TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 22/^?. Date: 2./^!/oa 

Address: 35-// yy.^rrl S f 

Remediation Contractor: Coastal Enyironmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

s / Video of property (DVD) 

U Executive Stimmary 

0 EPA-provided property sketch 

M Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

a Restoration Agreement 

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

Confirmation data 

Photographs 

B As-built sketch 

W Satisfactory restoration signed by Property Owner 

m Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information irom Douglas Coimty Assessor's Office 

D 

D , 

^i^y^^^^ ^ -^IM^ 

.ignatur<! 

40317745 

Superfunc 
y^<^3 /. 

Final Report Property Check List (piease place with each nie) 

Har d Cop y informatio n 

1. Property Check List 

2. Site Working Drawing Map 

3. EPA originals Map 

4. Douglas County Asses.sor's Map 

5. Property Contact Sheet 

A}»reement 

1. Access Agreement 

2. Restoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

3. XRF Data 

4. Any emails or PO airrespondences 

Property Completion 

1. Executive Summary 

2. AS BUFLT 

3. Property Completion Agreement 

4. Any buyout into or reimbursement into 

5. Check or money order copies 

6. EPA Property Close Out Form 

7. Attached Begin Video 

Electroni c Documentatio n 

Drawings 

1. EPA original 

2. Working Drawing 

3. AS Built.v.so 

4. AS Built.jpg 

Photos 

1 Begin Photos 

2 During/Excavation Photos 

-5 Sod Photos 

4 30-Day Sod Photos 

Scanned Documents 

' Final Documents 

^ Executive Summary 

Videos 

Begin Video 

2 My Movie 
Property Access Checklist 

PropertylD: ^7^71^0 ^ D WORK STARTED ON: / / 

Property Adilress: ^5"/ / ^^/^/X/fl^^/^f. D WORKCOMPELTED ON: / / 

Renter: 0,vner: -y^miy"/ililf^ ) 

Address: J f 1 Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

•''"•"- 34{D'iD9 ^ 

Fax: 

Ccll/Pager: 

n Notification Letter Sent: / / By: 

1 ^ Access Agreement Signed: [p I Q- lO / By: /2yVi^ 

r ^ Restoration Agreement Signed: ^ l 9 ' iO l B.y: ^ZJciy 

n Topsoil Sampling (if applicahle) 1 1 By: 

n Disposal Sampling (ifapplicable) 1 1 By: 

CH Carden Sampling (if applicahle) 1 1 By: 

• ^ Utility Clearance Called: ^' 1 ±i l 0^1 ^y^rr/sht^ tm'sm^: % ^ 

Q*- Video/Photos (Befoie) On: U? 1 "d-l O' l By= /£/a i 

D Video/Photos (During) On: / / By: 

n Video/Photos (After) On: / / By: 

D Video/Phot<»s (30-Day) On: / / By: 

1 1 Propertv Completion Agreement Signed: / / By: 

1 1 Final Report Issued: / / By: 

Air IVIonitoring (as applicahle) 

n Community CD Crew On:_ / / By: 

Results: 

n Community • Crew On:_ / / 1 

Results: 

n Community CH Crew On:_ / / By: 

Results: 

Omaha Lead Site 
y1lm\ ^phmi- M ^

Total Q^Mttnt Square Footage to be Excavated = 4333 

Propert:yy Classiflcatiorfr^OO ' ^ ^ Tot^^Ba Zone Linear Footage to be Excavated = 0 

Howard Street 

Legend NorthAr Arro w Omaha Lead Site

Concrete Omaha, Nebraska 

Excavated Area Property Number 

CZ] Existing Structure Nl OLS-22603 

Scale 

Permanent Landscaping Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft 3511 HOWARD ST Fence (.••"Ste, 

Quadrant Boundary Post Excavation Concentrations (ppm) V HQL F1 . B2 PlayArea Street Boundary F2 ____ DZ Easement o >it.,y Tree/Shrub B1 Garden Other 

Desaiption of post excavation areas: F1, front yard left-hand quadrant; F2, front yard nght-hand quadrant; 81. backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ. drip zone (1-3 foot area of soil around the foundation of the house). 
Print Preview Page 1 of 1 

^&^03 Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

Sec-TwnRng 

1418790000 

TIPPETS 

TERRY R 

3511 

HOWARD ST 

OMAHA 

68105 

3511 

HOWARD ST 

OMAHA 

NE 

68105 

21-15-13 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old Assessor 

Site 

Now 

«

^jt l

ISAACS & SELDENS ADD 

6 

2 

W1/2 

33X124 

http://webarc.co.douglas.ne.us/dcassessor/details.asp? 

PARCELNB=1418790000 

 http://webarc.co.douglas.ne.us:8080/RealWare1/details.do? 

 jid=R1418790000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy Is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 171 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 4/25/2007 i 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 99'1^0 3 

m/ ymrd s-t. ''^^'^'y/P^-^ ^2^«"^^) 

 Date: Time:_ Action:_ 

 Date: Time:_ Action: 

 Date: Time:_ Action: 

 Transmit to EPA D Other Action: D 

fl^^f. WiS fi:3o 
,-•'"""'" , 

Consent For Access To Property 

RiciHToi' ENTRY TO PRI'MISI'IS 

(iranlor (Ihc properly ovvner) consents to and authorizes Ihc Uniteci States BnvironmenUil 

I'rolcclion Agency (\iPA) or its authorized repiesentntives, colleclivcly Ihc Grantee, fo 

cnlcr aiul perform ccrlain environmental response aclivilies upon llie following described 

premises: 

OWIUM'S Name: 

Day(i«ic Phono: ^CZ'3^i-^zst 

Address: _ _ /-/o^^;/1/^.J^ ^ ^ ^ S // 

Address: 

Addresses of 

Address: 

' Properties covered by 

this A<!;reeinent: 

Address: 

Address: 

_ .,^, , , 

PlIkl'O.SI'OfRl'SPONSl'ACTIVITII'S 

The BPA is requesting access'to collect soil samples and remove soil that contains 

elevated concenlralions of arsenic and/or lead and may pose a heallh hazard. The soil 

will he removed and the excavated area(s) will be replaced with elean materials and 

restored. This work is being performed under the Omaha Lead Site Superfund Site 

reniediaiion i^rogram. 

An iiPA rcprcsenlalive will contact the Grantor in-person lo discuss the work lo be 

performed, the Grantor will have an opportunity to review and approve the planned .soil 

removal, and resloralion work before it begins. Once the work is Unished, the Grantor 

will be asked to review the work and confirm that it is complete and meets wilh Ihe 

(iranlor's approval. Upon completion, the Grantor will receive written documentation 

from f:PA lhal llic properly has been remediated. 

P>JV1R()NMI':NTAI, Rii.snoN.si': ACTIONS 

By signing this Access Agreement, the Grantor is gianting Ihe EPA, its employees, 

conliaclors and subcoiilractors the right to enter the property, al all reasonable times and 

wilh prior nolice, for the .sole purpose of performing the work. This access shall remain 

ni effect unlil the work has been satisfactorily compleled. The Granlor also agrees to: 

ccPropcrl.y :I:D» Paye I of 2 
'imi­

' Remove obstructions

piles, dog houses, etc; 

including boats, irailers, vehicles, playscape ilems, wood 

" Remove llower bulbs or plants that the Grantor or Ihe (iranlor's l

lo save, 

enanl may wish 

• Water and mainlain replacement vegetation, including ferlilizer

necessary subsequent to an initial watering period by EPA; 

application, as 

•• Abide by heallh and safely guidance piovided by EPA; 

• Ifthe property is rented, assist EPA in obtaining tenant approval for access to Ihc 

property to perform the work if EPA is unable lo oblain such access; and 

• /Mlow videotaping and/or photography of the properly including c.xlerior and 

interior areas ofbuildings 

A(iRi:i;.M);NT Nor To 1NTI:KIT;RI{ 

The Cjrantor agrees not to interfere or tamper wilh any of the activities or work done, or 

the et|uipmenl used lo perform the activities, or to undertake any actions regarding the 

i.isc of said properly which would lend to endanger the health oi' welfare ofthe Grantee:; 

(M the enviioiimenl, or lo allow olliers to use the properly in such a manner 

Should yuu have any questions aboul Ihis program, please conlacl 

( ^i an* access (o my properties 

f—1 I I 1 do not <jrant access to my ])ro!ieilies 

Signature ' "^ Dale Sigiiadire Dale 

G I wonki like to he present during any sampling that is required. 

Page 2 of 2 

«r;:opp:r. y 11 
Restoration Agreement 

The purpose ol lliis agreement is to proxide a mutual agreement as Io condiiions of property prior to 

remediation aclivilies. This uil l also serve as dcconlnininaiion for the purpose of assuring ihnt 

restoration aclivilies are completed to the satisfaction of Ihe propertv ouner and the United .Stales 

Environmenial Protection Agency (liPA). 

Properly ID: £ 2 60 ^ 

Property Address: ^^, ^ ^ U^.^^^ X 

^^"^'•^Y^^^^ x.L.y ^ 

''"""^= '63^^sHG -Vzi- 4 

On the attached diagrani(s) indicaie area(s) to excavated and depth of excavalion. location of all known 

utilities, subsurface features, surface structures and landscaping features, access Kication(s) lo be esed bv 

contractor, and the direction of Nonh. Indicate distances, depths, material l}pcs. etc. I:idic:!!e digital pliot.-s 

h> referencing the photo-log number uitli an arrow indicating direction ofv iew. 

Items To Be Ramoved By Owner Before Start Cf ReT.ediaticr:; 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's rsspor.sibifty. 

Item: 

Item: 

/Idlkv^A*^ 

y 

^ 

^ 

\ 

Item: y ^ 

Item: y ^ 

Item: 7 

Item: / 

Item: y ^ 

Item: 

Page 1 of i^ ^---- ^ y 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: y 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Pag ( , e 2 of 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of U 
m 

Item 

I'lo-cxi.sliiiji piopcily area 

lll.ll IS co\'eic(l Willi gi'dss. 

Numher ii\' Irecs ^ 2 inch 

Inink (liainclcr 

Niinilu'r ol' Irecs <-- 2 inch 

Inink (liamclcr 

Number of Sprinkler 

/.ones. Conlidl Valves, 

Timeis. I leads, clc. 

AII.KI I .1 :.keU ll "I lib­

,^pi inkK 1 lax I'lil 

Niinihcr of and si/.e of 

each j.iai-(len/ rhnvcr bed 

area. 

Allaell .1 -keUh I't iri,ili\ r 

sl,\'s .llld IlKaUlMl:. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Condition/Type/Species 

.St]uaic Icel 

V353 

3 

{ach 

liach 

I'acli 

S(|uarc feel 

Page 4 of 
m^ 

Item 

A|;iec(l upon value of 

planl malerials not lo l>e 

replaced by coniracior. 

N"lr llu. \ aliii w ill |ir 

I1-.rd 1.' I . .Ill- .1 pkiiil 

\niulii'i 111 IIK' pmpi'iu 

nw lu'l 

Aj.>ieetl upon list ol' planl 

materials lhal will be 

rc]ilaced by conlracloi'. He 

very spceil'ic and delailed. 

Iiu liidi a .ki'li ll i>| ucir 

each planl will In' pliircd 

i'\ llu' (I'lill rieloi 

Aj.u'Lxxl upon area of 

propeilv lo lie replaced 

v\ ilh j.;i'ass sod. 

Iniliuli' .1 -.kckji 111 llu 

,iH'ai:.i 1(1 1H' ii-pk'u'i'd w Iih 

la'il.s^ '.od 

Area of Citv or (.bounty 

propeilv lo be landseaped 

per Iheif rec|uiiemcnls. 

Iiulikk- a skrUll >A llu 

.Ufa ! o 

Quantity Unit Condition/Type/Species 

liach 

Sf 

Yin 

Sf 

ISO 

Page 5 of t/­
^^^^ 

y^ 

B^hec k the box if Owner does not want CEG to document interior foundation walls and possible 

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. 

O I do not agree [H 1 do not agree agree Dif i

agree 

C/< /CT^ 

hviior'.s Si);<iiitiiic Date Cw/ilractoi'. Cwiilractor'.ss Signatur Signaturee Date

Page 6 of 
Punchlist Items 

ID# ^^UO? ^ 

Date: lr//o/o1 ' 

Name: yj/^ ^ Jjuppef S 

Description: 

\Ar^y ^ ^^.A ^ ,W l @L TlMuy^ IAJOA ^AO^<SJI^ ~ 
5

PROPERTY CLEARANCE WORKSHEET 

Date yn 19. r n Property ID 77Cy)^ 

Property Project Omaha Lead -- Fixed Price Address 35(( ^^fcco^ei'^'S-r 

Measurement XRF ID ClOl-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

_g[S_ FA-K^ 3ia ^ g q .^s± R /^' ' 

3S1 7?r^ F I -Z-U­ _SS2L JSCL. fiZ- Fr^­ ,^9-^¥=y^.i^^\ -2'^ "

3S3-

Sample Area m-L Pass/Fail ? \ 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7 

2 <;i9 

3 (n-z Q ^ 

^ ( o T D ! 

XRF Corrected Value - > 

 (us e calibration chart or add 

l20<%> to value) 

' uq ' 

Sample Area ra ^^a- Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 ^ 1 (Bag) Sieved) ? 

2 ^1 2-7 

3 z4 12. 4 sg f^C) 7 ^ 

-y M XRF Corrected Value --> 

5 ' (us e calibration chart or add 

20<^ t o value) 

: ^3 ' 

Sample Area P Pass/Fail ? I cQ-^'^ 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) •> 

Number Results 1 (Bag) Sieved) 

2 7^ ^? t 

3 3^ ' 

4 

4 

3 i . 0 ^ n 

XRF Corrected Value --> 

(use calibration chart or add 

201% to value) 

J^S 

Sample Area BZ 2-U- Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent Number Results ( oay ; 1 (Bag) Sieved) rl 

Confidential 5/2/07 Page 1 of 2 

5 
2 -ztt­ -r^^ 

3 ^ q 7 d ^ 

4 - S 3 }(=:' t ^ ^ 

XRF Corrected Value - > 

5 ~7b (use calibration chart or add 

2 0 % t o value) 63 

Sample Area ^ l 77-^^'^ Pass/Fail ? 

-Aliquot 

1 

I n Situ 

Reading 

s:-? 

Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent Lab 

Number 

Analytical 

Results 

2 ^ i 1 

3 

4 

^ ^ 

4 ^ 

CfiZ 

Z7. 2^ 

5 22 XRF Corrected Value - > 

(use calibration chart or add 

2 0 % to value ) n 

USE ADDITIOHA L SHEETS I F 

XRF HEEDED Technician's Signiture 

JQh l L\^ M LjLX^y-^ 

Confidential 5/2/07 Page 2 of 2 
Total Qua quare Footage to be Excavate(J = 4333 

P'iperty <:cifiraMnn'- ftHfl ^^ ^ Classification: 800 Total on0 e Linear Footage to be E)(cavate(j = 0 

Alley 

I;.: -( . 

. I 

:J ' 

\,,T\.xA'^^ y 

L 1.'^ '-C .7 L 

Howard Street 

Legend 

ZZ 

• 

Concrete 

Excavated Area 

Existing Structure 

North Arrow f 

N 

Scale 

Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-22603 

Permanen Property A(dd ress t Landscaping 1 Inch = 20 feet or 1 grid = 5 x 5 ft 3511 HOWARD ST 

Fence 

Ouadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary •,^0.'V V HG L Ft _ B2 Play Area 

F2 DZ Easement o Tree/Shrub B1 Garden Other 

Desaiption of post excavation areas Fl. front yafcj left-fianci cjuadrant. F2. front yard nght-hand quadrant. Bl. backyard left-hand quadrant. B2. backyard nght-hand quadrant. 

DZ dnp zone (1-3 foot area of soil around the foundation of the house) 
Total Qi^vi t Square Footage to be Excavated = 4333 

Property Classification^800 Tot^^ j Zone Linear Footage to be Excavated = 0 

Legend 

izz 

• 

o 

Concrete 

Excavated Area 

Existing Structure 

Permanent Landscaping 

Fence 

Quadrant Boundary 

Street Boundary 

Tree/Shrub 

NorthAr Arror w 

M 

Scale 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

V HGL F1 .

F2 

ii'. y Bl 

Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-22603 

Property Address 

3511 HOWARD ST 

Post Excavation Concentrations (ppm) 

B2 Play Area 

DZ Easement 

Garden Other 

Desaiplion of post excavation areas: Fl. front yard left-hand quadrant: F2. front yard right-hand quadrant, 81, backyanl left-hand quadrant: B2, backyard right-hand quadrant; 

DZ, dripzone (1-3 foot area of soil around tfie foundation of the house) 
X 

/\^D^' o Omaha Lead Site—Fixed Price EP-R7-07-05 itt ^ 

S ,^^^ , ° Coastal Environmental Group Inc. ^V^^^ r 

\^^^p * www.coastalhazmat.com 

%PBoTe.'i^ COASTA L ENVIItONnENTAL 

GROUP , INC . 

EXECUTIVE SUMMARY: 

22603—3511 HOWARD ST 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Squs re Footage to be Excavated - 4333 

Property Claastfication 800 Total Drip Zone Linear Footaqe to be Excavated = 0 

1 1 1 ' 1 1 1 1 : 1 !Alle • y 1 1 l i l

1 1

. . ^ ?m^ ; 1 

1 

—- 1 

B2 = 50PPM 

— — ­ i ^ 

®^^ i y7. ^^^^^ ) ^ I 

Bl = 28 PPM ^ t

USOL.;' 

"^. \ ^^^® 

! ~ " ^ ^^S 

— 

}-- - —— — ­• - ­ t-z - 5(3 rnvi 

Fl •^y^^^ . = 22 =PM 

~ ^ :i; ^ 1 i 

wS?0v'w5v*v^^ ! 

• ^ d ; 

^ 

g 

1 - • — 1 

EA-N == 95PPM - • 

i 

SSc^'' » . •. / • •• • '-:' . • i •;-

- , « - u . ' 1 , • •-'.'••• , •' • ; ' : ':.'y:::,t''- /,- ••"v-' i --: r^ ;•" y' : _ y y •'... l' ' .': -.••1 , 

X • J • - ^- -.'_ •••j' ? 

, 

.- -i'.' 

i 

• . , 1 • • - • •_ • , - • . ^ . ^ j - y ^^..-,,..•-1-^7^'

7. ••:•. • 

! ' A i 1 1 1 

1 1

! ' .. 1

— -• ^ y. ...J loward Street • • 1 1 1 

Legend ^^_^^. 22603 NorthArrow Omaha Lead Site 

Omafia. Nebraska 

y ~ Date Excavated- 6/18/07 • 

Property Number

Pate USEPA Signed Off: 7/10/07 OLS-22603 _ ; L.^-:.- ^ .--.­ i^.-. Scale 

2 Permanent Landscaping 

Property Address

s 1 In;ht = 20 feet or 1 grid ' 5 x 5 ft 3511 HOWAR D ST 

Quadrant Boundary Post Excavation Concentrations (ppm) 

Fl B2 Play Are! joi y ;,0/. • HGL. Vk 4 4

/ T — F2 _ DZ Eas€ ment T Iee/S w j b Bl Gar<ten_ a h e r 

Ocvatnban of peat evcavation w«as F1 tront yard teft-t>aiKt quadrant t-2 Iront yard rigtit-hand quadrant Bl bac^ard left-ruind quadrant. t}l\ backyard ngm hand quadrant. 

OZ, dr^ zone (1 -3 foot aiMi of BOH around ttw foundabon of the tiouav) 

o — 

Legen d 

Area not Excavated yyy] Dripzone Excavated QQQ^ Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
SEPA 

^ 

PA Property Close Out FiTf Wr m 

Property #: 77<^<^ 3 Property Address: 357 7 77v<yJ/^1^A Sf ^ 

Datc/Tlmc: Owaer't Name: y7yj^ 7 y?/^/^yX S 

Quads Excavated: Contractor Group 

Excavatloa GcBcral Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? y 

2. If nccessa.7, were the correct areas ofdrip zone excavated and restored? y 

GradlDf Sod aad VctcUtioB Yes No 

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

from the house? 

l y 

2. Has sod been laid in all areas that were excavated? y 

3. Does the sod appear to be generally healthy and growing? (Onlv evaluate .f '.nspected at a 30 

day tinw period) c^ 

4. .\r« sodded areas gcnerallv fum and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 50 day 

y time period) 

6. Was the property graded such that water wil! not poo! on the prope'ry ? y ^ 

1. Was damage lo landscaping or pla-it materials av cided? y \ 

Gaicv, FCDCCS aad RcuiaiDt '^aiis Ves No 

I 

!. E>o gates open and close freely'' If applicable) fjji i 

i 2. Were al! gates or fences taken down during resioratior, aci:\ i'.ies .-einsiallec? .if applicable) f}^ 1 

3. Was damage to gates or fences avoided? 'Ifapplicable) A M 

\ 4

 Was damage tc retaining walls avoided? (;if applicable) y ^ 

.^oundatioB, Sidiit and Gutters > es No 

1. Was damage to the siding or trim av oided? A^ 

2. W'^ damagfe to the foundation avoided? /J^ 

3. Was damage to windows avoided? fi ^ 1 

4 Was damage to windows or door screens avoided? r 

1 

5. Was damage to downspouts or dov^Tispout extensions Evoided? f} ^ ! 

Sidewalks and Driveways (Concrete) Ves No 

1. Was damage to driveway surfaces avoided? 

ty ^ 

2. Was daraage to walkway surfaces avoided? 

y ^ 
c—•* 

Owners comments: 

II Injpectic Injpecticnn nctes nctes:: 

Remc\El and restcration actixates corr.p'ete including the 30-da>' sod '-v arrant): 

EPA Represe•ntati\5,.^/^^X^^^^:;VA>C'^cvJL€Z5^ Date: y^/c ) — /) y 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on i-ny properly. My 

signature will designate that 1 am satisfied with the resloration of my properly, and that no ilcnts are in 

questions, now, or at any time in the future, except those items listed below, if any. 

PropertylD: T^^^^C S 

Property Address: 35-^^^^,^;^ ^ 5 ^ 

Owner: 

-777)2^1/ 71py^yr<. Phone: ^^ ^ ', ^^^ ^ 

Restoration Items in Question: 

Item: 

.'\n . -^vac \ ' ^ T^.ix-c^Ud.^ 

Item: 

Item: 

Item: 

Item: 

Item: 

1 

\/^ \ ;if;rcc restoration is completed, except as noted 

I I I (Jo not agree restoration is completed 

Vjyvu^ Ii I AyyjJ^ -7-7-7 '^^^^^^k/rl 2y. ^ 71?/)? 

Owner's Sif^naturc '^^ ^ Date Contractor's Signature Date '