TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID # n ^ n Date: \ [ ^ \ 0 

Address 

Remediation Contractor: Coastal Environmental Group_ Year: 200fl| 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

\fi Executive Summary 

EPA-provided property sketch 

t/ Signed Access Agreement for subject property 

-B- Signed Access AgFeement(s) for adjacent property 

M Restoration Agreement 

-B- Settlement docimients (i.e., for damage or to replace plants, etc.) 

~n Confinnation data 

[/ Photographs i"^ J} ^ ^ ^ y ^gAVmWv^ \ fft ^C^A^ ^ 

^ As-built slcetch 

W Satisfactory restoration signed by Property Owner 

U Property close-out checlc list signed by EPA 

-& Description of areas not meeting ROD cleanup criteria 

U Utility clearances 

U Property information from Douglas County Assessors OfTice 

D 

JatT 

30054474 

•1 

Superfund 
Property Access Checklist 

Property m : H

Pn,pertyAddress:

 q0 5 

 ^Ofj O Mf^hWvS V 

D

D

 WOBK STARTED 

 WORK COMPELTED 

ON:_ 

ON:_ 

/

/

 / 

/ 

Ownen FrtA

Address: 

 Chf.^hrA Renter: 

Phone: 

Fax: 

OHPifh.Kt^. LyftlQ5: 

Phone: 

Fax: 

^(\^. q(Qft. z^f^?. 

Cell/Pager. 

Additional Information: 

Cell/Pager: 

D

^

^

D

 Nodfication Letter 

 Accesa Agreement 

 Restoration Agreement 

 Topsoil Sampling (if applicable) 

Sent: / By: 

Signed: 9_/2k/D3 By: 

Signed: 3-/^/0 ^ By: 

/ /. By: 

D Disposal Sampling (if applicable) / / By: 

D

H

0

D

D

 Garden Sampling (if applicable) 

 Utility gcarance 

 video/Photos (Before) 

 Video/Photos (During) 

 VidetVPhotos (After) 

By: 

Called: 4^/^5 ^ By^q/.^/Q4 

On:3_/lkO^ By: 

On: By: 

On By: 

D

/S 

D

 Video/Photos (30-Day) 

Property Completion Agreemait 

 Final Report 

On: 

Signed: 

Issued: 

/_ / By: 

By: 

By: 

Air Monitorine (as avplicable 

D Community QCrcw 

Results: 

On: / / By: 

n Conunnnity

Results: 

 QCre w On: / / By: 

Q Comnmnity

Results: 

 QCrcw On: / / By: 

Omaha Lead Stte 
Douglas County Accoimt I: t^^n^tion Page 1 of2 

Douglas County, Nebraska Property Record - R0814600002 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vlev y O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ^ - • - • Auto Sales Search 

Owner 

GEPFORD FREDERICK F 

ETAL 

2950 MARTHA ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1460 0002 08 

Account Type: Residential 

Parcel Number: 0814600002 


Parcel Address: 2950 MARTHA ST 

OMAHA NE 68105-0000 

Legal Description: CLARKS PLACE LOT 24 BLOCK 0 E 41 S 133 FT LOT 23 & W 9 S 133 FT LOT 24 

50X133 

Value Informatio n 

Land Improvement Total 

2009 $6,800.00 $103,400.00 $110,200.00 

2008 $6,800.00 $103,400.00 $110,200.00 

2007 $6,800.00 $103,400.00 $110,200.00 

2006 $6,800.00 $89,200.00 $96,000.00 

2005 $6,800.00 $89,200.00 $96,000.00 

2004 $6,800.00 $89,200.00 $96,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6650.0 1.0 133.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R08... 9/17/2009 
Douglas County Account I ^^tio n Page 2 of2 

iTff • 

ta cai 

Secona Floor , 5640sq.n.5, 

1 r 

130- -ivi 

1 1/2 STORY FINISHED Bqnrt Pis > 15 ft 

CUCK TO ENLARGE IMAGE 

Square Footage: 1683.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Vinyl Units: I 1.0 

Interior: Drywall Baths: ' 1.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: \ 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 92 

Detail Type Detail Description Units 

Add On Covered Patio 102.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1119.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 600.0 

Porch Encl Solid Wall 24.0 

User Attic Full Finish 564.0 

User WD - VP condtion 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 9/17/2009 
CONTACT FORM 

Property ID # /7m 

Property ^ ^ 

Address: /f ^ /V/jHtm r f 

Initial Contact: Date: f/^ Time: /Z ^ Action: /l^ocM^//>* ^ Hy^y^ 

Second Contact: Date: f^ / Time: /t/^ y Action: [S/PsJ^ <*r fa'y^/t<7^U7if-' 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site l/Zt/^f P ^ ^^'' ^ r/^ri.y^TV ^ B^r^i-^^oM* 

Coordinator J / H/^Q^Uie^ ^^ ^ 9y*^l^i> S/ ^ 4L><566^ V^Y-zCfy 

Comment (s): 
Page 1 of2 

"> 

[,y Create AnotherTicket |][ Back tojrth Internet J i[ Send Email ;| 

• YOUR TICKET NUMBER IS 2373758. 

Original Call Date: 9/28/09 Time: 10:25 am Op: ELIZABETH18790 

Work to Begin Date: 9/30/09 Time: 11:00 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2950 Street: MARTHA ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-SE-SW 

Tv/p: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

NfUD02 METROPOLITAN UnLITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/28/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://vwm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/28/2009 
As-Built Drawing M H 

COASTA L Omaha Lead Superfund Site INVmONMINTAL O II O U P . IN C 

17903 

Exterior Paint Uorth Arrow 

[ 2 Good 

Omah a Lea d Sit e 

Sit e Sketc h • Poor 

Sampling Address: 2950 MARTH A ST I I No t paint \ 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Firm: FP/ 1 CC,f?K/ 

RYASCPXA-17903 Fl Q . 3 ppm D 

Dale: / - //) -

 /) ^ 

RYBSCPXA-17903 F2 3o 3 ppm n Time: 

RYCSCPXA-17903 Bl -*> -^2 . ppm 

n Samples Analyzed RYDSCPXA-17903 B2 "~1 1 ^ ppm n 

RDZSCPXA-17903 DZ 3Hf ^ oom n XRF Unit: Cpt^HO Book: 7_0 3 

ROZOOPXA-17903 SS - ppm a n Date: O l - 2 2 -Of t 

RPZOOPXA-17003 PS- — ppm 

a n 

Time: PA I 

Staff: fA'^ W Number of Samples • ddl 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from tf-fc street, facing property 

OLS#:17903 

Date Excavated: 10/7/09 

USEPA Sioned Off: 10/30/09 

KtK 5 CpMn i 1J-DCC.U7 

n4r>l4l III23 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 


Area left bare 
 Sod	 Rock/Mulch 


Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

U "1 1^ 

17903 

Exterior Paint North Arrow Omaha Lead Site 

[2 Good Site Sketch • Poor 

Sampling Address: 2950 MARTHA ST [ ] Not paint f 

Sample Number 

RYASCPXA-17903

RYBSCPXA-17903

RYCSCPXA-17903^

RYDSCPXA-17903

 Fl 

 J 2 

 ¥ l 

 B2 

Lead 

Concentration 

G 3 ppm 

3o 3 ppm 

.*iHl . ppm 

~l \9 ^ ppm 

Sample 

Collected 

I 

LAB 

D 

D 

D 

D 

Firm:

Date:

Time:

Samples Collected 

 F M CC,i^W 

/ - //? - 09> 

 I'll p n 

Samples Analyzed 

RDZSCPXA-17903 DZ 3^f i ppm D XRF Unit: (pfkHr> Book: 7/^ 3 

RGZOCrXA-17903 S2 ppm D Date: Olll-Of ^ 

r^rzoGnxA-17903—p* ppm n D Time: Pf ^ 

Number of Samples = 5 UC L Staff: M:Sl / 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed rom the sfreet. facing property 

ENTERED 
^'^15(7 ^ r\ c?­ ny 17903 

Omah a Lead Site Exterior Paint North Arrow 

Site Sketch [ g Good 

• Poor 

Sampling Address: 2950 MARTHA ST Q Not paint \ 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: FVf\ CC,R W 

RYASCPXA-17903 F1 0 3 ppm D Date: / - ID ' nP) 

RYBSCPXA-17903 F2 3^ 3 ppm D Time: 1-1/ p m 

RYCSCPXA-17903 B1 5H2 L ppm i n Samples Analyzed RYDSCPXA-17903 B2 _UJ&i__PPm D RDZSCPXA-17903 DZ 3^ 6 ppm D XRF Unit: (pfkH D Book: 2Q3 _

RGZOCPXA-17903 ©€ ppm D D Date OV22'Qf l •nPZCGPXA-17903 P * - ppm D D Time :En. Staff: Number of Samples = i 5 i O MSi^ 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed 
17903 

Omaha Lead Site Extarior Paint North Arrow 

Site Si(etch [ 2

•

 Good 

 Poor 

Sampling Address: 2950 MARTHA ST Q Notpaint 

Sample Number Lead Sample Samples Collected 

i

i 

LAB Concentration Collected Finn: F M CC,iiW 

RYASCPXA.17903 Fl Q S PP^ D Date: / ' iQ ' Cl^ 

RYBSCPXA-17903 F2 30 3 ppm D Time: /'/ / p m 

RYCSCPXA-17903 Bl ^H2 ^ ppm D 

Samples Analyzed RYDSCPXA-17903 B2 _ILi&_PP m D

RDZSCPXA-17903 DZ 3Hf* , ppm D XRF Unit: Cpf^Hn Book: 7Z) 3 

nO2OOPXA-17903 82 - ppm u D Date: QlTl ' Qf^ 

nPZOOPXA-17003 PS- - ppm u D Time: p ^ 

Staff: jila ^ Number of Samples = [ 5 | Q | 

Legend: Fl = Front Left, F2 = Front Right, Bi = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Alt quadrants are as viewed |rpm the ^eet. being property i f 

• 1 El ^TS:?^B : > 

T 1 

iAN 12 i m 

i\ • . ..PI. n/a.' f 

• 4 

f 

•fl 

\ 

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... M^Hk* i.St, Rev 5 Crejted 14-Dec-*)7 IM6I41 0123 

' :ai: . IT M 10 :t . .yf>i - ]w ; .-.••».• I» M .-;:*« • .-iTj^faiir^w j*i;ic'J)»i . .' »•..-••»)' ,«.*•-'*».«',-T»:. I rr ;jo; ."•" .-luiaf .!«> 'IMI J ^IfV.fC i 
I

.jfi'-^r*'*. 

COASTA l 

INVtRONH I If TAI PHO't ' C t O tl P IW C 

Oonser^lfoi Access To Propfefly 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatK'es, collectively 

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

following described premises: ^/. . _ \'-^ n Ov^ 

Owner's Name: Daytime Phone: 

Address of Property 

covered by this 

Agreement: ^75 ^ Mav4-K<^ 5 

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 perfonmed, 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 
COASTA l 

IKVlKOHHtttTJll 

' "I PRO'*^ C I O U » IH 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; 

c Water and maintain replacement vegetation, including fertilizer application, as 

necessary' subsequent to an initial watering period by EPA; 

f 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. 

t 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 (402) 991-1199 

^ I grant access to my properties D I do not grant access to my properties 

1-2C-01 

Date Signature Date 

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

Page 2 of 2 
# 

a 

•-•' IM;I,>-\ ' 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # ffl03 

Property Address ^^ O (TICVAVYX ^'^ 

Owner Name rrgA Qpatr^rA 

Date /Qjnnjr^c^ 

Comments 

^'v<^^ \iK)S^ XI^ D ^ rP^Xace 

^ \ I ^ ^ 

Owner Signature. 

Contractor Signature < ^ oi^tU{j^i^ 
COASTA L 

Restoration Agreement 

The puipose of this agreement is to provide a Tnulual agreemem as YO conditions ofthe property prior to 

rcmeidiation activities. This will also serves as documentation for the puipose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property IP: |^^ ^ 

^Property Address; qc^C^Q ^/4<WW- S | 

Ownen f-y-e^ CS^J^ M 

Phone: \V\OQr\^^-V^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to iae Removed by the Owner before Start of Remediation: 

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

items to t>e Removed by the Contractor During Remediation and Mot Replaced 

Item: 

^ t^<-\ euA 

ttem: 

Kon: 

Kem: 

Page l o f y 
iQ -^.' ^ 

COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

! Item: 

^^^f.,(- B>2 

Itsm: 

Item: 

Item: 

Item 

that will be excavat^ that 

is covered with grass. 

Number of trees > 2 mch 

trunk dmneto' 

Number of trees <= 2 inch 

tnmk diameter 

NumtxT of Sprinkler 

Zones. Control Valves, 

Tuners, Heads, etc 

Aiiaih ,T skeicli ol llie 

sprifkloi Inv'.iiii 

Number of and size of 

each garden/ flower bed 

area. 

Aiiatb :i skcich ol r«.-!:iiivf 

^izl•s nnd loc;iiii>ns 

Agreed upon valne of plant 

materials not to be 

replaced t>v contractor. 

Voir Ihi- \HIIIC ^MII HI 

usrt' u) liiuv .1 plan; 

vniii-Iu'; K. llie iiropcrlv 

on ner. 

Easement Area, to be 

excavated 

Landscape inventory 

Quantity Unit Condition/Type/Species 

32 Quadrants 

f Each 

Each 

^ 

Eadi 

^ 

f Eacfa 

/ S 

V Each H ^ ^ 

^ 

Page 2 of. 
C O A S "< A L 

I Additional Comments / biatnictiorB: 

^ Check the box if Owner does not want CEG to document interior foundation walls and possible 

^re-exlsting damage. By checking thte txix CEG is not responsible for any damage done to the 

interior of house, including foundation oacks or fissures. 

O' l agree O I do not agree 

Date Contractor's Signatnre Date 

Page 3 of i _ 
Date 

Project 

XRFID# 

Shot# 

7WY 

Average

Shot# 

1

mL 1

7 ^ 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

BVID#_L2fe5 

XRF PROPERTY SAMPLE SHEET 

Address ijiZ-^'oi 

Omaha lead FP 2nd year option Sample time am/ptn 

sample length 30 sec 

Reading 

^12 ^ 

^ ^ ^i ^ 

'M. 

^Z - ^1-7 ^ 

T ^ J . I'^ ^ 

Reading 

/fey rfc /(^ 

ISS' ^^( ^ -sisr-^i 

24i^ ^ l t 

 / V^ " ^/9 

Reading 

Reading 

Lab result 

Sample area 

M 

Depth 

2 ^ 

Sample area 

Depth 

^ 

Sample area 

Depth 

Shot# 

T^f^^ 

4±^ 

.Z4L 

Average

Shot# 

Average 

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Sample area XRF Avg. 

Sionature/WA/^i/P M 

Reading 

3 ^n 

^12 ^ 

ft>U :^/ ^ 

^ >^^12 ^ 

^ ^t I Z^ 

Reading 

Reading 

Reading 

Sample area 

3 ^ 

Depth 

M L 

Sample area 

Depth 

Sample area 

Depth 

Sampie area 

Depth 

Print Wjuyhf^ Onrr^ff^ 
% >^K ? o

1^^ ^^ ^ \

V*^^! ?

Xp„oT«<^

 Coastal Environmental Group Inc.

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

 www.coastalhazmatcom 

 >\ ^^:P 

 COASTA L mVilOIIMIIITAl 

ciour , m c 

EXECUTIVE SUMMARY: 

BVID #17903-(2950 MARTHA ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
# 

'SSi EPA w 

EPA Property Close Out Form 

Property Address:^? ^S- 6 W^l^ ^ S + Property #: /^<t. O "^^ 

Datc/Tline Owner's Nane:. Jt.X'>^ , _ j ^ffH P T tf"^ : 

Quads Excavated: p V t ^ ^— 

Contractor Group Ctoc>.»4-^w) a '•ot*^ 

Excavation Yes No General 

1. If necessaiy, were the correct quadrant(s) excavated and restored? cy ' 

2. If necessaiy, were the correct areas ofdrip zone excavated and restored? 

Grading Sod and Vegetation 

Yes JiO 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

fix)m the house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

4. Are sodded areas generally fum and evenly graded? T^^ 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day t^ ' 

time period) 

6. Was the property graded such that water will nol pool on the propertj'' xy 

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls 

Yes No 

1. Do gates open and close fteely? (Ifapplicable) L . ' 

2. Were all gates or fences taicen down during restoration activities reinstalled? (tf applicable) 

3. Was damage to gates or fences avoided? (I f applicable) y

4. Was damage to retaining walls avoided? (Ifapplicable) 1 ^ ' 

Foundation, Siding and Gutlers Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? T^"" 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? ~7 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewallts and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? A 

2. Was damage to walkway surfaces avoided? -7
Owners comments: » # 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative / Ir ^ /j/?/ti^ y Date: /o/jo/oj 
y 

# # 

Property Completion Agreement 

This agreement documenls the complclion of remedial activities perroimed on my properly My signature 

will designate Ihal I am satisfied with Ihe restoration of my properly, and Ihal no ilems are in queslions. 

now, or al any tune in the future, except those ilems listed below, ifany 

Property ID: nQOi? ) 

Property Address: ^gC^f ^ \(\Qkr\^K(A ^ 

Otvncr: FrCd fclgp-fei Phone: M07.^Ua.?M^^ 

Restoration Items in Question: 

Item: 

Item: 

Item; 

item: 

Item: 

Item: 

Additional Comments: 

Sy I xyrcc restoration'\% completed, except as noted 

[_| I rio nnt iit;rec restoration j;; completed 

Date Conti artor's Signature Dale