TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 

-m^l 

Date: \wy 

Address: Ho ^ U^IU| ^ M 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Vtdeo ofproperty (DVD) \^/V^^ r fMt( ^ 

y 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

/ 

Restoration Agreement 

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

Confirmation data 

y 

Photographs -proPAr-ii^ S^ d \[(UL \ 5 0 Q 

As-built sketch 40316469 

Satisfactory restoration signed by Property Owner ill 

Superfund Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

1 / Property information from Douglas County Assessor's Office 

y 

(ripfier-Lu Access ci\eMi^T 

D 

Signature 
% 

16 

Property Access Checklist 

Property ID: 2^5>3 ^ 

Propertv Address: ,:{^^^y^,|^^ ^ <\^)f 

n

n

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

^""^''•=C.\;(^c \ VhViVSNn<; 

Address: ^^ ^ SftXodUn^S V 

Phone: q ^ _ ':^^^^ 

Fax: 

Cell/PiiKcr: 

Renter: 

Phone: 

Fax: 

Cell/Paj;er: 

Additional Information: 

1 1 Notillcation Letter 

P ^ Access Agreement 

]y\ Restoration Afircement 

[U Top.soil Sampling (if applicable) 

O Disposal Sampling (if applicable) 

1 1 Garden Sampling (if a|)|)licablc) 

J 2 Utility Clearance 

JZ^ Vidco/Photos (Before) 

n Vidco/Photos (During) 

n Video/Photos (Aftci) 

D Video/Photos (3(I-Day) 

Q Property Coni[)letion Agreement 

n Final Report 

Sent: / / 

Signed: "^ / Z'=i / Oi 

Signed: ^ / Z^ / £3jr 

/ / 

/ / 

/ / 

Called: 3_/23_/6i -

On:jl/ \ /O^ 

On: / / 

On: / / 

On: / / 

Signed: / / 

I,s.sued: / / 

By: 

B>'=KAArr/S3 

^y- \-\ajrcQ^ 

By:

By:

By: 

^>'=T-3|.oS 

B.v: \At/\ /t o 

By:

By: 

By: 

By: 

By: 

1 

1 

j 

Air Moniloring (as a|)plical)le) 

1 1 Conununity CD Crew 

Results: 

On: / / By: 

lU Community

Results: 

O Cre« On: / / By: _ 1 

O Community

Results: 

 [U Crc« On: / / By: 

Omaha Lead Site 
CONTACT FORM 

Property ID # (9^r^3 ^ 

Property 

Address: Rfy7 \KV\\\^S y 

Initial Contact: Date: l-2g-oETime: Itib Action: Spr\yp fa ,^\(^ Ccitl AAor^tLy 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

p.nhh\n^ yyf A ^5 ^ - 'v-.gq 

Comment: 

Owner 

Comment (s): 

Site ^im Cal l K\(xv}iCiM KKDco'ioa. 

Coordinator 

Comment (s): 
Douglas County Account Infonnation Page 1 of 1 orma 4 

Dougla s County , Nebrask a Propert y Recor d - R240169000 0 

Print Report 

NEW Feature Parcel Dimensions available ffi scale 0-50 ft west of 90th St - Vie w On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature -•-»- • Auto Sales Search 

Owne r 

ROBBINS CLIFFORD A 

ETAL 

5014SPAULDINGST 

OMAHA NE 68104-0000 

Propert y Informatio n 

Key Number: 0169 0000 24 

Account Type: Residential 

Parcel Number: 2401690000 

Parcel Address: 1705 WILLIS AV 

OMAHA NE 68110-0000 

Legal Description: VICTOR PLACE LOT 10 BLOCK 0 E 5 FT LT 11 & ALL 45 X 100 

Valu e Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

$400.00 

Lan d Informatio n 

Acres 

0.1 

SF 

4500.0 

Units 

0.0 

Depth 

100.0 

Width 

45.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24... 7/17/2008 
f Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2094105. 

Original Call Date; 

Work to Begin Date; 

7/29/08

7/31/08

 Time:

 Time:

 5:40 pm 

 6:15 pm 

Op: ELIZABETH18790 

State: NE 

Address: 1705 

County: DOUGLAS 

Street: WILLIS AVE 

Place: OMAHA 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 10-SW 

Sect-Qtr: 

Type of Work: lead remidiation 

Location of Work: LOCATE ENTIRE PROPERTY ALL THE WAY TO THE STREET. 

Remarks: FAX ALL CLEARS TO: (877)662-4211 

: UNSURE OF CORNER LOT 

Company : COASTAL ENVIRONMENTAL SERVICE 

Contact Name: ELIZABETH Phone: (877)662-4210 

Work Being Done For: coastal 

Depth of Excavation: 4ft Corner Lot: N 

Involves Tunneling or Horizontal Boring : N 

Front: Y Rear: 

Explosives: N 

CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT EDWINA

Day: 4025047823 

 Alt: 

Emerg: 4025047946 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULTS... 7/29/2008 
f Page 2 of2 

Day: 4067289343 


0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/29/2008 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

28339 

Exterior Paint North Arrow 1 Owner Name: CLIFFORD A ROBBINS Omah a Lea d Site • Good Address: 1705 WILLIS AV

 *»'^® Sketc h • Poor Phone: H: W: |3^o t paint \ 1 

Sample Lead Sample 

Samples Collected Number LAB Concentration Collected 

RYASCPXA-28339 F1 

ppm IE" D Date: f^.OboS 

RYBSCPXA-28339 F2 ppm D Time: to-'l o 

RYCSCPXA-28339 Bl ppm D Samples Analyzed RYDSCPXA-28339 B2 ppm D 

nDzecp,Vu^ aesso—oz ppm D D XRF Unit /<93 7 Book: i2J^ 

nc;gooP)(A-2ooo9—es- ppm D D Date: 9-1-05 -

RPZSCP.Y,A 38330 U ppm D D 

Time: Pry\ 

Staff: ^-A Number of Samples = i l 

Dat; 

Omaha Lead Sue 

46130 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with El;" 

Sod Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Enviroiunenta l Group In c 
28339 

Owner Kamii: CLIFFORD A ROBBINS Omaha Lead Site 

Address: 1705 WILLIS AV ^'*® Sketc h 

Phone: H; W: 

Sannple Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-28339 Fl 3^ 1 ppm n 

RYBSCPXA-28339 F2 3V< 9 ppm n 

RYCSCPXA-28339 Bl 3Z2. ppm D 

RYDSCPXA-28339 82 tZSO l ppm .uy D 

RDZSCPXA 2833Q OZ ppm D n 

nozocpxA"g0300—e?-

RPZSCPXA-38339 RZ 

ppm 

ppm 

n D 

n 

Number of Samples = iP " 

Exterior Paint Nortti Arrow 

• Good 

• Poor 

[3^o t paint 

Samples Collected 

Firm: FDA T^/R\^J 

Date f>OOo S 

Time 10 '2.0 

Samples Analyzed 

XRF Unit: /03 7 Book: 12."^ 

Date: ^7-/ 05 -

Time /^/v? 

Staff .^A 

Oinahn I c^d S:ie •46 l.'^!!] 
28339 

Owne Omaha Lead Site r NJamn: CLIFFORD A ROBBINS 

Site Sketch Address: 1705 WILLIS AV 

Phone: H: W: 

Sample Number Lead Sample LAB Concentration Collected 

RYASCPXA-28339 Fl 3^ 1 ppm n 

RYBSCPXA-28339 F2 5V<P ppm D 

RYCSCPXA-28339 Bl 3^Z ppm or D 

RYDSCPXA-28339 B2 IZ501 ppm uy D 

RDZSCnXA 28330 DZ ~ PPin D D 

ROiIOCPKA-g0009 S? ­ n D 

RPZSCPXA 38330 (22 ~ ppm D D

Numberof Samples = It' 

f^.t.c^­

"^jujoumJiJbu.... 

^AjC^.aidJyr\ 

Exterior Paint North Arrow 

• Good 

• Poor 

Q^o t paint \ 

Samples Collected 

Firm: F/>A 7 b /R\AJ 

Date: P;.%oS" 

Time: lo • 'lo 

Samples Analyzed 

XRF Unit 103 7 Bool<: 12.'^ 

Date: *7-/-oSTime: P/^ 

Slaff: ^A 

•SMTBHEI) 

Afyp 

yoptr-V"^ tmA 

^^•^••^^l^^^"^ " 

\NJ:(VL ^ 

\jO;\l.LlS.....MJ. 

Omaha Lead Site 46130 

I . .^s^.: : 
28339 

Owne Omaha Lead Site r Hamft: CLIFFORD A ROBBINS 

Site Sketch Address: 1705 WILLIS AV 

Exterior Paint Nortri Arrow 

• Good 

• Poor 

Q^o t paint 

i 

Samples Collected 

Firm: _EnB—y[hyBM. 

Date: P)OtioS 

Time: '0' ±0 

Samples Analyzed 

XRF Unit: /03 7 Book: /2.* ^ 

Date; 'J-l-oS ' 

Time: P ^ 

Staff: Z./4 

•SMTEBBD 

4 ' prof«^+'5^ »'«^ 

Phone: H; 

Sample Number 

RYASCPXA-28339

RYBSCPXA-28339

RYCSCPXA-28339

RYDSCPXA-28339

RDZSCRJXA 28330

ROIIOCPXA-20009

RPZSCPXA 38330

W: 

Lead Sample LAB Concentration Collected 

 Fl 3 ^ t ppm n 

 F2 ^V< g ppm D 

 B1 32- Z ppm or n 

 82 IZ50 1 ppm uy n 

 DZ ~ ppm n n 

 Qir ppm D D PZ ppm D 

n 

Number of Samples = / ^ 

rtf^<-^ 

^jujxMuyby. 

i5C auxxcL / 

iXAjLy.(L&lIjuyijit 

1705.'WJ .11.5 

AM 

• 

"i^lijUJjcy. yju^ . . 

OyiU4, zyAjC4uu<£iy' 

" J 

3\ 

UJALK u QJtOfH 

I­

-f-Z. ft : 

3'40 

I Ifl f ^^^^^^^ * f •! 

A L <VL<. I 

\JO \l.Ll6.....A^. Omaha Lead Site 46)30 
Cm'' # 

COASTA L [HVIIONHtNTAl 

C • O V F. IMC 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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: CL ] f fD^V p^H\V\'> Daytime Phone: M^C-fol/ ^ 

Address of Property 

covered by this 

Agreement: hn' viiLi^ m 

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 Grantor's 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 
s*^*'** 

# 

COASTA L INViaONMfWTAl 

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

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantors 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 (712) 352-0188 

G3>^rant access to my properties D I do not gxant access to my properties 

pj/A.ya, yy/^ . v-^f.^ ^ ,/y7 ^ ^h l 

Date Slgnj^ure Date 

Q I would like to be present during any sampling that is required. 
4 1 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe property prior lo 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property ouner and the United States Environmental 

Protection Agency (EPA). 

Property ID: T F ^ 

Property Address: V^pt; \|y/UU4 hi t 

Owner: C/Llf^/| V f^gl^g^/H^ 

Phone: Oi^yio^<\ 

On the attached diagram(s) indicate area(s) to excavated and depth of e.xcavation. location of all known 

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

contractor, and the direction of North. Indicate distances, depths, material t>pes, 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 removal, storage, disposal, and/or return of these items is the Owners responsibility. 

Item: 

ii:^l46 2_ 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) 

Page 2 of 
^ 

C O A S TA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: . 

Item: 

1/ , 

\t^ u ^ t Vvyyy/c, ---^^_ ^ 

Item: J 

Item: y 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 7 

Item: 

Item: 

Item: 

Page 3 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 

irunk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, etc. 

Aiiach a sketcli u!' ihc 

ipi'iiikle:" !;i \ oui. 

Number of and size of 

each garden/ flower bed 

area. 

-L'es nnJ. locations. 

Quantity Unit Condition/Type/Species 

% 

' ^u r ^W> 

Square feet 

/ ) Each 

j y Each 

i 

y Each 

Each 

Square Feel 

1 

i 

(P 

Page 4 of 
m^ 

-COASTA L 

Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this \alue «il l be 

used to issue a plant 

\oucher to ihe propert> 

owner. 

Agreed upon list of plant 

materials that wil l be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant \\\\\ be placed 

h\ the contracior. 

Agreed upon area of 

propertv to be replaced 

w ith grass sod. 

':ii.'h:de a v^eich u:' the 

.iieais! to be :cp|-.K'L-J •.'- •th, 

L;'a-.> >od. 

•Area of City or Count) 

property to be landscaped 

per their requireinents. 

!riti,:l.lc ; -i-.i'i,-!' K'\ :! t 

.1; c'.! IS ! 

Easement .Area. 10 be 

excavated 

Quantity 

y 0-

y 

\ ) l 

Unit 

$ 

Each 

SF 

Condition/Type/Species 

SF 

SF 

Page 5 of ^ 
: O A S T A L 

Additional Comments / Instructions: 

• Check the box if Owner does not want CEG to document interior foundation walls and possit>ie 

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. 

G3^g Q I do not agree agree 

iture Date [Contractor's Signature 

Page 6 <^y 
XR F PROPERT Y SAMPLE SHEET 

BVID# i%^^^ 

Date 

Project 

XRF ID# 

"{ 9V\ H 

Omaha lead FP 2nd year option 

%^P^ ^ 

Address 

Sample time 

sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

1M

^^k 

1 II-ID

\\y i

I

 1.1

 1.1 U 

1 u

\\Al 'tz. qMt n M Depth Depth 

M^ U.Th\ 'Uk q. 

Average ( i ­ l \ ^ /• U U Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

^ 

Depth 

y

y

y^

/

/ 

y Depth 

Average Average 

lab sample* Lab result Sample area XRF Avg. 

Signature 

Print \K^G n KffHV 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1680 

Mode SOIL 

Time 2008-08-02 17:27 

Duration 120.91 

Sequence Final 

Flags 

AVERAGE fAvg of 1676-1679 

ADDRESS 1705 Willis av 

QUAD/ZONE B2 

INSPECTOR lopez 

DEPTH ! 4 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pr'PE 

NOTE 

ppm 

Pb 11.199 

Supervised By: 

Certificate of Verification 

1676 

SOIL 

2008-08-02 17:25 

30.32 

Final 

28339 

1705 Willis av 

B2 

lopez 

4 

CLEARANCE 

± Error 

± 7.116 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE PI'PE 

NOTE 

ppm 

Pb 21.401 

Supervised By: 

Certificate of Verification 

1677 

SOIL 

2008-08-02 17:25 

30.22 

Final 

28339 

1705 Willis av 

B2 

lopez 

4 

CLEARANCE 

± Error 

± 7.764 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1678 

Mode SOIL 

Time 2008-08-02 17:26 

Duration 30.14 

Sequence Final 

Flags 

BVID # 28339 

ADDRESS 1705 Willis av 

QUAD/ZONE B2 

INSPECTOR lopez 

DEPTH 4 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 22.448 ± 7.893 

Supervised By: 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pi'PE 

NOTE 

ppm 

Pb 22.732 

Supervised By: 

Certificate of Verification 

1679 

SOIL 

2008-08-02 17:27 

30.23 

Final 

28339 

1705 Willis av 

B2 

lopez 

4 

CLEARANCE 

± Error 

± 7.886 
• % 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVHONNENTAL 

GROUP . IN C 

EXECUTIVE SUMMARY: 

BVID # 28339 - (1705 Willis Ave.) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
Sit. EPA 

EPA Property Close Out Form 

Property Property Address:" 

Date/Time 'Z':::yzzy^^ykm^ 

Quads Excavaled: ^ ^ 

Contractor Group (j7)0r^fiRtExcavation General V^ACftNfT IS) \ 

Yes

1. If necessary, were the correct quadrant(s) excavated and restored? i / 

2. If necessary, were the correct areas ofdrip zone excavated and restored? > / 

GradinK Sod and Vecetation Yes 

1 Does the grading around the perimeter ofthe house in excavaled areas generally slope away 

from the house? y 

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 

dav time period) 

4. 

Are sodded areas generally firm and evenly graded? x/ 

5. 

Are the joints between the sod strips generally tight? (Only evaluate ifinspected at a 30 day 

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? y 

Gates, Fences and Retaining Walls 

Yes

1. Do gates open and close freely? (Ifapplicable) 

Were all gates or fences taken dovm during restoration activities reinstalled? (Ifapplicable) 

3. Was damage to gates or fences avoided? (Ifapplicable) A)F 

4. Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, SidiDg and Gutlers Yes 

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

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? ^ ^ 

4. Was damage to windows or door screens avoided? r 

5. Was damage lo downspouts or downspoul extensions avoided? \ > 

Sidewalks and Driveways (Concrete) 

Yes

1. Was damage to driveway surfaces avoided? 

# 2.

 Was damage to walkway surfaces avoided? 

 No 

No 

 No 

No 

 No 
Owners comments: % 

Inspection notes: 

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

EPA Represent^tp<;^^^,^^.^^>^^\Xg ^ Date: E^d t 
• • 

Property Completion Agreement 

This agreement documents the complelion of remedial activities pertbiined on my property. My signature 

will designate that I am satisfied with the restoration of my properly, and Ihal no ileins are in questions, 

now, or al any lime in the future, except those items listed below, ifany. 

Property ID: d^ ^ ^' ^ f 

Property Address: / J ^ f VUTIZl ^ A^ d 

Q—- ClxfPo. A (S?AV;^^ 

Phone: 

Restoration Items in Question : 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I I I agree restoration Is completed, excepl as noted 

I I I do no( ayrcc restoration is completed 

M H y 

O^ii-r' s Signature Datoy Contractor's Signature Dale