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

# . : ^^<^ ^ Date : ^ H 1 /

Remediatio nContractor : Coasta l Environmenta l Group

_Year ; _200 ©
SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S t

/ Vide o o f property (DVD ) t 2 Executiv e Summar y 0 EPA-provide dproperty sketch |{ 2 Signe dAcces s Agreemen t fo r subjec t propert y - D Signe dAcces s Agreement(s ) fo r adjacen t propert y ( ZRestoratio nAgreemen t -B

- Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) -B

- Confirmatio ndat a E

/ Photograph s ^T^^A-IT^ ^ Y lU ^CAV* ^ n^> ^ 

# i As-buil t sketc h Satisfactor y restoratio nsigne db y Propert y Owne r U Propert y close-ou t chec k lis t signe db y EP A "E ~ Descriptio no f area s no t meetin g RO D cleanu p criteri a ^ Utilit y clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s Offic e

Superfun d

## Propert yAcces s Checklis t Prope,t,ID : ZU 5 S ) D WOR K STARTED O N _/ /_ D WOR K COMPELTE D ON : / / PropertyAddr^^.:'2^2' S Dri'A-fU ' Sf V Rente r 

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### Signed : :!./23/0 4 

## 8>0t."\ra.v» D IB " ReslonttiO D Agreemen t 

### Signed : JI/2/|/6 5 

## ^ yVev^-Wv / O Topioi l Samplin g (i f applicuble ) / / By ; O Disposi U Sanaplio g (r f ;ipplicable ) / / By :

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### Signed : ^//£9/J2 ^ By : D Fina l Repo n Is!(ued : / / By : Ai rMonitorin E (* & jpplicable )

D Communrt yO Cre w O D : / / By :

_ Results : Q Communit yd l Cre w On : / / By : Results :
n u Communir i D Cn^ w On : / / By : _.. _ Resultj :

Omah a Lea d Srt e

## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Final Contact : Fina l Action :

Comment : Owner Comrhent (s) : Site Coordinato r Comment (s) : CONTACT FOR M 

## 21^5-5 ) 90(2 5 n^DA+n r S ^ Date : 7/ ^ Time : i^a S Action : Date : ' Time : Action : Date : Time : Action : Transmit l o EP AD Other Action : D



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## Dougla s Count y Accoun t Info i inn^mn 

## Pag e 1 of 1
Dougla s County , Nebrask a Propert yRecor d - R221240000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e IS fscal e 0-5 0 ft wes t o f52n d S t - Vle WO n Ma p Informatio n i s vali d a s o f2009-7-2 0 Treasurer' s Ta xRepor t Ne wFeatur e - ^ *4 > - ^ Aut o Sale s Searc h Owne r MASE KMARJORI E 293 5 DECATU R S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumbe r 124 0 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221240000 0 Parce l Address : 292 5 DECATU R S T OMAH AN E 68111-OOO O Lega l Description : SHINN S 2N D AD D LOT5 BLOC KR 6 0 X 127. 5 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lan d $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Lan d Informatio n Acre s 0.1 7 S F 7620. 0 U nit s 0. 0 Dept h 127. 0 Widt h 60. 0 V acan t Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accotmtinfo.jsp?accountno=R22..
. 7/23/2009

### Pag e 1 of 2

" > [(^^_._7^CreateAnotherTjcket , .~ \ Back-t o Irth:Inteme t |[. : Sendjmail ^ i ]



### • YOU RTICKE T NUMBE RI S 2324307
. Origina l Cal l Date : 7/23/0 9 Time : 9:1 3 a m Op : EL1ZABETH1879 0 Wor k t o Begi n Date : 7/27/0 9 Time : 9:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 292 5 Street : DECATU R S T Twp : 15 NRng : 13 E Sect-Qtr : 16-NE-NW 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 : 4f 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 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Number UtiUt y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL3 COMMUNICATIONS , LL C N A Alt : Emerg : 877366834 4 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 

### Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/23/200 9

## Pag e 2 of 2

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
QLNNE l C QWES 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..
. 7/23/2009OLS# : 2653 1 

# i ^ As-Buil t Drawin g Dat e Excavated:7/31/0 9 Dat e USEP ASigne d Off : 8/11/0 9 C CAST AL 

# Omah aLea dSuperfun dSit e , Are a Sodden : 387 8 s a f t


### 2653 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h Samplin g Address : 292 5 DECATU R ST 02"^ No t pain t Sampl e Numbe r RYASCPXA-2653 1 F l Lea d Concentratio n 

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## D D D 

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### pEotru t Ss r Legen d Concre't e Dri p Zon e Excavate d Quadranti s Excavate d
Are a replace d wit h Are a replace d wit h Are a lef t bar e So d ' ' Rock/Mulc h ' ' 

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

## 2653 1 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h

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## Firm : ?C IMC

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# n Date : 

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# n D Time : 

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## O Staff : 

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s viewe d fro m th e street , facin g oropert y


# ENTEBE B JU H 1 7 200 9

Rev:0(l S Created : 'I5-Nm'-0S ! i:a47f)i 01,: 3

## 2653 1 Exterio rPain t Nuilh|AiiiJ W Omah a Lea d Sit e • ^Good Sit e Sketc h Sampffn g Addresi : 292 5 OECATU R S T ' E d '^° * P*" * 

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COASTA L ENVIKONHENTA l " t PHO^* ^ CROUP , IH C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) 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 : ^ ^ ^ 

# • 7^^ 

# 3 1
Owner' s Name : Daytim e Phone : 

# ^ 

# ^ J S yj/iy y 

# w

Addres s o fPropert y covere d b ythi s 

# l^t 6 Vt^C^Mu ^ 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 flea 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 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 fCoasta 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 performed , 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 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 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 fperformin 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.vito«r,
. f COASTA L ENVI80HHENTA L GROUP , IN C



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e 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 necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; e Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; *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
. •Allo wvideotapin g and/o rphotographin g o fth 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 wother s t o us e th e propert yi n suc h a manner . Should yo u hav e an yquestion s abou t thi s program , pleas e contac t Coastal Environmenta l Group , a t (402 ) 991-119 9
I gran t access t o m ypix>pertie s D i d o not gran t access t o m ypropertie s


# I^L X 

# ^^ 4 2^£ ^ Signatur e Dat e

O I wouf d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f2COASTA L I M VIMO N M l N TA L G H O t J r. IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s ofth e propert y prio r to remediationactivities
. 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 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)
.

Property ID : ^(^ ^ ^ j * Property Address : 7,^x 5 \yeCj^u(L ^ Owner : 

### jyui.\i.(ixt^.y\iyii^y<< ^ Phone ; l-^ii ^ - \\ \\,j ^ O nth e attache ddiagrani(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 usedb 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 i f necessary . 

### item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e Item s i s th e Owner' s responsibility
. Kem : 

## • n 

# y ^ 

# "^^ M pu U Kem : Kem : Kem :



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d



# Jrw ^ b>—^l l yil/h ^ y^Vf y ^ 

# m

ttem:
Item : Item :

Pag e 1o fyC O ASTA L C R O U r. < N C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d Item : 

# ^ l i 

# - ^'ir t

ttem:
ttem:


## 1-andscap e Inventory 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 inch Eac h trun k

diamete r 

# f
Number o f tree s < = 2 inch Eac h \ trunk diameter Number o f Sprinkler Zones , Contro l Valves , Eac h Timers , Heads , etc . Atiachaskeicli o t llie sprinkler la\oui
. Number o f andsiz e o f eac hgarden / flowe r be d Eac h 

# n . area . Square Feet Aiiacl i askcichof relativ e size s an dlocatidiis
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . Not e thi s \alii c will h e use dl o issu e H plan t \oiiehe r to th e propcrt> owner . Easement Area , t o b e Each 

# tJ O excavate d
Pag e 2 

# .: kCOASTA L

• NVIIIOMnl.f4TA L aNO U P
. IN C


### AddKiona l Comment s / Instructfons :

^C^Chec k th e boxi fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e /pre-existin g damage
. Bycheckin 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 cracks o rfissures
.

I agre e Q I d o no t agre e ^ 

## Fof^C/JiA

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

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pp m P

b 389.62 8 Supervise dBy : 

## Certificat e o fVerificatio n

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± Erro r 26.36 9

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

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pp m P b 351.69 2 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r 24.43 2

# 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 365.16 1 Supervise d By : 

## Certificat e o fVerificatio n

245 4 SOI L 2009-07-3 1 17:0 8 40.7 3 Fina l 2653 1 292 5 Decatu rs t F l Nicola s 2 4 CLEARANC E

± Erro r
± 26.09 5

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

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pp m Pb 370.96 5 Supervise d By : 

## Certificat e o f Verificatio n

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± Erro r
± 25.73 2

# 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 246 1 Mod e SOI L Tim e 2009-07-3 1 17:1 3 Duratio n 121.1 9 Sequenc e Fina l Flag s AVERAG E LAygo.f,2457-246 0 j ADDRES S ^2S*Decatij rs t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 1 8 SAMPL E TYP E CLEARANC E NOT E

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## Certificat e o fVerificatio n

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± Erro r ± 33.49 5

# 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 464.95 4 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r
± 28.50 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 457.30 7 Supervise d By : 

## Certificat e o fVerificatio n

245 9 SOI L 2009-07-3 1 17:1 3 30.3 2 Fina l 2653 1 292 5 Decatu rs t B l Nicola s 1 8 CLEARANC E

± Erro r 29.73 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 437.99 6 Supervise d By : 

## Certificat e o fVerificatio n

246 0 SOI L 2009-07-3 1 17:1 3 30.3 2 Fina l 2653 1 292 5 Decatu rs t B l Nicola s 1 8 CLEARANC E

± Erro r
± 30.63 9

# 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 246 6 Mod e SOI L Tim e 2009-07-3 1 17:2 3 Duratio n 121.5 1 Sequenc e Fina l Flag s AVERAG E C5vg3Qgi2H2465 3 ADDRES S 292 5 Decatu rs t QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b Supervise d By : C^i/i h $l/ )

# 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 142.48 5 Supervise d By : 

## Certificat e o f Verificatio n

246 2 SOI L 2009-07-3 1 17:2 1 30.6 5 Fina l 2653 1 292 5 Decatu rs t easemen t Nicola s 1 CLEARANC E

± Erro r ± 15.11 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 174.27 8 Supervise d By : 

## Certificat e o fVerificatio n

246 3 SOI L 2009-07-3 1 17:2 1 30.3 1 Fina l 2653 1 292 5 Decatu rs t easemen t Nicola s 1 CLEARANC E

± Erro r ± 16.28 6

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

XL3t-3208 9 Readin g No Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTOR DEPT H SAMPLE TYP E NOTE

pp m P

b 138.64 7 Supervise dBy : 

## Certificat e o fVerificatio n

246 4 SOIL 2009-07-3 1 17:2 2 30.3 1 Fina l 2653 1 292 5 Decatu r s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 14.70 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 SAMPLE TYP E NOTE

pp m Pb 164.28 9 Supervise d By : 

## Certificat e o fVerificatio n

246 5 SOI L 2009-07-3 1 17:2 3 30.2 4 Fina l 2653 1 292 5 Decatu rs t easemen t Nicola s 1 CLEARANC E

± Erro r ± 16.20 6

## flA. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 § ^^^^ ^

I S!y^^ ^ Coasta l Environmenta l Grou p Inc
.

www.coastalhazmatco m M ^ '•-'tPBOT* ^ COASTA L IHVItONNiHTA L G • 0 U P , IH C 

# EXECUTIV ESUMMARY ; BVID #26531-(292 5 DECATU RST )
No Issue s o r Concern s Issues/Concern s Detail Explanation :St0 L 

# P A EP APropert y Clos e Ou t For m Propert y # : ^^?.^ J Datcn'inic : Quad s Excavated : f p > ~ h\ Contracto r Grou p C'r^if^ APAW i roninOenK J
Excavatio nGenera l 1
. I f necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 

### ^ 2
. If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# y
Ye s IS O Gradin g So dan dVegetatto n 1
.Doe s the gradin g aroun dthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y fromth e house ?
_ ^ 

# y 2
.Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3
.Doe s th e sodappea r to b e generally healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 

# y da y time period ) 4
.

Ar e soddedarea s generall y nrman devenly graded ? S
.Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# ( Z ^ tint e period) /

­ 6
.Wa s the propert y grade dsuchtha t wate r wil l no t poo l o nthe property ' 

# ~ y 7
.Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fepcc s an dRcUinln g Wall s Ye s JS o 1
.D o gate s ope nan dclos e freely? (Ifapplicable ) 

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

# ? ^ 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 ) 

# V Foupdatton , Sidin g an dGuller s Ye s N « \
. Wa s dainag e t o th e sidin g o r tri mavoided ? 

# y ^ 2
. Wa s damag e t o the foundationavoided ? 

# y ^ Wa s damag e to window s avoided ? 

# ~ y 4
.Wa s damage to window s or doo r screen s avoided ? 5
.

Wa s damag e to downspout s o r downspoul extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Vc s N o 1
.Wa s damag e to driveway surface s avoided ? 

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

# y

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complet e including the 30-da y so dwarranty : EP ARepresentativ e 

# DO>.J1ML
. 

# o..y////o f

### Propert yCompletio n Agreemen t
riii s agreemen l documeni s Ih e complclio n o fremedia l activitie s perloime d o n m yproperl yM ysignatur e willdesignal e Iha l J a m satisfie d wil h th e restoralio n o fm ypropeity
. an d iha l n o ilcm s ar e i n questions , now , o ra l an ylim e i n th e fulure , excep t ihos e ilem s Iisle d below , ifan y

Propert yW : Ih^' ^ \ Propert yAddress : 2^" ^

^^6^ ft/lL~"V( ^ Owner : M^j^ggg-t ^ MV\5>ft ^ 

### ft>o»e : q^^ yJbMM^ M Restoratio n Item s i n Question :

Item : Item : Item : uliii
. WMPssana' * w* MW Wm^tm^n^" ^ Item : Item : Mem :

1 ^

I I ngrc crc.^tar«(Jo n i s complcttd , excep t A S nofer i I , I I rto no t aure crcstorntin n i s complete d

ONfiif/'.' ! Sinnatm e Duf c Cont i »i:\m' % Signaliir c Dat e