# 

TRANSMJTTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID .iiM 

Date: \< \\o 

Address: 

Remediation Contractor: Coastal Environmental Group Year: 20i 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ Video of property (DVD) 

/ Executive Summary 

/ EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

r—\ 

Confiimation data 

y 

Photographs 7(7 ^ W t b<CA\/<\tUK^ V \\{ W L 

/ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

s/ 

Property infomiation from Douglas County Assessors Office 

[' 

D 

n 

\yh . Date 

30054490 

Superfund 
t 

t 

Property Access Checklist 

Property ID: I<R M 2 1 

n WOBK STARTED ON: / / 

Propert D WORKCOMPELTED ON: / /y Address: ^^C^ ^ l^n e S + 

Owvner p^^) ^ P^Oim-el ) 

Renter 

Address: 53/^^ ^ 

Phone: 

Fax: 

Cell/Pager. 

Phone Additional Information: : ^52 'J:505 

Fax: 

Cell/Pagen ^5 ^ .Z/32 ^ 

D Notification Letter 

Sent: / / By: 

Q ^ Access Agreement 

Si^ed: * / U / o l By: 

•''^Restoration Agreement Signed: 9 1 <f / ot, By: 

D Topsoil Sampling (if applicable) 1 1 By: 

D Disposal Sampling (if applicable) 1 1 By: 

D Garden SampUng (if applicable) / / By: 

0 ^ Utility Clearance Called:2_/3L/e3 

By: ^I'z^'bicyH 

JB^Video/Photos (Before) On: ^ / 11 / b t By: VE,V^U.<,S ? 

• Video/Pbotos (During) On: / / By: 

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

• Vldeofl»liot08 (30-Day) On: / / By: 

D Property Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air Monitorine (as aoDlicable 

G Community DCrcw On: / / By: 

_ _ J 

Results: 

0 Community QCrew On: / / By: 

Resuhs: 

D Community QCrcw On: / / By: 

Results: 

Omaha Lead Site 
Pouglas County Account Infornfl|io >rna|c n Page 1 of2 

• 

Douglas County, Nebraska Property Record - R1038770000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VlO W O n Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature ^ • • • • Auto Sales Search 

Owner 

ODONNELL PAULA N 

3533 PINE ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3877 0000 10 

Account Type: Residential 

Parcel Number: 1038770000 

Parcel Address: 3533 PINE ST 

OMAHA NE 68105-0000 

Legal Description: FIELD CLUB TERRACE LOT 4 BLOCK 0 49 X 129 

Value Informatio n 

Land Improvement Total 

2009 $6,300.00 $107,300.00 $113,600.00 

2008 $6,300.00 $107,300.00 $113,600.00 

2007 $6,300.00 $107,300.00 $113,600.00 

2006 $6,300.00 $100,500.00 $106,800.00 

2005 $6,300.00 $100,500.00 $106,800.00 

2004 $6,300.00 $100,500.00 $106,800.00 

Sales Informatio n 

Sales Date: 1990-05-09 

Deed Type: Book: 1877 Pago: 538 

Price: $57,500.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

6076.0 1.0 124.0 49.0 No 

Improvemen t Informatio n 

0.13 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accotmtinfo.jsp?accountno=Rl 03... 7/7/2009 
Douglas County Account InforM«|ion Page 2 of2 V # 

Building 1 

tnnsF «mosf 

SUtRUfCM 

: It t J 

Dmctatf Oaiii i 

OTSOSf 

TWO STORY 

CLICK TO EN LARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1352.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: | Average 

Unit Type: Condition: Fair 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip Stories: ! 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1925 0 0% 1925 83 

Detail Type Detail Description Units 

Add On Unfinished Attic W/floor 676.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 676.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch Slab Roof Ceil 208.0 

User Needs TLC 1.0 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.jsp?accountno=R 103... 7/7/2009 
Propetty ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact 

Final Action 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 |qm. \ 

^f)lZ ?inf S­^ 

 Date: '7J\'?J<^ Time: ty.f^ 

 Pate: i[->iJy/ Time: 7'\o Action: U-^r fiyfryiZ 

Dale: Time; Aciion; 

Transmit lo EPA D Other Action: D 
• • 

Page 1 of2 

"> 

Create Another Ticlcet ] [• Back to Irth Internet ,, Send Email, ] 

• YOUR TICKET NUMBER IS 2373175. 

Original Call Date: 9/25/09 Time: 4:55 pm Op: ELIZABETH18790 

Work to Begin Date: 9/29/09 Time: 5:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3533 Street: PINE ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-NW,29-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMNfUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/25/2009 
Page 2 of2 

• • 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/25/2009 
OLS#: 19421 ^ As-Built Drawing flt Date Excavated:9/30/09 

Date USEPA Signed Off: 10/13/09 

COASTA L Oinaha Lead Superfund Site Area Sodden: 3609 sa ft 

Name: ypOfJ/J^J t 

Address: "^^^ T '^x>ygr ^ 

Phone: vfeja-<y7^?- eygjT 

Omatta Lead Site 

Site Sketch 

Team//5W/^>i'<-/6^/^^-t^- ^ BVID# ff*/^ / 

Sample Number 

RyAb<^PXA - i9*fZ / 

kY<SSOf-'xA-/^4:L I 

p.YD5<^PX/A- /9^Z / 

P.PZ6.CPx A ­ J^h--2.i 

Lead Concentration 

527? ±5 ^ 

t^lIf.XZ4.0 

ST-? j : SMppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Date: ^V^ T North Arrow 

Time: yi^:'7S/4A^ 

N I. 

l^OLf. 

Confirmation Sample 

XRF Code 

f^f Yes a No .J3' 

^Pves a No ^ 

f 7 Yes

^Ye s

 a 

 C3 

No.'S- No -E3 

•psr Yes

• p Ye s

 CD 

• 

Uoy ^ 

NO..S 

Y e s • No • 

! LIGHT POLE! 

•----4------)r 

^ i --XF1 = 28 PPM @ 8" ^ \p^ \S^7r:^^ \f ^ 1661+23 

Omaha Lead Site 46130 

Legend 

Concret e Drip Zone Excavated Quadrants Excavate d 

Are a replace d

Sod 

 wit h Area replaced with 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
LL W 

Name: QDa^jJTf O Omaha Lead Site Date: 7/^V^T 

AddressPhone: •?5^%7 Tg/^^g r " 

*fo^-'CT> ' g/o$ ' 

Site Sketch Time: ^.'VS^s^ i i 

Team/ZiW/^/^^V^^/^^^^ BVID # ff¥P / XRF Code 

Sample Number Lead Concentration Confirmation Sample 

S2 7^±3^ f f Yes O No ^ gr8S6PxA- /<?^ai ppm 

^P Yes n No -2 RYCSCPXA- /^^7.1 ppm 

ppm / / Yes CD No ^ f^YD5CPx/A- /9^Z( ST-? ISM­ ppm ^Ye s n No -E^ 

ppm ^Ye s 1^ No ^ 

ll<t 1-^.0 ppm f Yes n No ^ 

ppm Yes n No C 

,'0\^Ph^O(AKif^ 

^ i ^ 

^ 

vS 

^ ^ 

^ 

Omaha Lead Site 46130 
^ 3S 3i^ ^y^ g 

^ 

Name: /^DO/^JJTEJ ^ Omaha Lead Site Date: ^//^/c j 

Address^?5'^7 "R^/f^ ^ Site Sketch Time: /CZ*7S/f^ 

Phone: Vte:3-q 7;?-g/o r i 

Team /ISW^ftfA/^r/t/'^i^f' ^ BVID# /f^ / XRF Code /S^(?lfSample Number Lead Concentration Confirmation Sample 

12YA6CPXA- i9'»Zf f( Yes a No ^ g.Y8S6Px:A- [<iXrL\ ^pYes n No -ED 

/"/Yes C3 N o ^ 

^Ye s a No - ^ 

RD^S CPXA- y^^T-i •^0^ 1 -2-? •pzYes O 

i^P?ScPxA-/^'+'Z-l f Yes n 

Yes • No n 

,V\Cn 9^mK},(^ 

••A 4 1 If ^ 1661+^5 

<- , r ' 

?^»T'kew<<S 

46130 
Name: C^DBhijJSjju. Omaha Lead Site Date: Nortti/Vrrow 

Address: t?^ ? 7^<rg r Site Sketch Time: 

Phone: */ofi^€^T:^^foT >P 

Team//5ty/^^v6^/^A> ^ BVID# / f ^ / XRF Code /FOff 

Sample Numt)er 

Lead Concentration Confinnation Sample 

£i: fJ Yes n 

No^a " 

No ^ ^Pves n f/Yes n No A . ^Ye s O RD^ScPyA>/<?^^l 3^|^S'p m 

No-a IjeYes O 

lt<« ^'^ O ppm f Yes n No^-er 

ppm Yes • 

No • © 

^ = ­ : ;i^ K' \^ A 

m 

C^PP ^ 

> ^ 

-?>?­

15i 

t3Si ,M^ 

-^f 514 i^O 

s-ni^ 

^6­

ii'^t^Jrxf^ 

7<^ 

^£ 7 < ^ • ?• ''-T * 

^ K 

r 

)f- 1^ 

I 

i 

7 ^ 

»f--

7 ^ E 

f^—^ 

yDS 

O'H-t m. - » - / / y 

/ ^ ' 527 Jtif 1 /^^I6^ ±zs 

1 

^ 5>ofevO<^ 

'^//^S^ 

Omaha Lead Site 

46130 
.s*^'"""* . 

COASTAL ENVIHONHENTA L VpROrt.^"^ C « 0 U r , IN C 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

follovi/ing described premises: 

^ 

Daytime Phone: (HoX ) 3 ^ H ' '^'5^ ^ 

PURPOSE OF RESPONSE ACTIVITIES 

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

elevated concentrations of lead and may pose a health hazard. The area(s) vi/ill be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

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

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of perfomning the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to; 

Page 1 of 2 
COASTA L ENVIKONMENTA l 

*^'»tpno^^ CROUP . IN C 

• Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

I grant access to my properties 

D I do not grant access to my properties 

^r^^ A &i±:£l 

Signnu£e_-—-^ Date Signature 

Date 

D I would like to be present during any sampling that is required. 

Page 2 of 2 
C 0 d s •T > I , 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: jduj 

Property Address: l,^}, ^ f>;^^ Sf 

On the attached diagram(s) indicate area(s) lo excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Btoms to ba Removed by the Ot^ner before StsrC of Remediation: 

ii3 :c-f iovc.i. siotece, c-ispjfcg.1,fcno/ot :et.;i:t o', thLKt itfcr/iS i.*- iu'-. Uwtt^i ? ii:£f.L'i({:li>,!i:iy. 

Keim: 

^^// p/XU 

i Kem: 

Rem: 

Item: 

Items to be Removed by the Contractor Ourinq Remediation and Not Reolaced 

Item: 

4 , S-, ^ / / Xl^nf Ufr XJ^^J- Item: / 

Item: 

Item: 

Page 1 of- ^ 
i 

C ^ U S T M L* 

Iterms tc Be Kemcved BY Contrsctor During [Remediation ?.nd (^episced 

l£em: 1. 

S<sJ, ^^^; i 

litem: 

i Item: 

\ Item: 

I 

I 

Landscape Inventory 

item Quantity' Unit Condction/Type/Spectes 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers

Attach n

, Heads

 skeirl

, etc

i u

. 

\ thf 'r

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Aiiach .1 skcicli 111 rt-laiiMiizcf- and li>c;iiii)ii^ 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. $ ' 'z'.<- .'•••i-. ' , It ' • •• 1. I)'. 

.is''(' .r '-•• I : - y.i-fi­

' Cl l v . V •!. ' :•• 1".. CIV. " 1 

o>'. per. 

Easement Area, to be Each 

excavated \b V'-evA^^^ 

Page 2 of. 0
I- \ s 1 r L, 

( Additiona.1 Commente / Instructions: 

ji 

o ^ 1, \5*^ S^CrT(C<S J (2on-f(fV/v^ Vn'^ST 

^y^^O-^ 'T-^A^e-^c "^c* '?'^' ^ iV^ IS OK . 

1 THfe^P- ^ a>ATr<^C-TrO» ^ Ot ^ +4oc^<,i $ . ^ ^ v&..v5s£~,^ 

I e 

i 

t 

v^0 Check 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. 

^,0 1 agree Q I do not agree 

re —Date Contractor's Signature Date 

Page 3 of ^ 
# 

BVID# I^^ U 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRFID # 

Shot# 

j ^ L 

KtSSL 

iLi ^ 

u a ^ 

Average

Shot# 

M£ ifefeg i

/I/^f ^ o 

/U^? 

Average 

Shot# 

Average 

Shot# 

Average 

lab sample # 

Address U^?, S Fl-..x<^ cET 'W^ 

Omaha lead FP 2nd year option Sample time am/pm 

sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

ICO t '3 Jle ^ s:s 

I ?J ^ *^ I \s \7^tr K a lltldL z^£ ^ £^ 

Depth Depth /^•t - !>: U t ^ loy <- 1?? iU3L % . 

 t2^2* "^ / ^^ Average ^l±^ 

Reading Sample area Shot# Reading Sample area 

SI l e ^ ^ U ? Bl MUL 1 ^ BZ. L • ^ 

& ^ Dept Dep h Depth {[nU fa^ IZ- Dep 

y r » Uc±2^ \H1 - ir l ^ 

^ 2 y Average ^ < ^f2 -

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

Signature ^CAM ^ 

PrlntgJUAAV^Sth QMM ^ 
^ 

/ jQk^ '\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^^ ^ I Coastal Environmental Group Inc. ^^^9S^^ 

\!^^y y wwifw.coastalhazmat.com ^^^^ 

^"tPBO^' ^ COASTA L iNVIIONNENTAl 

C lour . IN C 

EXECUTIVE SUMMARY: 

BVID #19421-(3533 PINE ST) 

~y| No Issues or Concerns []] Issues/Concerns 

Detail Explanation: 
EPA # 

^ 

EPA Property Close Out Form 

Property #: Property 

DatcH'Intc: , Owner* 

Quadi Eicavated; y\ :(-y;\ r ^ ^ Contractor Group 

Excavatioii Geaeral 

1. If necessary, were the correct quadrants) excavated and restored? ^ 

2. If necessary, were the correct areas ofdrip zone excavated and restored? X

GradlDg Yes No Sod and Vegetation 

1. Does the grading around the perimeter of the house in excavated areas generally slope away X^ from the house?

 , 

2. Has sod been laid in ali areas that were excavated? X 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

4. Are sodded areas generally Tinn and evenly graded? 

S. Are the joints between the sod snips generally tight? (Only evaluate if inspected at a 30 day 

time period) y

6. Was the property graded such that water will not pool on the propert>'? 

~y 

7. Was danuge to landscaping or plant materials avoided? -y 

Gates, Fencea and Rctatnlng Walls 

Yes No 

V 1.

 Do gates open and close freely? (Ifapplicable) X 

^ 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) y 

3. Was damage to gates or fences avoided? (Ifapplicable) l y 

4. Was damage to retaining walls avoided? (Ifapplicable) y^ 

FouDdation, Siding and Gutters 

I. Was damage to the siding or trim avoided? 

^ 

2. Was damage to the foundation avoided? X

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? X 

5. Was damage to downspouts or downspoul extensions avoided? x\ 

Sidewalks and Drh-cwayt (Concrete) 

Yes No 

1. Was damage lo driveway surfaces avoided? X 

2. Was danmge to walkway surfaces avoided? X 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete induding the BOrday sod warranty: J OV/M VTUilUlIlJ . 

EPA Representative L^J:P' ^ f j/^M^A^^ Date: 
Property Completion Agreement 

This agreement documenls the complclion ol remedial acliviiies perlbimed on my properly My signalure 

will designate lhat I am satisfied with the restoralion of my property, and lhat no ileitis are m queslions. 

now, or al any Dme in ihe fiituie, excepl those ilems lisled below, ifany 

Property ID: | ^ q ^ I 

Property Addrcus: ^^T, ^ Pl^ e S t 

Q"'"''-^Pa^r. O'O C-At^g ^ LL 

Phone: M b^- ^ ^p . - ^g^S " 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

\X ' "(.''•ce Jc.sfor«(ion is complcitd, cxccpl a> noled 

 I I do nol i|;rec resloration ii; completed c yy 

yy-- \Ax\X 

Date (^ntia onti arlor' r s Signature Dale 

l