## TRANSMITTALo f

OMAHALEA D SIT E SOILREMEDIATIO NFIL EFOLDE R

SA1D « 

### Dale

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# h s Address : \^^°\^'* H Ij f Remediatio nConlractor : Coasta l En\'ironmenta ) Grou p Year : JOIOARR A
SOI LREMEDIATIO N PROPERT V FIL EFOLDE RDOCUMENT S 

## l / Vide o o f propert y (DVD ) 

## { / Executiv e Summar y 

# Y EPA-provide dpropert y sketc h 

# y Signe dAcces s Agreemen t foi subjec t propen y Signe dAcces s Agreement(s ) for adjacen l propert y 

# Y Restoralio nAgreemcn l Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confinnatio n dat a 

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# y As-buil t sketc h Satisfactor y restoralio nsigne db y Propert y Owne r ( / Propert y close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanu p criteri a 

# y Utilit y clearance s 

# d Propert>Uflfonnatio nfro mDougla s Count y Assessor' s Office


# -^AP// / Ignatur e Date ' 3023739 2 Superfun d

# ^ v 9 / 

## Propert yAcces s Checklis t PropertylD : ^SS9 ^ D WOR K STARTE D ON : / / D WOR K COMPELTE D ON : / / *2ff ^ PropertyAddress : j(Q0< Y/^iki L
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. Topsoi l SampUn g (i f applicable ) Disposal Samplin g (i f applicable ) Garde nSamplin g (i f applicable ) Utility Clearanc e

Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After ) Video/Photo s (30-Day ) Propert y Completio nAgreemen t Fina l Repor t Ai r Monitorin g (a s appUcable )

• Conununit y • Cre w On : Results :

• Communit y • Cre w On : Results :

• Communit y • Cre w On : Results : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

Sent : / / By : 

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Dougla s County , Nebrask a Propert yRecor d - R160133000 0 Prin t Reoor t Vie wInteractiv e Gi S Ma o Informatio n i s vali d a s o f2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e ^ - 4 ^ Subdivisio n Sale s Searc h Owne r BRUNKE N S ETA L 250 3 N 1 6 S T# 8 OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 013 3 000 0 1 6 Accoun t Type : Multipl e Re s Parce l Number : 160133000 0 Parce l Address : 160 9 LAK E S T OMAH AN E 68110-000 0 Lega l Description : LAK E AD D LO T1 BLOC K6 W66.3 3 FT52.6 6 X 66.3 3 Valu e Informatio n Lan d improvemen t Tota i 201 0 $400.0 0 $0.0 0 $400.0 0 200 9 $400.0 0 $0.0 0 $400.0 0 200 8 $400.0 0 $0.0 0 $400.0 0 200 7 $400.0 0 $0.0 0 $400.0 0 200 6 $400.0 0 $0.0 0 $400.0 0 200 5 $400.0 0 $0.0 0 $400.0 0 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 7 3432. 0 0. 0 52. 0 66. 0 Ye s



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. . 9/3/201 0

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### • YOU RTICKE TNUMBERI S 2637693
. Origina l Cal l Date : 11/08/1 0 Time : 5:4 5 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 11/10/1 0 Time : 6:1 5 pm State : N E County : DOUGLA S Place : OMAHA Address : 160 9 Street : LAK E S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTAL Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTAL ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTAL Dept ho f Excavation : 4 F T Corne r Lot : N Front : y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V

MUDO l OMAHACO F OPPDGPR S QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utility Typ e 

### Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , INC HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRICTSANDY 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCITY OFOMAHA-TRAFFlC,SEWE RRICH/TRAFFIC Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH APUBLIC POWE RDISTRICTEL M LOCATINGAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES TLOCA LNETWORK EL M LOCATINGAh : 406207149 4 Emerg : 888728934 3


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. . 11/8/201 0

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# mah aLea dSuperfun dSit e OLS# : 28S7 8 Dat e Excavated : 11/11/201 0

Dat e USEP ASiane d Off : Are a Sodden : 51 0 s a f t Omah a Lea d Sit e Owne rName : S BRUNKE N TURNE R Sit e Sketc h Address : 160 9 LAKE S T Phone : H ^ Sampl e Numt>e r RYASCPXA-2857 8 RYBSCPXA-2857 8 RYCSCPXA-2857 8 RYDSCPXA-2857 8 RDZSCPXA-2857 8 RGZSCPXA2857 8 RPZOCPX A28S7 B 

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### Coasta l Environmenta l Grou p Inc .

# 2857 8

OmahaLeadSite 4613 0

# 2857 8 Omaii a Lea d Sit e Owne rName: S BRUNKE N TURNE R 

### Sit e SIcetcl i Address : 160 9 LAK E S T Phone : H : W : Sampl e Nunnbe r Lea d Concentratio n antra l Sampl e Collecte d LA B RYASCPXA-2857 8 RYBSCPXA-2857 8 RYCSCPXA-2857 8 RYDSCPXA-2857 8 F l F2 B l 8 2 

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# 2857 8 Omah a Lea d Sit e Exterio rPain t Noftti Arro w Owne rName : S BRUNKE N TURNE R 

### Sit e SIcetcl i •Good Address : 1609 LAK E S T •Poo r Phone : H : W : Q No t pain t Sampl e Numt>e r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

### Firm : "CV} ^ (>VZ^\ ( y S RYASCPXA-2857 8 F l 

# D Date : RYBSCPXA-2857 8 F 2 

# n Time:Ijn2E_ : RYCSCPXA-2857 8 B l 

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### CoiTsan l fo rAoc&s s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Gfanto t (th e propert yowner ) consent s t o ant d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o i it s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s followin g describe d premises :
Daytim e Phone : 

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Addres s o fPropert y covere d b ythi s 

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# / V 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 heait 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 Coasta 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 perfonned , 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 Ki 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 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 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 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 satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2..-^•^^'""e
.

COASlA l 

## y IKVIHOhKfKTA l C ft O I ) ' IK 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 maywis h t o save ; Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen 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 byEPA ; I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo i acces 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 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 wothers 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

migran t access t o m ypropertie s D I d o not grant acces s t o m ypropertie s


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Pag e 2 o f2COA S T AL • N V I n O H n I N TAL o a o u p . IN C 

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s o f th e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s are 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)
.

Property ID : 2 - g ' 5 " J ^ PropertyAddress : // • A \ 

# La.j^< ^ sf 7^ Owner : 

# 7 < ^ Phone : 

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1 ~ O nth e attache ddiagram(s ) indicate aFea(s ) t o excavate , surfac e stmcture s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y docimient th e existin g condition s ofth e property an dth e basement i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e Item s I s th e Owner' s responsibility
. Item : 

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### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s that wil l b e excavated , that 

# { ? ^ i s covere dwit hgrass . Number o f tree s > 2 inc h Eac h trunk diamete r Numbe r o f tree s < = 2 inc h Eac h trunk diamete r Ntmiber o f Sprinkle r Zones , Contro l Valves , Eac h Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Niunbe r o f an dsiz e o f eac hgarden/ flower be d Eac h area . Square Fee t Attac hasketc ho f relativ e size s andlocations
. Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e will b e use dt o issu e aplan t vouche r t o th e propert y owner . Easemen t Area , to b e excavate d 

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# i/hofn q/ye- ^ c//r J Pag e 2 of3A ' COASTA L a I t o l i p , INC

.
Addttiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibt t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t wtthstandin g an yremova l o rreplacemen t o fsoi l b yth e EP A I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. O Pleas e chec k thi s bo xI fyo u understan d th e informatio n outline d above
.



# J G Chec 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 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 fhouse , includin g foundatio n crack s o rfissures

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 131.44 7 Supervise d By : 

## Certificat e o fVerificatio n

4 8 SOI L 2011-01-1 3 13:5 1 90.8 8 Fina l Av g o f45-4 7 160 9 LAK E S T E A 1 " C.PADIL U CONFIRMATIO N CLEA R

Erro r 17.46 0

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 156.01 1 Supervise d By : 

## Certificat e o fVerificatio n

4 5 SOI L 2011-01-1 3 13:5 0 30.4 8 Fina l 2857 8 160 9 LAK E S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 17.66 3

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

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pp m P b 126.63 5 Supervise d By : 

## Certificat e o fVerificatio n

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# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerlca , M A0182 1

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pp m P b 111.69 5 Supervise dBy : 

## Certificat e o fVerificatio n

4 7 SOIL 2011-01-1 3 13:5 1 30.2 0 Fina l 2857 8 160 9 LAK E S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.94 7

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 8 Mod e SOI L Tim e 2011-01-1 3 19:3 6 Duratio n 92.6 0 Sequenc e Fina l Flag s AVERAG E Av g o f5- 7 ADDRES S 160 9 LAK E S T QUADRAN T B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D ; 7.58 4 Z r 429.49 6 ± 14.60 5 S r 141.42 1 ± 7.83 4 U < LO D : 13.52 6 R b 63.31 9 ± 6.04 2 T h 12.93 3 ± 6.75 3 P b 44.97 3 ± 10.52 1 S e < LO D 4.77 4 A s < LO D 14.45 5 H g < LO D 10.95 4 Z n 86.43 8 ± 16.10 0 < LO D 75.68 2 

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

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— • • —
pp m ± Erro r M o < LO D 7.44 6 Z r 412.28 7 ± 14.38 7 S r 135.72 2 ± 7.71 5 U < LO D 12.68 0 R b 63.04 6 ± 5.95 6 T h 14.97 6 ± 6.98 5 P b 47.78 8 ± 10.80 1 S e < LO D 4.83 0 A s < LO D 14.61 5 H g < LO D 11.15 2 Z n 89.36 8 ± 16.26 8 < LO D 71.93 7 

## w C u < LO D 29.37 0 N i < LO D 67.06 2 C o < LO D 166.35 9 Fe 15971.00 8 i 347.41 2 M n 668.72 2 ± 108.66 3 Supervise d By :

# 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 6 Mod e SOI L Tim e 2011-01-1 3 19:3 6 Duratio n 31.2 1 Sequenc e Fina l Flag s BVI D 2857 8 ADDRES S 160 9 LAK E S T QUADRAN T B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D 7.63 6 Z r 421.14 8 ± 14.36 4 S r 137.34 7 ± 7.66 6 U < LO D 13.81 9 R b 61.14 4 ± 5.96 6 T h 11.71 4 ± 6.47 6 P b 34.80 9 ± 9.70 0 S e < LO D 5.02 5 A s 14.36 1 ± 9.09 2 H g < LO D 10.70 9 Z n 84.43 6 ± 15.99 2 

## w < LO D 80.32 3 C u < LO D 29.09 6 N i < LO D 68.87 0 C o < LO D 159.72 6 Fe 15867.70 8 ± 342.46 3 M n 495.89 4 ± 96.61 0 Supervise d By :

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

## Certificat e o fVerificatio n

7 SOI L 2011-01-1 3 19:3 6 30.8 7 Fina l 2857 8 160 9 LAK E S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

Erro r 7.67 0 ± 15.06 5 ± 8.12 2 14.07 9 ± 6.20 2 ± 6.79 8 ± 11.06 1 4.46 6 15.11 1 11.00 2 ± 16.03 9 74.78 7 28.49 0 70.85 0 167.95 2 ± 354.83 2 ± 105.99 9 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o F e M n pp m < LO D 455.05 2 151.19 4

< LO D 65.76 8 12.10 9 52.32 2 < LO D < LO D < LO D 85.50 9 < LO D < LO D < LO D < LO D 16645.54 1

626.13 1 Supervise d By :.*^'^'-«
. 

## / ^ Q ^^ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 ^^^^ / I Coasta l Environmenta l Grou p Inc
. S^y^y ^ www.coastalhaimat.co m ^4 , y ^

''"iP^a ^ COASTA L EHVIIONHEHTA L C 1 0 U r , IN C 

# EXECUTIV ESUMMARY : BVID #28578-(160 9 LAK EST )
No Issue s o r Concern s Q Issues/Concern s
Detai l Explanation :

## EP APropert y Clos e Ou t For m Propert y # : i^^.7 ^ Propert y Addr«, : ^^fl-^^^-S^ " Daten-iine : ">f > ^ 1 Owner' s Name:
. fe(^ T7<yy*'^rSy^ = Quad s Excavated : Contraclo r Group
. - ^ Yes No Excavatio nGenera l 1
.I f necessaiy , wer e th e correc t quadtant(s ) excavate dan drestored ? / 2
.I f necessary , wer e th e con«c t area s ofdri p zon e excavale dan drestored ? 

# y Yes No 1 Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y Gradin g So dan dVegelatio B / fromth e house ? 2
.Ha s so dbee nlai dI nal l area s that wer e excavated ? 

# f / 3
.Doe s th e so dappea r t o b e genetBll y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
. Ar e sodde darea s generall y nr man devenl y graded ? 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 

# 7 tim e period ) 6
.Wa s th e propen y grade dsuc hthat wate r wil l not poo l onth e property ? 

# 7
7
.Wa s damtg e t o landscapin g o r plan t ntaterial s avoided ? 

# r 7

Gates , Fence s an dReuinin g Wall s Ye s N o I
.D o gate s openan dclos e freely? (I f applicable ) 

# 7
2
.Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (i f applicable ) 

# T
3
.Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# 7"
4
.Wa s danug e t o retainin g wall s avoided ? (Ifapplicable ) 

# 7

Foundation , SidioKan d Gutter s Ve 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 ? ?

. Wa s damag e t o window s avoided ? AWa s damag e t o window s o rdoo rscreen s avoided ? 5. Wa s damag e t o downspout s a t downspou i extension s avoided ? ; 

# J 

# J J
Sidewalk s an dDriveway s (Concrete ) 1
. Wa s damag e t o drivewa y surface s avoided ? Yes , 

# 7 N o
2
. Wa s damag e t o walkwa y surface s avoided ? 

# y

## Ort'oer s comments :

In.spectionnotes :

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## Remova l an drestorationactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentative fiyi ja« ^ Date : Sisl.'i

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## Propert yCompletio n Agreemen t
Thi s agreemen t document s th e completio n o l remedia l acliviiie s perlbime d o n m ypropert yM ysignatur e wil l designat e tha t I a m satisfie d wit h th e resloralio n o f m yproperly , an d tha t n o item s ar e i n questions , now , o rat an ylim e i n th e future , excep l thos e item s liste d below , ifan y

Propert yID : ^5 - 7 ^ PropertyAddress : /j/ , f ^ /M^JJZ- - Owner : ]^J^ T^yyUlAJ^^^. ^ p T 

## Phone : 'tlHg~-'l I ^ ^ Restoratio n Item s i n Question :

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

\l7 \

I agre e iMtoralio n wcompleted , mccp l a s note d [_ | I d o no t a|;r( C restoratio n i s complete d



# /^^.>v..t^ , /^-xj^-A^y yc-y/y/y ^ y/zy^

. Owner' s Signatin e Dat e Cont i arlor' s Signatur e /6a( cI