## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # 

## n ^ nDate : \ [ ^ \ 0 Addres s Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200fl | SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S Vide o ofproperty (DVD ) \f

i Executiv e Summar y EPA-provide dproperty sketch 

# t / SignedAcces s Agreement fo r subject propert y -B
- SignedAcces s AgFeement(s ) fo r adjacen t propert y M Restoratio nAgreement -B
- Settlement docimient s (i.e. , fo r damag e o r to replac e plants , etc. ) ~nConfinnatio ndata

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Photograph s i" ^ J} ^ ^ ^ y ^gAVmWv ^ \ff t ^C^A^ ^ ^ As-built slcetc h WSatisfactor y restoratio nsignedb y Propert y Owner U Propert y close-out checl c lis t signedb y EP A

- & Descriptio no f area s no t meetin g RO D cleanup criteri a U Utilit y clearance s U Propert y informatio nfro mDougla s Count y Assessor s OfTic e D



### Jat T 30054474 

# • 1 Superfun d

## Propert y Acces s Checklis t Propert y m : H Pn,pertyAddress : q0 5

^Ofj O Mf^hWvS V D D

WOB K STARTE D WOR K COMPELTED ON: _ ON: _ / / / / Owne n 

# Frt A Address : 

# Chf.^hr A Renter : Phone : Fax : 

## OHPifh.Kt^ . LyftlQ5 : Phone : Fax : 

## ^(\^ . q(Qft . z^f^? . Cell/Pager . Additional Information : Cell/Pager : D ^ ^ D Nodficatio nLette r

Acces aAgreement Restoratio nAgreemen t Topsoil Samplin g (if applicable ) Sent : / By : 

## Signed : 9_/2k/D 3 By : 

## Signed : 3-/^/0 ^ By : / / . By : D Disposa l Samplin g (if applicable ) / / By : D H 0 D D Garde nSamplin g (if applicable ) Utilit y gcaranc e video/Photo s (Before ) Video/Photo s (During ) VidetVPhoto s (After) By : 

## Called : 4^/^5 ^ By^q/.^/Q 4 

## On:3_/lkO ^ By : On : By : O n By : D 

# / S D Video/Photo s (30-Day ) Propert y Completio nAgreemai t Final Report On : Signed : Issued : /_/ By : By : By : Ai r Monitorin e (a s avplicabl e D Communit y QCrc w Results : On : / / By :

nConunnnit y Results : QCre w On : / / By : Q Comnmnit y Results : QCrc w On : / / By :

Omah aLea dStt e

## Douglas Count y Accoim t I:

t^^n^tio n 

## Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R081460000 2 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VlevyO n Ma p Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ - • - • Aut o Sale s Searc h Owne r GEPFOR D FREDERIC KF ETA L 295 0 MARTH AS T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 146 0 000 2 0 8 Accoun t Type : Residentia l Parce l Number : 081460000 2 Parce l Address : 295 0 MARTH AS T OMAH AN E 68105-000 0 Lega l Description : CLARK S PLAC E LO T2 4 BLOC K0 E 4 1 S 13 3 F TLO T2 3 & W 9 S 13 3 FTLO T2 4 50X13 3 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,800.0 0 $103,400.0 0 $ 110,200.0 0 200 8 $6,800.0 0 $103,400.0 0 $ 110,200.0 0 200 7 $6,800.0 0 $103,400.0 0 $ 110,200.0 0 200 6 $ 6,800.0 0 $89,200.0 0 $ 96,000.0 0 200 5 $ 6,800.0 0 $89,200.0 0 $ 96,000.0 0 200 4 $ 6,800.0 0 $89,200.0 0 $ 96,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6650. 0 1. 0 133. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R08.. . 9/17/200 9

### Dougla s County Accoun t I ^^tio n Pag e 2 of 2

iTf f • t aca i Secon a Floo r , 5640sq.n.5 , 

## 1 r

130

- -iv i

1 1/ 2 STOR YFINISHE D Bqnr t Pis > 1 5 ft

CUC KTO ENLARG E IMAG E Squar e Footage : 1683. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Viny l Units : I 1. 0 Interior : Drywal l Baths : ' 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 1. 5 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 6 0 % 191 6 9 2 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Covere d Pati o 102. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 1119. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 600. 0 Porc h Enc l Soli d Wal l 24. 0 Use r Atti cFul l Finis h 564. 0 Use r W D - V P condtio n 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08. . . 9/17/200 9

## CONTACT FOR M Propert y I D # 

# /7 m Propert y ^ ^ Address : /f ^ /V/jHt mr f Initial Contact : Date : f/ ^ Time : /Z ^ Action : /l^ocM^//>* ^ Hy^y ^ Secon dContact : Date : f^ / Time : /t/^y Action : [S/PsJ ^ <*r fa'y^/t<7^U7if- ' Fina l Contact : Date : Time : Action : Final Action : Transmit to EP A D Other Action : D

Comment : Owner Comment (s) : Sit e l/Zt/^ f P ^ ^^'' ^ r/^ri.y^TV ^ B^r^i-^^oM * Coordinato r J / H/^Q^Uie ^ ^^ ^ 9y*^l^i > S/ ^ 4L><566 ^ 

## V^Y-zCf y Comment (s) :

### Pag e 1 of 2

" > [, yCreat e AnotherTicke t |] [ Bac k tojrt h Interne t J i [ Sen d Emai l ; |



## • YOURTICKE T NUMBE RI S 2373758 . Origina l Cal l Date : 9/28/0 9 Time : 10:2 5 a mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 9/30/0 9 Time : 11:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 295 0 Street : MARTH AS T Twp : 15 NRng : 13 E Sect-Qtr : 28-SE-S W Tv/p : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T 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 CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL3 COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 Day : 402504782 3 NfUD0 2 METROPOLITA NUnLITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO N Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/28/200 9

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://vwm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/28/200 9

# As-Buil t Drawin g M H COASTA L 

# Omah aLea dSuperfun dSit e INVmONMINTA L O I I O U P . IN C 

### 1790 3 Exterio rPain t Uort h Arro w [ 2 Goo d Omah a Lea d Sit e Sit e Sketc h • Poo r Samplin g Address : 295 0 MARTH AS T I I No t pain t \ Sampl e Numbe r Lea d Sampl e LA B Sample s Collecte d Concentratio n Collecte d Firm : FP/ 1 CC,f?K / RYASCPXA-1790 3 F l Q . 3 pp m 

## D Dale : / - // ) -/) ^ RYBSCPXA-1790 3 F 2 3o 3 pp m 

# n Time : RYCSCPXA-1790 3 B l -*> -^2 . pp m 

# n Sample s Analyze d RYDSCPXA-1790 3 B 2 "~ 1 1 ^ pp m 

# n RDZSCPXA-1790 3 D Z 3Hf ^ oo m 

# n XR F Unit : Cpt^H O Book : 7_0 3 ROZOOPXA-1790 3 S S
- pp m 

# a n Date : O l - 2 2 -Of t RPZOOPXA-1700 3 PS - —pp m 

# a n Time : PA I Staff : fA'^ W Numbe ro f Sample s • 

# dd l Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m tf-fcstreet , facin g propert y OLS#:1790 3 Dat e Excavated : 10/7/0 9 USEP ASione d Off : 10/30/0 9

Kt K5 CpMn i 1J-DCC.U 7 n4r>l4 l III2 3 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are a replace d wit h Are a lef t bar e So d Rock/Mulc h 

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

# U 

# "1 1 ^ 1790 3 Exterio rPain t Nort h Arro w Omah a Lea d Sit e [ 2 Goo d Sit e Sketc h • Poo r Samplin g Address : 295 0 MARTH AS T [ ] No t pain t 

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### Date : Olll-Of ^ r^rzoGnxA-17903—p * pp m 

# n D Time : Pf ^ Numbe ro f Sample s = 5 UC L Staff : M:Sl / Legend : F 1 = Fron t Left , F 2 = Fron t Right , 8 1 = Back Left , B 2 = Back Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d ro m th e sfreet . facin g propert y 

# ENTERE D

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# ^'^15( 7 ny 1790 3 Omah a Lea d Sit e Exterio rPain t North Arro w Sit e Sketc h [ g Goo d • Poo r Samplin g Address : 295 0 MARTH AS T Q No t pain t 

### \

Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : FVf \ CC,R W RYASCPXA-1790 3 F 1 0 3 pp m 

## D Date : / - I D ' nP ) RYBSCPXA-1790 3 F 2 3^ 3 pp m 

## D Time : 1-1 / p m RYCSCPXA-1790 3 B 1 5H2 L pp m 

# n Sample s Analyze d 

# i RYDSCPXA-1790 3 B 2 

### _UJ&i__PP m 

## D RDZSCPXA-1790 3 D Z 3^ 6 ppm XR F Unit : (pfkH D Book : 2Q3

_ 

## D RGZOCPXA-1790 3 © € pp m 

## D Dat e 

### OV22'Qf l 

## D • nPZCGPXA-1790 3 P *
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## D D Tim e 

# :En . Staff : Numbe rof Sample s = i 5 i O 

## MSi ^ Legend : F l = 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 = Pla y Al l quadrant s ar e a

s viewe d

## 1790 3 Omah a Lea d Sit e Extario rPain t Nort h Arro w Sit e Si(etc h [ 2 • Goo d Poo r Samplin g Address : 295 0 MARTH AS T Q Notpain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# i i LA B Concentratio n Collecte d Finn : F M CC,ii W RYASCPXA.1790 3 F l 

### Q S PP ^ 

## D Date : / ' iQ ' Cl ^ RYBSCPXA-1790 3 F 2 

### 30 3 ppm 

## D Time : /'/ / p m RYCSCPXA-1790 3 B l ^H2 ^ pp m 

## D Sample s Analyze d RYDSCPXA-1790 3 B 2 

## D _ILi&_PP m RDZSCPXA-1790 3 D Z 3Hf* , pp m 

## D XR F Unit : Cpf^H n Book : 7Z) 3 nO2OOPXA-1790 3 8 2 - pp m 

## D 

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COASTA l INVtRONH I I f TA I PHO't ' C t O t l P IW C 

### Oonser^lfo i Acces s T o Propfefl y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) o rits authorize d representatK'es , 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 : ^/. . _\'- ^ n Ov ^ Owner' s Name : Daytim e Phone :

Addres s o f Propert y covere d b ythi s Agreement : 

# ^75 ^ Mav4-K< ^ 5 PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove 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 byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonmed , th e Granto rwil l hav e a n opportunityt 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 has 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 , contractors an d subcontractors th e righ t t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k has bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f 2COASTA l IKVlKOHHtttTJl l ' " I PRO'* ^ C I O U » IH 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 ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; f 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 . t 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 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 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 (402 ) 991-119 9

^

I gran t acces s t o mypropertie s D I d o no t gran t access t o mypropertie s 

# 1-2C-0 1

Dat e Signature Date
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J 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# 

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# RESTORATIO NCHANG EORDE R OMAH A LEA D Propert y I D #ffl03 Propert y Addres s ^^ O (TICVAVY X

# ^' ^ Owne r Nam e rrg A Qpatr^r A 

# Date /Qjnnjr^c ^ Comment s ^'v<^ ^ \iK)S ^ XI^ D ^ rP^Xac e ^ \I ^ ^



# Owne r Signature . Contracto r Signatur e < ^ oi^tU{j^i ^COASTA L 

## Restoratio n Agreemen t Th e puipos e of thi s agreemen t i s t o provid e aTnulua l agreeme ma s Y O condition s ofth e propert y prior t o rcmeidiationactivities . Thi s wil l als o serve s a s documentation fo r th e puipos e of assurin g tha t restoratio n activitie s are completedt o th e satisfactio n o f th e propert y owne r andthe UnitedState s Environmenta l Protectio nAgency (EPA) .

Propert y IP : |^^ ^ ^Propert y Address ; qc^C^Q ^/4<WW
- S | Ownen f-y-e^ CS^J^ M Phone : 

## \V\OQr\^^-V ^ O

n th e attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscaping feature s an d acces s location(s ) t o b e usedby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if necessary . 

## Item s t o ia e Remove db y th e Owner before Star t o

f

Remediation : Th e (emova Lstorage , disposal , and/or retur n o f thes e item s i s th e Owne r s responsibility .



## item s t o t> e Remove db y th e Contracto r Durin g Remediatio nan dMo t Replace d Item : t^<- \ ^ 

# eu A ttem : 

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## Item tha t wil l b e excavat ^ tha t i s covere dwit hgrass . Numbe r o f tree s > 2 mc h trun k dmneto ' Numbe r o f tree s < = 2 inc h tnm k diamete r Numtx T o f Sprinkle r Zones . Contro l Valves , Tuners , Heads , et c Aiiai h, T skeicl i o l lli e sprifklo i Inv'.iii i Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Aiiat b : i skcic ho l r«.-!:iiiv f ^izl• s nndloc;iiii>n s Agree dupo nvaln e o f plan t material s no t t o b e replace dt> v contractor . Voi r Ihi
- \HIII C ^MII H I usrt ' u) liiu v . 1 plan ; vniii-Iu' ; K . lli e iiropcrl v o nner . Easemen t Area , t o b e excavate d 

## Landscap e inventor y Quantity Unit Condition/Type/Specie s 

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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 ^re-exlstin g damage . B ycheckin g tht e txi xCE 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 oack s o rfissures .

O' l agre e O I d o no t agre e

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# 1 7 ^

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# BVID#_L2fe 5 XR F PROPERT YSAMPL E SHEE T Addres s 

# ijiZ-^'o i Omah a lea d F P 2n d yea roptio n Sampl e tim e am/pt n sampl e lengt h 

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# Wjuyhf ^ Onrr^ff ^ Prin t% >^K ? o 

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\ V*^^! ? Xp„oT«< ^ Coasta l Environmenta l Grou p Inc . 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 www.coastalhazmatco m > \ ^^: P COASTA L mVilOIIMIIITA l ciour , m c 

# EXECUTIV ESUMMARY : BVID #17903-(295 0 MARTH A ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation :# 

# 'SS i 

# EP A 

# w EP A Propert y Clos e Ou t For m Propert y Address:^ ? ^S- 6 W^l^ ^ S + Propert y # : /^<t. O "^ ^ Owner' s Nane: . Jt.X'>^ , _j ^ffH PT tf" ^ Datc/Tline : Quad s Excavated : p V t ^ ^— Contracto r Grou p Ctoc>.»4-^w ) a'•ot* ^ Ye s N o Excavatio nGenera l 1 .If necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 

## cy ' 2 .If necessaiy , were th e correc t area s ofdri p zone excavate dandrestored ? Gradin g So dan dVegetatio n Ye s Ji O I .Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y fix)mth e house ? 2 .Ha s so dbee nlai di nall area s tha t wer e excavated ? ^ 3 .Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 day time period ) 4 .

Ar e soddedarea s generall y fuman devenl y graded ? 

# T^ ^ 5 .

Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y t^ ' tim e period ) 6 .Wa s the propert y grade dsuchtha t wate r will nol poo l o nth e propertj' ' 

## x y 7 .Wa s damage t o landscapin g o r plan t material s avoided ? 

### y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope nan dclos e fteely? (Ifapplicable ) 

### L . ' 2 .Wer e all gate s or fence s taice ndow ndurin g restoratio nactivitie s reinstalled ? (tf applicable ) 

# y 3 .Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 1 ^ ' Foundation , Sidin g an dGutler s Ye s N o I .Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundationavoided ? 

# T^" " 3 .Wa s damage t o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

# ~ 7 5 .Wa s damage t o downspout s o r downspoul extension s avoided ? Sidewallt s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damage to drivewa y surface s avoided ? 

# A -7 2 .Wa s damage t o walkwa y surface s avoided ?

## Owner s comments : » #



## Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y so dwarranty : EP A Representativ e / Ir ^ /j/?/ti^y Date : /o/jo/o jy 

### # #



## Propert yCompletio n Agreemen t Thi s agreemen t documenl s th e complclio n o f remedia l activitie s perroime d o n m yproperl yM ysignatur e wil l designat e Iha l I a m satisfie d wit h Ih e restoratio n o f m yproperly , an d Iha l n o ilem s ar e i n queslions . now , o ra l an ytun e i n th e future , excep t thos e ilem s liste d below , ifan y

Propert yID : nQOi? ) Propert y Address : ^gC^f ^ \(\Qkr\^K( A ^ Otvncr : 

# FrCdfclgp-fei Phone : 

# M07.^Ua.?M^ ^ Restoratio n Item s i n Question :

Item : Item : Item ; item : Item : Item : Additiona l Comments :

S yI xyrc crestoratio n '\% completed , excep t a s note d [_ | I rio nn t iit;re crestoratio n j; ; complete d

Dat e Cont i artor' s Signatur e Dal e