## TRANSMITTALo f

OMAHALEAD SITE SOI LREMEDIATIO NFIL EFOLDER
SAID#: '^"iH h Date : S | (p / Address : l/j V o \l\x ) u t ^ o ^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S 

# e f Vide o o f property (DVD ) 

# e f Executiv e Summary / EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t property 'T T Signe dAcces s Agreement(s ) for adjacent property / Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio ndat a 

# y Photograph s Wh^Co^f^VO^ ^ ^XClk\/M]o ^ YC,^ ^ .0 / As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EPA Descriptio nofarea s no t meetin g RO D cleanu p criteri a 

# y Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e

3026101 3 Superfun d

## VV 

## Propert yAcces s Checklis t Propert y TD : 

## ^T-^fet V D WOR K STARTE D ON : __/__/
_ nWORKCOMPELTE D ON : / / Propert y Address : ^ ^ ^Z ^ btff^i o S^ T
Owner : Renter : 

## CCh ^

AOnrygJAue ^ Address :

Phone : 

# t/t/uf>y2^ r Fax : Cell/Pager :
D Notificatio nLette r ^ Acces s Agreemen t 1 ^ Restoratio nAgreemen t D Topsoi l Samplin g (i f applicable ) D Disposal Samplin g (if appUcable ) Q Garde nSamplin g (i f applicable ) D Utility Clearanc e { p Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After ) D Video/Photo s (30-Day ) [~

l Propert y Completio nAgreemen t D Fina l Repor t Ai r Monitorin g (a s applicable )

• Community • Cre w Results :

nConununit y H ] Cre w Results :

• Conununit y • Cre w Results : On : /

On : /

On : / Phone : Fax : Cell/Pager : Additiona l Infomiation :

Sent : / / 

### By : 1 Signed : V ) I\w l \L ; By : V>VcA c Signed : vo / \M / x

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Ontah a Lea d Sit e

### Dougla s County Accoun t Infifl|aatio n Pag e1 of 2
Dougla s County , Nebrask a Propert yRecor d - R074755000 0 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e • * - ^ •¥Subdivisio n Sale s Searc h Owne r CiT YO F OMAH A C/

O CITYFINANC E 181 9 FARNA M S T OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 475 5 000 0 0 7 Accoun t Type : E xGovernmen t Parce l Number : 074755000 0 Parce l Address : 262 0 BLOND O S T OMAH AN E 68111-000 0 Lega l Descri'ption : CARLBERGSUBDIVL0T3BL0CK 1 E 1 6 FTLT7 & AL L1 6 X37-3 8 X137.6 4 Valu e Informatio n
201 0 200 9 200 8 200 7 200 6 200 5 Lan d $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $400.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $400.0 0 

### Sho wAl l Transaction s

Lan d Informatio n 4cre s S F Unit s DepH i Widt h Vacan t 0.0 1 592. 0 1. 0 37. 0 16. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accouritno=R074..
. 9/2/201 0

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YOURTICKE TNUMBE RI S 2699982
. Origina l Cal l Date ; 3/31/1 1 Time : 12:5 2 pm Op : ALFONSO1879 0 Wor k t o Begi n Date ; 4/04/1 1 Time : 1:1 5 pm State : N E County : DOUGLA S Place : OMAHA Address : 262 0 Street : BLOND O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,16-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 : FA X AL L CLEAR S TO : (402)934-281 1 : PLEAS E INCLUD E AL L EASEMENT S Company: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ALFONS O Phone : (402)934-283 7 Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4f t Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCATV LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



## Servic e Are a Contac t nion e Numbe r Utilit y Typ e
CXCATV CO XCOMMUNICATIONS , IN C HEIDI Day : 402934046 9 AH : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 AH : Emerg : 877366834 4
MUDO l METROPOLITA NUTILITIES DISTRIC T SAND YMUD Day : 402504782 3 AH: Emerg : 402504797 0 Day : 402444719 7 CITYO FOMAHA

- OMAHACO F RICH/mAFFI C AH: 402444516 1 TRAFFICSEWE R Emerg : 402444516 0 dhon.org/irthintemet/.../MessageText.as.

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## Day :

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## D Date : ^\lf i )o 1 RYBSCPXA-2726 4 F 2 

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## D Sample s Analyze d RYDSCPXA-2726 4 B 2 

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## 2726 4 Omah a Lea d Sit e Exterio rPain t r^ort h Arro w 

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### Coiif;eii \ ji) fAc:cc^.s;i^ ' i o riopeii y RiGH7 O F ENTR Y

### T O PREMISE S 

### Grsnto i (th e properb, ' ownei ) conserit^

. t o an d aulhoriie s th e Unite d State s Environmenta l Protectio n Agenc y(FPA ) o i it s sulliorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l lespons e activitie s upo n th e followin g describe d premises : 1'^' 7 fcS

Owner' s Nan'ie : Daytim e Phone : ^/•r ^ O f Oi^/\AH A 

## H^ ^ 

## H^'i ^

Addres s o fPropert y covere d b ythi s Agreement : 

# ^lo W'^Lomo ^

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 ) 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 b yUSEPA , wil 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 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 EP Atha t th e property ' ha s bee n remediated

.
ENVIRONMENTA LRESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s 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 ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2c c•- . ^'/.- ^ 9

l^Vl^o••^^^t*. [ CHOL' '



### ' Remov e obstruction s incluriin g boats , traileis , vehicles , plsyscap e iiemr , vvcio d piles , do o houses , etc ;

' Remov e flov^'e i bulb s o i plant s tfia l th e Granto i o rth e Gianlni' s lencn l ma ywis h t o save ;

' Wate ran d maintai n leplacemen t vegetation , includin g feriilize rapplication , a s necessar) ' subsequen t t o a n initia l Vv'aterin g perio d b yEPA ;

' Abid e b yheslt h an d safet yguidanc e provide d byEPA ; <•I fth e property ' i s rented , assis t EP Ai n obtainin g tenan t appiova ! fo i acces s l o th e propert yt o perfor m th e work

. t Allo wvideotapin g and/o rphotographin g ofth e properly

. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yofth e Vv'or k

activities , o i v/it 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 property ' whic 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

0 1 gran t acces s t o m ypropertie s •I d o no t gran t acces s t o m ypropertie s

Dat e Signetur e Dat e

O i Vt'oui d [ik e t o b e ptesen t durirt g an yssmpliri g tt\£ i i s leqi/ited

. ' » •

Pao e 2 of2C C A

. S TA , L E N V t HONM C NTA L cn o u , r, INC

. 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s to condition s of th e property prio r t

o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th epurpos e of assurin g tha t restoratio n activitie s are complete dto th e satisfactio no f th eproperty owner andthe Unite dState s Environmental Protectio nAgenc y (EPA)
. 

## IP^op^*-^^

- &7H-15SOOO O —Z7Z0Y

Property Address : ^I Q g^^^ g ^ Owner : ^./T Yo r 0/^P>» ^ Phone : HH ^ MlMg i Onthe attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s andlandscaping feature s an d acces s location(s ) to b e use dby the contractors . Indicate distances , depths , materia l types , etc . Photographically andVideographically documen t th e existin g condition s ofth epropert y andthe basement i

f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibilit y



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

Pag e 1 of

.C O AS TA , L C N O U I 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d



## Ite m Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Number o f tree s > 2 inch trun k

diameter Number of tree s < = 2 inch trunk diameter Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc , .Attac hasketcho f th e sprinkler lavout
. Number of andsiz e of eachgarden / flowe r be d area . .Alitic hasketc ho f relati v t size s an dlocations
. Agree dupo nvalu e of plant material s no t to b e replace db v contractor . Not e till s valu e \vil l hc user f lo is.sii e aphii K NdiicliiM' 1( 1 th e proprri ) OWIU'l
. Easement Area , to b e excavate d 

## Quantit y 

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## Landscap eInventory Uni t Condition/Type/Specie s Quadrant s

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.

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.

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 underlyin 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 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 maycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150

. r~ l Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

.

•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 pre-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 interio ro fhouse , includin g foundatio n crack s o rfissures

. 

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# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 l^iddlese xTurnpik e Billerica , r^ A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 8 Mod e SOI L Tim e 2011-04-0 8 10:0 1 Duratio n 91.5 7 Sequenc e Fina l Flag s AVERAG E Av g o f5- 7 ADDRES S 262 0 BLOND O ST QUADRAN T 8 2 DEPH T 4 " XRFTEC H C.PADILLA MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D 8.42 7 Z r 476.38 9 ± 16.81 6 S r 180.59 7 ± 9.61 4 U < LO D 15.56 5 R b 67.42 4 ± 6.84 1 T h 12.33 1 ± 8.19 5 P b 125.52 5 ± 16.71 3 S e < LO D 6.06 6 A s < LO D 22.40 9 H q < LO D 13.20 2 Z n 189.69 8 ± 24.47 5 

### w < LO D : ^— -) 92.37 4 C u < LO D 

### y / 34.06 5 N i < LO D / 83.51 3 C o < LO D / 

# y : ' 209.31 8 Fe 21300.631 / 

### ±y 436.09 1 M n 676.413 ^ , 121.10 1 

# y Supervise d By : \ Z

# y ^• • 

# Therm o

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 5 Mod e SOI L Tim e 2011-04-0 8 10:0 0 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D 2726 4 ADDRES S 262 0 BLOND O S T QUADRAN T B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D ; 8.61 3 Z r 473.58 9 ± 16.93 1 S r 181.98 8 ± 9.73 2 U < LO D 16.10 1 R b 67.10 8 ± 6.93 7 T h 13.17 9 ± 8.59 1 P b 150.75 3 ± 18.20 5 S e < LO D 6.21 7 A s < LO D 23.50 8 H g < LO D 13.52 4 Z n 186.31 8 ± 24.63 7 W < LO D : 96.45 8 C u 37.83 6 ± 23.77 3 N i < LO D : 80.75 9 C o < LO D : 213.12 6 Fe 21621.93 9 ± 443.18 5 M n 682.34 1 ± 122.68 0 Supervise d By :• • 

# Therm o

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 6 Mod e SOI L Tim e 2011-04-0 8 10:0 0 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D 2726 4 ADDRES S 262 0 BLOND O S T QUADRAN T B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D \ 8.50 1 Z r 479.27 2 ± 16.78 2 S r 183.82 0 ± 9.64 8 U < LO D : 15.45 2 R b 65.63 8 ± 6.73 0 T h 11.89 1 ± 7.91 3 P b 105.60 9 ± 15.53 9 S e < LO D ; 5.91 4 A s 26.26 7 ± 14.42 0 H g < LO D • 13.35 0 Z n 183.81 3 ± 23.99 5 W < LO D : 90.92 8 C u < LO D • 34.25 4 N i 97.51 4 ± 57.91 1 C o 297.64 0 ± 141.84 4 Fe 21463.96 7 ± 435.56 5 M n 678.07 3 ± 120.71 3 Supervise d By :• • 

# Therm o

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 7 Mod e SOI L Tim e 2011-04-0 8 10:0 1 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D 2726 4 ADDRES S 262 0 BLOND O S T QUADRAN T B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D 8.16 8 Z r 476.30 5 i 16.73 4 S r 175.98 3 ± 9.46 0 U < LO D 15.14 2 R b 69.52 5 ± 6.85 5 T h < LO D 12.12 2 P b 120.21 4 ± 16.39 4 S e < LO D 6.06 8 A s < LO D 22.08 7 H g < LO D 12.73 3 Z n 198.96 3 ± 24.79 3 W < LO D 89.73 7 C u < LO D 32.28 2 N i < LO D 82.91 2 C o < LO D 202.06 1 Fe 20815.98 2 ± 429.52 1 M n 668.82 7 ± 119.91 1 Supervise d By :• • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3208 9 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

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F

e M n pp m
< LO D 473.51 6 160.55 3

< LO D 70.90 0 < LO D 124.90 8

< LO D < LO D < LO D 145.40 4

< 3 8 < < 1899 3

65 9 Supervise d By : 

## Certificat e o fVerificatio n

4 SOI L 2011-04-0 8 09:5 8 91.9 0 Fina l Av g o f1- 3 262 0 BLOND O ST EA 1 " C.PADILL A CONFIRMATIO N CLEA R

Erro r 8.28 0 ± 16.32 1 ± 8.88 2 15.19 1 ± 6.80 9 11.88 4 ± 16.27 4 5.71 3 21.70 9 12.47 2 21.33 7 

## n s .72 4 .33 2 .64 1 .43 1 .03 7• • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTumpike Billerica , M A0182 1

XL3t-3208 9 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 M o < LO D Z r 484.82 0 S r 153.39 0 U < LO D R b 72.20 1 T h 14.57 0 P b 101.05 4 S e < LO D A s < LO D H g < LO D Z n 158.75 0 W < LO D C u < LO D N i < LO D C o 188.62 9 Fe 18104.21 9 M n 589.22 4 Supervise d By : 

## Certificat e o fVerificatio n

1 SOI L 2011-04-0 8 09:5 7 30.8 7 Fina l 2726 4 262 0 BLOND O S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

Erro r ', 8.28 0 ± 16.35 6 ± 8.63 5

: 14.92 5 ± 6.78 6 ± 7.93 3 ± 14.86 5 5.33 7 19.52 8 12.91 6 ± 21.98 5 87.46 8 33.01 2 79.00 3 ± 125.66 4 ± 390.19 5 ± 110.33 6• • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 MiddlesexTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 2 Mod e SOI L Tim e 2011-04-0 8 09:5 7 Duratio n 30.5 2 Sequenc e Fina l Flag s BVI D 2726 4 ADDRES S 262 0 BLOND O S T QUADRAN T E A DEPH T 1 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D : 8.29 3 Z r 481.36 7 ± 16.40 7 S r 160.24 7 ± 8.85 4 U < LO D : 15.10 2 R b 72.81 0 ± 6.85 7 T h 15.64 6 ± 8.42 2 P b 138.95 4 ± 17.05 8 S e < LO D 6.22 7 A s < LO D 22.65 8 H g < LO D 12.42 6 Z n 152.88 6 ± 21.69 2 W < LO D : 85.88 2 C u 34.55 5 ± 22.25 9 N i < LO D : 77.94 8 C o < LO D : 195.69 5 F e 20135.92 8 ± 413.29 5 M n 696.43 5 ± 118.68 0 Supervise d By :• • • • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTumpike Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 3 Mod e SOI L Tim e 2011-04-0 8 09:5 8 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D 2726 4 ADDRES S 262 0 BLOND O S T QUADRAN T EA DEPH T 1 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r M o < LO D : 8.26 8 Z r 454.36 1 ± 16.20 0 S r 168.02 2 ± 9.15 6 U < LO D \ 15.54 6 R b 67.68 9 ± 6.78 5 T h < LO D : 11.12 1 P b 134.71 5 ± 16.89 9 S e < LO D : 5.57 4 A s < LO D 22.94 2 H g < LO D : 12.07 5 Z n 124.57 5 ± 20.33 5 

## w C u < LO D 48.94 0 J ± 91.47 6 23.90 6 N i < LO D I 81.04 4 C o < LO D : 193.73 3 Fe 18741.55 3 ± 403.80 3 M n 693.89 4 ± 119.09 3 Supervise d By :

## y^' % i^JJ L \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 lj^^2 > < Coasta l Environmenta l Grou p Inc

. V^^^LJ ? www.coastalhazmatco m ^"tPROt* ^ COASTA L ENfllONDEIITA L O O U P

. I N C 

# EXECUTIV ESUMMARY : BVID #27264-(262 0 BLOND O ST )
No Issue s o r Concern s \~ \Issues/Concern s
Detail Explanation : -DA NGARVE YWALKE D TH EPROPERT YO N04/21/201 1

### Fron:ENVIROWORK S LLC . 40 2 93 4 281 1 

## 04 / 1 1 18:5 2 #14 4 P.008/00 9 ^



### Propert yCompletio n Agreemen t
I hi i agreemen i documents (h e complclio n o l remedia l acliviiie s paionne d o n mypiqpcri yM ysignature wil l (tesiynai cIha i I a m $a(it.rie d wit h lh e rcsioiaiio n o fm yproperly , an d (ha l n n itei m ar e i n question s now . o ra i an ylim e t n Ih e fulure

. excep i ihos e uem s )i»ie d below , ifan y

Propert)

- ID : T^ZZe M Propert yAddre*, : ^ ^ W^V ^ '^T ' 0«vncr : Phone : 

## H(^H-'^2^H B Restoratio n Item s I n Quealion : Item : Item : Item : Item ? Item : Item : Additiona l Comments :

I >V^^«ytt fiMlerklie n i t tamplcltd , tkccp l a i niiit d LJ > rio no t itiirt t rc»l«ralia n i » tompiele d 

# '^^I\^nyji>/ / Owner'. * onl i aeioi'(Sicnmiiri :

### <« » 

# EP A EP APropert y Clos e Ou t For m ^ ^ Propen , # : ^ip^Z^Ce^ ^ Propert y Address : Date/Time : Owner' s Name:
. /%-- J Qusd s Excavated : Contracto r Grou p Ye s No Excavatio nGenera l 1
. I f necessary , wer e th e coirec t qttadfant(s ) excavate dan drestored ? / 2
. I f necessary , wer e th e correc t area s ofdri p zon e excavate dao drestored ? 

## y Yts , N o IDoe s th e gr»liii g aroun dth eperimete r ofth e hous e i nexcavate darea s generrdly slop e awa y fromth e house ? __^_ ^ Gradin g So dan dVegctatio B

2
. Ha s so dbee nlai di nal l area s that wer e excavated ? 

### / 3
. Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

### / da y tim e period ) 4
. Ar e sodde darea s genetill y flrman devenl y graded ? / 5 , Ar e thejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y / tim e period )^ 6
. Wa s th e property grade dsuc hthat wate r wil l not poo l onth e propert>' ? / 7
. Wa s damag e t o landscapin g o r plant material s avoided ? 

# y Gates , Fence s an dRelainlD S Wal b Ves N o I
. D o gate s openan dclo. « freely? (I f applicable ) / 2
. Wer e al l gate s o r fence s take ndow ndurin g restoraiio nactivitie s reinsulled ? (I f applicable ) 

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

# y Foundation , SidiBKsn dGnlttr r Yes N o t . Wa s damag e t o th e sidin g o r tri mavoided ? / 2
. Wa s damag e t o Ihefoundatio navnidnl ? / 3
. Wa s damag e l o window s avoided ? 

# y 4 Wa s damag e t o window s o r doo r screen s avoided ? 

## y 5
. Wa s damag e t o downspout s o r downspou t extension s avoided ? / 1 Sidewallt s an dDriveway s (Concrete ) Ye s No 1
.Wa s damag e t o drivewa y surface s avoided ? / / 2
. Wa s damag e t o waOcwa y surface s avoided ?

## 0>»'ber s comments :

^ 

## jlhspectio hnotes :

Removal andresloratio nactivate s completeincludin g the 30-da y so dwarranty : EPARepresentativ e 6<y) ^ _^Date : HJ«^1' 1