### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : .^nS ^ • Date : ^/^/pB / 

# Address : ^JU-^ ^ T^Aar/^ s Si ~ Remediatio nContractor : _Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDL^TIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f property (DVD ) 

# y Executiv e Summary EPA-provide dpropert y sketc h 

# y Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacent propert y M Restoratio nAgreemen t D Settlement docviment s (i.e. , for damag e o r t o replac e plants , etc. ) E'^ Confirmatio ndat a M Photograph s ^ As-buil t sketc h M Satisfactory restoratio nsigne db y Property Owne r M Property close-ou t chec k lis 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 •" 

# ^73777 3 

# ^^'4^^«^^^^^^^''^ ^ ignatur e ^" ^ ' Dat e 4031777 0 Superfun d

## Fina l Repor t Propert y Chec k Lis t (Pleas e plac e wit heac htiie ) Har dCopy Informatio n i . Propert y Chcci c [.is t /^^^^ ^ 2 . Sit e Workin g Dfawin g Ma p ^ . IAP A

### original s Map 4 . Dougla s Count y Assessor' s Map ,S . Propert y Contac t Sliec t ^ . ; / (iic^^ ^

Afjreenien t 1 . Acces s Agreemcii f 2 . Resloratio nAgreemen t Miscellaneou s Document s 1 . Final Map fro mth e Fiel d 2 . Chang e Order s
, 1 XR 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 3 . Propett y Completio nAgreemen t 4 . An y buyou t int o orreimbursemen l inl o 5 . Cheei< o r mone y orde r eopie s 6 . liP APropeil y Clos e Out For m 7 . Attache dBegi nVide o

I 7 •^ ' ! F^Iectroni c Documentation l)rawin<!; s 1 . HP Aorigina l 2 . Workin g Drawin g

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' ^ Scanne dDocument s Final Doeumeni s lixeeuliv e Summar y I 2 Video s

Begi nVide o M y Movi e

# e tQP ^ Propert yAcces s Checklis t Propert y ID : £57*54
- nWOUKSTARTli D ON : _ nwokKcoMPELiI: D ON: _ 

# -y- 1 1 Properl y Address : 2^2 2 CAo T )e S '^•^ • Renter :

Owner : p^^^ , ^< a ^S^rVLt'-l- k



# __J Address : ( Plione : Fax : Cell/P:ifjer : Ailditioiia l Iniormatioir . 

## Phono : B?>G'8ll 5 Fax : Cell/Pauer : Q INotificatloi i Lette r Sent : / / By : P ^ Aeees s Aj^reenien t •Signed : \ 0 1 t 1 O l 

## B>=CjKr; ^ K . Kestoratio n A}>reeinen t Signed : 1 0 1 ^ 1 O l 

# «>^Chrv S ­ 1 1 Topsoi l Sani|)liiit i (i f applicable ) 1 1 By : 1 1 Disposa l Sampling ; (i f a|)|)licahle ) 1 1 By : 1 1 Garde n Sainplin* ; (i t applicable ) 1 1 By :

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Video/Photo s (Betbir ) On:_L0/_^ / 0 1 

# ^ yN^r4\f..-f+- ' D Video/Photo s (Duiinji ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/IMioto s (3(I-Day ) On : / / By : 1 1 Pro|)ert yCompletio n A<>reemen f Signed : / / By : 1 D Fina l Re|M)r l Issued : / / By : Ai rIVIoiiiloriii ^ (a s applicable ) 

### 1 1 Communit y C UCre « On : / / By : ResuKs : 1 1 Commuiiit. \C UCre w On : / / Bv : Resid<s : 

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

# p^ ^ 07o/7t7^r710 /

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# Z5n3 \ H Name : t>kv«-f/>-t SmiZ- A Oinah a Lea d Sit e Date : t ^fs/a f Nort h Arro w [• Address : 3 aa 3 ^///faiS s t f Sit e Sketc h Time : /2 •• 3 5" Phone : S-S"6 - Stt S 

# ^ 1

Tea m g. s y^< ^ 7f^* ^ BVID # or? 3 7 XR F Cod e /0 3 7 goo K: / 3 2 Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e pp m 

### /^/Yes ° No ^ gVBSC/>XA-2573 W pp m f?Ye s n No ra^ f^Vg$^:/OxA-2S73 W pp m /J / Ye s a No ^ I^Vb-5cfiy.A-zsi3 H 

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## ci+A/txe s Omah aLeadSite 4613 0

### Dougla s County Accoun t InJfcriatio n Pag e 1 of 2

n|^ £ Dougla s County , Nebrask a Propert yRecor d - R202881000 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 SMIT H DWAYN E E 322 0 CHARLE S S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 288 1 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 202881000 0 Parce l Address : 322 0 CHARLE S S T OMAH AN E 68131-000 0 Lega l Description : PROSPEC TPLAC E LO T1 1 BLOC KC E 3 0 F T3 0 X 127. 5 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $2,100.0 0 $2,100.0 0 $2,100.0 0 $2,100.0 0 $2,100.0 0

$0.0 0 Improvemen t $18,100.0 0 $18,100.0 0 $18,100.0 0 $5,500.0 0 $5,500.0 0

$0.0 0 Tota l $20,200.0 0 $20,200.0 0 $20,200.0 0 $7,600.0 0 $7,600.0 0

$0.0 0 Sale s Informatio n Lan d Informatio n Acre s 0.0 8 S F 3810. 0 F F 30. 0 Unit s 1. 0 Dept h 127. 0 Widt h 30. 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/accountinfo.jsp?accountno=R20. . . 10/5/200 7

### Dougla s County Accoun t In|jmatio n Pag e 2 of 2

322 0 CHARLE S S T

liffl O

l-iti ) Proo t BTRf J Bum H 0ioc* i n I t 

### RANC H Clic k t o Enlarg e Imag e C I ic k t o Enlarg e Imag e Squar e Footage : 808. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Lo w Uni t Type : Condition : Averag e Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : Ranc h Rooms : 4. 0

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

Roo fType : Gabl e Foundation : Bloc k Floorcover : Allowanc e Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 189 5 0 0 % 189 5 10 9 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 808. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 20. 0 Porc h Sla b Roo fCei l 128. 0 Use r NE WROO F AN D WINDOW S 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 10/5/200 7

## Douglas County NE 

## GI8 Map

Oisdaimer: This map is not guaranteed to be accurate, correct, current, or complete and conclusions drawn are the responsibility of fhe user.

## Propert 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 'Z ^ "73 ^ 

# -^TTT ^ 7f/^/^/ysS7 ^ Date : y// ^ Time : 77<7 ^ Action : /WvW^^^ ^

Date : Time : Action : Date : Time : Action : Transmi t t o EP AD Othe r Action : DX • 

### /lfi^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 S ^^^ ^

° Coasta l Environmenta l Grou p Inc . Sy^^^y www.coastalhazmat.co m

%PRoit^= ' COASTA L ENVIRONMENTA L C B O U F , IN C 

# EXECUTIV ESUMMARY : 25734—322 2 CHARLE S S T N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanatio n

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e 2513 H

—Name : p'*M.'^/i < Smft- h Omah a L»ac i Sit a MoilhAirw r Sit e 5tc<!tc h Time : r- 2 - 3 i ^ / ^ i Tea m <-. a y^< ^ yf*' ^ BVID S a3~? 3 V

_XR F Cod e ^o 3 7 J&SJJ C : / ^ 2 Sampl e Numbe r Lea d Concentratio n ConMmatio rSampl e 

### £ i pp« n /HYe s a N o ° ^ fZt&SceXA-'Z5-f3 S f?Y9 « C 3 p p m ^ No 5 ^ 

# k <j / Ye a a ppn i JLUe - A*Ye « C D N o ^ PP«Ti N o ca r ppr- i N u P ­ ppi n Te s a W B P p p m Tt wa •N u P 

# IH l ^ii. 1 iiii i j^'iuyrrr : i 

### ftf^^' C Di g aroun d al l tree s remov e th e 2 ' wal l an d

concret e i f possible .

OLS# : 2573 4 46n D Orassht Dat e Excavated : 10/27/0 7 Dat e USEP ASigne d Off : 12/5/0 7 

### Legen d Are ano t Excavate d Dripzon e Excavate d Quadrant s Excavate d 

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

### S l ^ 

# EP A EP APropert y Clos e Ou t For m Propert y # : S-^ l Z7\ Propert y Address : ^ 2 2 . 2 CJl/ipj r i-^ 5 S^^ k Date/Time : Owner' s Name : pinjc^ypi ? "^p^/fTi ^ Quad s Excavated : Contracto r Crou p l^/rsrj': . ^r a\ Excavatio nGenera l Ye s No 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# 7 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? ^ ^ Gradin g So dan dVecetatio n I . 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 fromth e house ? Ye s i

/ No 2 . Ha s so dbeenlai dinal l area s that were excavated ? 

## y 3 . Doe s th e sodappea r to b e generall y healthy andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 

# y 4 . 5 . Ar e sodde darea s generall y fir man devenl y graded ? 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 ) 

# y y 6 . Wa s the propert y grade dsuc htha t water will not poo l onth e property ? uy 7 . Wa s damag e t o landscapin g or plan t material s avoided ? 

# y Gates , Fence s an dRetaininj ; Wall s Ye s N o 1 . D o gate s openandclos e freely? (If applicable ) 

## K; A 2 . Wer e all gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

## )( M 3 . Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

### /(i 4 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) ^ Foundation , SidinK "i dGutter s Ye s N o I . Wa s damag e t o th e sidin g o r tri mavoided ? 

## /U l 2 Wa s damag e to th e foundatio navoided ? 

# T A 3 . Wa s damag e to window s avoided ? 

## A/ A 4 . Wa s damag e to windows o r doo r screen s avoided ? \^ ^ 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

## A/ f Sidewalk s an dDriveway s (Concrete ) Ye s N o I . Wa s damag e to driveway surface s avoided ? t ^ 2 . Wa s damag e t o walkway surface s avoided ? 

## y 

# \/G^cyify ^ lo- f

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA^^Vi^s.QTM\v^y7SL^27!z^^^^a^t<.i:jL ^ Date :.^.^^m! " 

# ^'^ m Propert yCompletio n Agreemen t Till s agreemen t document s th e completio no f remedia l activitie s performe donmy property . M y signatur e wil l designat e tha t I a msatisfie dwithth e restoratio no f my property , an dtha t n o item s ar e in questions , now , o r at an y tim e inth e Future , excep t thos e item s liste dbelow , ifany . Propert y ID : Uy,- J ^y[ - Propcrt y Address : -^2-2- 2 C}\n r \e\ ^ \

Restoratio n Item s i n Question :

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

I agre e re.sloratio ni s completed , excep t a s note d I I d o no l a^re e restoratio ni s complete d 

# .f\^^.zf^y. ^ 17(7- 7 yyTyyy . y^ n (Twncr'. s Signatifr c Dat e "^ ^ Contractor' s Signatur e Dat e ' I

# y,-^ ) r^^j f " y 'O ^ •^oy^::> 7yo / A J ^ ^ ^ / Z5-13 H 

# 1 qIzga o TM tyy eyy^^ ^ 

# i '

Name : t>w/Q«|/i. g Sm't-t- h Omah a Lea d Sit e Address : 3 a J a ^fy/juts s -s r Sit e Sketc h Phone : 5^(a - Btl ^

• Cj , y^rv t ^ Tea m ' / ? ^ BViD#_a_£2l_j L Sampl e Numbe r Lea d Concentratio n 

## £ 7 pp m IZl/e>5C/>)CA-Z5l3 H pp m pp m 

### B l ^ pp m pp m pp m pp m Date : n7/s/a ^ Nort hArro w Time : tl'-'i ^ ^ 5 \e^FF : LAD<\f « •- tO-J-^S ' T"^e.-/>/ ^

_XRFCod e lo3 7 Bool C : 13 2 Confirmatio n Sampl e 

### /t/Ye s •No 2 ^ f^

2 Ye s [ ^ N o ^ ^ /

Ye s n N o ra^ ^Ye s n N o ra'

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Omah aLea dSit e 4613 0

### % PROPERTYCLEARANC E WORKSHEE T

Dat e Propert yI D 

## Id'ii'O l 25-73 y Propert y Projec t Omah a Lea d - Fixe d Pric e 

## 3ZZ Z C/^U ^ ^ r Addres s Measuremen t XR F I D 0107-5 1 Count/Tim e Fiei dShot s Readin g Sampl e Are a Sho t # Readin g Sampl e Are a Sho t # 

### £2A
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# l l 

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## j m
Sampl e Are a 

## eA- S I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 

### l y 3 

### "^ 7 

## b 8 4 

## z l XR F Correcte d Valu e — > ,5 (us e calibratio n char t o rad d 2 0 % t o value ) 

# 7 3 Sampl e Are a 

### F t 2.' ^ Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s ? 1 

### £, Z (Baq ) Sieved ) 2 

### ( 9 3 3 

### / lol . 

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

# n 1 5 2 0 % t o value ) Sampl e Are a 

### R l 7,- H Pass/Fail ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 

### ^ B (Baq ) Sieved ) 7 2 1^ 0 

### 9 / 3 

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# 7 7 4 I f i 

## J v XR F Correcte d Valu e -- > 5 

### 11 5 (us e calibratio n char t o rad d 2 0 % t o value ) 

# 7fc Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t 1 (Bag ) Numbe r Result s (Bag ) Sieved ) ? 2 3 4 XR F Correcte d Valu e — > 5 (us e calibratio n char t o rad d 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Aliquo t Composit e Composit e Analytica l Composit e Reading s L a b Analytica l Readin q Aupranf > (Drie d & Spil t Sen t (Bag ) 1 Numbe r Result s (Baq ) Sieved ) 7 2 3 4 XR F Correcte d Valu e — > 5 (us e calibratio n char t o rad d 2 0 % t o value )

iii i AUD I I IIIHA I mi l I t I I XR F Technician' s Siqnitur e Nffll l I I\T^^ > COASTA L ^ •rt* ' EHVmONMiNTA l CROUP , 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 Environnnenta 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 :

Owner-sName:^^^ ^ Daytim e Phone : ^^ ^

' ^ f^ '^ 

# ^7^777 7 

# 3-^r z yi/Ty/i^^^^ ^ ^T Addres s o fPropert 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 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 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 fperformin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f2

# m > •• #

%"••***% •COASTA L

••Si , ..« C IMVttONMIHTA l

' t PHOT * ca o u r. i > . 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 maywis 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 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 INTERFER E 

### 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 equipment 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



# pi g I gran t access t o m ypropertie sD I d o not gran t access t o m ypropertie s
Signsitur e / Dat e I | Signatur e

Dat e
C

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

### Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e a mutua l agreemen t as t o condition s ofth e propert yprio rt o remediatio n activities . Thi s wil l als o serv e as documentatio n fo rth e purpos e o f assurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n ofth e propert yowne ran d th e Unite d State s Environmenta l Protectio n Agenc y(EPA) .

Propert yID : Z- ^ V'S H Propert yAddress : ^-^" ^

^ 7'y7A7^7^ ^ * S T Owner : TTyuTiUyJ ^ ^yt^yry i Phone : O n th e attache d diagrain(s ) indicat e area(s ) l o excavate d an d dept h o f excavation , locatio n o f al l know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s location(s ) t o b e use d b y contractor , an d th e directio n o f North . Indicat e distances , depths , materia l t>pes . etc . indicat e digita l photo s b yreferencin g th e photo-lo g numbe rwit h a n arro windicatin g directio n o f view . 

### Itenri 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 removal , storage , disposal , and/o rretur n o f thes e item s i s tn e Owner s responsibility .

Item : Item : Item : Item : Item : Item : Item : 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 : y 

## iy>Ky7^y:7y/ ^

7 P ^6^3766 ^ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 o fCOASTA L 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 ) Ite m 

## oi > Item : 

# 5 o/ U Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o fCOASTA L 

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

## Ite m

Pre-existin g property area , tha t will 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 trunk diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves . Timers . Heads , etc . Anac haskeic ho f tli e sprinkle r Iavout .
Numbe r o f andsiz e o f eac hgarden/ flower bed area . .Atiacl i asketcl i o f relaiix e size s an dlocations . 

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

Square feel t 

# 7 ^ Each 

### I 

# y Each 

# 7 Each 

# y Each Square Feet

Pag e 4 o f 

# 1

### 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 replace db v contractor . Not e thi s \alu e will b e use dt o issu e aplan t \ouche r t o th e propert y owner . Agree dupo nlis t of plant material s lhal will b e replace db y contractor . B e ver y specifi c anddetailed . Each includ e asketc hof wer e eachplant will b e place d b \the contractor . Agree dupo nare ao f propen y to b e replace d wit hgras s sod . 

### S F liU'ltid e asketc hof the aiea(s ) to be replace d\\ith Lirass sod .

• Are aof Cit y or Count y property l o b e landscape d pe r thei r requirements . S F Includ e a^kei^'i" ! of tlic are a(s )

Easemen t .Area, t o be S F e.\cavate d

Pag e 5 o fCOASTA L


### Additiona l Comment s / Instructions :

•Chec k th e boxi 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 . B ycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , Includin g foundatio n cracks o rfissures .



# 0 ^ agre e nI d o no t agre e 

# ^./yTyy^^yJsU ? TLy-y - /y//a- 7 Owner' s Signatur e Date Contractor' s Signjmir e Date Pag e 6 of .