## TRANSMITTALof OMAHALEAD SITE SOI LREMEDIATIO NFIL EFOLDE R SAI D # : Z%55 3 

## Date: \2''^ \^T) % Address : 2^7 M K ^^ ^ ^- V Remediatio nContractor : Coasta l Environmenta l Grou p SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ 

### Vide o ofpropert y (DVD ) Executive ' Summary 

## a / EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confirmatio ndat a Year : 200 8

4031643 7 

# Illl i Superfun d



## Photograph s pr^-.^)cr/?J^4DY>^ fi^zukkiso ^ SC<L ^ \t(U^ l So d As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property infOTmaHo nfro mDougla s County Assessor' s Offic e 

# lie -Ihin'smiffal Shc.^ V ^(1^/^ ^ )at e

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# € m Propert yAcces s Checklis t Proi,crtylP?2?5|^ 5 D WOR K STARTE D ON : / / Propert y Addre.s.s : ya^-J ^ M 3^^^^: ^ D WOR K COIVIPELTE D ON : / / Renter : Address : Phone : Fax : Cell/Pase i 

## phon^^^I|gt T L\<^i-2q ^ Additiona l Information : Fax : Cell/Payer :
n Notificatio n Lette r Sent : Bv : 

# K Acces s Asjreemen t Siuncd : J l'9 ^ I O ^ B.v : i\(^a.rr \ 0 ^ Restoratio nA{»reement Siuncd : t> IS O I 6 I Bj^ , CLtrs_ E

H Top.soil Sam|)lin< ; (i f applicahle ) By : d l Di.sposa l Samplinj j (if ap|)licahlc ) Bv : 

### r n I I Garde nSamplin g (if ap|)licable ) Bv : B Utility Clearanc e Called : i^j^/^^j l 

# ^X ^ c^Of^T^' ^ V^DA ^ 13

2 Video/Photo s (Before ) 0,1 : l ^ i3,S~ i o % Bv : 

# M nVideo/Photo s (During ) On : Bv : nVideo/Photo s (After ) On : By : nVideo/Photo s (30-Day) On : Bv : I I Proport y Coni|)letio nAgreemen t Siuncd : By : I I Fina l Re|)or ( Issued : Bv : Ai r IVloiiitonnu (a s ap()lical)lc ) 1 IZ ] Coninuinit y C H Cre w On : / / By : Results : 1 nCoinniunit y C ] CrcM ' On : / / Bv : Results : 1 nCommunit y Q CrtM v On : / / By : Results : Omah a Lea d Sit e

## CONTAC T FORM Propert y I D # 

# ^g^^ 3 Propert y Address : 

# Qsa ^ ^ . 

# ir^s ^ Initia l Contact : DateS-3tb-ty S Time:\9'^ " Action:Aki\ ^ ^/ | 0^1 1 Q^ C / < Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP AD Othe r Action : D

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : '-^ll/O S QJXSLUQC)
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## Si^c / b^CJXs no p dAA^ 4

### Dougla s County Accoun t :im£mm . atio n Pag e 1 o f 1 Dougla s County , Nebrask a Propert yRecor d - R191826000 0 Prin t Repor t Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f14 4 St - Vie W O n Ma p Informatio n i s vali d a s o f2008-4-1 7 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- » Aut o Sale s Searc h Owne r MIAM I HEIGHT S DEVELOPMEN TC O ft,^-JP^|g^, jfJAi k ix^^^^ ^ 

### 1701N24ST#10 2 'Myd-^ ^ T^Tn^9 ^ OMAH AN E 68110-000 0 (L/A'A N U<" / ^ ^ ^ O ' Propert yInformatio n Ke yNumber : 182 6 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 191826000 0 Parce l Address : 252 4 N 3 3 S T OMAH AN E 68111-000 0 Lega l Description : OMAH AVIE W LOT2 BLOC K1 5 LT S 1 & 100 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 7 $1,000.0 0 $0.0 0 $1,000.0 0 200 6 $1,000.0 0 $0.0 0 $1,000.0 0 200 5 $1,000.0 0 $0.0 0 $1,000.0 0 200 4 $1,000.0 0 $0.0 0 $1,000.0 0 200 3 $1,000.0 0 $0.0 0 $1,000.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2003-06-3 0 Dee d Type : W D Book : 200 3 Page : 13080 9 Price : $ 7,000.0 0 Grantor : Sale m Baptis t Churc h Grantee : Miam i Height s Developmen t Valid/lnvalid : Vali d Exclusio n Reason : Lan d Sal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.2 7 12000. 0 0. 0 120. 0 100. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R191. . . 5/7/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L CROUP , INC . 

## 28553 ^ Exterio rPaint Nort h Arro w Omah a Lea d Sit e Sit e Sketc h Owne rName : MIAM I HEIGHT S DEVELOPM E • Goo d Address : 252 4 N 3 3 S T • Poo r Phone : H W [ 3 No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm . RYASCPXA-2865 3 F 1 

# n o pp m 

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### 0 ^ RYBSCPXA-2855 3 F 2 

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### D Time : i''Pi ^ Prfs RYCSCPXA-2855 3 B l IH ^ pp m Sample s Analyze d RYDSCPXA-2855 3 B 2 -2.9^ 6 pp m 

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### D 

### D Time : ^ 5**
- 

### D Staff /^^ ^ Numtse rof Sample s = U Legen d F 1 = Fron t Left , F 2 Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden . P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e streel , facir\ g propert y 

# ENTERE D OLS# : 2855 3 Dat e Excavate d :7/2/200 8 Dat e USEP ASigne d Off:9/10/200 8 Are a Sodde d 336 6 s q ft



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are a replace d wit h m i Are alef t bar e So d ' ' Rock/Mulc h 

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

## 2855 3 Mi?u ' CmoOMniVy ^^- g IcaSlW ' 

# i^ Exterio rPair t Nort h Arrow Omah a Lea d Sit e Owne rName : MIAM I HEIGHT S DEVELOPM E 

### • Goo d Sit e Sketc h Address : 252 4 N 3 3 S T • Poor 

## Phone : H;^MZ^/-W3?? ? [y ] No t paint Sampl e Numtie r Lead Sampl e Sample s Cotlecte d LA B Concentratio n Collecte d Firm : fO ^ 71 , ^r . RYASCPXA-2855 3 F 1 

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# n o pp m Date : //-/f'^y ^ RYBSCPXA-2855 3 F 2 

## R S pp m 

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## 23±L ± pp m 

# n RDgOCr)C/t-205G 3 B Z pp m 

## D XR F Unit : lOO l Book : il3

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## D RQZOCrXA^2050 3 6? - pp m 

## D Date : jZ - il - o L 

## D RPZSCP.YuA , 2855 3 9 ^ pp m 

## D Tim e i/iO - 

## D Staff : /^^t1 / Numbe ro f Sample s = U Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Ai t quadrant s are as viewe d fro m th e street , facin g property

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# t 2855 3 f|?DC*"^.'r»i Extfefk xPair ! Nort C Arrcw / Omah a Lea d Sit e Owne rName:MlAF<^ l HEIGHT S DEVELOPM E • Goo d Sit e Sketc h Address : 2524 N 33 S T • POOi 

## Phone : HV<I ) 

## ' "i^i-^^ij ] [ ^ No l pain t Lea d Sampl e Sampie s Collecte d Sampl e Numt)e r Concentratio n Collecte d LA B 

## Firm : F|| 3 J j q , RYASCPXA-7865 3 F T pp m 

## 13 ; D Date : \ l - n 'C'</ / 

# n o RYBSCPXA-2855 3 F2 Q ^ pp m 

## D Time : i i i'i g '^i n RYCSCPX A2855 3 B l \ H ^ pp m 

## D Sample s Analyze d RYDSCPXA-7855 3 8 2 

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## D ROgOCrX A200S O O ? pp m 

## D Dale : iZ - il - n L — 

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## D Tim e ffy ^ 

## D Staf fi^^i^ . Numbe rof Sample s = W Legen d F l = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t D Z - Dri p Zon e G Z = Garden , 97 . - Pla y Al l quadrant s ar e a

s viewe d fro m ttwctraet . facin g propert y 

# ENTERKD

(ti'.i n •

## 2855 3 Omah a Lea d Sit e Owne rName : MIAM I HtlGHTSDEyELOPM E Address:.252 4 N 33 S T Phone : H : Sampl e Numbe r RYASCPXA-2855 3 F l N O RYBSCPXA-2855 3 F 2 fi^ RYCSCPXA-2855 3 B 1 IH ^ RYDSCPXA-2855 3 B 2 •^q^ 5 RDZOCPXA'2055 3 B Z " RGHOCPX A20550—Q? " RPZSCPX A2856 3 i32 > Legend : F l = Fron t Left , F 2 • 

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### 05-21-'0 8 11:5 9 FROM
- T-49 1 P002/00 9 F-93 1
<.'• " =•'•' , ^ J COASTA L 

# ( 4

< • cto * ' » r 

## Consen t Fo rAcces s T o Propert yA*^3^ ^

^ ^ RIGH TO P ENTR YT O PREMISE S 

### Granto r(th e propert yowrter ) 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 , l 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 Namerv ^ i ^ t /" ' D.y«mePhon, : HcQ^^Ll ^ } ^ ^ J

Addres s o fPropert y covere d b ythi s Agre9m«nt : PURPOS E O F RESPONS E 

### AcTivrriE S Th e EP Ai s requestin g acces s t o collec t soi l sample s an d rennov 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 sol i 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 ih 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 wil h th e Grantor' s approval . Upo n completk)n . 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 wor k Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n salisfactorii ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f2

### 05-21-'0 8 11:5 9 FROM -T-49 1 P003/00 9 F-93 1

V*****' / 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 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 rphotographir> 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 equipmen t use d o n hi s property , o rt o urnjertak e an y action s regardin g th e us e o fsak l propert ywhic h woul d len d t o erKlange 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
I gran t acces s t o m ypropertie s Q I d o no t gran t acces s t o m ypropertie s ^ 

## rJ^QfO . ^'-^ti'Oi ^ Signatur eoai e 

### OI woul d lik e t o b o presen t durin g an ysamplin g ttta t i s required .

### < # COASTA L INVIRONMIN^A l S • O a » . IN C 

# te^&3 Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) 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 Nam e Daytim e Phone : ^QQ,-^ ^ \ - l ^ y

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 l o collect 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 byUSEPA . 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 EPAtha t th e propert y ha 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 , at 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 of2COASTA L (NVII0NMENT4 1 «mf ^ C a O U ' > < • 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 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 . 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 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 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

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

t^CJFX ^ -^'^b-O l Signatur e Dat e Signatur e Date
QI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

### T-49 1 P004/00 9 F-93 1 05-21-'0 8 11:5 9 FROM ­

.* •
COASTA L 

## Restoratio n Agreemen t The purpos e ofthi s agreement i s t o provid e amutual agreemen t a s to condition s ofth e propen y prior 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 nofth e propert y owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Property ID : ^^*^ ^ ' ^ Voperf y Address : -^r ^ -^Lf tT^X V^^ ^

——^—• • n r^ ^ —** * —

- -' - ' — ' ^" " * m^ ^ I I tifii l I f I • 

### O nth e attache ddiagram($ ) indicate area(s ) t o excavale dan ddept ho f excavation , locatk mo f ai l know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) r o b e use db y contractcr , an dthe directiono f North . Indicate distances , depths , maicria l types , etc . indicate digital photo s b

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### 05-21-'0 8 12:0 0 FROM - T-49 1 P008/00 9 F-93 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 42 4 Mod e SOI L Tim e 2008-07-0 2 15:5 6 Duratio n 121.7 1 Sequenc e Fina l Flag s AVERAG E Av g o f420-42 3 ADDRES S 252 4 n 3 3 QUAD/ZON E B 2 INSPECTO R DETRIC H DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 57.93 0 Supervise d By : 

## Certificat e o f Verificatio n

42 0 SOI L 2008-07-0 2 15:5 4 30.6 1 Fina l 2855 3 252 4 n 3 3 B 2 DETRIC H 1 0 CLEARANC E

± Erro r ± 10.74 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 116.84 9 Supervise d By : 

## Certificat e o fVerificatio n

42 1 SOI L 2008-07-0 2 15:5 5 30.1 2 Fina l 2855 3 252 4 n 3 3 B 2 DETRIC H 1 0 CLEARANC E

± Erro r ± 14.04 0

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 42 2 Mod e SOI L Tim e 2008-07-0 2 15:5 6 Duratio n 30.5 5 Sequenc e Fina l Flag s BVI D # 2855 3 ADDRES S 252 4 n 3 3 QUAD/ZON E B 2 INSPECTO R DETRIC H DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 79.23 8 Supervise d By : 

## Certificat e o f Verificatio n

42 3 SOI L 2008-07-0 2 15:5 6 30.4 3 Fina l 2855 3 252 4 n 3 3 B 2 DETRIC H 1 0 CLEARANC E

±Erro r ±11.80 7

### f^QL \ Omali a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^J^^^ ' I Coasta l Environmenta l Grou p Inc . ^^^^^{ ? wvvw.coastalhazmat.co m

%P„o^t ^ COASTA L INVIRONMENTA L CROUP . INC . 

# EXECUTIV ESUMMARY : BVID #2855 3 - (2524 N33"' ' St) 'xl No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation:

# ^^EP A EP APropert y Clos e Ou t For m 

# , : 1^^^ ^ Propert y Date/Tim e Contracto r Grou p Quad s Excavate d 

# -f c Ye s N o Excavatio nGenera l 

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/L 0 r 1 , If necessary , were th e correc t quadrant(s ) excavate dan drestored ? / 2 .If necessary , wer e th e correc t area s ofdri p zon e excavate dandrestored ? 

# M Gradin g So dan dVecetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e awa y 

## a M fromth e house ? 2 . Ha s so dbee nlai di nall area s tha t were excavated ? ^ 3 . Doe s th e sodappea r to be generall y healthy an dgrowing ? (Onl y evaluat e i f inspecte da t a.10 da y time period ) 4 . Ar e soddedarea s generall y firman devenl y graded ? t / 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 6 . Wa s the propert y grade dsuc htha t water will not poo l o nth e property ? ( ^ 7 . Wa s damag e t o landscapin g or plan t material s avoided' ' / Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s openandclos e freely? (Ifapplicable ) 2 .Wer e all gate s or fence s take ndowndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) # 3 .Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 4 .

Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## s / Foundation , SidiD g an d Gutter s Ye s N o 1 .

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

# ^^^o^ > 3 .

Wa s damag e t o window s avoided ? 

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• 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? 5 .

Wa s damag e t o downspout s o rdownspou t extension s avoided ? \ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e to driveway surface s avoided ? t / 2 .Wa s damag e to walkway surface s avoided ? ^

## Owner s comments :

Inspectio nnotes :

Removal an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EPARepresentative/^'^^^^,,^^^^^,^^^^^^^ ^ Date : "T^Z/Q/^ S

# 4

Propert yCompletio n Agreemen t Thi s agreement document s the completio n of remedia l activitie s performe d on my property . My signature wil l designate tha t I

amsatisfie dwit hth e restoratio n of in y property , an dtha t no item s ar e inquestions , now , or at any time inth e future , excep t thos e item s liste dbelow , ifany . Property ID : ^yfj ^ Property Address : J^j- ^ 1 A J 3 1> r X 5 + Owner : /JQ ^ C ot'^V^ V n'dy 9' ^ vAcy f i^ ^ i^ l Co ^ 

## Phone: '-(flX'^l' ^ Restoratio n Item s in Question :

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

agre e restoratio n is completed , except as noted do not agre e restoratio n is completed

e Owner' s Signatur Dat e ( Comractor' s Signatur e