## TRANSMITTALo f

OMAH ALEA D SIT E SOILREMEDIATIO NFIL EFOLDE R 

# ^kl Dat e

Remediatio nContriictor : Coasta l Environmenta l Grou p Year : _20]0ARR A
SOILREMEDIATJO N PROPERT V FIL EFOLDE RDOCUMENT S 

# 1

/ Vide o o f property (DVD ) 

# 1 / Executiv e Summar y / 

### EPA-provide dproperl y sketc h / 

### Signe dAcces s Agreement fo r subjec t propen y 

# 7 Signe dAcces s Agreement(s ) fo r adjacent properl y Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or t

o replac e plants , etc. ) Confirmatio n dat a 

# y Photograph s |[( T irf'Cfin/fir]^^ ^ ^ h < CAvifr[\s^ A- 9# ^ As-buil l sketc h 

# t / Satisfactory restoratio nsigne db y Property Owner 6 ? 

### Property close-ou t check lis t signe db y EP A Descriptio no f area s not meetin g RO D cleanu p criteri a Utilit yclearance s 

# 1 / 

# 7 Properl y informatio nfro mDougla s County Assessor' s Offic e

Superfun d

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### D WOR K STARTE D ON : / 1
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_ D WOR K COMPELTED ON : l_ 

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### SlffHa:Jj7lZ£2'i O "y= vi.vi f L ^ Restomtio nAgreemen t Signed : | ^ iJ ^ !/£ > By : v^^. v D Topsoil SampUng (if applicable ) 1 1 By : D Disposa l Samplin g (if applicable ) / / By : D Garde nSamplin g (if applicable ) /__ / By : ^ Utilit y Clearanc e Called ; y l 1 ^ U o ^y-W/^oL.: , ^t»Mi.
. '£ 1 Video/Photo s (Before ) OKJI}I2£IIJ O *y jV^^LX
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### aVideo/Photo s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Videoa>hoto 8 (30-Day ) On : / / By : Q Property Completio nAgreement Siened : / / By : D Fina l Report Issued : / / By : Ai r Monitorin e (a s applicabl e nCommunit y D Cre w On : / / By : Results :
nCommunit y D Cre w On : / / By : Results : Qcommnnft y QCrc w On : / / By : Results :
Omah a Lea d Sit e

## Dougla s Count y Accoun t I

# •^0P

- Pag e 1 of 2 # > Dougla s County , Nebrask a Propert yRecor d - R074331000 0 Prin t Repor t Vie winteractiv e Gi S IMa o Informatio n i s vali d a s o f2010-7-3 0 Treasurer' s Ta xReoor t Ne wFeatur e ^ ^ ^ Subdivisio n Sale s Searc h Owne r JUR YJAME S J ETA L 612 0 8 4 8 S T OMAH AN E 68117-000 0 Propert yInformatio n Ke yNumtyer : 433 1 OOO O 0 7 Accoun t Type : Multipl e Re s Parce l Numtter : 074331000 0 Parce l Address : 244 0 S 2 0 A V OMAH AN E 68108-000 0 Lega l Description : CAMPBELL S AD D LO T2 0 BLOC K4 W9 9 E 11 1 FT5 0 X 9 9 Valu e Informatio n Lan d Improvemen t Tota i 201 0 $500.0 0 $0.0 0 $500.0 0 200 9 $500.0 0 $0.0 0 $500.0 0 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 

## SIlo w Al l Transaction s Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4950. 0 0. 0 99. 0 50. 0 Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07..
. 8/14/201 0Pag e 1 of 2

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


### YOURTICKE T NUMBERI S 2637698
. Origina l Cal l Date : 11/08/1 0 Wor k t o Begi n Date : 11/10/1 0 Time : Time : 5:4 8 p m 6:1 5 p m Op : ELIZABETH1879 0
State : N E Address : 24 4 0 County : DOUGLA S Street : S 2OT H AV E Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 27-SW,34-N 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 : FA X 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 Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ALTS7 2 ATTNEBR l CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Nuniber UtiUt y Typ e
ALT87 2 WINDSTREA M COMMUNICATIO N EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
ATTNEBR l ATT/ T Day : 8002413624 9 Alt : 

### Emerg : 8002413624 9
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
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 1 1 /8/201 0

### Pag e 2 of 2

METROPOLITA NUTILITIE S MUD0 2 SAND Y DISTRIC T

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ELM 0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T LOCATIN G

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### Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/8/201 0

# As-Buil t Drawin g C OASTA L 

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. P Z = Pla y A n quadrant s are a s viewe d fro m th e street, facin g propen y



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are areplace dwit h Rock/biulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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## %f COASTA l INVItONKlNTA L '" l PHO'* ' / C I 0 U fIN C 

## Consen t fc fAcces s TcPropert y RIGH T OF ENTR Y TO PREMISE S 

### Granto r(th e propert yowner ) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta i respons e activitie s upq n 3o n th th e

e follov\/in g describe d premises : 

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Owner' s Name : Daytim e Phone : 7 " 3 / <£J~J~ / 

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Addres s ofPropert y covere d bythi s 

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- Agreement :
PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP Ais requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e contaminate d soil
. 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 be restore d to it s origina l condition
. Thi s wor k is bein g perfomne d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e ofCoasta l Environmenta l Group , contracte d byUSEPA , wil l contac t th e Granto rin-perso n to discus s th e wor k to be perfonmed , th e Granto rwil l hav e an opportunit y to revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e it begins
. Onc e th e wori t is finished , th e Granto rwil i be aske d to revie wth e wori ( an d confin n tha tit is 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 r is grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperfomiin g th e worit
. Thi s acces s shal l remai n in effec t unti l th e wori t ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 of2V -'^^'^i * COASTA L

' "no" - c II 0 u rI Kc



### « 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 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 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 rvint 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

M

\ gran t acces s t o mypropertie sQ i d o no t gran t acces s t o mypropertie s 

## yi>-j^ a yz 7 Signatur eDate

DI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Page 2 o f 2COA S T AL G fl O U P , INC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutiia 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 the purpos e of assiuiag tha t restoratio n activitie s ar e completedto th e satisfactionof the propert y owne r an dthe UnitedState s Enviromnenta l ProtectionAgency (EPA)
.

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nthe attacheddiagram(s ) indicat e aFea(s) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby 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 fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility
. Kem : 

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## Landscap e Inventor y Item Quantity Unit Condition/Type/Specie s Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h trun k

diamete r / Numbe r of tree s <= 2 inc h Eac h 

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### # size s an dlocations
. Agree dupo nvalue of plan t material s not t o b e replacedb v contractor . Not e thi s valu e will b e usedto issu e aplan t 

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### < \ COASTA L • NVinONH I NTA L O H O U P , INC
.
AddKiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo 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 case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi 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 cKyi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t wKhstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
. I fyo 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 cKyo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. O Pleas e chec k thi s bo xI fyo u understan d th e informatio n outline d above
. 

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. 

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 50.86 0 Supervise d By : 

## Certificat e o f Verificatio n

25 5 SOI L 2011-01-2 8 16:1 2 30.1 1 Fina l 1682 2 244 0 S 2 0 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±13.59 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 f Verificatio n

25 2 SOIL 2011-01-2 8 16:0 9 90.3 3 Fina l Av g o f249-25 1 244 0 S 2 0 S T F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 102.87 7 Supervise d By : 

## Certificat e o f Verificatio n

24 9 SOI L 2011-01-2 8 16:0 6 30.0 2 Fina l 1682 2 244 0 S 2 0 S T F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±16.34 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 214.72 2 Supervise d By : 

## Certificat e o f Verificatio n

25 0 SOIL 2011-01-2 8 16:0 8 30.1 4 Fina l 1682 2 244 0 S 2 0 S T F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.33 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 64.07 7 Supervise d By : 

## Certificat e o f Verificatio n

25 1 SOIL 2011-01-2 8 16:0 9 30.1 7 Fina l 1682 2 244 0 S 2 0 S T F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.28 1

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 24 8 Mod e SOIL Tim e 2011-01-2 8 16:0 5 Duratio n 90.6 8 Sequenc e Fina l Flag s AVERAG E Av g o f245-24 7 ADDRES S 244 0 S 2 0 S T QUADRAN T B 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

Supervise dB y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 201.71 9 Supervise d By : 

## Certificat e o f Verificatio n

24 5 SOIL 2011-01-2 8 16:0 4 30.3 3 Fina l 1682 2 244 0 S 2 0 S T B 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.71 9

# 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 259.45 9 Supervise d By : 

## Certificat e o fVerificatio n

24 6 SOIL 2011-01-2 8 16:0 5 30.3 2 Fina l 1682 2 244 0 S 2 0 S T B 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 24.02 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 324.19 7 Supervise d By : 

## Certificat e o f Verificatio n

24 7 SOIL 2011-01-2 8 16:0 5 30.0 3 Fina l 1682 2 244 0 S 2 0 S T B 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 26.21 1

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

## Certificat e o fVerificatio n

24 4 SOI L 2011-01-2 8 16:0 3 90.5 0 Fina l Av g o f241-24 3 244 0 S 2 0 S T B l 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 74.75 8 Supervise d By : 

## Certificat e o f Verificatio n

24 1 SOIL 2011-01-2 8 16:0 1 30.1 2 Fina l 1682 2 244 0 S 2 0 S T B l 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.71 4

# 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 24 2 Mod e SOI L Tim e 2011-01-2 8 16:0 2 Duratio n 30.2 2 Sequenc e Fina l Flag s BVI D 1682 2 ADDRES S 244 0 S 2 0 S T QUADRAN T B l DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r P b 96.38 0 ±16.44 5 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 98.80 0 Supervise d By : 

## Certificat e o f Verificatio n

24 3 SOI L 2011-01-2 8 16:0 3 30.1 6 Fina l 1682 2 244 0 S 2 0 S T B l 6 " C.PADILL A CONFIRMATIO N CLEA R

±Erro r ±16.32 0

## ! > J^ ^

\

Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 o ^^^ ^

ICoasta l Environmenta i Grou p Inc
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www.coastalhazmat.co m ^"inatt' ^ COASTA L INVIRONMENTA l CROUP , IH C 

# EXECUTIV ESUMMARY : BVID #16822-(244 0 S 2 0 AVE ) No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation :

# t
» iFi i

Propert y # ; Datc/Tlrae ; 

# : 'HY\^' ' Quad s Excavate d 

## EP APropert y Clos e Ou t For m 

# ,7MHoSZ£j^^- ^ Propert y Address : Owner' s Name:
. / ^ 

# , - Contracto r Grou p ravaled ; H rSb \^b ^ r Yes No Excavatio nGenera l I
. I f necessaiy , wer e th e correc t qtiadrant(s ) excavate dan drestored ? / 2
. I f necessary , wer e th e correc i area s ofdri p zon e excavale dan drestored ? / Gradin g So dan dVenctatto n Ye s No 1 Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e awa y 

## y fromth e house ? 2
. Ha s so dbee nlai di nal l area s that wer e excavated ? / 3
. Doe s th e so dq>pear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

## y da y tun e period ) 4
. Ar e sodde darea s generall y firman devenl y graded ? 

# 7 5
. Ar e th e joint s twtweeti th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y

_ 

## y tint e period ) ^_ 6
. Wa s th e propen y grade dsuc hthat wate r wil l no l poo l onih e property ? 7
. Wa s danug e t o landscapin g o r plan t material s avoided ? 

# r y 

# y Gates , Fence s an dRcUfnlDi ! Wall s Ve s N o 1
. D o gate s ope nan dclos e freely? (Ifapplicable ) 

# y 2
. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsulled ? (I f applicable ) 

# 7 3
. Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) / 4
. Wa s damag e t o reuinin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidio Kan d Goiter s Ye s .N o t
. Wa s damag e t o th e sidin g o rtri m avoided ? / 2
. Wa s damag e t o th e foundatio n avoided ? / .^
. Wa s damag e t o window s avoided ? / 4 Wa s damag e t o window s o rdoo rscreen s avoided ? / 5. Wa s damag e t o downspout s o rdownspou i extension s avoided ? / 1 Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damag e t o drivewa y surface s avoided ? 

# "7 2
. W&s damag e t o walkwa y surface s avoided ? /

# • t 0>»'Ders comments :

ninspectio nnotes :

Removal andrestoratio naclivale s complete includin g lhe 30-da y so dwarranty : EPARepresentativ e Q* ^ j^/y , Date : l^'LlL

# c " k Propert yCompletio n Agreemen t i hi s atneemen i documenls
. Ih e complclio no l remedia l achviiic s perloime do nm y pioperl y My signalui e will de.signal e iha i I a msalisfie dwilhlh e restoralio no f m y properly , andlha( n o item s ar e i nquestion s now , or al an y lim e i

nthe future , excep t thos e item s hsle dbelow , ifan y Property ID : Pioptrr) ' Address : 

# l o Own e Phon e Restoratio n Item s i n Question : Item : Hem : Item ; Item
. Item : Item : Additiona l Comments :

J «^rr c ir.^torklio nu complclrd , occp l a s noltr i I I rio no l ii(;if c rcJioiAdo nhcornplclc d


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