# • r TRANSMITTALof OMAHA LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R

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### SAID# : Date : 

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. f ^\f^ i Remediaiio nContractor : CoastalEnvironmenta l Grou p Year : _2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# i / Executiv e Summar y 

## / EPA-provide dproperty sketc h 

# t / Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen l Settlemen t document s (i.e. , fo r damag e or l o replac e plants , etc. ) Confirmatio n dat a 

### Photograph s X U ^ ^KVUrw n^ ^MVA^H^, ^ } f < ^ As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EP A Descriptio no f area s no l meetin g RO D cleanu p criteri a Utilit yclearance s 

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### Dougla s County Accoun t I ij^jj^tio n Pag e 1 of 4
Dougla s County , Nebrask a Propert yRecor d - R210143000 0 Prin t Repor t Vie wInteractiv e GI S Ma o Informatip n i s vali d a s o f 2010-8-3 0 Treasurer' s Ta xRepor t Ne wFeatur e • ^ - 4 - > Subdivisio n Sale s Searc h Owne r LAD D PETR AR C/ 0 DB AP L ENTERPRISE S POBO X 181 2 COUNCI L BLUFF S I A51502-181 2 Propert yInformatio n Ke yNumber : 014 3 000 0 2 1 Accoun t Type : Multipl e Re s Parce l Number : 210143000 0 Parce l Address : 53 6 S 3 1 A V OMAH AN E 68105-000 0 Lega l Description : REDICK S - E S - AD D LO T4 BLOC K2 S 5 F TLT3 & N 4 0 FT4 5 X 13 0 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $12,000.0 0 $63,000.0 0 $75,000.0 0 200 9 $12,000.0 0 $63,000.0 0 $75,000.0 0 200 8 $12,000.0 0 $63,000.0 0 $75,000.0 0 200 7 $12,000.0 0 $63,000.0 0 $75,000.0 0 200 6 $12,000.0 0 $63,000.0 0 $75,000.0 0 200 5 $12,000.0 0 $63,000.0 0 $75,000.0 0 Sale s Informatio n Sale s Date : 2000-07-1 2 Dee d Type : D SooIr : 215 7 Page : 25 9 Price : $73,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1997-07-0 7 Dee d Type : D Book : 206 5 Page : 68 7 Price : $65,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R210.
. . 9/1/201 0

### Dougla s County Accoun t I i]fl|M|tio n 

### Pag e 2 of4
Grantee : Valid/invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 5850. 0 1. 0 0. 0 0. 0 N o Improvemen t Informatio n Buildin g 1 

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CLIC KT O ENLARG E IMAG E 1 CLIC KTO ENLARG E IMAG E Squar e Footage : 1950. 0 Percen t Complete : 100.0 % Perimete r 154. 0 Quality : Averag e Uni t Type : Condition : Averag e

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

HVAC : Centra l Ai rt o Ai r Rooms : 10. 0 Exterior : Fram e Aluminu m Units : 6. 0 Interior : Drywal l Baths : 6. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 5. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 0 0 192 0 8 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 1110. 0 Basemen t Finishe d 960. 0 Fixtur e Additiona l Fixture s 1. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R210.
. . 9/1/201 0

### Dougla s Coimty Accoun t I

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. . 9/1/201 0

### Dougla s County Accoimt In^Batio ^ Pag e 4 of 4 Ii|^B|tio n 1^ ^

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. . 9/1/201 0

## Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai i 

# ]
YOURTICKE T NUMBE RI S 2612617
. Origina l Cal l Date : 10/08/1 0 Time : 2:0 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/13/1 0 Time : 2:3 0 p m State : N E Co\inty : DOUGLA S Place : OMAH A Address : 53 6 Street : S 31S T AV E Twp : 15 NRng : 13 E Sect-Qtr : 21-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . 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 Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 lE C QLNNEI C
UtiUt y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CO X COMMUNICATIONS , CXCAT V HEID I Alt : 402934046 9 IN C Emerg : 402932975 7 Day : 877366834 4 Tc^n^T , LEVEL 3 COMMUNICATIONS , ... . Alt : LiiViiL j rrr ' Emerg : 877366834 4 Day : 402504782 3 METROPOLITA NUTILITIE S MUDO l SAND Y Alt : DISTRIC T Emerg : 402504797 0 

## Day : 402444719 7 CIT Y O FOMAHA

- OMAHACO F RICH/TRAFFI C 

## Alt : 402444516 1 TRAFFICSEWE R 

## Emerg : 4024445160
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. 10/8/201 0

### Pag e 2 of 2

OMAH A PUBLI C POWE R OPPDGPR 5 EL M LOCATIN G DISTRIC T

N O NEE D T O CAL LOU T PAETE C PAETE C COMMUNICATION S EMERGENC Y
QLNNEI C QWES T LOCALNETWOR K EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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. . 10/8/201 0

# 1 ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2260 4 Dat e Excavated : 10/12/201 0 Dat e USEP ASlqne d Off : 12/9/201 0 

### 2260 4 Are a Sodden : 112 5 s o f t Omah a Lea d Sit e Exterio rPaint Nort h Arro w Owne rName : PETR AR LAD D Sit e Sketc h • Goo d Address : 53 6 S 3 1 A V • Poo r Phone : H : W : Q^wi t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : P. ^ mTt - (Y\.-SA ^ RYASCPXA-2260 4 F l pp m 

### D Date : <? ; LJ>- a RYBSCPXA-2260 4 F 2 pp m 

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

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## Consen t fc rAcces s T o Property / RIGH TO F ENTRYTO 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 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 :

owner' s Name : ^ ^ ^ [^^k A Daytim e Phone : ^ ^ \~'OH'^Z ^

Addres s o f Propert y covere d b ythi s 

### S1>C L

## ^ -^Icxvt
. 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 that contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o remove contaminate d soii
. Th e remove d contaminate d soi l wil l be 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 Lead Superfun d Site remediatio n program . Arepresentative o f Coasta l Environmenta l Group , contracte d b yUSEPA , v^l 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 reviewan d approve th e planne d soi l removal , an d restoratio n work before i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rviril l receive v\fl-itte n documentatio n fro m EP Athat th e propert y has 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 , its 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 of performin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f 2A * * *

COASTA L IMVINOhHIKTA l - I PBort ^ SHO O ' IK C 

### t 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 ; cWate 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 ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; i 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
. cAllo 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 f th 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 regardin g th e us e o f sai 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 wothers 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

5 1 ^ gr a 

### D I d o not gran t acces s t o m ypropertie s I gran t access t o m ypropertie s 

# '/ ^ fyiyp/ o Dat e Signatur e Dat e
Q I woul d lik e t o b e presen t durin g an ysamplin e tha t i s required
.

Pag e 2 o f 2COA S T AL • HViaOMMHNTA L amo V r , INC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amuttia l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r th e purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof th e propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

PropertylD : ^XCcC H Propert y Address : CJ3 ^ S
. "i V oco e Owner : fa^^ L ^ Phone : QtS ^ ~C>'<';t': i 

### O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedb y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibiiity
. Kem : 

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Pag e 1 of
.COA S T AL • MVIKONMI N TAI
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. 

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## Ite m Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r o

f tree s > 2 inc h tnm k

diamete r Numbe r of tree s < = 2 inc h tiiin k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r of an dsize o f eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not t o b e replacedbv contractor . Not e thi s valu e wil l b e usedto issue aplan t voucher to th e property owner . Easemen t Area , to b e excavated 

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Pag e 2 of
.COA S T AL O I I O U P
. INC
.
Additiona l Comment s / Instructions : Th e ctt yo f Omah a ordinance s ma yprohibt t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underiyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e c£»e , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi l doe s no t mea n tha t an yIllega l drivewa yo rparkin g are a o n you r propert yI s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t wtthstandin g an yremova l o rreplacemen t o fsoi l b yth e EP A I f yo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e ctt yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q Pieas e chec k thi s bo xi f yo u understan d th e informsrtio n outline d above
.



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. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e

interiorpffiouse , includin g foundatio n crack s o rfissures
. 

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Supervise d By : 

## Certificat e o f Verificatio n

8 SOI L 2011-01-2 0 13:4 5 90.2 9 Fina l Av g o f5- 7 53 6 S 3 1 AV E F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

# 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 64.48 3 Supervise d By : 

## Certificat e o f Verificatio n

5 SOI L 2011-01-2 0 13:4 4 30.0 7 Fina l 2260 4 53 6 S 3 1 AV E F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.50 5

# 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 90.82 4 Supervise d By : 

## Certificat e o fVerificatio n

6 SOI L 2011-01-2 0 13:4 4 30.1 5 Fina l 2260 4 53 6 S 3 1 AV E F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r ±

16.27 1

# 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 85.80 0 Supervise d By : 

## Certificat e o f Verificatio n

7 SOI L 2011-01-2 0 13:4 5 30.0 7 Fina l 2260 4 53 6 S 3 1 AV E F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±16.19 8

# 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o fVerificatio n

1 2 SOI L 2011-01-2 0 13:4 8 90.4 9 Fina l Av g o f9-1 1 53 6 S 3 1 AV E D Z 13 " C.PADILL A CONFIRMATION CLEA R

# 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 101.62 7 Supervise d By : 

## Certificat e o f Verificatio n

9 SOI L 2011-01-2 0 13:4 6 30.1 5 Fina l 2260 4 53 6 S 3 1 AV E D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.80 0

# 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 116.47 4 Supervise d By : 

## Certificat e o f Verificatio n

1 0 SOI L 2011-01-2 0 13:4 7 30.1 9 Fina l 2260 4 53 6 S 3 1 AV E D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 17.56 1

# 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 87.36 6 Supervise d By : 

## Certificat e o f Verificatio n

1 1 SOI L 2011-01

- 2 0 13:4 8 30.1 5 Fina l 2260 4 53 6 S 3 1 AV E D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 15.81 9X 

## /

^

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^ '"iPHOi* ^ 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENViaONHINTA l CROUP , IH C 

# EXECUTIV ESUMMARY : BVID #22604 - (53 6 S 3 1 AVE ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N12/9/201 0

## EP A Propert y Clos e Ou t For m Propert y tt : _»3lbO< ^ Propert y Addresr
. -^kl—f_M_AiA

- Date/Time : Owner' s Name

- / • .r^^f<»..—V*jd|ff-
. •:. • ;- . Quad s ExcBV8l»d : \p ] \ ' ^ A V ^ Contracto r Grou p _ Ve * N o Excavatio nGenera l 1
. I f necessary , wer e th e correc t quadrantfs ) excavale dan drestored ? / 2
. If necessary , wer e th e correc l area s ofdri p zon e excavate dan drestored' ' 

## y Gradin g So dan dVegetatio n Ve s ^ o I Doe s th e {radin g aroun dth e perimete r ofth e hous e inexcavale darea s generall y slop e awa y 

# -yj-y

_fromtfa e house ? 2
. Ha s so dbeenlai di nal l area s tha t wer e excavated ? / i Doc s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluai e if inspecte da i a3 0 / da y tim e period )
___ __ 4
. Ar e sodde darea s generall y fir mandevenl y graded ? 

# y^ ! I * Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y > 

# y ' tim e period ) 6
. Wa s th e property grade dsuc htha i wate r wil l no t poo l o nth e property' '

' 7 Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Ftpce s aa dReuinin g Wall s ____ ^ Ve s Ni l D o gate s openan dclos e freely? (Ifapplicable ) 

## + - 

## • 2 Wer c al l gate s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (1 1 applicahlf) I - I 3
. Wasdamagelogateso r fence s avoided ? (Ifapplicable ) / I 4 Wasdamag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 1/ 1 Foupdation , SidiBRan dGnUer s __ _ Ye s N o I I Wa s damag e t o th e sidin g o r tri mavoided ? 

# 7
2
. Wa s damag e t o th e foundatio navoided' ' 

# H T .'
. Wa s damag e t c window s avoided' ' 

### /
_ 4 Wa s damag e to window s or doo r screen s avoided ? ~^i\. \ 1 ." ^ Wa s damag e t o downspout s or downspou i exien.sion s avoided'. ' t
_

__ _ ^ 

# A I Sidewalk s an dDriveway s (Concrete ) Vc ) N r 1
. Wa s damag e to drivewa y surface s avoided ? 

# V 2
. Wa s darnag e t o walkwa y surface s avoided " /

### OM-ner s comments :

i Fn.spectio nnotes :

Remova l an dresloratio naclivaie. s compiet e includin g th e 30-da y .so dwarranry : \:.P A Rcpresenimiv c 6< ^ ^ Date : jj\=iVo

# <L
. Propert yCompletio n Agreemen t
I In s agreemen l documenit
. ih e compiclio n o t remedia l aclivme s perloime d o n m ypioperi yM ysignalui e wil l designat e iha i I a m sali.'.fie d wit h th e restoratio n o f m yproperly , an d lh? l n o item s ar e m quesiion s now , o ra l an ylim e m th e fulure
. exccp l ihos e iiem s liste d below , i f an y

Propert y 10 : _3L51^^V. ^ Propert yAddress ; c 

### SJi k J5i_i- ^ hA
. Owner : 

## AVr ^ A>!A A I!:!!!!i-^-MBi^3^i-jmA-.....
. .. _^ J Restoratio n Item s i n Question :

llem : Item : item : Item : Item :
Additiona l Comments :

. fl i ayrr ricstornlio n i s completed , ctctp l H S noler i \ ^iJ'-it o nn \ ^(jif crr.sioiat)O n j s coni^lclci' l 

# ' t j /A ^ ^yA<f?.//// /

^ -A d •—Owiicr'. s Sigoatnr f yDat e