./0^'i

 ^^ 8/ gl. Ihh 7.0'i 

ppm 

ppm 

ppm 

ppm 

FiYes

F2Yes

©VYes

62Yes

 n 

a 

Q 

^ 

No —, ra^

No ^ 

No ra^ 

No 'S ' 

43g ppm Yes n No n 

t€rE ppm Yes n No n 

-pg. ppm Yes • No DE 

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( 

5^tfJff)eV' 

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Omaha Lead Site 46130 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 1912805. 

Original Call Date: 10/12/07

Work to Begin Date: 10/16/07

 Time:

 Time:

 1:56 pm 

 2:30 pm 

Op: LORI18790 

State: NE 

Address: 508 

County: DOUGLAS 

Street: POPPLETON AVE 

Place: OMAHA 

Twp:

Twp:

 15N Rng: 13E

 Rng:

 Sect-Qtr: 26-NW 

 Sect-Qtr: 

Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: 504 POPPLETON ALSO. LOCATE ENTIRE PROPERTY 


Remarks: UNSURE IF CORNER 


: RESENT DUE TO WORK EXTENDING, REFRESH PAINT 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name: LORI Phone: (712)352-0188 


Alt. Contact: NONE 


Work Being Done For: EPA 


Depth of Excavation: 3FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MCI MCLEODNE MUD02 OMAHACOF 0PPDGPR6 


QLNNEIF QWEST2 


Service Area Contact Phone Number 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 

COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCI MCI NO CALL PER MEMO 

Day: 

Alt: 

8002893427 

Emerg 8002893427 

MCLEODNE MCLEODUSA DO NOT CALL OUT 

EMERGENCIES PER MEMO 

Day: 

Alt: 

8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/12/2007 
Page 2 of2 

MUD02 

OMAHACOF 

OPPDGPR6 

QLNNEIF

QWEST2

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

 QWEST LONG DISTANCE

EDWINA 

RON 

NA 

 NA 

 SARA 

Emerg: 8002891901 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

Day: 8002834237 

Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/12/2007 
ParcellD 0323240000 

Parcel City Omaha 

Parcel Zip fyHIOH-OOOO 

Owner Name C.appellano Frank 

Owner Address 

Owner Address 2 504 Poppleton Ave 

Owner City Omaha 

Owner State Ne 

Owner Zip 6SI0H-()mm 

Addition (UyLois 

Acres 0.09 

r­

— 1 

i L. L ..1 . 1 . ,.J 

« 

-GQgQ§|Q3~~ 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

^ \ 7^^S\ 

So?> fopp(^-h)>V A\Jf 

Date: Time: Action:_ 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 

R f^0\l\K9r^ 

l^y^ioK 

7\Ja P-ySuy{/­

^//^/oT- /err-P//7y7i yj r 

7/J 

? 0 /.,>y^ 7-3gfeg^ ^^ 

-y 7y/fy/^!^jfM^ 

^eA^^r^f (KAhr^^\ s,, yy^^ . 
,,vto su . 

COASTA L ENVtHONMENTA L 

CROUP . IN C 

• Consent For Access To Property > > 

RIGHT OF ENTRY TO PREMISES ;-, :.t*/4/f. 

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 Name: Daytime Phone: g , g ^ - / ^ ^ 

7t^j>/t cjf^y-^ t 

Address of Property 

covered by this 

Agreement: ^0% ?on^yy s y 

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 performed, 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 Grantors 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 
m •

 • ^ 

%^^*^ ^ COASTA L '*'^ , .eC''"*

 ENVIRONMINTA C U L ft 0

 P , INC . 

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

piles, dog houses, etc; 

• 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; 

• 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 (877) 234-6270. 

I grant access to my properties CU i do not grant access to my properties 

'-/y ? 

Date Signature Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the 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). 

Property ID: ^(G7J 7 

Property Address: ^Cf ^ f h PT^tyTVAJ 

Owner: -p^^^^j ^ (L^^^lCT ^ C 

Phone: yTsO - )09 ^ 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The rennoval. storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

UCi hiC 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

uo y 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees < = 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves. 

Timers. Heads, etc. 

Anach a sketch of the 

sprinkler la\out. 

Number of and size of 

each garden/ tlo\ ver bed 

area. 

.-\tiach a sketch ot relaii\e 

sizes and locations 

Quantity 

^i-L­

] 

Unit 

Square feet 

Condition/Type/Species 

y Each 

d Each 

0 Each 

1 

7 Each 

Square Feet 

Page 4 of. 
COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

xoucher to the propeny 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

b\ the contractor. 

Agreed upon area of 

propert>' to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

.Area of City or County 

propert>' to be landscaped 

per their requirements. 

Include a sketch ol the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

y $ 

7 Each 

m ^ 

SF 

ny ^e 

\y^ye.^\Ci 

SF 

i 

SF 

Page 5 of 
COASTA L ENVIRONMENTA L 

CROUP , INC . 

Additional Comments / Instructions: 

• 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. 

• I do not agree agree 

7-/y^> cJ7. ' 9/yoy Owner's Signature Date Contractor's Signature DatZ ( ' 

Page 6 of. 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID lO-lL-Dl ^ Ziol9 

Property Project Omaha Lead -- Fixed Price Address .^ ^ ht;yh76y} A-/F 

Measurement XRF ID 0107-51 

Count/Time 

Field Shots 

Shot # Reading Sample Area Shot * Reading Sample Area 

t% 190 &(kSe/nt/tt je^/i . 

-iMf*- r/ a tf 

I61 Ifl P\ v-fc 

XRF Corrected Value

Sample Area ^aQ/^tflf hjtti 

Aliquot 

1 

I n Situ 

Readinq Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

/TV 

Zoo 

il l 190 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 1 5 6 

Sample Area cr q^io Pass/Fai l ? 

Aliquot 

1 

I n Situ 

Reading 

llC 

Composite Readings 

(Bag) 

Composite 

Average 

(Baq) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

t i mu 

•?•/ 

ay /ZO 

i s t / /7 

5 (use calibration chart or add 65- - > 

/V9 20% to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 

2 

3 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

20% to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) ? 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) ? 

2 

3 

4 

XRF Corrected Value - > 5 (use calibration chart or add 

20% to value) ^—, 

y.9f AODIflONAL SHfFIS I f 

XRF Technician's Signiture HflDH t 

\ i 
/0^oi 5 l^O^^ijP >a>" (7^M7 yyTTyf'-y 

A.L ^ \ \'\oy=\'7yh, Totalll ^ nt Square Footage to be Excavated = 892 

( ^ r^.'/' 7c y Total.- .fj Zone Linear Footage to be Excavated = 0 Property Classification: 800 

Description of post excavation areas: Fl, front yard leB-hand quadrant: F2. front yard nght-hand quadranl: Bl, backyard left-hand quadrant: B2. backyard right-hand quadranl. 

DZ. drip zone (1-3 foot area of soil around the foundation of the house). 
X 

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. ^ < # www.coastalhazmat.com 

COASTA L ENVIRONMENTAL 

6 R O U r , IN C 

EXECUTIVE SUMMARY: 

21029—508 POPPLETON AVE 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
^ As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadom square lQt)eExcwiAea-892 

iMal Diil|)Z«ie Ln» r ftiixerty C&Bdllcaboti: 800 tobeExcavaiECl-a 

Slope DZ away from 

the garage. 

F l = 11£ 

EA-S= 190 PPM 

M-Stt: 21029 

r7~\ Da|?,Ej<iCayated: 10/13/07 

}&ste U|EP A Signed Off: 12/1 5/07 

•—•— • Ftnx 1 wen -

O ;5t

Area not Excavateti 


^'' • 

- : >f 

-y.­

oppi<3ton/ivenuij 

NorflYAncNt Omaha Lead Srte 

A Phip«rty Number 

OLS-21029 seiM 

Praperly Address

20 TBet or 1 j M - 5 1 5 It 508 POPPLETON AVE 

Ptist Excauaten Concentrations tpfxn]

• HG L Fl B2 PlayArea • H e F2 DZ &»anent 

Bl Garten Otier 

»iiw< 1 , >^e^t|l•<al^iM>l^^^ll^lHC6^«>»M^^^»»^«l>a^pllll^i^ 

Legen d 

^ 

Dripzone Excavateti w^ Quadrants Excavateti 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc , 
S ) ^ EPA 

EPA Property Close Out Form 

Property #: o^* 0 ^ ^ Property Address: t-,o9, pr^pplfJx)A 

Date/Time: t| /^ J Chvner's Name: ^ro^Y^k 'r i [^p-^ "AY I O 

Quad Contractor Group Cs^'at'^ s Excavated: 

Excavation Yes General 

I. If necessary, were the correct quadrant(s) excavated and restored? 

y 

2. If necessary, were the connect areas of drip zone excavated and restored? A/AGradine Sod and Vecetation 

Yes 

1. 

Does the grading around the perimeter of the house in excavated areas generally slope away y from the house? 

2. Has sod been laid in all areas that were excavated? y 

3. 

Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) y 

4. 

Are sodded areas generally firm and evenly graded? y 

5. 

Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day y ^ 

time period) 

6. 

Was the property graded such that water will not pool on the property? y 

7. 

Was damage to landscaping or plant materials avoided? ^ 

Gates, Fences and ReUining Walls Yes 

1. Do gates open and close freely? (If applicable) 

y 

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

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

y 

4. Was damage to retaining walls avoided? (If applicable) 

y 

Foundation, SidinK and Gutters 

Yes 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? 

y 

 No 

No 

No 

No 

 No 
Owners comments: 

Inspection notes: 

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

EPA Representativ;&-7::^^£^:3•^^^£..<^:^yX^ Date: /^j^T " 
> < ^ 

Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My .signature 

wil] designate that 1 am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the future, except those items listed below, if any. 

I Property ID: ^ | 6^C ( 

Property Address: ^(-VGL g> p6pp'-cit>r\ hrc 

Owner: :f^, ^ t < Cc^pp^Wcun n 

Phone: g g)0 - 1 Oq ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

^ I auree restoration i.s completed, except as noted 

 I I do not agree restoration is completed 

y y%yyy7o)> 

Owner's Signature Date 

I