### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D a : filnf Date : <^//^ ^ Address : 4J^1 ^ Ma2^X\Sh Reinediatio nContractor : Coasta l Environmenta l Group

_Year : _200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S v f

Vide o o f propert y (DVD ) M Executiv e Summary EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t propert y 5 /

Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) M Coniirmatio ndat a^__ ^ -. ^ Photograph s 4/ . As-buil t sketc h M Satisfactory restoratio nsigne db y Propert y Owne r S

/ Propert y close-ou t chec k lis t signe db y EP A D Descriptio nofarea s not meetin g RO D cleanu p criteri a D Utilit y clearance s D Property informatio nfromDougla s Covmt y Assessor' s Offic e D D , D 

# ^/^^^•^^J^^ ^ ^Hi ^ ignatur i 4031767 9 Superfun d

## Fina l Repor t Propert y Chec k Lis t (Pleas e plac e wit heac hfile ) H^r dCop y Informatio n /\ . Propert y Chec k Lis t [ y^'$>\\. Q Workin g Drawin g Ma p

3 . EP A original s Ma p .x4

r Dougla s Count y Assessor' s Ma p ^,5<^Property Contac t Shee t Agreemen t ^•'-I'^^cccs s Agreemen t '"L . Restoratio nAgreemen t iVIiscellaneou s Document s --'-^rrT^nal Ma p fi'o mth e Fiel d

^ . Chang e Order s ,/3-r^R FDat a \^ . 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<Hf*i'0pert y Completio nAgreemen t v^i^ . An y buyou t inf o o r reimbursemen t inf o ^^^Chec k o r mone y orde r copie s .,-^rrliP A Propert y Clos e Ou t For m ^.w^Attache dBegi nVide o j

Electroni c Documentatio n Drawing s EP A origina l •^Working Drawin g 3 . "A s Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s LJS . During/Excavatio nPhoto s \So dPhoto s 'X 30-Da y So dPhoto s Scanne dDocument s ' Fina l Document s • 2 Executiv e Summar y Video s 

# t \ Begi nVide o M y Movi e

## Propert yAcces s Checklis t PropertylD : 'M H ^ 

### D WORK STARTE D ON : / / Propert y Address : I ] 1 ^ ^ ^ V^W^Ql ^ H ' 

### nWORKCOMPELTE D ON : / / 0>vner : Jf^ ^ \- \C^t ^ Renter : Address : Phone : Fax : Ccll/Pagcr : Ph„ne : 1^5 2 (,(,1 - \^0^T , Additiona i Information : Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : 5 2 Acces s Agreemen t Signed : [ p l.\[ p 1 ^ 1 By : f 0 0 Restoratio nAgreemen t Signed : ^ 1 IV l (r \ By:^^f/ \ imTopsoi l Samplin g (i f applicable ) 1 1 By : r~l Disposa l Samplin g (ifapplicable ) 1 1 By : 1 1 Garde nSamplin g (ifapplicable ) 1 1 By : tZ

l utilit y Clearanc e Called : \ o il ^ /tT ] 

## By:M M \UM l tr/^iGi^^f/^t E J Video/Photo s (Before ) On : n l li:, ! a l "• ^ fil e W ) • Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : n \Propert y Completio nAgreemen t Signed : / / By : 1 1 Fina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) nCommunit y C H Cre w On : / / By : Results : i mCommunit y [ H Cre w On : / / By : Results : C

H Communit y C D Cre w On : / / By : Results :

Omah a Lea d Sit en t Squar e Fod^Ht o b e Excavate d = 73 0 PropertyClassification : 8 ' 'on e Linea rFootag e t o b e Excavate d = 13 6

Desaiptio n o f pos t excavatio n areas : F1 . fron t yar d left-han d quadrant ; F2 , fron t yar d right-han d quadrant : Bl , bad<yard left-han d quadrant ; B2 , backyar d right-han d quadrant ; DZ , dri p zon e (1- 3 foo t are a o f soi l aroun d th e foundatto n of th e house) .

### Prin t Previe w Pag e I o f I 

## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 161828000 0 RICHTE R THOMA S P 438 8 MASO N S T OMAH A 6810 5
438 8 MASO N S T OMAH A N E 6810 5 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Websit e Lin k 20-15-1 3

LEAVENWORT H HEIGHT S 0 18 4 45X10 8

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountnQ=R161828000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 8 2 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogi s aIias/dogis/printPreview.aspx?PrinlOptData=Dougla s County-.. . 6/8/200 7

## Propeil y ID # Property Address : Initial Contact : Secon dContact : Final Contact : Fina l Action :

Comment : Owne r Commen t (s) : ! 

## Site

Coordinato r Commen t (s) :

' 

## CONTAC T FOR M 

# ^//7 ^ 

# /^3g 8 hjiaso nsi ^ Date : O/v/o l Time : ^f<^ 3

Date : Time : Date : Time : Transmi t t o EP A D 

# Action : U^iLi^'^^fi^ ' Action : Action : Othe r Action : D

# ^111 ^

COASTA L ENVIRONMENTA L G I t 0 U P , 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 :

Owner' s Name : 

# ^* ^ JS/'<^h~^ r ^ 

# ' Daytim e Phone : 

# lf.o2^U/-i^? ^

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 ma ypos 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 Coastal 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 compietion , th e Granto rwil l receiv e writte n documentatio n fro m EP A tha t th e propert yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors 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 satisfactonl ycompleted . Th e Granto rals o agree s to :

Pag e 1 o f 2

# : ^ 1 COASTA L ENVIRONMENTA L " 1 . PROl* ^ 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 necessarysubsequen 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 ; Ifth 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 ofth 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 Coastal Environmenta l Group , a t (877 ) 234-6270 . 

# ¥I gran t access t o m ypropertie s D I d o not gran t access t o m ypropertie s Signatur e Dat e Signatur e Dat e G I 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 2COASTA L 

## 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 that restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert yID : 'f^ \ \"~|< ^ Propert yAddress : ^')^ ^ 

## W h m <A < Owner : ^ ^ U^fMH - Phone : 

### Onth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f excavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to b e usedb y contractor , andth e directio no f North . Indicate distances , depths , material t\pes , etc . Indicat e digital photo s b

y referencin g th e photo-lo g number wit ha narro w 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 removal , storage , disposai , and/o rretur n o f thes e item s i s th e Owner' s responsibility . Item : . « ^ - ^ —^ Item : Item : / ^ Item : X ' Item : ^^ ^ Item : y ' Item : ^ ^ Item : 

### ^ Pag e 1 of .COASTA L ENVIRONMENTA L CROU P IN C 

### 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 : ^I/I/ITVI I W I . 

# \fm j \lp\Yh ^ ^ Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item :

Pag e 2of .^^^^ m 

# ^m ^

COASTA 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 as necessary ) Item : / Item : / i 

# 701 ^ Item : . 

# VO^cb 

# ^ ifm^i^ f(/ p |Vca; « QMI^ ^ 

# 1 —- ^ Item : V ) Item : / item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / ' Item : / Item : 

# y

Pag e 3 of .COASTA L



### Ite m

Pre-existin g property area , that wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trun k diamete r

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves , Timers . Heads , etc . Anac hasketc ho f th e sprinkle r ia\out . Numbe r o f an dsiz e o f eac hgarden/ flower bed area .

. \nacl i asketc hof relativ e size s an dlocations . 

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

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

Square feet 

# '(7^1 ^

X 7 Each 

# i7^y \^9\l l Each

Eac h 

# G 9-^7 ^ Each Squar e Feet

Pag e 4 o fCOASTA L ENVIRONM I N T AL CROU P IN C 

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e o f plan t material s no t t o b e 

# <l ^ 

# Uw%n . replace db v contractor . $ Not e thi s valu e wil l b e ^ ' use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plan t material s that wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Eac h Includ e asketc ho f wer e eac hplan t vvil l b e place d b

y th e contractor . Agree dupo nare ao f property t o b e replace d wit hgras s sod . S F Includ e asketc ho f th e 

# ftf area(s ) t o b e replace dwit h gras s sod . Are ao f City o r Count y property t o b e landscape d pe r thei r requirements . S F Includ e asketc hof th e are a(s )

Easemen t Area , t o b e S F excavate d



# &T^f^^ f T^ r

Pag e 5 o fCOASTA L ENVIRONMENTA L CROU P INC . 

### Additiona l Comment s / 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 . 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 .

U agre e n1 d o no t agre e ^ [P^y ^ 

# \Um ^ bM ^ Owner' s Signatur e Dat e 

### Pag e 6 of .I 

# rt Tota l Q^^un t Fod^Hi an t

Squar

Square e Fod^Hl o o be Excavate d = 73 0 Properl yClassificalion : 8< Tola l O^Kon FooS! wn e e Linea

Linea r rFooSf e e t

t o o be Excavate d = 13 6



# .. i ' :-. r-t—t • 

# as '|..-.'^.*i.+S-.-vi;';-_'*r ; 

# Ljai i lltv:.!5.f e _ - X

---r ­ 

# 3^i^4- ^

kiL...t!'i^ll i 1 !



# [3g5:i:Ti : M M 

# f-M M fa ^ M H -•-•i— 1 

### ^'tl L ^ P[lj^t 4 

# a^ ": . ^.!^^.^ f i Maso n Stree t Legen d NorthArro w Omah a Lea d Sit e Concret e Omaha , Nebrask a j/^ A i i Excavate d Are a Existin g Structur e Scal e Propert yNumbe r OLS-2117 9 >s5i ; •—•— • Permanen t Landscapin g Fenc e 1 Inc h « 20 feet or1 gri d = 5 x5 ft Propert yAddres s 438 8 MASO N ST Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Street Boundar y Fl . F2 B2 DZ Pla yAre a Easemen t (Q ) Tree/Shru b 8 1 " Garde n Othe r Desa«3tio n of pos t «xcavatto n area s Fl . fron t yar d left-rian d quadrarrt . F2 . fror^t yar d rigrtt-han d quadrant : B1 . badcyar d lefl-f\an d quadrant . B2 , t>ackyar d ngtit-han d quadrant , o z . dri p zon e (1 -3 foo t are a of so ^ aroun d ttM i foundatio n of th e house) .Tota l C ^fcSquar e Foe l O b e Excavate d = 73 0 Propert yClassification : 80 i Tota l L Linea rFootag e t o be Excavate d = 13 6

pV4l^«l^S •

Descriptio n o f pos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d right-hand quadrant ; Bl , bacl<yar d left-han d quadrant : B2 , badiyar d right-han d quadrant ; DZ , dri p zon e ( 1 - 3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .

# l # PROPERTYCLEARANC E WORKSHEE T

Dat e Propert yI D 

# W M ^ Propert y Projec t Omah a Lea d - - Fixe d Pric e Addres s Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d Shot s Shot * Readin g Sampl e Are a Shot * Readin g Sampl e Are a 

# 3 ^ ^ ^ ^ ^ 

## i ^

Sampl e Are a 

## ^'.Su 3 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 (Bag ) Sieved ) -> 2 3 

# + • k

^

^ 4 

# -3 ^ 

# 5;; ^ XR F CorrectecfValu e - > 5 (us e calibratio n cliar t o rad d 2 0 % t o value ) 

# /^ r Sampl e Are a 

## 0? : i^ - 

## /c| " 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 (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 

## i ^ ^ 3 

### 'A-f ­ 

# b" ] 4 (jp O 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 ? 

# 3 1 

# ^'^ " I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l eadin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved ) 

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

# lod
- 

# m ± 2 0 % t o value ) 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 (Bag ) Numbe r Result s 1 (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 ) Sampl e Are a 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 (Baq ) 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 ) i; u AUD I non/i i sntu s / / XR F Technician' s Signitur e m i 1) 1 I I

# ID# : ,^^ ^ ^^^x / 5 T Date : 7/3^ ' N ame : C^^ ^ ^ Description : 

# 0/= - ymf/^^^^^tt^ s /y^ ^ TT) /?u/^:r' ^ 1/777 ^ <>/^P^ '

y r 4AJ 7 ^.a^77^ALS7'^7 / TW/CfSTT " ^7j<7^;d^6t^ ."tPBoTP ' 

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

# EXECUTIV ESUMMARY : 21179—438 8 MASO NS T I I N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation: P O wa s issue dagif t certificat e #254 4 fromIndianCreek Nursery inth e amoun t o f $150.0 0 fo r mulc h androc k whic hwer e remove dfromth e property du e t o remediatio nactivities .

# SEP A W l A Propert y Clos e Ou t For m Propert y# : '7-7l7' 7 Propert yAddress : j/^f ^

A7J:><! ^ Datc/rinc : Owner' s Nane : ^/O/i ^

/€/c^f^:7 ^ Quad s Excavated : Contracto rGrou p Eicavatlo aGenen l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? ^ 2 .I f necessaiy , wer e th e correc t area s o f drip zon e excavate dan drestored ? t / Gradio c So dan dVetetatio B Ye s N o 1 .Doe s th e gradin g aroun dth e perimeter ofth e hous e i n excav ate darea s generall y slop e a^^a y fromth e bouse? i ^ 2 .Ha s so dbee nlai di n al l area s tha t were excavated ? u ^ 3 .

Doe s th e sodappea r t o b e generall y health y andgrowing ? (Onl v evaluat e . f inspecte da t aj O da y tim e period ) ly 4 .

Ar e sodde darea s generall y fir man devenl y graded ? i ^ 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y esaloat e i f inspecie da t a} 0 da y ^ tin K period ) 6 .Wa s th e property grade dsuc htha t wate r wil l no t poo l on th e propern ? ^ ^ \\ 7 .Wa s idairag e t o landscapin g or pla.n t material s avoided ? ; j ^ Gales , FCDCC S an dRciaiDint'^al b Ve s .N o '. D o gate s apc na.n dclos e freely'' (Ifapplicable ) 1 1 2 . Wer e all gate s o r fence s take ndow ndurin g restoratio nactiv itie s reir.£ta!!ec ? ,: f applicable ) ^ 3 . Wa s damag e t o gate s o r fence s avoided ? 'Ifapplicable )• ^ 4 . Wa s damag e t c retamin g v»-a]l s avoided ? i,! f applicable ) V* ^ i FouDdation , Sidia t ao dGutter s ^ e s Nc 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 ? ^ 3Wa s damag e t o w indow s avoided ? ,y ^ 4Wa s damag e t o window s o r door screen s avoided ? 5 .Wa s damag e t o downspout s o r dov^Tispou t extension s avoided ? < ^ Sidewalk s an dDriveway s (Concrete )\« No 1 .Wa s damag e t o drivewa y surface s avoided ? ^ 2 .Wa s daraag e t o v*al3cwa \surface s avoided ? w ^ I

### (Owner s coroments :

Inspectic ncctes : A . Ol —



### Remc\£ l an drestcratio nacii\ate s corr.r'et e includin e th e 30-dav so d•>-> • arr2.n ^ • 

# ^v/ ­ ate ' ^ ^

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedia l activitie s performe do nm y property . M y signatur e will designat e tha t I a msatisfie dwit hth e restoratio no f m y property , an dtha t n o item s ar e i nquestions , now , o r a t an y tim e i nth e future , excep t thos e item s liste dbelow , i f any . 

### PropertylD : ^//Z ^ Property Address : ^^fj ' /g/^r^/ 7 Owner : --f^ ^ J^fC^rT^Z - 

### Phone : ^^/ , jff ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

[yj. ! agre e restoratio nI s completed , except a s noted I I do not agre e restoratio ni s complete d 

# 9A/o 7 Owner' s Signatur e Contractor' s Signatur e ^ liat e I

### # 

## Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r To mRichte r Propert y Addres s 438 8 Maso nS T 

### Propert y Identificatio nNumbe r 2117 9 Materia l Remove d Replacemen t Valu e Flowe r be dare a $150.0 0

Tree s Itemize d

- 

### shrubs/bushe s Tota l $150.0 0 Th e acceptanc e o f th e replacemen t certificat e an dth e signatur e belo w i s fiall acknowledgemen t b y th e property owne r that thi s i s afai r andreasonabl e compensatio n for plan t material s remove ddurin g remediatio nactivities , bu t no t plante do r installe db y th e governmen t o r it' s contractors . Th e tota l amoun t o f $ 150.0 0 ha s bee nreceive db y th e owne r inth e for mo f agif t certificate , #254 4 , t o b e utilize da t IndianCreek Nursery . 

# /T . 

# iz4 ^ —cy ^ V w ^ Property Owner' s Signatur e Dat e Contractor' s Signatur e Dat e