## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D Date : 

# ^llt ? Address : Remediatio nContractor : _Coasta l Environmenta l Group _ Year : 20 i 

# T SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 0 ^ Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmationdata Photograph s ^- ^ ^ h ^ y {;f'Cfi(V(X^\9 n \ ( ^ ip,aC^fii^^-ir\ ^ 

## e f As-built sketch Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit y clearance s Propert y infomratio nfro mDougla s Count y Assessor' s Office 

# \' ^ 1^ T5at & Superfun d

# vv Propert yAcces s Checklis t Propert y m : H C^L^T ^ Propert y Address : ^ylC ^ 3 O^C ^ /^ ^ n nWOR K STARTE D WORKCOMPELTE D ON : ON : / // / Owner : [jg ^

r^-nnAnft) l Address : ^ . 

# I.n0 [ 

# 5 3 5 AVE : Phone : ^(^y (^(^O ^ r)^_^\ Fax : f l IAO A /yrk \. v ^ \ o 

### Cell/Pa i ^ 

### Oj' M • \'\\ D Renter : Phone : Fax : Cell/Pager : Additional Information :

i~l Notificatio nLette r 

# M Acces s Agreement

/ 3 Restoratio nAgreement

Q Topsoil Samplin g (if applicable ) r~ | Disposa l Samplin g (i f appUcable) Q Garde nSamplin g (i f applicable ) nutilit y Clearanc e Q^ideo/Photo s (Before)
• Video/Photo s (During ) nvideo/Photo s (After ) D Video/Photo s (30-Day ) roperty Completio nAgreement Final Report Sent : / / 

### Signed: ^ /)^/CPi 

## Signed : g_/_!3C 3 / / / / / / 

### CaUed : / / 

### On:_f./2^/_0 5 On : / / 

### On : / / 

### On : / / 

### Signed : 4^^ ^ Issued : / / By : 

## ^r-B C "y'F^ r By : By : By : By : By : /^/V^/A^/i' . By : By : By : By : By : Air Monitorin g (a s appUcable) D Conimunit y QCre w Results : On : / / 

### By : 1

nCommunit y Results : QCre w On : / / By : D Communit y Results : Q Cre w On : / / By :

Omah a Lea d Sit e• • 

## Douglas Coimt y Accoim t I

; n||k^|ip r Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R254159000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e l ® scal e 0-5 0 ft wes t o f52n d S f - ViewO H Ma p Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ " * ^ Aut o Sale s Searc h Owne r ODONNEL L LE E A 212 9 S 3 5 AV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumtier : 415 9 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 254159000 0 Parce l Address : 2129S35A V OMAH AN E 68105-000 0 Lega l Description : WINDSO R PLAC E LO T10 4 BLOC K0 5 0 X 13 3 Vaiu e Informatio n Lan d Improvemen t Tota l 200 9 $6,500.0 0 $70,600.0 0 $77,100.0 0 200 8 $6,500.0 0 $70,600.0 0 $77,100.0 0 200 7 $6,500.0 0 $70,600.0 0 $77,100.0 0 200 6 $6,500.0 0 $70,600.0 0 $77,100.0 0 200 5 $6,500.0 0 $70,600.0 0 $77,100.0 0 200 4 $6,500.0 0 $70,600.0 0 $77,100.0 0 Sale s Informatio n Sale s Date : 2003-07-2 3 Dee d Type : W D Booilr : 200 3 Page : 16123 0 Price : $116,000.0 0 Grantor : Vincen t Heat h Eta l Grantee : Le e O'Donnel l Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2000-10-2 0 Dee d Type : D SooHr ; 216 6 Page : 36 6 Price : $109,000.0 0 Grantor : 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.. . 9/17/2009• • 

### Dougla s County Accoun t I iii^^tto n 

### Pag e 2 of 3
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6650. 0 1. 0 133. 0 50. 0 N o Improvemen t Informatio n Buildin g 1 1 1/ 2 STOR YRNISHE D 1 5 IT 

# f Fira t Floe i t « ,„ . secon d Floo r 84B. 0 »q . ft . 6530sq,1 l ^° |

1 3 i r ;^ 0 imaa^ n Ban m BkKk SI I DaiKfa d amj a B*

B a »a . ft . ST : si F ,.',BH»J.I,M.WIMt.«BHIimCT<tMIEeBr a CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : ; 1500. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Goo d

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Viny l Units : 3. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 189 5 0 % 189 5 11 4 Deta/ 7 Typ e Detai l Descriptio n Unit s 1. 0 Applianc e Allowanc e Ad d O n Fenc e Chai n Lin k 1. 0 Basemen t Bsmn t Bloc k 8 f t 848. 0 Fixtur e Additiona l Fixture s 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25. . . 9/17/200 9• • 

## .Douglas Count y Accoun t I

i nSmjMt^ t 

## Pag e 3 of 3 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 672. 0 Porc h Sla b Roo fCei l 140. 0 Porc h Woo d Dec k 320. 0 Use r 3 UNI TCONVERSIO N 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.. . 9/17/2009

### • • • # 

## CONTACT FOR M Propert y ID #\^<^^g > Propert y Address : 

# -L\z q^ , 7\^p,K j Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Final Contact : Date : Time : Action : Final Action : Transmit t

o EP AD Other Action : D

Comment : Owner Comment (s) : Site Coordinato r Comment (s) :

### Pag e 1 of 2

" > Create Anothe rTicke t Back t o Irt h Internet Sen d Emai l YOU RTICKE T NUMBE RI S 2369192 . Origina l Cal l Date : 9/21/0 9 Time : 5:3 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/23/0 9 Time : 6:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 21 2 9 Street : S 3BT H AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-SW,29-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Are a Contac t Phon e Number UtiUt y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL3 COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/2 1 /200 9

### Pag e 2 of 2

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www;dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/21/200 9OLS#:1794 3 

# As-Buil t Drawin g Dat e Excavated:9/26/0 9 Dat e USEP ASigne d Off : 10/5/0 9 COASTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 9 0 s o f t CNVmONHENTA L C I I O U P . IN C

Name : Omah a Lea d Sit e Date : Nort h Arro w Address : j^\X.< i S.^( ^ Sit e Sketc h Time : Phone : Tea m 

### \iA\^c\(V^\V.^ ^

<^.t > BVID # ]1^^3 > XR F Cod e 

## 3SDZ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e N o sa ^ pp m / ¥ Z * • Z ^ pp m N o CS ^ ^»Ye s • N o [3 ^ <e-ybScPyA- - |-7^^ 3 pp m pp m $V& % C D N o E3 ^ 3 V ^ ^ .SZ . pp m N o ca ^ pp m Ye s CD N o CD pp m Ye s • N o •



# ^ . 3 6 ef ^ Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h Are areplace dwit h Are alef t bar e So d Rock/Mulc h 

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

# u I h

1—- . ^

—/ Name : Omah a Lea d Sit e Date : Nnrt h AlTO W Address : ^\X ^

S . 5S(w t Sit e Sketc h Time : Phone : Tea m 

## \\A\^tV^\-^^?.t > BVID # ]1'^^ 3 XR F Cod e 

## SSDZ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## n^Lf 3 (^e s n N o S3 ^ pp m ftYe s n N o ts- ' pp m 

### 3 ^ / fc 3( ^ 4lYe s n N o S ^ pp m / I O * I'Z
­ pp m ^Ve s 1 ^ N o Q ^ 

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# / . ^ ^ 

# J^! ^

# u ^ 

# df \ 2^M t

-. . / Name : Omah a Lea d Sit e Date : Ncirt h Arro w Address : 

### ^\X ^

S \ 25/W b Sit e Sketc h Time ; 

## 1 i-.t fp.n. . Phone : 

# ^er- — Tea m 

## ^\•AV^(^V>^^ | g.t > BVID # ]1^^ 3 XR F Cod e 5SD"Z ­



# 3 ^ 

# (Pi ^Name : _ Omah a Lea d Sit e Date : Nnrt h Arro w Address : ;aL\3L q s.isi ^ Sit e Sketc h Time : 

### » : nVQfp.*^ . Phone : 

### Tea m \\AV<>\ft^\U ) (^>t ^

BVID # ll ^

'^ 3 XR F Cod e 6>SD'Z - Sampl e Numtw r Lea d Concentratio n Confimiatio n Sampl e pp m «Ve s a N o B ^ pp m N o C& " 

# 3 2 pp m •lYe s a No B ^ pp m No O * ^ e s ° 3^ ^ * SZ . pp m N o ta ^ j^ye s a pp m Ye s a No CD Ye s • pp m N o O



# / . ? ^ # *»*^'^"v . COASTA l IHyiROHn fRTA l C I O t l P . IH C 

## Consen t fc f Acces s T o Pfopsft y RIGH TO F ENTR YT O PREI^ISE 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 : . <IQI . 

### . .

Owner' s Name : Daytim e Phone : 

## r^t^OA/NCi l i^ ^ 

# ^ b z ^^S-OZ'^ l Addres a o f Propert y covere d b ythi s Agreement : 

## -^2.12- 9 ^ '^'DMJl ^ PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o f lea 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 its 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 Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunityt 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 confin n 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 property 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 , Its employees , contractors 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 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 f 2s^-'^"''* ^ COASTA l tNVmONHIKTA l '•" I POO^*' ' C I O U ' 

### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; e 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 ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; e 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 . 6 Allo wvideotapin g and/o rphotographin g o f th 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 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 (402 ) 991-119 9 I gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s
Signature Date G I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required . t •« C



### Page 2 of 2# ,.y 1 

# iC J - COASTA L 

# Restoratio nAgireemen t Th e purpos e of thi s agreemen t i s to provide amutua l agreemen t a s t o condition s ofth e propert y prior t

o remediatio nactivities . Thi s will als o serv e a s documentationfo r th e purpos e of assuring tha t restoratio n activitie s ar e completedto th e satisfactio nof th e propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y IP : \'^qT^g- ^ Propert y Address : T^^-^ A S 1\ ^ l^^/£ J Owner ; 5^y^f^g\ | ^p ^ Phone ; 4^g>^to^ m O

nth e attacheddiagram(s ) indicat e area(s ) t o excavate , surface structure s an dlandscaping feature s an d acces s location(s ) to b e usedby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t th e existing condition s ofthe propert y an dthe basemen t i

f necessary . 

## item s t o b e Remove db y th e Owner before Star t o

f

Remediation : Th e I enoval , storage , disposal , and/or retur no f thes e itom s i s th e Owner' s responeibility .

Pag e 

## 1of 7

# c :'i COASTA L 

### Item s t o B e Remove d ByContracto rDurin g Remediatio n an d Repiace d Item : Item : 

## Sgfe /

iF V Item : Item :



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

# i s tha t wil l b e excavated , tha t i s covere dwithgrass . Numbe r o f tree s > 2 inc h trun k diamete r \ Numbe r o f tree s < = 2 inc h tnm k diamete r 

### \ Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . 

### ^ Aiiai h; i skeicli
- o i iln? .".pripklo i ti;\'.uii . V Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Alliith; i skoic hol ri.-!;itiv f 

### \ <izi- s nndloc;iiiiv K Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . \CU
- Illi " \HIII C VMI I fi l {iSc C 1 0 li ; u< ' . 1 ;IIHII ; 

### \ »(iiK-iii;r I dlli f i:rii|)cri > ii w ner : Easemen t Area , t o b e excavate d \ 

### Landscap e Inventor y Uni t Condition/Type/Specie s Quadrant s

Eac h Fflc h

Fac h

Fjir h Squar e Fee t

S

Eac h 

# "^bvcVorK x^i^^^^f^ ^ Pag e 2 

# .,' VCOASTA L
! Additiona l Comment s / Instnictions :

y\phec k th e bo xr fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pr&^xistin g damage . Bycheckin g thi s t>o xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures .


### O I do no t agre e 

# ti ^ 

# ^ 

# i^ H

## BVID#_lJiM 3 XR F PROPERT YSAMPL E SHEE T Dat e Projec t XRFID #

Shot # 

# U S 

# f u ^ rni . Averag e

Sho t #

Averag e

Shot #

Averag e

Shot #

Averag e

la b sampl e # 

# tl^Jrl m Omah a fee d I^P 2n d yea ropilo n 

# h^^^ ^ Readin g 

# /^rj ^ /t ^ /^I j -J^ l Readin g

Readin g

Readin g

La b resul t Sampl e are a ^)ept h 5 ^ Sampl e are a Dept h

Sampl e are a Dept h Addres s Sampl e tim e sampl e lengt h Shot # 

# V3> T 7 3 ^

Averag e

Shot #

Averag e

Shot #

Averag e RETES TAREA S Sampleare a Shot # Dept h Averag e Sampl e are a XR F Avg . 

### n^X-x ^ < ; ^<> ~ A0I 5 am/p m 3 0 se c Readin g Sampl e are a / / ^ -^ /. ^ /g^-^f c1 3 

# £ L Dept h 

# '?2^l / V \ "Z-l — / 7 Readin g Sampleare a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Signatur e 

# F^itu i ^SA. 

# Prin t

P^U^he ^ Or/r^_ s

## iysAJ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^ ^

I ST^^T ^ Coasta l Environmenta l Grou p Inc .

www.coa8talhazmat.co m V ^ ^•'tpfia^ ^ COASTA L mVltOIIHIIITA l CIOUP , IN C 

# EXECUTIV ESUMMARY : BVID #17943-(212 9 S 3 5 AVE ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :4 

# m EP A Propert y Clos e Ou t For m Propert y#:_QaH2i- _ DatcHlroc : Owner' s Name:..j)^^^ . < ^ WHTI^ ^ ^ - • ^\ ^ \ Quad s Excavated : ^\ Contracto r Croup f ^T^r^A ^ yjCWiX^tjtMrCC^ ^ • Ye s N o Excavatio nGenera l 1 .

I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## i^ ' 2 .

I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# y Ye s N o Gradin g So dan dVegetatio n I .Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e awa y fromth e house ? 

# t r 2 .Ha s so dbee nlai di n al l area s tha t wer e excavated ? 3 .

Doe s di e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

## l ^ " da y tim e period ) 4 .Ar e sodde darea s generall y firman devenl y graded ? 

## -;:? ' 5 .Ar e th e joint s twtwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day 

# i:; ^ tim e period ) 6 , Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o n th e property ? 

# T 7 ^ 7 .

Wa s damag e t o landscapin g o r plan t malerial s avoided ? Gates , Fence s an dRciatoin g Wal b Ves N o I .

D o gate s ope nan dclo.s e freely? (Ifapplicable ) ^ ' Wer e al l gale s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# y 

# y 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGmier s Yes ..No 1 .Wa s damag e l o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundatio navoided ? 3 .

Wa s damag e t o window s avoided ? 

# -^ r Wa s damag e t o window s o r doo r screen s avoided ? 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDrh-eway s (Concrete ) 1 .Wa s damag e t o drivewa y surface s avoided ? ^ 2 .Wa s damag e t o walkwa y surface s avoided ? 

# U- "

## Ch^'Der s comments : - #



## Inspectio nnotes :

Remova l an drestorationactivate s complete , including the 30-da y so dwarranty : EP ARepresentativ e L JcSK . jj > aJi\jL ^ Date : jt)j5 ^ 0 ^^



## Propert yCompletio n Agreemen t I hi s agreemen t documenl s th e completio n o fremedia l activitie s perroime d o n m yproperl yM ysignalur e wil l designat e tha i I a m satisfie d wit h th e restoratio n o f m yproperly , an d tha i n o item s ar e i n queslions . now , o ra l an ytun e i n th e future , excep t Ihos e ilem s liste d below , ifan y

Propert yID : \" ^ C | L^ ^ Propert yAddress : ^^^-^^ ^ 5 3 5 Owner : ^ p Q'Aor\r\P. \ \ 

### Phone : ^O^MOi?, . Om l Restoratio n Item s i n Question :

Item : Ilem : Item : Item : Item : Item : Additiona l Comment s A/^ . 

### PA^' . MQ2 . QQl . l^l D



## ^ 5 LOM ^ rvi ? i § ^c^ D TH>^' ^ -^^' ^ w//7/c ^

^ p^Ts I «t!rc cr cstoraiio n i % complded , cxccp l a s note d [_ J I d o nn faurt crcsforfltio n i n eomplele d 

## ^ Owner'. * Signariir rDat e Cont i artoi' s Signatur e On( c 

## h\o^f\