## TRANSMITTALo f

OMAH ALEA D SIT E SOILREMEDIATIO NFIL EFOLDE R

SAID^ : 

### Date : 

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# n Addrcs. s 

# y' ^ i\ift u ^ f Remediatio nContractor : Coasta l Environmenta l Grou p Year : _2010ARR A
SOILREMEDIATJO N PROPERT V FIL EFOLDE RDOCUMENT S [ / 

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

# J
. EPA-provide dproperty sketc h / 

### Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confinnatio n dat a 

# y Photograph s \k iy^Qwf^V^^ y ^C^tc^\jr ^ \'ft ^ As-buil t sketc h Satisfactory restoratio nsigne dby Property Owner 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 

# y Utilit yclearance s 

### Property-rnformatio nfro mDougla s County Assessor' s Offic e 

# y

Signatur e 'Date '
3021881 0 

# mi l Superfun d

## Propert yAcces s Checklis t PropertylD : ^^oe>g, ^ Propert yAddress : 

## !^!!L^>-5L„5ii^c!^„^ ^ D DWOR K STARTED WOR K COIVIPELTE D ON : ON : / / / /
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Acces s Agreemen t Restoratio nAgreemen t Topsoi l Samplin g (if applicable ) Sent : / / Signed : \ 0 / o\ / \e > Signed : vo/o > /v o / / By : By : By : By : ^^ * tV c Vi.^ct ^ Q Disposal Samplin g (if applicable ) / / By : Q ' P Q D D Garde nSamplin g (if applicable ) Utilit y Clearanc e Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After) / / Called : v O /Q ^ /^ o

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Omah a Lea d Sit e

## Douglas Count y Accoun t IniKmatio n

tAaa z Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f2010-8-1 6 ­ R221799000 0

Ne wFeatur e ^ - ^ f * Prin t Repor t Vie wInteractiv e GI S Ma o

Treasurer' s Ta xReoor t Subdivisio n Sale s Searc h Owne r BOECKE R RONAL D F ETA L 1091 0 JOH N J PERSHIN G D R OMAH AN E 68152-000 0 Propert yInformatio n Ke yNumber : 179 9 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221799000 0 Parce l Address : Lega l Description : 251 3 PIERC E S T OMAH AN E 68105-000 0 SHULL S 2N D AD D LO T8 BLOC K7 E 1 /2 3 0 X 16 8 Valu e Informatio n
201 0 200 9 200 8 200 7 200 6 200 5 Lan d $4,300.0 0 $4,300.0 0 $4,300.0 0 $4,300.0 0 $4,300.0 0 $4,300.0 0 Improvemen t $25,900.0 0 $25,900.0 0 $26,700.0 0 $26,700.0 0 $29,300.0 0 $29,300.0 0 Tota l $30,200.0 0 $30,200.0 0 $31,000.0 0 $31,000.0 0 $33,600.0 0 $33,600.0 0 Sale s Informatio n Sale s Date : 2001-11-0 1 Dee d Type : W D Book : 219 6 Page : 5 2 Price : $25,000.0 0 Grantor : Grantee : Validtlnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5040. 0 1. 0 168. 0 30. 0 N o Improvemen t Informatio n


## http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R22..
. 8/20/201 0

### Dougla s County Accoun t IiAaiiatio n Pag e 2 of 3

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### 1144. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Poo r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Shingl e Units : 

### 1.0 Interior : Plaste r Baths : 

### 1.0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 2. 0 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 191 0 191 0 

### 10 1 Detai YTyp e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 672. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 60. 0 Porc h Sla b Roo fCeilin g 140. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22.
. . 8/20/201 0

## Pag e 1 of 2

Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l


## YOURTICKE T NUMBE RI S 2612874
. Origina l Cal l Date : 10/08/1 0 Time : 6:1 3 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 10/14/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 251 3 Street : PIERC E S T Twp : 15 NRng : 13 E Sect-Qtr : 27-NW,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 : 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 Contact 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 METHODI S MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a 

## Contac t Phon e Numbe r UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL 3 LL C LEVEL S COMMUNICATIONS , ^ ^ 

### Day : 877366834 4 Alt : 

## Emerg : 8773668344
K«cTuriTM « METHODI S METHODIS T HEALT H SYSTEM S CONSOLIDATE D UTILIT Y SERVICE S 

### Day : 888847475 7 Alt : 

## Emerg : 888847475 7

MUD0 2 METROPOLITA NUTILITIE S DISTRIC T 

### SAND Y 

## Day : 402504782 3 Alt : Emerg : 402504797 0
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. 10/8/201 0

### Pag e 2 of 2

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. . 10/8/201 0

# ( ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2088 4 Dat e Excavated : 10/14/201 0 Dat e USEP ASigne d Off : 10/26/ 2 

### 2088 4 Are a Sodden : 79 0 s a f t Omah a Lea d SH e Exterio rPain t hJorl h Arro w Owne rName : RONAL D F BOECKE R • Go9 d Sit e Sketc h Address : 251 3 FIERCES T

Phone : H : W : r~ | No t pain t Lea d Sampl e Sample s Collecte d Sampi e Numbe r LA B Concentratio n Collecte d Fimi : RYASCPXA-2088 4 F l y^ 7 PPf n 

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

# 2088 4 C W f V V 

## vo/i M Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e rOwne rName : RONAL D F BOECKE R 

### • Go^ d Sit e Sketc h 13'l^o r r~ l No t pain t

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## 20884
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### Omah a Lea d Sit e Address : 251 3 PIERC E S T 

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## 2088 4 Omah a Lea d Sit e Exterio rPain t Nortti Arro w Owne rName : RONAL D F BOECKE R 

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### C:()iii=c^ii \ U) t /',(•.v.(ii;i - 'u > I lopt-^ii y KiGH i O F ENTR YT O PREMISE S 

### Granlo i (th e property ' owner) consenl Kt o sn d authorize s th e Unite d State s Environmenta l Protectio n Agency(FPA ) o i its suthorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upor t th e follovv'in Q describe d premises :

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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 ma ypos e a healt h hazard Th e area(s ) v^il l be excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l v/il l be replace d wit h clea n material s an d th e are a wil l b e restore d t o its 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 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 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 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 , 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 o fperformin g th e wor k Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycomplete d Th e Granto rals o agree s to :

Pag e 1 of2C C A£ 1 Ai I fvl»Oh^,^ ^ Ti l c» 0 u » I k c



### ' Remov e obstruction s incluriin p boets , tioileis , vehiclcE , picyscap e itf;mr , woo d piles , rioo houses , etc ;

' Remov e fiov/e rbulb s o i plant s tlia t th e Gisnto i o rth e Grantor' s tenen t ma ywis h t o save ; ^

Wate ran d maintai n leplacemen t vegetation , includin g fertilize rapplicstion , a s necessary ' subsequen 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 property ' i s rented , assis t EP Ai n obtainin g tenan t approva l fo i acces s t o th e property ' t o perfor m th e wor k I Allo wvideotapin g and/o rphotograpfiin g o fth e property
. AGREEh/IENTNO TTO INTERFER E Th e Granto ragree s no t t o interler e o rtampe rwit h an yo fth e v»'or k

activities , o i wit 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 Q^gr j D I d o no l gran t acces s t o mypropertie s gran t acces s t o mypropertie s



### Signzturc Dat e

O I woul d lik e l cb t preieit l duriri g an ysempHri o (ha t i s reqi'ired ,C O AS T AL • NVinOMMINTA L OROUP

. IMC

. 

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

PropertylD : ZiS ^ H Propert y Address : "Z^ " 1" ^ Ve-t^CC C 

## Owner : fC ^ „ IJ (^p^tyy ^ 

## Phone : ^ f^ ^ / f J X O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) t o 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 fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e Item s i s th e Owner' s responsibility
. Item : 

# Ar)\ f pion^ ^ f o ht : <r<?trP( / Item :
Item :
Item :



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

# A n y^lyyJT^ S l^l^jy j Item : 

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.COASTA L ENVtRONHSNTA L OROUP

. INC

. 

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# y.^ t Item : 

# S. J item :
item :


## Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , Quadrant s that wil l b e excavated , that 

# fSb- ^ i s covere dwithgrass . Numbe r o f tree s > 2 inc h Eac h ^ trunk diamete r Numbe r o f tree s < = 2 inc h Eac h ^ trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Eac h Timers , Heads , etc . ^ Attac hasketc ho f th e sprinkle r layout
. Numbe r o f an dsiz e o f eac hgarden/ flower be d Eac h area . ^ Square Fee t Attac hasketc ho f relativ e size s an dlocations
. Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . $ Not e thi s valu e will b e ^ use dt o issu e aplan t vouche r t o th e propert y owner . Easemen t Area , t o b e Eac h excavate d / 

# /e^Ji(^ ^ H^c^ol h

Pag e 2

. ^

## v s C O AS T AL OROUP

. IN C

Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi 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 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 cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova i o rreplacemen t o fsoi l b yth e EP A 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 cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q Pleas e chec k thi s bo xi fyo u understan d th e informatio n outiine d above
. 

# -h i ^^^-^Uc ^

I / Q Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e iypre:>existin g damage
. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e TterJo ro fhouse , includin g foundatio n crack s o rfissures

. 

### nI d o no t agre e

Owner' s Signatur e Date Contractor' s Signatur e Date Pag e 3 of

. 

# JDat e Project XR F ID #

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

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# 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 2 0 Mod e SOI L Tim e 2011-01-2 1 11:4 2 Duratio n 90.6 4 Sequenc e Fina l Flag s AVERAG E "oTi? ^ ADDRES S •'2;5T3rPIERC E S T QUADRAN T DEPH T XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

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 54.71 0 Supervise d By : 

## Certificat e o fVerificatio n

1 7 SOI L 2011-01-2 1 11:4 0 30.1 4 Fina l 2088 4 251 3 PIERC E S T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r
±

14.68 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 48.26 9 Supervise d By : 

## Certificat e o fVerificatio n

1 8 SOI L 2011-01-2 1 11:4 1 30.0 2 Fina l 2088 4 251 3 PIERC E S T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r ±

13.92 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 49.08 8 Supervise d By : 

## Certificat e o fVerificatio n

1 9 SOI L 2011-01-2 1 11:4 2 30.4 8 Fina l 2088 4 251 3 PIERC E S T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r
±

12.48 6

# 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 2 4 Mod e SOI L Tim e 2011-01-2 1 11:4 4 Duratio n 90.9 3 Sequenc e Fina l Flag s AVERAG E 

## /^yror2i-2 3 - y ADDRES S QUADRAN T DEPH T 25T3-PIERCE^ T 

# 1 9 XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

Supervise d B y

# 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 194.69 4 Supervise d By : 

## Certificat e o fVerificatio n

2 1 SOI L 2011-01-2 1 11:4 3 30.5 2 Fina l 2088 4 251 3 PIERC E S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 18.86 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 242.83 3 Supervise d By : 

## Certificat e o fVerificatio n

2 2 SOI L 2011-01-2 1 11:4 3 30.1 9 Fina l 2088 4 251 3 PIERC E S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 23.13 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 198.52 9 Supervise d By : 

## Certificat e o f Verificatio n

2 3 SOI L 2011-01-2 1 11:4 4 30.2 2 Fina l 2088 4 251 3 PIERC E S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 21.69 1

## / ^A ^

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

I Coasta l Environmenta l Grou p Inc
. V"^^ ^

www.coa8talhazmat.co m ^"inoy ^ COASTA L INViaONHENTA L C 1 0 U P , IN C 

# EXECUTIV ESUMMARY : BVID #20884-(251 3 PIERC EST )

X 

# No Issue s o r Concern s Q Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N10/26/201 0

## EP APropert y Clos e Ou t For m Proptrt y tf : Dste/Tlnie : Quad s KxcBvatrd ; 

# -.MH

- Propert y Address ; Owner' s Name : /•.,,
. • • Contracto r Crou p __ 

## sy ^

Excavatio nGenera l i f

necessBO'
. wer e th c correc t quadmnKs ) excavate dan drestored ? 1 i f necessary , wer e th e correc t area s ofdri p /on e excavate dan drestored' ' 

### y Gradin g So dan dVegetatio n_._ ! I Doe s th e gradin g aroun dth e perimete r ofth e hous e mexcavairr i area s generall y slo|> f awa y I
_fromthe house ? 2 Ha s so dbeenlai di nall area s tha i were excavated ? i Doe s th e sodappea r l o b e generall y healthy andgrowing ? (Onl y evaluai e i f inspcrtc da i a3 0 I da y tim e period )

^ • 

### r 4
. Ar e sodde darea s generall y firman devenl y graded ?
^ Ar c th e joint s berwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a? nda y tim e period ) ^
__ 6
. Wa s th e property grade dsuc htha i water wil l nol poo l o nth e property' ' 7 Wa s damag e t o landscapin g o r plant material s avoided' '

, Oitw
. Fence s an dRetainin g Wall s _ D o gate s openandclos e freely? ri f applicable ) Wer e all gate s o r fence s take ndowndurin g restoralio nactivitie s reinstalled'. ' fi f applicahl f i I ^ Wa s damag e l o gate s or fence s avoided ? (Ifapplicable ; I 4 Wa s damag e t o retainin g wall s avoided ? (I f applicable ) foupdation , Sidin g an dCutler s __ I I Wa s damag e t o th e sid'in g o r tri mavoided ? Ve j , .\ o
I 2 Wa s damag e t o th e foundatio navoided' ' Wa s damag e l o window s avoided' '

^ Wa s damag e i o window s o r doo r screen s avoided' '

. * Wa s damag e l c dounspuui s n r downspou t extension s avoided' ' Sidexalk s an d Driveway s (CoDcrete ) I Wa s damag e to drivewa y surface s avoided ' > CS , >f
.
2
. Wa s damag e l o walkwa y surface s avoided' '

## O^'ver s comments :

fnsp*'Ctio nnotes :

Removal andresloratio naclivalK. s coinplel e including th e 30-da y .so dwarraiir) f;P ARcprcspmaiiv f
_^"^ i
__ . f^iiie : lolze/i o

## Propert yComplelio n Agreemen l
I hli , ajiittmen i clocuiTieiii s lii e Lomplclio no l icinedi? ! aciiviie s pcfloime do nm y pioper'. y M y sigici;ui t wili df;M|iiiai e liia i ( a msalisfie dwif h(h e restoralio no f m y propeil y anr l (h? ( n o item s at e 11 1 quest.QM S iiov*'
. O" ^ a \an) ' lin e :) i thc fuluif excep t ilios e ilern s liste dbelou , i f aii ) Propert y ID : 

# 7(? m^ ' Propert y Addres s Ownei- : Phone : 

# H4r.Bg p Restoratio n Item s i n Queslion

.

Item : Item : Item : Item : Item : Item :

, . J Additiona l Comments :

2f^ \ A\.^f rir^toialio p i s complcitd , octp l a s noler i j J I rio no l ajjif crrsinralin n wluniplrlc d



# ~ y
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