TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^^02£ > Date: 4lnld& 

Address: ^JSl f S* / / ^^V 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

/ Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

7 Restoration Agreement 

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

Confirmation data 

Photographs 

As-built sketch 

4 Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature - ^ 

40317824 

iiiinii 

Superfund 
y o '^'b 

Final Report Property Check List (piease place with each file) y 10^ 1 

Har d Cop y Informatio n

y y Property Check List 

yy^'xi c Working Drawing Map 

^^ y EPA originals Map 

/ ^ Douglas County Assessor's Map 

y^y?rotpGxiy Contact Sheet 

 -^ySCe ^jiP ' 

Agreement 

^.x+^^cccss Agreement 

.-^Restoration Agreement 

IVIiscellaneous Documents 

/TFina l Map fi-om the Field 

yyC^h-dngQ Orders 

^^-XRF Data 

Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

^^Propcity Completion Agreement 

K\^Any buyout info or reimbursement info 

V V ^^V^ieck or money order copies 

y y EPA Property Close Out Fonn 

^xfTAttached Begin Video 

Electroni c Documentatio n 

Drawings 

N^ EPA original 

3v^ Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

\ Begin Photos 

"•S^ During/Excavation Photos 

X_^ Sod Photos 

V 30-Day Sod Photos 

*

2

Scanned Documents 

 Final Documents 

 Executive Summary 

.

(X^

 Videos 

 Begin Video 

My Movie 
Property Access Checklist 

Propertv ID: -/^Z;^^ ^ Q \NORK STARTED ON: / / 1 

Propertv Address: y'^7^( ^ <^ } ^J ^ ' LJ WORK COMPELTED ON: / ./ 

Q\\ ne yJ^p.Renter: T^EJOQ. Sy. .Address: 

Phone: 

Fax: 

yi^ju^_y_y/yi_ Ccll/Pajier: 

Phone: 

.Additional Infoimation; ]@'^^^-7^..^ 

Fav: 

Cell/Pajjcr: 

' L ] Notification Lettei Sent: 

I ^ Access Ami'cnicnt Si.^ned::g://J/ ^ B 

&hHLdtf pr " •'—I simicd: yiiyicyyy' B JNfoTj^CLCt/' 

I I Topsoil Siimplinj; (if applieahle) ' ; 

I ! Disposal Sam|)lin<: (if applicahlel ' ' B 

_—— ; 

I I Gaiden Samplinj; (if applicable) I 

CJ ttilitv Clearance Calle^

d ^ y$JW\ li(^lf.yyMS­ \ ^ \ ideo/Phdtos (Bcfote) On: ^ / 3 Q^ B \c:yy^CjJd y 

I I I \ ideo Photos (Duiini;) On: 

n N'ideo/Photos (After) On: 

\ D Video./Photos(3()-Dav) On: B 

i CJ Propertv Completion .Aj;reemenl j Signed: / / 

I I Final Report 

; Is.sued: 

Ail Monitorina ( as applicable) 

1 i Ccmimunit} n Crev> 1 On: / / Bv: i —— j Results: 

i; 

EJ Community n Ci-e« ! On: /_ / 1 

1 Results: 

1 1 1 Communitv nCi-e « i On: / / B v: 1 

i Results: i 

Omaha Lead Site 
Total Quadrant Square Footage to be Excavated = 1442 

Property Classification: 800 Total DjjjZone Linear Footage to be Excavated = 90 

Desaiption of post excavation areas: F1, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard nght-hand quadrant; 

DZ, drip zone (1 -3 foot area of soil around the foundation of the house). 
49028 

Exterior Paint North Arrow Omaha Lead Site Owner Name: JOE DELOA SR 

Address: 4736 S 19 ST 

Phone: H; 

Sample Number 

RYASCPXA-49028 F1 

RYBSCPXA-49028 F2 

RYCSCPXA-49028 B1 

RYDSCPXA-49028 B2 

RDZSCPXA-49028 DZ 

Ri:.2:scpxA-noo2G -GZKPZOCPXA-49020 -P^ -

Lab RDZSCPLA-49028 

Result 1570 ppm 

ENTERED 

NOV 0 1 2SQ4 

• Site Sketch 

W; 

Lead 

Concentration 

."^ oIC^' ppm 

ppm 

U U I ^PPm 

ppm 

ppm 

ppm 

Number of Samples =

tF«^:°C 

>r 61 

-V a

0

Q

Sample LAB Collected Firm:

• 

D Date:

D Time: 

0 D 

D 

 Good 

 Poor > 

 Not paint 

Samples Collected 

 l^'PA \ U /M' ^ 

 JC-'I^^-g H 

ili ^ 

Samples Analyzed 

D Ur XRF Unit: '^ l \ Book: ID2--

D D Date: 

D D Time £M 

Staff: c,.:ap i J I l i 

*z. 

p€[yieXjOo.y y. 

fe9k 

f)'r\ed 

ryz^jlu¥^ B5t 

, r 

\ 

vt> 

.„< 

O T : 

VA/Ai-H ^ 

-.< V ' ' 

F^ 

VA^MJ C 

.S. .\qMry_ s-^. 

Omaha Lead Site 

46130 
Douglas County Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d

Information is valid as of 2007-7-19 

Values not finalized until after Board of Equalization 

­ R172863000 0 

Print Report 

View on Map 

Owne r 

DELOA SR JOE 

4736 S 19 ST 

OMAHA NE 68107-0000 

Propert y Informatio n 

Key Number: 2863 0000 17 

Account Type: Residential 

Parcel Number: 1728630000 

Parcel Address: 

Legal Description: 

4736 S 19 ST 

OMAHA NE 68107-0000 

MCGAVOCK & OKEEFES LOT 9 BLOCK 3 N 35 FT 35 X 130 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$0.00 

Improvement 

$41,600.00 

$31,400.00 

$31,400.00 

$31,400.00 

$26,800.00 

$0.00 

Total 

$47,200.00 

$37,000.00 

$37,000.00 

$37,000.00 

$32,400.00 

$0.00 

Sales Informatio n 

Date Type Book Page Price 

Lan d Informatio n 

Acres 

0.1 

SF 

4725.0 

FF 

35.0 

Units 

1.0 

Depth 

135.0 

Width 

35.0 

Vacant 

No 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R172... 8/4/2007 
Douglas County Page 2 of2 

*7S9S1»ST 

FMlFloar ••0 

.'•i1-.q 

"L.it^fii.Fj-.. : 

RarKh 

BASEMENT PER APPRAISER 

432 SO FT 

Click to Enlarge Image 

Click to Enlarge Image 

Square Footage: 891.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Condo Square Footage: 0.0 

Built As: Rancti Rooms: 5.0 

HVAC: Central Air to Air Units: 1.0 

Exterior: Frame Vinyl Baths: 1.0 

Interior: Drywali Bedrooms: 2.0 

Roof Cover: Composition Shingle Stories: 1.0 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 0 0% 1920 87 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 432.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch End Screen 70.0 

Porch Slab Roof Ceil 115.0 

User Partial Basement 432.0 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.jsp?aeeountno=R172... 8/4/2007 
# 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

4<^C^28 

4730 S /^ _^t. 

Date:<3fe /2^7Time: ?y ^ Action: <,:^., ,j ^ 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 

|! 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMENTAL 

GROUP , INC . 

EXECUTIVE SUMMARY: 

49028-^736 S 19 ST 

X No Issues or Concerns Issues/Concerns 

Detail Explanation 
1^ As-Built Drawing 

COASTA

CNVIRONMINTA

L 

L Oinaha Lead Superfund Site a K O U P . IM C 

TtAai Ouadnsil Squae FOolage to t>e Enavaleil - 1442 

JRMOr^ZniiLJne s Fodbge ID be Excavated - 90 

Place gravel in B1 and around the 

backyard. Replace border around 

DZ and F2 and remove all small 

plants. Retaining wall along F2 

area and dig around bushes 

B2 = 57 PPM @ 6" 

B1 =45 PPM I 

•z 

1668 piini DZ=447PPM@14" 

EA-E = 51 PPM 

^ . . ' . i ", J, y^'-- ••.-i 

< .1- . y 

SotJth 9 Street 

^k]rthA^mv Omali a Lea d Sit e ^ OLS#: 49028 Omana. HetxaEka TM ^ DateExcavated: 8/27/07 

Property Nunibef 

Bate UsipAsigneSbff: MI/QZ OLS-49028 

rtoperty Address •—•— • Fence llrKli-zaileetarlgncl-SxSIt 

R ^ PamanefTt UndGcapmg 

4736 S 19 5T 

Quociianl Boundaiy Post Excavation Concentrations (ppm) 

Street Boundafy A i • HGil Fl BZ Ptay/>vea 

F2 DZ EaEement ^^ ^ ^ - ^ II-,II<KCWI---:J: t ^ Ttee/stmu B1 Garten 0(J»er 

L ^3. Mnlftrt rtoM.Mnd4 1 H. Mr«cirt li i in M qiRiJiRRt Ift, c»«iiM« ^]piiiin» < 

CC m^ sxrm (1.4tone «• • of ao« «KMRd vw iswMMivt or»« MUM ^ 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
t PA Property Close Out Form 

Property #:_i/f^2 ^ Property Address: ^^Zf^ZZZ^ ^ 

Datt/Tlmc: Owner'i Name: t-^ ^ />6 CC^i • SJe' 

Quads Excavated: Contractor Group 

Excavatton Gencnl Yes No 

1. Ifnecessary, were the correct quadrBm(s) excavated and restored? y 

2. If ncccssaw, were the correct areas ofdrip zone excavated and restored? 1 ^ 

GradioK Sod and Vctetatioa 

Yes No 

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

2. Has sod been laid in all areas that were excavated? y 

3. Does the sod appear to be generally healthy and g^o^» ing? (OnK evaluate if inspected at a 30 

day time period) 

4. .Aje sodded areas generally fkmi and evenly graded? l y 

5. Are the joints between the sod strips generally tight? (Only evaloate if inspected at £ 30 da\ 

time period) 

6. Was the properry graded such that w ater will not pool on the propern ? l y 

'•^'as damage to landscaping or pla.it :^;ateri6ls £\ cidec ? 

Guicv, Fences aati ReiainiDt VVaiis Yes No 

1 1 ':

 Do gates 3pen a.nd close freeh? (If applicable) -- 1 

! 2.

 Were all gates or fences taken dov/n during restoration acti\ i-.ies re;r.£*Jil!ed? , if applicable) *^ i 

1 

1 3. Was damage to gates or fences avoided? Mf applicable) 

4. 'A'as damage tc retaining walls avoided" i,!f applicable) H^A i 

Foundation, Sidiag and Gutters 

Ves N't 

1 

1. Was damage to the siding or trim avoided? 

2. Was damagi to the foundation avoided? ^ 

3. Was damage to 1* indows avoided'' 

1 ^ 

: 1 

4 Was damage to windows or door screens avoided? 1 

^ 1 5.

 Was damage to dovN-nspouts or downspout extensions avoided? 1 

Sidewall(S and Drtveways (Concrete) >es No 

!. Was damage to driveway surfaces avoided'' ^ h 

2. Was damage to walkvav surfaces avoided? y 
Inspecticn ccte? 

Scx k I A. Qji^Jt^x^Jic a^ ^ h z appear s 4 o t>.^ o/L^Ke>sSfeci 

Remc\al and restoration acti\ates corr.r'ete including the 20-ia\' sod •'•^arran^ 

EP.^ Representativ£--/^L>(/7^ J^ , y 3t £ * ^^y/y^yy 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the fiiture, except those items listed below, ifany. 

Property ID: ^^'j^, ^ 

Property Address: <^~7^ y "^ y^ P ^Y ' 

Owner: ^ ^ 7P^y<:, y 

Phone: -733' 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

v \ I agree restoration Is completed, except as noted 

 I I do not agree restoration is completed 

OWiier's Signature Date ' Contractor's Iignature '' D^te 

I
'V 

PROPERTY CLEARANCE WORKSHEET 

Date mnio Property ID i 4yjyyy>f 

Property Project Omaha Lead — Fixed Price Address 

Measurement XRF ID 0107-51 Count/Time 

Field Shots 

Shot # Reading Sample Area 

Sample Area 12^?^ 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 

: ^ ^ 

l a

<9

L 

1 57 XRF Corrected Value —> 

(use calibration ctiart or add 

2 0 % to value) 

i jI 

Sample Area j^/-^7^ ~ Pass/Fai l ? 

I n Situ Composite Composite Analytical

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results (Baq) Sieved) 

^ 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

iSi 

Sample Area m-/ Pass/Fai l ? ^ I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) ? 

2 47 

4 

XRFk/Correcte ) d Value - > 

5 (use calibration chart or add 

20% to value) ISO 

3 n ? /:!5 

Sample Area Pass/Fail ? /^^ y y I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical 

Readinc g Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 

M52_ ^ry j 

M XRF Correcte3 Wd Value —> 

m

(use calibration chart or add 

2 0 % to valuel 

llf i 3 ^ 

Sample Area Ol Pass/Fai l ? y y I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results (Bag) Sieved) 

yh 

XRF Corrected Value —> 

(us

2 0 %

e calibratio

 to value

1; 

) 

n chart or add 

s^^ 

USE /lODinOHAL SHCHS i f 

XRF Technician's Signiture HIFDFD 
Omaha Leac^l^ Property #49028 

All Samples taken t^ffg Equipment #0107-51 XRF for 61 nomin'3rsecond n^^e s 

Date Reading # Time Stanards Reading Tolerance (+/-) 

3/31/2008 76 1600 High 4380 +/- 230 

77 Med 1000 +/-84 

78 Low 24.3 +/-29 

85 1630 High 5050 +/-270 

86 Med 1060 +/-89 

87 Low 37.7 +/-31 

Date Reading # Sample Depth Reading Tolerance (+/-) 

3/31/2008 79 DZ 14" 476.0 51.0 

80 DZ 14" 412.0 47.0 

81 DZ 14" 452.0 49.0 

AVE 446.7 49.0 

82 EA-E 0-2" 48.2 26.0 

83 EA-E 0-2" 30.3 25.0 

84 EA-E 0-2" 73.5 31.0 

AVE 50.7 27.3 
.-2 /<• * ••' tv ' ' Total Quain t Square Footage to be Excavated = 1442 Property Classification: 800 \.y C:Jtj.>^ts'i Z. f> ui : IZ. Total^J^on e Linear Foolage to be Excavated = 90 

? y sC 

rh 

6 ­ .ci 

1--^ 

-y ^" , 

fcl< •'• 

L wB<^i 

y 

'^•^-' 1^/.- ^ 5 

/o^^r- 55Z) 

Legend 

Concrete 

To Be Excavated 

Existing Structure 

Fence 

Penmanent Landscaping 

Quadrant Boundary 

Street Boundary 

o Tree/Shrub 

Description of post excavation areas: Fl, front yard left^iand quadrant; F2, front yard nglit.hand quadrant; Bl, backyard left-^hand quadrant; B2. backyanj right-hand quadrant; 

DZ. dnp zone (1-3 foot area of soil around the foundation of the house) 
cn 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID #_£W ^ 

Property Address V?3U y . IV^ 

Owner Name y^'i- 77'^'-^ A 

Date ^'z^'c y 

Comments 

^yyi y (ix^yc [^ SO L y - y>y^s y 

'v/ic/^ O I y j ^ v., y~: h J ^cy, ^ 'S,\r^..i>-_ 

Owner Signature J ^ ^ ^ ^^/---^^ _^ 

Contractor Signature"^^ ; r 7 ''--^^^y^ ^A . 
^,^to au . 

COASTA L E N V I R 0 N n E N T A L 

C R C U P IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to an(d authorizes the Uniteci States 

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

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

following described premises: 

Owner's Name: 'JQc 7>cl&t^. ^i ^ . Daytime Phone: yO Z ~ 7 ^ ^ -79 ? ^ 

Address of Property 74 

covered by this ^7/6, ^ yy^"^ M- Agreement: 

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) will 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 performing the work. This access shall 

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

agrees to: 

Page 1 of 2 
sy^ «j 

\ '••'* * o* ^ ^ ^ ^ COASTA L 

' "SO^* -C . C U F . 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 (877) 234-6270. 

I grant access to my properties Q I do not grant access to my properties 

%.^ 7^ y , ^^ fjiil,:^ 

Signature Date Signature Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: ^^^ ^ 8 

Property Address: i/7-^ y S. / Q ^ ^ S -f-

Owner: ^^ _ ^^,^ ^ ^ ^ 

Phone: y^ , ^^ , -, . jcj^^ ^ 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Remove d By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: . 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
.(P^ 

Item s To Be Remove d By Contractor During Remediation An d Net Replaced 

(Use additional sheets as necessary) 

Item: 

^ ^ 

Item: 

o// 

- — - — • 

rs^nyyy^ 

s^>^y 

.J<il=/ ^ X - _^ 

/ ^ r- l 

~~~~~ 

-=S ^ 

/'i^. . 

=^____^ 

^^^ ^ 

D? 

^^^^2^^ . ^ 

Item: 

Item: 

Item: 

Iter;:

!te"-.: 

It 

!te-r:

1

itST.: 

1 

r 

1' 

f 

n 

i; 

 i, 

? 

i 

Item: 

il 

Item: 

Item: 

Item; 

Item: 

Item: 

Page 2 of 
m^ 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

5^D 

Item: 

Ui 

Item So,7 

D-z 

Item: 

f^^^u Ij^^M C..J Dz ; /^ ^ 

Item: 

Itsm: 

IteItem; 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 0^ Square feet 

is covered with grass. 

pz ^^ ^ 

Number of trees > 2 inch Each trunk diameter 

Number of trees <= 2 inch Each trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. Each 

Attach a sketch of the 

sprinkler las out. 

Number of and size of 

each garden/ flower bed 

area. Each 

Square Feet 

.Attach a sketch of relative 

sizes and locations. 

Page 4 of. 
Item Quantity Unit Condition/Type/Species 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. Each 

Include a sketch of v.ere 

each plant will be placed 

bv the contractor. 

— 

.Asireed upon area cf 

property to be replaced 

with grass sod. 

f S ^ SF 

area(s

Includ

)

e

 t

 a

o b

 sketc

e replace

h o

d

f

 wit

 the 

h 

H

srass sod. 

Area of Cit\ or CountN 

propert} to be landscaped 

per their requirements. SF 

Include a sketch of the 

area(s) 

Page 5 of 
Additional Comments / Instructions: 

C^7 j ^c^^^fi ^ ^ 7 /?/Z J^e'T^^Q ^ ^ 

Qcuficyt i^f-^^i-y Grc^A 

y B^cLyt^n/ Qadf'^ 

LN^^^ ^yyn^iii. \.4xjjsyi jVU^er c , ^ B^ ^ y^ / 

Thibet . 

fe^S^ hv S-'^ ' ^ ^-^ *A D2. .A^^ 

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. 

Q I agree I 1 I do not agree 

Dl I I I do not agree aaree 

•yyy^=^y ^y-J^' ^ .7 

gnature Date 

y^ K y..2, ^e-'^-^ yy^&L 

O'wner's Signature Date Page 6 of ictor's Sisnatu