## TRANSMITTALof OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID#:_2.R5 qDate : __:Z/3Q/D a Address : 2U0 ^ '^fjtS
. 9 & Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200 (
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S [

/ Vide o o f propert y (DVD ) \H

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^ Executiv e Simimar y EPA-provide dpropert y sketc h N/ Signe dAcces s Agreemen t fo r subjec t propert y TVll : Signe dAcces s Agreement(s ) fo r adjacen t propert y * w Restoratio nAgreemen t tifj ^ Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) s Y Confirmatio ndat a ^ Photograph s V lg» l ^TT J ^ hcCfVATl ^ V fft^^Q^^[*1nu- » D As-buil t sketc h ^ ^ Satisfactor y restoratio nsigne db y Propert y Owne r V T Propert y close-ou t chec k lis t signe db y EP A l^/ii j Descriptio nofarea s no t meetin g RO D cleanu p criteri a ^ f

Utilit y clearance s ^ Propert y informatio nfromDougla s Coimt y Assessor' s Offic e D D
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^ Notificatio n Lette r js , Accei i Agreemen t Q ^ Renorvtio D Agreemen t G Topsoi l Samplin g (i f applicubic ) D DisposaJ Saraplio g ( Kapplicable ) D Gnrdc n Samplin g (i f applicable ) Q Utilit yClearanc e g rVideo/Photo s (Before ) D Video/Pholo s (During ) D Video/Pholo s (After ) D Video/Photo s (30-Day ) D Projicrt yComplelio n Agrcemen i D Fina l Repor t 

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## Dougla s Count y Accoun t I

# w tio n Pag e 1 of 2
Dougla s County , Nebrasic a Propert yRecor d - R130745000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e (S H scal e 0-5 0 f t wes t o f52n d S t - ViewO H Ma p Infonnatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e -•••- • Aut o Sale s Searc h Owne r DAVI D KAI N PROPERTIE S LL C P 0 BO X 406 6 OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 074 5 000 2 1 3 Accoun t Type : Multipl e Com m Parce l Number : 130745000 2 Parce l Address : 260 8 REE S S T OMAH AN E 68105-000 0 Lega l Description : HICKOR YPLAC E LO T1 0 BLOC K0 LT S 8 & 1 0 9 0 X 11 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $14,900.0 0 $14,900.0 0 $14,900.0 0 $14,900.0 0 $14,900.0 0 $14,900.0 0 $117,500.0 0 $117,500.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $132,400.0 0 $132,400.0 0 $90,000.0 0 $90,000.0 0 $90,000.0 0 $90,000.0 0 Sale s Informatio n Sale s Data : 2004-10-2 1 Dee d Type : WD M SooJ^ : 200 5 Page : 00427 2 Price : $0.0 0 Grantor : DAVI D E KAIN E ETA L Grantee : DAVI D KAI N PROPERTIE S LL C Valid/Invalid : Invali d Exclusio n Reason : Multipl e Parce l Sal e Sale s Data : 1997-11-1 7 Dee d Type : D Book : 207 6 Page : 11 1 Price : $79,000.0 0 Grantor : 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R130..
. 6/6/2009

### Dougla s County Accoun t I i^li^tio n Pag e 2 of 2
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.2 2 9900. 0 1. 0 0. 0 0. 0 N o Improvemen t Informatio n Buildin g 1

rfSfc

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 4448. 0 Percen t Complete : 100.0 % Perimete r 192. 0 Quality : Averag e llni t Type : Condition : Fai r

Buil t As : Apartmen t < = 3 Storie s Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 0. 0 Exterior : Masonr yCommo n Bric k Units : 5. 0 

### Interior : Plaste r Baths : 0. 0 Roo f Cover : Buil t U p Roc k Bedrooms : 0. 0

Roo f Type : Flat 

### Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 189 8 0 % 189 8 11 1 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Porc h Ope n Uppe rDec k 266. 0 Basemen t Bsmn t Bloc k 8 f t 1224. 0 Basemen t Finishe d 1000. 0



### http://dougIasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R130.
. . 6/6/200 9

## CONTAC T FORM Property I D #7 \H5 ^ Property Address : Initial Contact : Secon dContact : Final Contact : Final Action : 

# yV^aX & g.f,f, S Date : Time :

Date : Time : Date : Time ; Transmi t to EP AD 

# ?A Action : Action : Act i on : Other Action : D

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) :



# i• • 

### Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOURTICKE T NUMBE RI S 2307224
. Origina l Cal l Date : 6/30/0 9 Time : 5:0 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/02/0 9 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 260 8 Street : REE S S T Twp : 15 NRng : 13 E Sect-Qtr : 21-SE,28-N 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 : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l MUD0 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 QLNNEI C QLNNEI F

Servic e Are a Contac t Phon e Number UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4

Alt : Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3

Alt : Emerg : 402504797 0
MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3

Alt : Emerg : 402504797 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 6/30/200 9• • 

## Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRO N 

## Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160
OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E1 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..
. 6/30/2009

# As-Buil t Drawin g C OAST AL 

# Omah aLea dSuperfun dSit e

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. Sit e Sketc h Time : 3. : bU /f.^
. Phone : 

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

### % Name : l> v- J Address : 2Cc S Phone : 

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. COASTA L fll>i|0imiNT4 l • • O U p . IH C 

### 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 Envinanmenta 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 : „ lU^ ^
Owner' s Name : ^^^^. ^ Ka<r \ Daytim e Phone : 

# i)'S>m y Addres s of Propert y covered b ythi s 

## 2-UJO 8 RiS ^ 'ST : Agreement :

Th e EPAI s requestin g acces s t o collect soi l sample s an d remove sol i tha t contain s elevate d concentration s o f iea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o renx>v 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 perfonne 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 oontac 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 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 confir m tha t i t i s complet e an d meet s vi^t h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Athat th e property 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 , contractors 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 sot e purpos e of performir^ g th e wori(
. Thi s acces s shal l remai n i n effect unt B th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to : Pag e 1 o f 2COASTA L 6 S € u r , if t £



### •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 f th 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
. ^QREEM^N TNO TT O INTERFER E 

### Th e Granto ragree s no t t o Interfer e o rtampe rwit h an yofth e wor k activities , o rwit h an y o f th 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 reganjin 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 f th 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



# 9i gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s



### Signature Signature Dat e


### Qi woul dKk e t o b e presen t durin g an y samplin g tha t i s required
.f ^ O AS T^ AL
• M VMONM t NTA L C KO U P IN C 

## Restoratio n Agreemen t Th e purpos e ofthi s agreement i s t o provid e amutual agreement a s t o condition s ofth e property prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Propert y ID : Propert y Address : ^J[^A / ^< ^ "^ l Owner ; ^i^^ ^ K^;^ ^ Phone : 

### O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storaqe , disposal , and/o rretur n o fthes e Item s i s th e Owner' s responsibility
. Hem : 

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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 tha t wU I b e excavated , that i s covere dwit hgrass . 

### ^ ^ Numbe r o f tree s > 2 inch Eac h trunk diamete r Number o f tree s < = 2 inch Each trunk diameter Number o f Sprinkler Zones , Contro l Valves , Each Timers , Heads , etc . Atiac h a sketcl i o f th e sprinkle rlayout
. Numbe r o f an dsiz e o f eac hgarden / flowe r be d Eac h area . SquareFee t Auac h a sketc h o frelativ e size s an d locations
. Agree dupo nvalu e o f plant niaterial s no t to b e replace db v contractor . Not e thi s Mtlu cwil i b e use d t o issu e H plan t vouche rt o the'propcrt > owner . Easranent Area , t o b e 

# ys ? 

# ^yYAA^^yy A Eac h excavate d
Pag e 2 of
.COASTA L ^
. N 4 1 n O N n V N TAL 0" k

O U P , IN C
Addttlona l Comment s / instructions : 

# 7^" ^ HO'\\C t

\Oyhec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n wail s an d possibl e ^preexistin 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 Mnterio ro fhouse , includin g foundatio n crack s o rfissures
.


### Q I do no t agre e

Pag e 3 of
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 75 4 Mod e SOI L Tim e 2009-07-0 2 14:4 5 Duratio n 121.3 5 Sequenc e Fina l Flag s r—-'— , AVERAG E (^v q o f 750-753 7 ADDRES S 260 8 Ree s s t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E
pp m Erro r Pb \259.02 7 J ±520.23 6 Supervise d By : 6?(^( ^ ^QJlf^il j

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 75 0 Mod e SOI L Tim e 2009-07-0 2 14:4 3 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D # 2145 9 ADDRES S 260 8 Ree s s t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 256.83 9 ±19.98 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 296.37 2 Supervise d By : 

## Certificat e o f Verificatio n

75 1 SOI L 2009-07-0 2 14:4 4 30.3 3 Fina l 2145 9 260 8 Ree s s t B l Nicola s 8 CLEARANC E

± Erro r 21.75 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 255.03 3 Supervise d By : 

## Certificat e o f Verificatio n

75 2 SOI L 2009-07-0 2 14:4 4 30.2 6 Fina l 2145 9 260 8 Ree s s t B l Nicola s 8 CLEARANC E

± Erro r ± 20.37 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 227.86 4 Supervise d By : 

## Certificat e o f Verificatio n

75 3 SOI L 2009-07-0 2 14:4 5 30.2 3 Fina l 2145 9 260 8 Ree s s t B l Nicola s 8 CLEARANC E

± Erro r ± 18.83 0

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 75 9 Mod e SOI L Tim e 2009-07-0 2 14:4 9 Duratio n 120.7 2 Sequenc e Fina l Flag s AVERAG E [Av g o f 755-758 / ADDRES S 260 8 Ree s s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b Supervise d By : ZgC&.6^.gfl< j

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 75 5 Mod e SOI L Tim e 2009-07-0 2 14:4 6 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D # 2145 9 ADDRES S 260 8 Ree s s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E
Erro r pp m P b ± 18.04 6 209.12 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 286.08 3 Supervise d By : 

## Certificat e o f Verificatio n

75 6 SOI L 2009-07-0 2 14:4 7 30.2 8 Fina l 2145 9 260 8 Ree s s t B 2 Nicola s 8 CLEARANC E

± Erro r ± 20.82 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 317.09 7 Supervise d By : 

## Certificat e o f Verificatio n

75 7 SOI L 2009-07-0 2 14:4 8 30.1 2 Final 2145 9 260 8 Ree s s t B 2 Nicola s 8 CLEARANC E

± Erro r ± 22.01 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 215.53 6 Supervise d By : 

## Certificat e o f Verificatio n

75 8 SOI L 2009-07-0 2 14:4 9 30.1 5 Fina l 2145 9 260 8 Ree s s t B 2 Nicola s 8 CLEARANC E

± Erro r ± 18.89 1

# I ^•it B sr., ­ 

## / ^A ^

\ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 < < ( \^^^Y L I Coasta l Environmenta i Grou p Inc
. V J V"^^ ^

www.coastalhazmat.co m %PRoTt ^ COASTA L • NVItOHHENTA l GROUP
. IN C 

# EXECUTIV ESUMMARY : BVID #21459

- (260 8 REE S ST ) I No Issue s o r Concern s [x ] Issues/Concern s Detail Explanation : MONITO RSO D

### fit 

# EP A EPA Propert y Clos e Ou t For m Property# : ZmS^ , Propert y Addrew
. '2-loPJ i MiZ^ f Datemme : Ifyj^lO Q Owner' s Name: . i!aPft>Lt Q .J>.fia p i
. Quad t Excavaled : fil,^*! Contracto r Grou p CafiiT^*^ ^ fifMJlOfKAajniVal Ye s N o Excavatio nGenera l 1
.If necessaiy , were th e conec t qu8drant(s ) excavate dandrestored ? 

# L A 2
. I f necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# A Gradin g So dan dVetetatio n Ve s N o I .Doe s the {redin g aroun dthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

## I A

­ fromth e house ?
. 2
.Ha s so dbee nlai di nall area s tha t wer e excavated ? 

## l^ ' 3
.

Doe s th e sodappea r t

o b e generally healthy an dgrowing ? (Qnly evaluate I f iiyspecve da t a3 0 day time period ) 

# V 4
.Are soddedarea s generally fir man devenly graded ? U ^ S
.Are th e joint s behvee nth e so dstrip s generally tight ? (Only evaluate if inspecteda t a3 0 da y tim e period) 6 .

Wa s the propert y grade dsuchtha t wate r will no t poo l o nth e propeny ? 

## \ A ' 7 . Wa s danug e t o landscapin g o r plan t material s avoided ? ^ ' Gates , Fence s an dRctaipin g Wall s Ves N o I .D o gate s ope nandclos e freely? (Ifapplicable ) SA

2
.Were all gate s or fence s takendow ndurin g restoratio nactivilie s reinstalled ? (Ifapplicable ) 

### U- ­ 3
.

Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foupdailon , Sidin K

an dGnller s . Yes N o I .Wa s damag e t o th e sidin g or trimavoided ? 2
.Wa s damag e t o the fotuidationavoided ? 

### [A ' Wa s damage to window s avoided ? 

## A A ' 4
.Wa s damage to window s o r door screen s avoided ? L^- " 5
.Wa s damage t o downspout s or downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Yes N o 1
.

Wa s damage to drivewa y surface s avoided ? 

# A , 2
.Wa s damage t o walkwa y surface s avoided ?

## Ovi'Ders comments :

Inspectio nnotes :

Remova l andrestorationactivate s completejncludin g the 30-da y so dwarrariry : EP ARepresenUitive l^ffi^ , 

# D/lj / Date : 7/^ 7

## Propert yCompletio n Agreemen t Thi s sigreemcn l ciociimenl s fli ccomplclio n o fremedia l activilie s perlbime d o n m yproperly
. M ysigiuilin e wil l designat e (hat J a m .satisfie d wil h th e restoratio n o f m yproperly , an d tiia l n o itcni s ar e i n qucstion.s , now . o ra l an ytim e i n th e fulure , excep l tiios e item s lisle d below , il'any
. "Prapc i iTlDr ^

\Cy^ ^

" " ^ Propert yA(l(rfre.s.<! : I^Oft R.e.C 5
_ 

# ^' ^ t)i^^^K-<viZ
. 1 1 II
. I I H I Z I Z I

Restoratio n Item s i n Question :

Item : 

# 1 Item : Item : Item : Item : Item : Additiona l Comments :

I I j atsrc o re.storntio n i.s completed , exccp i a s note d orHtui n i.s complete d

Owner' s .Si{;nntiir c t J ' f (Vntfiictor' s .Signature Dat e