### TRANSMITTA L of OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 2Jl^(f i Date : J^Jn/o e Address : /O/ ^ S 2J ^ S i Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Vide o of property (DVD ) M Executiv e Summary EPA-providedproperty sketc h Signe dAcces s Agreemen t for subjec t property D 

### D Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag eorto replac e plants , etc. ) Confirmatio ndat a ^ 

### Photograph s ' As-buil t sketc h tf Satisfactory restoratio nsigne dby Property Owne r Sf

Property close-ou t chec k lis t signe dby EP A D Descriptio n of area s no t meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfro mDougla s Coimty Assessor' s Offic e D D , D 

# 4i M Dat e 4031769 5 Superfun d

### 1 2 ^ 4

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## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) cT-lCff(jp 7 HardCopy informatio n/ A,/ /

J ^ J V 1 . Property Chec k Lis t /^/ ^ ^ ^ 2 . Sit e Workin g Drawin g Map 3 . EP Aoriginal s Ma p 4 . Dougla s Count y Assessor' s Map 5 . Propert y Contac t Shee t Agreemen t 1 . Acces s Agreemen t 2 . Restoratio nAgreemen t Miscellaneou s Document s 1 . Fina l Ma p fro mth e Fiel d 2 . Chang e Order s 3 . 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 . Propert y Completio nAgreemen t 4 . An y buyou t inf o o r reimbursemen t int o 5 . Chec k o r mone y orde r copie s 6 . EP APropert y Clos e Ou t Fon n 7 . Attache dBegi nVide o 

## Electroni c Documentatio n Drawing s 1 . EP Aorigina l 2 . Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s During/Excavatio nPhoto s So dPhoto s 30-Da y So dPhoto s
, Scanne dDocument s I Fina l Document s i Executiv e Summar y Video s Begi nVide o M y Movi e

### % 

## Propert yAcces s Checklis t Pn>pcrtylD:J^j;^<^_ ^ D WOR K STARTE D ON : / / D WORKCOMPELTE D ON : / / _ Propert y Acl(l.ess:-( ^ 14 . <$ , ^ ( ^ <;!:)- .

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\7 \ronuminit y C H Cre w On : Results : C

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Omah a Lea d Sit etl/' ^ '%-,.'^ ^ Tota l Quadf^Aquar e Footag e t o b e Excavate d = 310 2 PropertyClassificatio n Tota l Drip^J I Linea rFootag e t o b e Excavate d = 14 6 .ification : 800/CHIL D ^ U J [b^^|P^ ^

Descriptio n ofpos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d right-hand quadrant ; Bl . backyard left-han d quadrant ; B2 . backyar d nght-han d quadrant ; D2 , dri p zon e {1- 3 foo t are a of soi l aroun d th e foundatio n o fth e house) .Name : Uc^o. J Av\Jsi/^^,t- > Omah a Lea d Sit e Date : /0' 5 ^' ^ Nort h Arro w Address : fO/ V S ZCP" ^ <. i . Sit e Sketc h Time : f : < ; s ' —_J:2 > Phone : Tea m \^l/»/ / i-^^^c ^ LMC- 7 BVI D # ^/(^t;:,, ^ XR F Cod e 2^ 1 C^G< ^ Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e pp m -f'Ye s a 

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### Dougla s County Accoun t Info^atio n Pag e 1 of 2 Q^^ t Dougla s County , Nebrask a Propert yRecor d - R171425000 0 Prin t Repor t Informatio n i s vali d a s o f2007-10-1 0 Vie wo n Ma p Value s no t finalize d unti l afte rBoar d o fEqualizatio n Treasurer' s Ta xRepor t Owne r ANDERSO N DAVI D E ETA L 480 5 N 10 7 S T OMAH AN E 68154-000 0 Propert yInformatio n Ke yNumber : 142 5 000 0 1 7 Accoun t Type : Multipl e Re s Parce l Number : 171425000 0 Parce l Address : 101 4 S 2 6 S T OMAH AN E 68105-000 0 Lega l Description : MARSH S AD D LO T4 BLOC K9 1/ 2 VA C ALLE YAD J & LO T4 BL K9 5 0 X 132. 5 Valu e Informatio n Lan d Improvemen t Tota l 200 7 200 6 200 5 200 4 200 3 200 2 $13,200.0 0 $13,200.0 0 $13,200.0 0 $13,200.0 0 $13,200.0 0 $0.0 0 $72,400.0 0 $65,000.0 0 $65,000.0 0 $65,000.0 0 $65,000.0 0 $0.0 0 $85,600.0 0 $78,200.0 0 $78,200.0 0 $78,200.0 0 $78,200.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2004-04-1 6 Dee d Type : Q C Book : 200 4 Page : 05383 9 Price : $0.0 0 Grantor : MARG E AANDERSO N Grantee : DAVI D E ANDERSO N Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F F F Unit s Dept h Widt h Vacan t 0.1 5 6600. 0 50. 0 1. 0 132. 0 50. 0 N o Improvement Buildin g 1 1 Informatio n 1 1 

### http://douglasne.mapping-online.com/DouglasCo Ne/static/accountinfo.jsp?accountno=Rl.. . 10/25/200 7

### Dougla s County Accoun t Info^^tio n Pag e 2 o f 2 a||^ t

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i » r v -~iA \ 0 0 i u j '~TV ~ ' Ffvlfb v n a «3da ) Fl (jf fS*COO O floo r 3kt

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### TW O STOR Y CLIC KT O ENLARG E IMAG E Squar e Footage : 1639. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Fai r Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : 2 Stor y Rooms : 7. 0

HVAC : Centra l Ai rt o Ai r Units : 3. 0 Exterior : Fram e Sidin g Baths : 2. 0 Interior : Drywal l Bedrooms : 3. 0 Roo f Cover : Compositio n Shingl e Stories : 2. 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 192 0 199 7 0 % 192 0 8 7 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 818. 0 Basemen t Finishe d 400. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h En d Scree n 112. 0 Porc h Sla b Roo f Cei l 54. 0 Porc h Sla b Roo fCei l 112. 0 Porc h Sla b w/Step s 63. 0 Porc h Woo d Dec k 54. 0 Use r Ne wwindow s 1. 0



### http://douglasne.mapping-online.com/DouglasCo Ne/static/accountinfo.jsp?accountno=Rl.. . 10/25/200 7

# To : ^^-^V W Fa x number : ^'y^-''^^/ ^ Date : 

# /^y-z-y/ o 7 Coasta l Environmental Group , Inc . Regarding : /6/ V S ^<^S T



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### OCT-27^k 7 **** * TIM E 07:5 1 ******* * MOD E = MEMOR Y TRANSMISSIO N START=OCT-2 7 07:4 9 END=OCT-2 7 07:5 1 FIL E No.=06 5 ST NCOMM . KE Y NAM E STATIO NNAME/EMAI L ADDRESS/TELEPHON E NO . PAGE S DURATIO N No . 00 1 O K s 402553301 4 010/01 0 00:01:2 1
-ENVIRONMENTA L RESTORATION ­ **** * DP-353 0 *********x*xxx*xxxxxxx **** * - 71 2 32 2 4061 - ******** *

Fax number : ^ 5-^ , 'Z^/c A 

### Date : /aV-z-^/ o 7 Coasto l Environmenta l &roup . Inc . Regarding : /^/ 7 5 ^^S? " 

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# e/\iiihNn.A>ii<A^''7 ^ (\AI7 ) T O

Date : 

# 10-2.9'0 7 R* i aUi^en t CiTor l Revf« wn Pleas e Coinmen t D Pleas e Repl yD Pleas e Recycl e

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1 0 3DV d oidiD3n 3 saiAv a PT0££9960 f r£:£ I /.006/66/0 TOCT-27-200 7 07:5 1 ^ra i 71 2 406 1 P . 1 0 .jaiVIRONMEaJTA LRESTORAJJOI I 32 2
CO * BTAI . Mditioni i ConviMnt s / InitoueSoiw :

O ChM k th e bo xI fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possM e pfa-exietin g damage . B ycheddn g Ihi s tx>xCE G i s no t responsible fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfiseur^s . 

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### TOTA LP.1 0 f 0 3DVc i oiaio3i 3 saiAv avi^zz^^z^ v vz'-z \z.006/66/0 1OCT-27-200 7 07:5 0 IRONMEHTA L RESTORATIOK 71 2 32 2 40B 1 P.V V

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### '# ^ COAfTa i 

## 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 Environnienta 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 premiees' .

Owner' e Nam* : 

### Daytime Phone : 

### "A
Addres s o fPropert y 

# I0\<\- ^ ^2^ ^ covere d b ythi s Agreement : PURPOS E O F RESPONS E 

### ACTivme 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 ma ypos e a healt h hazard . Th e area(s ) wi n b e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l t>e replace d wit h clea n material s an d th e are a wil l b e restore d l o it s origina l condition . Ihi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d SK e remediatw 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 l>efore 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 yha s beer ^ 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 , ccT^tractor s 3r=d-subcontreeters-th crigh t t e en^e rth e property , at-aW - reasonabl e flrros an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work . Thi s acces s sha H remai n i n effec t unti l th e wod < ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :

Pag e 1 o f z

£ 0 39V d Diai03i 3 saiAva fI0££SS60 f f£:£ I /.006/66/0 TOCT-27-200 7 07:5 0 

# € IROMMHiTA LRESTORATIO N 71 2 3ii Z 4Ub l f.U* " 

# 9 # :oasTA ; "•*" . oi^'* " 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov e Itowe 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 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 , AGREEME^^ • NO TT o iNIERFER g T.h e Granto ragree s no t l o interfer e o r:arrpd rMVT) ar. yc f:h e Acr Kactivities , o rwit h an y c fth e wor k done , o rwit h ih e equipmen t use d z- ^

h' s property . 3 rt o jr>dertak e ar y action s regardin g th e -s e c fsai d propert yvx'-.ic h v.c^'. d ten d t i er.car.gs r:l". e nealt h O ' .-.elfa^e c f:h e 3-ar.t*e = : ' t'- s r'i-D'.-.e.- : z : A . »"-•: , yjir.err i •; : ,s e T'- S T"cerr ; :.- . 3.: ra nar-e- . :s£s e ::r.'. = ; - -cas:£ . r-.,- - 'c—s f 2.'.- . • ' 5 t "i" ^

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## CONTAC T FORM Propert y I D #2/^(^( ^ Propert y Address : 77)7^ ^ ^ 2{^S r Initia l Contact : Date : A^/zA ^ Time : /.J5 ^ Action : /^rrT-l^i^ieyH-F^//^^ ^ Secon dContact : Date:/<y/4f Time : /"p^^ ^ Action : <^:^i^<y//V z /'^<!!:< ^ *~^> ^ Fina l Contact : Date : Time : Action : Fina l Action : Transmi t to EP AD Othe r Action : D

Comment : Owne r 7B0 6 /tApoysr Commen t (s) : Sit e Coordinato r Commen t (s) :X 

### fAOL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 g ^^^y ^ I Coasta l Environmenta l Grou p Inc . r . . ^

www.coastalhazmat.co m %PROi* ^ COASTA L ENVIItONHENTt l C K O u P , IN C 

# EXECUTIV ESUMMARY : 21666—101 4 S 2 6 S T N o Issue s o r Concern s Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g COASTA L 

# W n ah aLea dSuperfun dSit e PropeityCBBsimdMn : aoocuL D 

### B 1 leav e concret e border s i n place . Railroa d ti e wal l ai l cracke d b e carefu l othe rsid e ha s bee n fi x already . Railroa d tie s i n plac e F 1

L«gen d QLS* : 2166 6

, Date"^Ekcavated : 11/9/0 7 tJat e USiF* ASigne d Off : 12/3/0 7 Nort h Arro w Scat e •—•— » Fenc e 11nai-21}t6«tarigru-sx5 t K<: | Pemianefi t l.jTKlGca|]ti g Quadran t Boundai y Street Boundar y Ft . II,V<K:CPI'..T:<7 . n c F Z (^ < Trtei'siTi * B 1

OZ . <* ^ BM * <i- 3 IM C «| M D t I M anuB d «»IBuuMU i 4 t r wnouM } 

### Legen d Are ano t Excavate dAA ^ Dripzon e Excavate d Ibita l Ouadran I Square Footag e t o b e Excavate d - 3ia z

• Rji a Dfl p Zon e Unea rFootag e t o o e Excarat M -14 6

Omah a Lea d Sit e C3rnan ^ selxa& u Propert yN«nbe r

OLS - 2 1 se e Propert yAddres s

101 4 5 2 6 S T Pos t Excavatio n Concentration s <ppm ) B2 PlayAre a D

ZEaseinent Garde n oine r

l?Q<? ^ Quadrant s Excavate d 

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

## smL 

# EP A EP APropert y Clos e Ou t For m Propert y# : 3 \ / ^ ( n L Propert y Address : \i^\- \S ^ ^ ^ - Date/Time : \ i l:i, ^ Owner' s Name : Da\j » dA^c(- f Tso/" ^ Contracto r Grou p Csi ^ OL^AC K ) Quad s Excavated : Ye s Excavatio nGenera l I .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 d an d Vegetatio n Ye s 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 tha t 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 mandevenl 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 ) y 6 .Wa s th e propert y grade dsuc htha t water will not poo l onth e property ' 7 .Wa s damag e t o landscapin g or plant material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s 1 .D o gate s openan dclos e freely? (Ifapplicable ) 

### fO A 2 .Wer e al l gate s or fence s take ndowndurin g restorationactivitie s reinstalled ? (I f applicable ) 1^ ^ 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

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

## y Foundation , Sidin g an d Gutter s Ye s 1 .

Wa s damag e t o th e sidin g o rtri m avoided ? y 2 .Wa s damag e t o th e foundatio n avoided ? y 3 .

Wa s damag e t o window s avoided ? y 4 . Wa s damag e t o window s o rdoo rscreen s avoided ? y 5 . Wa s damag e t o downspout s o rdownspou t extension s avoided ? l y Sidewalk s an dDriveway s (Concrete ) Ye s I .Wa s damag e to drivewa y surface s avoided ? 2 .Wa s damag e t o walkway surface s avoided ? No

No

N

o

N o

N o

## Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y sodwarranty : EP ARepresentanv&^^^^^^,i^vj;^^^b-WZ ^ Date : /7ys/c 7

## Propert yCompletio n Agreemen t Thi s agreement documenl s th e completio no f remedia l activitie s performedo nm y property . M y signature wil l designate tha t I a msatisfie dwit hth e restoratio no f m y property , andtha t no item s ar e i nquestions , now , or a

t any time i nth e future , excep t thos e items liste dbelow , if any . Propert y ID : ^ ^ ( ^ ( ^ ^ Propert y Address : I ci , I <dl. , <: : o f _ ^ 

### Phone : 

## JA^A- ) ^B^ - I ^(. ^ Restoratio n Item s i n Question :

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

gre e restoratio ni s completed , excep t a s note d I I d o no t agre e restoratio ni s QOinpleted 

# //'30'O 7 \y7cAf/<W^- ^ 

# £ fim ; ^ > Owner' s Signatur e 

### Date Contractor' s Signature Dat e I

# 4 1 * (• ^ PROPERTY Dat e Propert yI D 

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# jaki ^ Propert y Projec t Omah a Lea d -~ Fixe d Pric e Addres s 

# M <;. 2 ^ s r Measuremen t XR F I D 010 7 5 1 Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Shot * Readin g Sampl e Are a 

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### 7( . (us e calibratio n chart o rad d 20 % t o value ) 

# w {l\ i AttOIIIONA l SHtff i I f NFFt n I ) XR F Technician' s Si q 

## -t" - A^T^^TT^A^iT ^ .-"^r^. ^I t / Tota^Mhran t Square Footag e t o b e Excavate d = 310 2 Propert yClassification : 800/C H TotSfli. p Zon e Linea rFootag e t o b e Excavate d = 14 6 

# UJik^f^i/ L 'r M ?>vob :

Desaiplio n ofpos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yard right-fian d quadrant ; Bl , backyard left-han d quadrant ; B2 , backyard 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 fth e house) . ••'-•.?S* ­l l -w^l , 

# RESTORATIO NCHANG EORDE R OMAH ALEA D Propert y I D #ZlC^^ ^ Propert y Addres s IQ H 5 ^C ^ ^ Owne r Nam e 7^'J( ^ ANJ"^^^ ^ 

# Dat e tlj^/o l Comment s

ort ^ /-szPQsr -rneAEt.QOT 3 . LBAIIF ^ 

# ^ ^ '^elj^M j

Owne r Signatur e Contracto r Signatur e C^T^ ii.^"*'^^* ' C O AS Ti COASTA L I ENVIRONMENTA L C B 0 U P . 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 :

Owner'sName : J^-^v i " Daytim e Phone :

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 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 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 yha 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 a! ! 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 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 f2• t - ^'* r 

# m COASTA L


### •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 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 ; •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 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 yofth 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 Vi/oul d ten d t o endange rth e healt h o r /v'elfare o fth e Grantee s o rth e environment ^

o rt callo wother s t cus e th e propert y; n suc h a manner . Should yo u hav e an yquestion s abou t thi s program , oieas e contac t Coasta l Environmenta l Group , a t (877 ) 234-5270 . gran t acces s t o m ypropertie s; 1 d o no t gran t acces s t o m ypropertie s

/ % natur e Dat e Sienatur e Dat e

n

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

Paae 2 cf 2COASTA L EN V IRO N M V NTA L C M O U r. INC . 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s to provid e amutual agreement a s to condition s o f th e property prio r t o remediatio nactivities . Thi s will 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 Environmental Protectio nAgenc y (EPA) .

Property ID : 

# Z/&U ^ Property Address : /(^7C 7 ^ ^(^^T " Owner : 

# P^^/^//AU/:^t;^^A 7 ~ Phone : 

# ^^^ ' 

# /K^- ^ ^/f) ' ^l-^ l O nth e attache ddiagram(s ) indicat e area(s ) to excavate danddept ho f excavation , locationo f all knownutilities , subsurfac e features , surfac e structure s andlandscaping features , acces s location(s ) to \y & use db y contractor , an d th e directiono f North , hidicate distances , depths , materia l types , etc . Indicat e digita l photo s b y referencing th e photo-lo g numt)e r wit ha narro w indicating directiono 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 , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility . Item : 

### '^;>^/?77/^7/fyiy7 ^ tP^rA^e-z^T y ^-^/V^ffV^ ^ 7T^^AAy4^r S Item : 

# ^4/^ ^ Item : 

## KAhS ^ Item : Item : Item : Item : Item : Pag e 1 o f/ ^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 : 

# A(-^^ 5A)i/f//P/^AJT^ ^ /epr - 3e^7777> , Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :



### Pag e 2 o f< CCOASTA L INVIROMHKNTA L CROUP , INC . 

### 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 : Item : 

## ^/L . Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o f< ^COASTA L INVIROMMINTA L CROUP . INC . 

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

## Ite m 1 Pre-existin g propert y area ,

tha t wil l b e excavated , tha t i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h 1 trun k diamete r

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

Numl)er o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout . Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations . 

## Quantit y 

# ?2y ^



# 3
A/ l

^

( ^ 

## Uni t

Squar e fee t 

## Condition/Type/Specie s

1

Eac h

Eac h

Eac h

Eac h Squar e Fee t 

## 1

Pag e 4 

## o f 6 PC O AS T AL 

## Ite m Quantit y 

## 1 Uni t Condition/Type/Specie s Agree dupo nvalu e of plan t material s no t t o b e replace db y contractor . Not e use d thi s valu e wil l b e t o issu e aplan t 

# (7 $ vouche r t o th e propert y owner . Agree dupo nlis t o f plan t material s tha t wil l b e replace db y contractor . B e very specifi c an ddetailed . Includ e asketc ho f were 

# 0 Eac h eac hplan t wil l b e place d b y th e contractor . Agree dupo nare ao f propert y to b e withgras s sod . replace d 

# '^Z'/ B Includ e asketc ho f th e S F 

## 1 area(s ) t o b e replace dwit h gras s sod . 

# •rSB e Are ao f City o r County propert y t o b e landscape d pe r thei r requirements . ;SF ' [ Includ e asketc ho f th e are a(s )

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

Pag e 5 of . 

# ACOASTA L 

### Additiona l Comments / Instructions :



# - J^e?Hou^4/ ^ 5^A///7UAU7 3 AAJ/ ) SuSHe S AA7} i

• 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 . Bycheckin 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 .

I 1 1 agre e H H I d o no t agre e

- Ow i



### _.vner' s Signature Date Contractor' s Signature Date Pag e 6 o fC ^