## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAID#:_Lil3B

_ Date : ^//^/2/3^ 6 Address : 3~ ] ^\S Z ^ Sn-egj T Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S M Vide o o f propert y (DVD ) S ZExecutiv eSummar y M EPA-provide dpropert y sketc h M Signe dAcces s Agreemen t fo r subjec t propert y E' Signe dAcces s Agreement(s ) fo r adjacen t propert y S / RestorationAgreemen t D Settlemen t documents (i.e. , fo r

damag e or to replac e plants , etc. ) M Confirmationdata E ^ Photograph s b^6j I A^ Qxejud^ cja nn ^ y SOd
u As-built sketch M Satisfactor y restoratio nsignedb y Propert y Owne r U Propert y close-out check lis t signedby EP AIA.ht/2AX) 7 D Descriptiono f area s no t meeting ROD cleanu p criteri a D Utilit y clearance s . M Propert y informationfromDougla s Count y Assessor' s Office


# ^ Om.\r/lc ^ r^rf \ D 

## Signatur e ignatur e / Dat e 4031284 4 Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) Har dCop y Informatio n \Property Chec k Lis t X. Sit e Workin g Drawin g Ma p 

# V 3. EP A original s Ma p ^. Dougla s Count y Assessor' s Ma p Propert y Contac t Sheet Agreemen t X Acces s Agreement S^ Restoratio nAgreement Miscellaneou s Document s 1. Fina l Ma p fromth e Field 2>Chang e Order s ^\* ( • ^^R FDat a. v

4>Any email s or PO correspondence s ^^ ^ V Propert y Completio n

KJExecutiv e Summar y VA S BUILT

\J*ropert y Completio nAgreement ^^ ^oy X^ny buyou t inf o or reimbursement inf o *^\ SN^I'hec k

or money orde r copie s y\to< . '"t

^ EP A Property Clos e Out For m Tss^ttache dBeginVide o 

## Electroni c Documentatio n Drawing s EP A original /S,. ^ Workin g Drawin g \ s AS Built.vs o Ns^A S Built.jp g

Photo s y BeginPhoto s \S ^ During/Excavatio nPhoto s k

So dPhoto s 30-Day So dPhoto s Scanne dDocument s ' Final Document s 2. Executiv e Summar y Video s Begi nVide o My Movi e 4

## Propert yAcces s Checklis t

nWOR K STARTE D ON : / /_ Propert y Address : ^:^P [ g ^ ^ j ^ D WOR K COIMPKLTK D ON : / /_ 0>>IK ' 

# '^LIU I £XK1_^L _ 

# E Renter : Phone : Fax : Ceil/PaL'cr : Plion c Additiona l Information : Fax : Cell/Pajje i 1 ^ Notificatio nLette r Scnt:/ dl^f l tf ^ 13 ' Acces s Ajjrccnicn t Sis?ned:/^/^/Z ^ Restoratio nAgreemen t 

## signcd/i LiQ k & 

# «•>• • Ql^j^ s I I Topsoi l Sampliii" ; (if applicahle ) By : 

## D Disposal Sampiin " (i f applicahle ) Bv : Garde nSamplin g (if applicable ) Bv : Utility Clearanc e Called : jbl^blA ^ 

## '^y-fch v //// @ Ji ^ ]^ \ J ^ Video/Photo s (Before ) 

# On:/i/2^/i ^ Bv : 

## S

1 ^ Video/Photo s (Durinj,' ) 

### On:illjZ.I_0y Video/Photo s (After ) Oiy.W_l(^ l CLJ D Video/Phofo s (3(>-Day) On : Bv : JS T Propert y Completio nAjirecmen f 

## Signed: ^^3_/A 7 Bv : 

# C hn 5 nFilial Re|)or t Issued : / / Bv : Ai r IVlonitoriii g (a s ap|)lical)l c 1 LJ Communit y C H Cre w ) 1 Results : On : / / By : 

# 1

I n Communit y

Results : O Cre w On : / / Bv : 1 n Communit y

Resuhs : Q Cre w On : / / 

# 1

Omah a Lea d Sit e

## 1278 8 Nort h Arro w Exterio rPaint 

### Omah a Lea d Sit e Owne rName : • Goo d 

### Sit e Sketc h Address : 3721^ 4 S T^^^ ^ J ^ • Poo r Phone : H: " 2^<5g'5 7 w : l^^o t paint Sampl e Numbe r Lead Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d (VAS S S.iW , Ky n RYASCPXA-1278 8 RYBSCPXA-1278 8F 1 F 2 

### 3£> Z "Z-"^ 8 

### pp m pp m 

# y n n Date ; Time : 

### T^'Oi ^ "^'^^prv ^ RYCSCPXA-1278 8 RYDSCPXA-1278 8 B l 8 2 13$ ^ 9 ?6> 6 pp m pp m 

# n D Sample s Analyze d RDZSCPXA-1278 8 D Z .9f^?S " pp m 

# n XR F Uni t 

### inr n Book : 1£ ± rtOZOCDCA-1270 0 8* - RPZoo^Xj ^ 12700—p z 

## (^ycscpK A *t:Arer pp m pp m Numbe ro fSample s 

## D D 

# = 5 n n Date : Time : Staff : _ ^ Po g M'Cu: ) 

### \ -o( p Legend : F l = Fron t Left , F 2 = Fron t Right , B l - Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y I I , AU quaelr^> 8 are a s viewe d fro m th e street , facin g property

### Dougla s County Accoun t Informatio n Pag e 1 o f 3 Dougla s County , Nebrask a PropertyRecor d ­ R231684000 0 Infonnatio n i s vali d a s o f 2007-10-1 0 Value s no t finalize d unti l afte rBoar d o f Equalizatio n Prin t Repor t Vie wo n Ma p Treasurer' s Ta xRepor t Owne r KOCHV,CTOR,A T ^ ^ ^ . ^ ^ ^ ^ 372 1 S 2 4 S T OMAH AN E 68107-000 0 PropertyInformatio n Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : 168 4 000 0 2 3 Residentia l 231684000 0 372 1 S 2 4 S T OMAH AN E 68107-000 0 SWETNAM S SU B DI V LO T1 5 BLOC K0 4 0 X 15 0 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $4,600.0 0 $4,600.0 0 $4,600.0 0 $4,600.0 0 $4,600.0 0

$0.0 0 Improvemen t $40,400.0 0 $40,400.0 0 $16,800.0 0 $15,300.0 0 $15,300.0 0 $0.0 0 Tota l $45,000.0 0 $45,000.0 0 $21,400.0 0 $19,900.0 0 $19,900.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2006-07-2 1 Dee d Type : W D Book : 200 6 Page : 08495 5 Price : $68,749.0 0 Grantor : SEMI N DOLORE S M T R Grantee : KOC H VICTORI AT Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2005-11-2 9 Dee d Type : W D Book : 200 5 Page : 15966 4 Price : $25,500.0 0 Grantor : Adai rHolding s Grantee : Dolore s M Semi n Truste e 

### http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 10/25/200 7
•!.• • ••; K\'. " '^ \••^^iu':*,::,^:t:-'.^.:i,fi,' i \/-.y^'a': :

### Dougla s County Accoun t Informatio n Pag e 2 o f 3

Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2003-10-2 8 Dee d Type : SH D Book : 200 4 Page : 04409 9 Price : $11,385.0 0 Grantor : Dougla s Count ySherif f Grantee : Adai rHoldings , LL C Valid/Invalid : Invali d Exclusio n Reason : Sal e b yGov t Agenc y Lan d Informatio n Acre s S F F F Unit s Dept h Widti i Vacan t 0.1 3 6000. 0 40. 0 1. 0 150. 0 40. 0 N o Improvemen t Informatio n Buildin g 1 2 1/ 2 Stor yUnfi n 372 1 S 2 4 S t

• J I ax.. . (ntfmmt ni«« « r i

It 19 1 p« n CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1563. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : 2 1/ 2 Stor yUnfi n Rooms : 8. 0 HVAC : Force d Ai r Units : 1. 0 Exterior : Fram e Sidin g Baths : 1. 0 Interior : Drywal l Bedrooms : 4. 0 Roo fCover : Compositio n Shingl e Stories : 2. 5

Roo fType : Gabl e Foundation : Bloc k Floorcover : Allowanc e 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 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 10/25/200 7

### Dougla s County Accoun t Informatio n Pag e 3 of 3

190 0 0 0 % 190 0 Deta/ 7 Typ e Deta/ 7 Descriptio n Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Basemen t Walkou t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h Cvr d Woo d Dec k Porc h En d Soli d Wal l Porc h Sla b Roo f Cei l Use r Bus yStree t 10 6 Unit s 1. 0 881. 0 1. 0 1. 0 1. 0 240. 0 239. 0 144. 0 239. 0 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 10/25/200 7

## Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

1 Comment :

Owne r Commen t (s) : Sit e 1 Coordinato r 1 Commen t (s) : CONTAC T FORM 

# f^7^ 9 ^171 ^ 

# 2^s r Date : A4 ^ Time : /// 5 Action : /Afi ^ f/y^K
­

Date : AaA/ C Time : ^fAA ^ Actio n\7l^A,/! ^ lA^CA/tO k

( Date : Time : Action : Transmi t t o EP A D Othe r Action : D

l/^y72ryy t A^<T<^A A

\X 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www . coasta l haz m at . co m .<P * COASTA L "IPBO-I* ^ ENVIRONHENTA L C R 0 U f, IH C 

# EXECUTIV ESUMMARY : 12788—372 1 S 2 4 S T N o Issue s o r Concern s Issues/Concern s Detai l Explanation:C CAST AL 

# As-Buil t Drawin g ^ % 

# mah aLea dSuperfun dS i it e 1278 8 Exterio rPain t Nort h Arrow Owne r Name : J^u>e.£: S SerTpj/A ? Omah a Lea d Sit e [[ ] Goo d Sit e Sketc h Address : 372 1 8 2 4 S T • Poo r W : Phone : H : 0^o t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : 

### (n£ s s-ivv , KA ^ RYASCPXA-1278 8 F l 3& Z pp m 

### D ~i-i«-otc . Date : RYBSCPXA-1278 8 F 2 

### 1-^ 8 pp m Time : Q . <^^pfy ^ 

### D RYCSCPXA-1278 8 B l pp m 

### D Samples Analyzed RYDSCPXA-1278 8 B 2 pp m 

### D RDZSCPXA-1278 8 D Z pp m 

# n XR F Unit : lOD l Book: /^ q ROgQQDCA-1270 0 S2 ­ pp m 

### D D Date : Q - I - 0(c ' nPZOOPXA-1270 0 P Z pp m 

### D 

# n Time : Prr , RYCSCPX A-fife r 7 8 ^ Staff : M'^u J Numbe ro f Sample s = Legend : F 1 = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrants ar e as viewe d fro m th e street , facin g propert y OLS# : 1278 8 Dat e Excavated : 11/10/0 7 

# m m Dat e USEP ASigne d Off : 12/4/0 7 

# ENTERED ^J'-'Z^ '
DZ=112PP M (d

> 1 4 " Q-z . 

## 3T;I(52H5 T COM: c U l 

### DX = 

# l^ s

CON G 3Q i EA-W=150PP M 

## Z-l S WM- K 04«I4L012 3 

# .s.m.m . Legen d Are ano t Excavate d ^ Dripzon e Excavate d Quadrant s Excavate d 

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

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remedia l activitie s performedo nm y property . My signature will designate tha t I a msatisfie dwit hth e restoratio no f m y property , an dtha t n o item s ar e i nquestions , now , or a

t any time i nth e future , excep t thos e item s liste dbelow , if any . Propert y ID : [ ^- y ^ ^ Propert y Address : "^7 ^ | <g^ ^ ^ ^-\^ . Owner : \(l^^j,^^; ^ l^.cl x Phon e •• ^A^ - ^ ^ ' ^ ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments : 1

• N

I agre e restoratio ni s completed , excep t a s note d j ' I I d o no t agre e restoratio nIs complete d 

## 1^-3-0 7 Owner' s Signatur e 

### Date Mgnfttur e I

# s ^ 

# EP A EP A Propert y Clos e Ou t For m Propert y # : \Xlo % Propert v Address : ^7^ 1 ^ - ^^" ^ ^t . Date/Time : ! l J ^< ^ Owner' s Name : \f; f.•H^r^V . W^,r^ r K Quad s Excavated : R i ^ 02 ^ £A Contracto r Grou p Cx><x^^o~] Ye s N o Excavatio nGenera l 1 . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? \ y ^ 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

## y Gradin g So dan dVegetatio n Ye s No I .Doe s th e gradin g aroun dth e perimete r o f th e house i nexcavate darea s generall y slop e awa y u y fromth e house ? 2 .Ha s so dbeenlai dinal l area s that were excavated ? 3 .Doe s th e so dappea r t o b e generall y healthy andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) _^__ _ 4 .Ar e sodde darea s generall y fir mandevenl y graded ? 5 .

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 tim e period ) ___^___ _ 6 .Wa s th e propert y gilde dsuc htha t water wil l not poo l onth e property ? u ^ 7 .Wa s damag e t o landscapin g or plant material s avoided ? Gates , Fence s an d Retainin g Wall s Ye s N o 1 . D o gate s ope n an d clos e freely ? (I fapplicable ) fJ A 2 . Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

### U k 3 . Wa s damag e t o gate s o rfence s avoided ? (I f applicable ) 

### hj K 4 . Wasdamagetoretabin g wall s avoided ? (I fapplicable ) 

### tJ! ^ Foundation , Sidio g an d Gutter s Ye s N o 1 .

Wa s damag e t o th e sidin g o rtri m avoided ? 1 / " 2 .Wa s damag e t o th e foundatio n avoided ?


### . X 3 . Wa s damag e t o window s avoided ? y 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? 

### y 5 .Wa s damag e t o downspout s o rdownspou t extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s No 1 .Wa s damag e t o drivewa y surface s avoided ? y 2 .Wa s damag e to walkway surface s avoided ? 

# y

## Inspectio nnote s

Remova l an drestorationactivate s complet e including the 30-da y so dwarranty : EP A RepresentativA^7^^;^:,,^,.,^^^^^.Sj: ^ Date : /4W^ 7PROPERTYCLEARANC E WORKSHEE T

Dat: e j-ld'O l Projec t Omah a Lea d - Fixe d Pric e XRFI D

Shot * Readin g t s i (9 / 2^ 5 N t 2 M 

### m
Sampl e Are a Aliquo t 1 2 3 4 5 I n Sit u Readin g



## w \ 

### I f 

## s U 

# n Sampl e Are a I n Sit u Aliquo t Readin g 1 2 3 4 5 Sampl e Are a I n Sit u Aliquo t Readin g 1 2 3 4 -) Sampl e Are a I n Sit u Aliquo t Readin g 1 2 3 4 5 Sampl e Are a I n Sit u Aliquo t Readin g 1 2 3 4 5 0107-5 1
Sampl e Are a B

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## R l (*- 8 Composit e Reading s (Bag ) 

### 1 1 

# P XR F Correcte d Valu e 

# h - > (us e calibratio n char t o rad d 20 % t o value ) D Z IZ-I H Composit e Reading s (Bag ) 

### 11 1 

### i K tH O XR F Correcte d Valu e - > (us e calibratio n chart o rad d 20 % t o value ) ^A,-\t i Composit e Reading s (Bag ) l^f l 

# m m XR F Correcte d Valu e — > (us e calibratio n char t o rad d 20 % t o value )

Composit e Reading s (Bag )

XR F Correcte d Valu e - > (us e calibratio n chart o rad d 20 % t o value )

Composit e Reading s (Bag )

XR F Correcte d Valu e —> (us e calibratio n chart o rad d 20 % t o value ) ^.-^—< i Propert yI D Propert y Addres s Measuremen t Count/Tim e Fiel d Shot s Sho t #

Composit e

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(Bag ) 

# & J /» 3 Composit e

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# H I if o 1178 6 2y M 

## ^ ^ 3 7 Z l ,S .

Readin g Sampl e Are a

Composit e Analytica l La b Analytica l

(Drie d & Spil t Sen t Numbe r Result s Sieved ) ?

Pass/Fai l ? Composit e Analytica l La b Analytica l

(Drie d & Spil t Sen t Numbe r Result s Sieved ) 7

Pass/Fai l ? Composit e Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t

• ? La b Numbe r Analytica l Result s 

## ISO 

# I9 S Pass/Fai l ? Composit e

Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t 7 La b Numbe r Analytica l Result s

Pass/Fail ? Composit e Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t

• ? La b Numbe r Analytica l Result s i

IJS t ADD I I lilHA I SHtr n I I XR F Technician' s Signitur e N i l II I I Io.e<^ ^ - *

COASTA L ENVIRONMENTA L C H C U P , INC . 

### Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O 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 rit s 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 Nar r 

### \j\t\HV(><\Uu^ ' Daytim e Phone : f^ ^

^fc/ ^

Addres s o f Propert y covere d b yttii s 

# 372 ( 5 zq-s T 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 tha t contain s elevate d concentration s o f lea 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 f Coasta 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 propert yha 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 , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al ! reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work . 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 f2t^^~T~^j * rn * « T& I \ "' " , / COASTA L ENVIRONMENTA L CROUP . IN C 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •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 necessarysubsequen 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 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 . •Allo wvideotapin g and/o rphotographin g o f th 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 equipment 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 f th 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 (877 ) 234-6270 . I gran t access t o m ypropertie sD I d o not gran t acces s t o m ypropertie s
Signatur e

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

Pag e 2 o f 2

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s t o condition s o f th e propert y prio r to remediatio nactivities . Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dSlate s Environmental Protectio nAgenc y (EPA) .

PropertyID : /^7 ^ Propert y Address : ^ "7/^ A 3 ^^^"^ ^ Owner : //rTT^ ^ ^^^4 Phone : 

## Z^^^^'^^ ^ O nth e attache ddiagram(s ) indicat e area(s ) to excavate dan ddept ho f excavation , locatio nof all know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e usedb y contractor , an dth e directio no f North . Indicate distances , depths , material t>pes , etc . Indicate digita l photo s by referencin g th e photo-lo g numbe r wit ha narrow indicatin g directio no f \iew . Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l stieet s a s necessary )



### • "h e rencval , storage , disposal , and.'o r retur no f thes e item s i s th e Owner' s responsibility . Item : 

### Item : Item : Ite m Item : Item : Item : Item : Pag e 1 of .COASTA L 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : / \ 

# t p po^SCBt^ " Item : , 

## t ^ \ ] /

VuAy ^ 

# ""'5MA^ ( plM/tS-^BUSK^ S Item : Item : Item : Item : ! Item :

Item : Item : 1 1 Item : I Item :

Item : Item : Item :

Pag e 2 of .COASTA L Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# So h Item : 

# S^ii-
- Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of .COASTA L 

### Landscap e Inventor y (Us e additiona l stieet s a s necessary ) 

## Ite m

Pre-existin g property area , tha t wil l b e excavated , tha t i s covere dwithgrass .

Numbe r o f tree s > 2 inch iTun k

diamete r

1 Numbe r o f tree s • = 2 inch trunk diamete r

1 

## 1 Numbe r o f Sprinkle r ! Zones . Contro l Valves . 1 Timers . Heads , etc .

•-.lUivl i askcici ; i-; ' :'' r :.:ir:,-.kle: ' !i;; . ova .
Numbe r o f an dsiz e of eac hgarde nflowe r bed area . ^i.'c
- ;;:"ij . !oc:iIio;•:^ . 

## Quantit y Uni t Condition/Type/Specie s

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Each ^

t Each ^ 1 

### 1 1 

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### Ite m Quantit y Uni t Condition/Type/Specie s Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor . Not e thi s \alu e wil l be use d t o issu e a plan t \ouche rt o th e propert > o\

> ner . Agree d upo n lis t o f plan t material s tha t wil l b e replace d b ycontractor . Be ver yspecifi can d detailed . Includ e a bkeic h o\ ' were eac h plan t \\\\\ he place d b\

ih e contracio!' . .Agree d upo n area o f properT N l o be replace d v\ii h gras s sod .

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1 .Are a o f Cir > o rCount\ 1 prope.r n t o b e landscape d ' pe rihei rrequirements .

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Easemen t .Area , to be excavate d 

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Pag e 5 of .COASTA L CNVIMOMMIMTA L C n O U P , INC . 

### Additiona l Comment s / Instructions : .~^ ^

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U Chec k th e bo xi f Owne 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 . Bycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n cracks o rfissures .

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A at e 7 V fnntrarfnr' « ^ia i 

### Dat e 7 Contractor' s Signatur e Dat e