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

# i I SAID# : ^{ 7 1^< ^ Date : Address : 1^3 ^ S U^ ^ ^ ^ Remediatio nContractor : _Coasta l Environmenta l Group _ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S 

# • a Vide o o f property (DVD ) Executiv e Summar y 

# k EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y 

# t k Restoratio nAgreement

• e- 

### Settlemen t document s (i.e. , fo r damag e or t

o replac e plants , etc. ) 

## -e - Confinnatio ndata 

## u

P Photograph s fe tKCl>i/AlU ^ As-built sketch 

## iP . / 

### Satisfactor y restoratio nsigne db y Propert y Owner Propert y close-out check lis t signedb y EP A 

## -e - Descriptio nofarea s not meetin g RO D cleanup criteri a Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Office 

# \ o

Year :20 0 

# H

3005549 2 Superfun d

# t »

Property Acces s Checklis t Propert y ID:-^^j^;-!; : D WOR K STARTE D ON : / / D WORKCORiPELTE D ON: _ / / Property Address : ,3:^ 7 ,* ^ ?. U 1 ^ Owne r Rente r 

# .b:y.p h<Sc,arpiiri ^ Address : Phone: Fax : Cell/Pager
. Additioaai Infonnation : 

## Phone : qQ2 . 3M|,0?,11 ^ Fax : Celt/Pager
. MOZ
. 203 - 3.^?>C ) D Notificatio nLette r Sent : / / By : ^ Acces s Agreement 

## Signed:9_/^'Q9 . By : ^ Restoratio nAgreement Signed : ^/i ^ / ^ By : C J Topsoil Samplin g (if applicable ) / / By : D Disposa l Samplin g (if applicable ) / / By : D Garde nSamplin g (if applicable ) / / By : ^ Utilit y Clearanc e 

## Called : 9_/^/0 g By:ir\|?)n Q Q' ^ Video/Piioto s (Before ) 

# On:BJ-' M By : l0'(L4n\i\ O 0 Video/Pboto s (During ) On : / / By : D Video^hoto s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : iP\Propert y Completio nAgreement 

## Signed : 40/ja/i2 ^ By : D FinalRepor t Issued :/ / By : Ai r MonitorinE(a s applicable ) D Commnnit y O Cre w On : / / 

## Br .1 Results : D Commnnit y DCre w | On : / / 

# 'r- 1 Resuhs : 0 Communit y Q Cre w On : / / 

## B r Results :
Omah a Lea d SK e

## "Douglas Count y Accoim t I

; [j^anjwtio n 

## Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R221854000 2 Prin t Repor t NE WFeatur B - Parce l Dimension s avaiiabl e @ scal e 0-5 0 f ) wes t o f52n d S t - VJeVt fO H Ma p Infoimatio n i s vali d a s o f2009-9-1 5 Ne wFeatur e Treasurer' s Ta xRepor t ->->- * Aut o Sale s Searc h Owne r SCARPIN O JOSEP H J ETA L 133 2 3 2 6 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 185 4 000 2 2 2 Accoun t Type : Residentia l Parce l Number : 221854000 2 Parce l Address : Lega l Description : 133 2 8 2 6 S T OMAH AN E 68105-000 0 SHULL S 2N D AD D LOT8 BLOC K9^50 X 12 7 Valu e Informatio n 

### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $4,900.0 0 $4,900.0 0 $4,900.0 0 $4,900.0 0 $4,900.0 0 $4,900.0 0 Improvemen t $48,600.0 0 $48,600.0 0 $48,600.0 0 $37,900.0 0 $37,900.0 0 $37,900.0 0 Tota l $53,500.0 0 $53,500.0 0 $53,500.0 0 $42,800.0 0 $42,800.0 0 $42,800.0 0 Sale s Informatio n Sale s Date : 

### 2009-01-2 7 Dee d Type : Price : Q C $0.0 0 Book : 200 9 Pago ; 00706 7 Grantor : SCARPIN O JOSEP H J Grantee : SCARPIN O JOSEP H J ETA L ValldHnvalld : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6350. 0 1. 0 127. 0 50. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online,com/DouglasCoNe/static/accountinfo.jsp?accountno=R22.. . 9/17/2009

### Dougla s County Accoun t L l|^iiM|tio n 

### Pag e 2 o f 2
Buildin g 1

Secon d FIOO ^ Rrsinoo r 354. 0 s q ft 792. 0 sq . fl
.

1 t/ 2 STOR YFINISHE D
CUC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1146. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : I 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : i Centra l Ai rt o Ai r Rooms : \ 7. 0 Exterior : i Fram e Viny l Units : ! 1. 0 Interior : Plaste r Baths : , 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 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 190 6 0 % 190 6 10 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 720. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Sla b Roo fCei l 160. 0 Use r Atti cFul l Finis h 354. 0



### http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R22. . . 9/17/200 9

### Pag e 1 of 2

" >

: ^ Creat e Anothe rTicke t J [ ^

Bac k t o Irt h Internet^ J Sen d Email
. ]



### • YOU RTICKE T NUMBE RI S 2382981 . Origina l Cal l Date : 10/08/0 9 Time : 2:4 2 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 10/13/0 9 Time : 3:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 133 2 Street : S 26T H S T Twp : 15 NRng : 13 E Sect-Qtr : 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 : FAX AL L CLEAR S TO : (877)662-421 1 UNSUR E O F CORNE R LO T RESEN T DU E T O WOR K EXTENDING . PLEAS E REFRES H PAIN T AN D FLAG S 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 : 4 F T Come r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F


### Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL3 COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emerg : 402444516 0 http://v4rvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/8/200 9

## Pag e 2 of 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

http://vmv^'.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/8/2009OLS# : 2015 5 Dat e Excavated : 10/17/0 9 Dat e USEP ASigne d Off : 11/13/0 9 

# As-Buil t Drawin g COASTA L Are a Sodden : 162 9 s a f t 

# Omah aLea dSuperfun dSit e

Name ; P.C->^! ? FTyJ a Address : -^ 5 5 c^6 ^ S-! ~ Phone : A'/ A Omah a Lea d Sit e Sit e Sketc h Date : Time : 'S:i<:jy y Nort h Arrow —i

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### Legen d Dri p Zon e Excavate d Concret e Quadrant s Excavate d Are areplace dwit h Are a replace d wit h Are alef t bar e So d Rock/Mulc hl-~k \ 

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

# \0\\ 3 

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Name ; Z^d'^l ^ FT/^ c ^ J Address ; r-J-^ Q S c•^(e' ^ S' k Phone ; A/X/f>i l ^O^lt , Omah a Lea d Sit e Sit e Sketc h Date : Time : 'P/.PpPo ^ ^Si.i^'pP x Nort hArro w
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## Consen t fo rAcces s T o Properf 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 Environmenta l Protectio n Agenc y(EPA) o rits 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 : 

# e>vip-
. zo\s s

owner' s Nan,e: ^JP^^j- fJ ^O^f|H ^ Daytim e Phone : ^^ ^

^ M | C^^ t

Addres s o fPropert y covere d b ythi s 

# i mw^ ^ 

# ^ r Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove 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 byUSEPA , vinl l contact 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 wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin 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 right 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 wori^
. Thi s acces s shal l remai n i n effect unti l th e wori t ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f2

### .^^'""v
.

' i PROli " 

### s COASTA L tHVinOHHIKTA L C « O U * IX C 

### €

Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cAbid 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
. c-Allo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TTO INTERFERE 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 . 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

[

^

gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s

e / Dat e Signature Date
Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Page 2 o f2

# i^ m z ^
COASTA L 

## Restoratio n Agreemen t Th e puipos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfbr 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 owne r an dth e Unite dState s Environmenta ) Protectio nAgenc y (EPA) . 

# I Propert y IP : ^<^\<V ^

Propert y Address : \\pj i C j ^ rV i ^ X •"*'• ' \1 7 (. y I Ly ^ ' 

### Owaer . ^FsIP hJ . 9Cl^\ ^ ^ Phone ; (^l^yj,) ^ ^ -o^-]^ ^ ^^ ^ ^y^ ^ O ndi e attache ddtagrain(s ) indicat e area(s } t o excavate , surfac e structure s an dlandscapin g feature s an d acces s locatiQn(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y an dVideographicall y documen t th e existin g condhiou s ofth e property an dth e basemen t i f necessary . 

### item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e lenoval
. stora.qe . disposal , snd/o rretur n o f thes e item s i s th e Owne rs responsibility
. 

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t Item : 

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## 1/^ ^9sk^ uk ^ }>^ ^ « ^ Item : tHem : L _
_ 

## 1 Item Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwit hgrass . Numlie r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < - 2 inc h ' trun k diamete r Num1)e r o f Sprinkle r Zones . Contro l Valves . Toners . Heads , et c .Ait.it hnsl-eicl r o l lli e vprinklc i liiv'.ui i Numbe r o f an dsiz e o f area . Allrtch;i skt'ic hu l relativ e ' <i/i" S nndJocatiiMi s

Agree dupo nvalu e o f plan t replace db y contractor . Vou
- Ihi ' ^>^I^I C «il l m csr C 10 IS ; m. i plan; ' j loiiclu- r II I lli e (;rii|ici-l > 0 " ner . Easemen t Area , t o b e excavate d 

## Landscap e Inventor y 1 Quantity Unit Quadrant s 

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# k r Eae h 

## VASNIC S Eac h 

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### Q Chec k th e bo x i f Ovmer doe s no t wan t CE Gt o documen t interior foundatio nwall s an dpossibl e pre-existtn g damage . B y checkin g thi s bo x CE GI s no t responsibl e fo r an y damag e don e t o th e interio r o

f house , includin g foundatio ncrack s o r fissures . 

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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 P b 132.56 7 Supervise d By : 

## Certificat e o fVerificatio n

52 6 SOI L 2010-01-2 6 16:1 3 30;2 1 Fina l 2015 5 133 2 S.2 6 St
. B l 6 E
. CACERE S 1 1

± Erro r ± 18.22 9

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 53 2 Mod e SOI L Tim e 2010-01-2 6 16:2 0 Duratio n 120.7 9 Sequenc e Fina l Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By :

# 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-3902 2 Readin g N o 52 8 Mod e SOIL Tim e 2010-01-2 6 16:1 7 Duratio n 30.2 1 Sequenc e Final Flag s BVI D 2015 5 ADDRES S 133 2 S.2 6 St . QUADRAN T D Z DEPH T 1 3 XR F TEC H E
. CACERE S MIS C 1 NOT E 1
Erro r pp m P b ± 20.62 7 185.68 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 141.07 7 Supervise d By : 

## Certificat e o fVerificatio n
52 9 SOI L 2010-01-2 6 16:1 8 30.2 2 Fina l 2015 5 133 2 S.2 6 St
. D Z 1 3 E
. CACERE S 1 1

± Erro r ± 18.58 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 167.17 4 Supervise d By : 

## Certificat e o fVerificatio n

53 0 SOI L 2010-01-2 6 16:1 9 30.1 7 Fina l 2015 5 133 2 S.2 6 St
. D Z 1 3 E
. CACERE S 1 1

± Erro r ± 19.89 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 185.80 9 Supervise d By : 

## Certificat e o fVerificatio n
53 1 SOI L 2010-01-2 6 16:2 0 30.1 9 Fina l 2015 5 133 2 S.2 6 St
. D Z 1 3 E
. CACERE S 1 1

± Erro r ± 20.82 0

# 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-3902 2 Readin g N o 52 2 Mod e SOI L Tim e 2010-01-2 6 16:0 6 Duratio n 120.8 4 

### Sequenc e Fina l Flag s AVERAG E ,,-fAVg5f5I8z521~- ^ ADDRES S ^-'133 2 S.2 6 Str~— ^ QUADRAN T E M DEPH T 1 XR F TEC H E
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 142.64 3 Supervise d By : 

## Certificat e o fVerificatio n
51 8 SOI L 2010-01-2 6 16:0 3 30.1 8 Fina l 2015 5 133 2 S.2 6 St
. E M 1 E
. CACERE S 1 1

± Erro r ± 18.63 8

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 51 9 Mod e SOI L Tim e 2010-01-2 6 16:0 4 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D 2015 5 ADDRES S 133 2 S.2 6 St
. QUADRAN T E M DEPH T 1 XR F TEC H E
. CACERE S MIS C 1 NOT E 1
pp m Erro r P b 135.63 3 ± 18.06 6 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 144.45 5 Supervise d By : 

## Certificat e o fVerificatio n

52 0 SOI L 2010-01-2 6 16:0 5 30.2 4 Fina l 2015 5 133 2 S.2 6 St
. E M 1 E
. CACERE S 1 1

± Erro r ± 18.78 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 108.86 6 Supervise d By : 

## Certificat e o fVerificatio n
52 1 SOI L 2010-01-2 6 16:0 6 30.2 5 Fina l 2015 5 133 2 S.2 6 St
. E M 1 E
. CACERE S 1 1

± Erro r ± 16.55 7• • 

## /VA^ % Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^k Z ° ST^^T ^ Coasta l Environmenta i Grou p Inc
. www.coa8talhazmat.co m V \ ^ ^ NPHO^* ^ COASTA L E N s 1 0 u r . IN C 

# EXECUTIV ESUMMARY : BVID #20155-(133 2 S 2 6 ST ) No Issue s o r Concern s Q Issues/Concern s Detail Explanation : . ­ •4 

# EP A EP APropert y Clos e Ou t For m Propert y Addrwr . I f?^"Z- . tf 

### Propert y # : "T^-^.l^Z ^ ?A> 0 Date/Time : I d/ Z-^/^ ^ Owner' s Name: . /L C '. O ,^f•ifjv^ii' . Quad s Excavated: ^ t s ( P ^ Contracto r Grou p gg^<J-MJ l g^r>&t ^ Ve s N o Excavatio nGenera l 1 . If necessaiy . were th e correc t quadrant(s ) excavate dandrestored ? 2 . If necessaiy , were th e correc i area s o f drip zoiie excavate dandrestored ? 

# k? ' Ye s N o Gradin g So dan dVegetatio n 1 . Doe s the gradin g aroun dthe perimeier ofth e hous e i nexcavate darea s generally slop e awa y 

# y fromthe house ? 2 . Ha s so dbee nlai di nail area s tha t wer e excavated ? 

# 1./ ' 3 . Doe s the sodappear to b e generall y healthy an dgrowing ? (Only evaluate i f inspecteda t a3 0 

# y day time period ) 4 . Ar e soddedarea s generally fir man devenly graded ? 

# k? ' 5 . Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

### i / tim e period) 6 . Wa s the propert y grade dsuchtha t wate r will no t poo l o nthe propert>* ? 

# \ y 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g Wall s Yes N o 1 . D o gate s ope nan dclos e (i-eely ? (Ifapplicable ) 

# k A 2 . Wer e all gate s or fence s takendow ndurin g restoralio nactivitie s reinstalled ? (Ifappiicabie ) 

### 1 / 3 . Wa s damage t o gate s or fence s avoided ? (Ifapplicable ) 

# V 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

### 1 / Foupdation , Sidin g an dGuMer s Ye s , N o I . Wa s danug e t o th e sidin g o r trimavoided ? 2 . Wa s damag e t o the foundationavoided ? 3 . Wa s damag e to window s avoided ? Wa s damage to window s o r doo r screen s avoided ? 

# - y 5 . Wa s damag e t o downspout s o r downspoul extension s avoided ? 

## iy ' Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 . Wa s damag e to drivewa y surface s avoided ? 

### L / 2 . Wa s damage t o walkwa y surface s avoided ? 

## L^ '

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y so dwarranty : EP ARepresentativ e LJcP hUofi/hl PDate : H /j/d f

### #



## Propert yCompletio n Agreemen t Ihi s agreemen i documeni s Ih e complclio no f remedial acliviiies perloime do nm y properl y M y signalur e will ciesignal e liia t I a msatisfie dwilhIh e restoraliono f m y properly , andtha i no item s ar e i nquestions , now , or a

t an y time i nth e fiilure . excep t thos e ilem s liste dbelow , ifan y Propert y ID ; ^1^ 5 Propert y Addrm : j:i^^ 2 ' S ^ 4 ^f . Ownc : "S^^^p ^ SZ-AApix h Phone : (qo^ ) l^H l ,^?g6?
- Restoratio n Item s i n Question :
Item : Item : Item : Item : Item :

\y ^ I >i(;rr c ir?for*(io ni » compltud , excep t a s nnler i [ I I H o no l Kf.rt c rr.«iorafin nil, complelcr l 

### (Vv\<L> v Owner' s Signafiir e Dat e C.nn K

actor' s Sicnalnr c Dal e