### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R
SAID# : \HlQ' S Date : ^liOJO ^ Address : .^1\'S^priA A 3 O Remediatio n Contractor : Coasta l Environmenta l Group

_ Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y Vide o o f propert y (DVD ) S r Executiv e Summary 0 EPA-provide dproperty sketc h y Signe dAcces s Agreemen t for subjec t propert y Isj u Signe dAcces s Agreement(s ) fo r adjacent property 0

^ Restoratio n Agreemen t ji ^ Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) y Confirmatio n dat a Photograph s ye^J iCCajJaJqOA^ jLX-(laJdJ-LG^
. - - t ru l SO< L y As-buil t sketc h y Satisfactory restoratio n signe db y Propert y Owne r B ^ Property close-ou t chec k lis t signe db y EP A / ^ Descriptio n o f area s no t meetin g RO D cleanu p criteri a y Utility clearance s ^y Property informatio n fromDougla s County Assessor' s Offic e 

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## Propert yAcces s Checklis t Propert ) ID : \l-:\\t: 5 Propert yAddress ; 

# ' • 3(^1- 1 ^x^^m^ i D D

WOR K STARTE D WORKCOMPELTE D ON : ON : _/ / /_ / 

# Q^^"^'­ ^ A^CX^/ \.\mx\rY^ \ Address : 

# Phone : c^^^-5^^at Fax : Rente r Phone : Fa.\ : Cell/Pager : Additional Infonnation : Ccll/Pager :
D Notificatio nLette r 0 ^ Acces s Agreemen t Q'^Restoratio nAgreemen t nTopsoi l Samplin g (i f applicable ) ! nDisposa l Samplin g (i f applicable )

• Garde nSamplin g (i f applicable ) 0 ^ Utilit y Clearanc e 0 Video/Photo s (Before ) nVideo/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (30-Day ) nPropert y Completio nAgreemen t D Fina l Repor t Sent : / / 

## Siened : IO/-2 / /C X Signed : L^/2i/il) K / / / / / / 

## Called : J0/:2i/i:: g On:^/^/Q / On : / / On : / / On : / / Signed : / / Issued : / / By : By

: K\.CVIHA ^ 

## By=KV^rV\n\/: ^ By : By : By : 

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' n Communit y O Cre w | Results : On : / / 

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Omah a Lea d Sit e

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

Comment : Owne r I Commen t (s) : Sit e Coordinato r Coinmen t (s) : CONTAC T FOR M j M \C) 6 

# 32n \^ priT o ^ 

## Dat e Time : Action : Date Time : Action : Dal e Time : Action : Transmi t t o EP AD 

## Othe r .Action : D

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### Dougla s County Accoun t Informatio n Pag e I of 2 tnati o
Dougla s County , Nebrask a Propert yRecor d - R232430000 0 Prin t Repor t NE

W Featur e - Parce l Dimensions availabl e @ scal e 0-5 0 f

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f 90th S t - Vie wo n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer ^ Ta xRepor t Ne wFeatur e -•-•- * Aut o Sale s Searc h Owne r RASHI D JEANN E J ETA L 327 1 SPRIN G S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : \ 243 0 000 0 2 3 Accoun t Type : Residentia l Parce l Number :232430000 0 Parce l Address : 327 1 SPRIN G S T OMAH AN E 68105-000 0 Lega l Description : THOMASO N & GOO S AD D LO T1/ 2 VA C ALLE Y& W 5 5 E 27 0 F TO F N RESERV E W O F 3 2 AV E 5 5 X 87. 8 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,800.0 0 $99,800.0 0 $105,600.0 0 200 7 $5,800.0 0 $99,800.0 0 $105,600.0 0 200 6 $5,800.0 0 $85,500.0 0 $91,300.0 0 200 5 $5,800.0 0 $85,500.0 0 $91,300.0 0 200 4 $5,800.0 0 $85,500.0 0 $91,300.0 0 200 3 $5,800.0 0 $65,200.0 0 $71,000.0 0 Sale s Informatio n Sale s Date : 1998-12-1 0 Dee d Type : Book : 211 3 Page : 08 7 Price : $87,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5225. 0 1. 0 95. 0 55. 0 N o Improvemen t Informatio n 

### http://dougIasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R23..
. 10/7/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 2 rn^io i

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Yea rBuil t 1641. 0 0. 0
2 Stor y Centra l Ai rt o Ai r Fram e Viny l Drywal l Compositio n Shingl e Hi p Allowanc e
Yea r Remodele d 191 0 198 3 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Fixtur e Porc h Porc h Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Bat h Hal f Cvr d Woo d Dec k Woo d Dec k " «2*0S q Ft ..»......, « 

### — 1 CLIC KT O ENLARG E IMAG E Percen t Complete : Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r 100.0 % Averag e Averag e 0. 0 7. 0 1. 0 2. 5 4. 0 2. 0 Bloc k 0. 0 Physica l Ag e Buil t 191 0 9 9 Unit s 1. 0 1. 0 624. 0 1. 0 2. 0 1. 0 64. 0 216. 0



### http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R23.
. . 10/7/200 8

### Pag e 1 of 2 %

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2159953
. Origina l Cal l Date : 10/22/0 8 Wor k t o Begi n Date : 10/24/0 8 Time : Time : 2:5 5 p m 3:3 0 p m Op : ELIZABETH1879 0
State : N E Address : 327 1 County : DOUGLA S Street : SPRIN G S T Place : OMAH A Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 33-NW Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G HOUS E AL L TH E WA Y T O TH E : STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 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 : 4f t Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T 

### N A Ah : 888728934 3 Emerg : 406728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/22/200 8

### Pag e 2 of 2 %
QLNN E1 FQWES T LOCA LNETWOR K 

### N A Day : Alt : Emer g 406728934 3 888728934 3 QWEST 2 QWES T LON GDISTANC E 

### SAR A Day : Alt : Emerg " 800283423 7 303992192 6 800283423 7



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/22/200 8

# As-Buil t Drawin g A
COASTA L 

# Omah aLea dSuperfun dMte

Name:^S^iq,!eA^M t Omah a Lea d Sit e 

### Date : Cf^ (CI/Q S Nort h Arro w Address : ^7^ 1 -T^^I/U^ T SKe Sketc h Time - , Phone : :^^U 7 - UV/c Z 

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# D S o d Rock/Mulc h 

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

## Name:'S^gllOj^^ ^ Omah a Lea d Sit e Dat e 

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COASTA L ENVIRONMENTA L C * O U P
. IN C 

## 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 Agency(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 : 

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# ^¥^S ^ Owner' s Name : ^1^^^ ^ M^/H I 0 Daytim e Phone :

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

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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 byUSEPA , 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 EPAtha t th e propert y ha 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 l 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 f 2•*»•* % 

### I 

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# M ^ COASTA L ENVIRONMENTA L C • O U P
. IN C 

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•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 necessar ysubsequen 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 yofth 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 (712 ) 352-018 8



# U ^ I gran t acces s t o m ypropertie s • I d o no t gran t acces s t o m ypropertie s 

# m 4 Signatur e Date Signatur e Date

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

## Restoratio n Agreemen t Th e purpos e of thi s agreement is t o provide amutua l agreement as t o condition s ofth e propert y prior t

o remediationactivities
. Thi s will als o serv e as documentatio nfo r the purpos e of assuring tha t restoratio n activitie s ar e complete dt o the satisfactio nofth e propert> ' owne r an dthe Unite dState s Environmenta l ProtectionAgenc y (EPA)
. Propert y ID : 

# 11T3 T Propert yAddress : 

### Owner : / ^ U A t \C K

y V \i O 

### Phone : O

nthe attacheddiagram(s ) indicat e area(s ) t o excavatedan ddept ho f excavation , locatio no f al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dth e directionof North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencing th e photo-lo g numbe r wit ha narrow indicating directiono f view
. Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona i sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : 

# y o y ^ Item : ^ Item : / item : 7 

# y Item : 

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# y y Item : 

# y Item : 

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—­ / > 

## c l 

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# y Item : | Item : / Item : / Item : Item : / Item : / Item : Item : 

# 7 Item : Item : Item : Item : / Item : / Item : / /

Pag e 2 o f ^ 

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# S y > ( 

# f x 0 ^ Item : Item : < ; 

# y f l f z / / Item : / Item : / • Item : Item : / Item : / Item : / Item : / Item : / Item : / Item : / I Item : / Item : / 

# I
Pag e 3 

# y—o C O A5 TAL K M •IKOMMtNTA L a M O U rIM C 

### Landscap e Inventory (Us e additiona l sheet s a s necessary ) 

## Ite m

Pre-existin g propert y area , tha t will b e excavated , tha t i s covere dwit hgrass .

Number of tree s > 2 inc h trun k

diamete r

Numbe r of tree s < = 2 inch trun k

diamete r

Number of Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attachasketc ho f th e sprinkler layout
.

Number of an dsize o f eac hgarden / flowe r bed area . Attachasketcho f relativ e size s an dlocations
. 

## Quantit y 

# 9 ^ 

# y

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## Condition/Type/Specie s

Eac h • ^

Eac h

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Pag e 

### 4 o f 6 ^COASTA L (MVIMOMMtMTA l C *> O U rtM C 

## Item Agree dupo nvalu e o f Dian t material s no t t

o b e renlace dbv contractor . Not e thi s valu e will b e usedto issu e aplan t vouche r t o th e propert y owner . Agree duponlis t o f plan t material s tha t will be replace db y contractor . B e ver y specifi c an ddetailed
. Include asketc ho f wer e eachplan t wil l b e placed b

y th e contractor . Agreeduponare aof propert y t o be replace d wit hgras s sod
. Include asketcho f the area(s ) to b e replace dwit h gras s sod
.
Are aof Cit y o r Count y propert y to b e landscape d pe

r their requirements
. Include asketchof the are a(s )

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## Quantity

^ ' 

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^ Eac h 

# y S F 

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. 

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.


### Additk>na] Comment s / Instructions : 

# ^cyc.p ^ ^-^'^ ^ ^""" ^ ^ ^ /loi / r y f d^

G Chec k th e bo xi f Owne rdoe s rio 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 boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , indudin g foundation cracks o rfissures.

Q I agre e -- ^ j • I d o no t agre e 

# ^yy y y y 'frmvois'"y.ir ^ Owner' s statur e - ^ Dat e Contractor' s Signature T)at e Pag e 6 of
.Dat e Projec t XRFID #

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# ib t .Qf..H«tn.q \ Dept h 

### .-Q(o3 l 99-13 1 ^.u q Dept h VT

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Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e
Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e

RETES T AREA S Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h ^..-" ^ Dept h 

# yy Averag e La b resul t Sampl e are a XR F Avg
. Signature
_ 

# Prin t MfH ^

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 102.24 9 Supervise d By : 

## Certificat e o f Verificatio n

267 4 SOI L 2008-11-0 6 15:3 1 30.9 0 Fina l 1410 5 327 1 sprin g s t F l Ventr y 6 CLEARANC E

± Erro r ± 12.77 8

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 267 5 Mod e SOI L Tim e 2008-11-0 6 15:3 2 Duratio n 30.4 4 Sequenc e Fina l Flag s BVI D # 1410 5 ADDRES S 327 1 sprin g s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 25.02 0 ± 7.68 7 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 25.88 4 Supervise d By : 

## Certificat e o f Verificatio n

267 6 SOI L 2008-11-0 6 15:3 2 31.1 6 Fina l 1410 5 327 1 sprin g s t F l Ventr y 6 CLEARANC E

± Erro r ± 7.91 2

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 170.30 3 Supervise d By : 

## Certificat e o f Verificatio n

267 7 SOI L 2008-11-0 6 15:3 3 30.9 2 Fina l 1410 5 327 1 sprin g s t F l Ventr y 6 CLEARANC E

± Erro r ± 16.46 9

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 267 8 Mod e SOI L Tim e 2008-11-0 6 15:3 3 Duratio n 123.4 2 Sequenc e Fina l Flag s AVERAG E Av g o f 2674-267 7 ADDRES S 327 1 sprin g s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 80.86 4 ±11.21 1 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 64.33 1 Supervise d By : 

## Certificat e o f Verificatio n

267 9 SOI L 2008-11-0 6 15:3 4 31.1 9 Fina l 1410 5 327 1 sprin g s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 10.71 1

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 268 0 Mod e SOI L Tim e 2008-11-0 6 15:3 5 Duratio n 31.2 8 Sequenc e Fina l Flag s BVI D # 1410 5 ADDRES S 327 1 sprin g s t QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m± Erro r P b 83.80 8 ± 11.78 1 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 22.73 3 Supervise d By : 

## Certificat e o f Verificatio n

268 1 SOI L 2008-11-0 6 15:3 6 30.9 7 Fina l 1410 5 327 1 sprin g s t D Z Ventr y 1 3 CLEARANC E

± Erro r 7.48 9

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 22.16 0 Supervise d By : 

## Certificat e o f Verificatio n

268 2 SOI L 2008-11-0 6 15:3 6 31.1 9 Fina l 1410 5 327 1 sprin g s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 7.43 0

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 268 3 Mod e SOI L Tim e 2008-11-0 6 15:3 6 Duratio n 124.6 3 Sequenc e Fina l Flag s AVERAG E Av g o f 2679-268 2 ADDRES S 327 1 sprin g s t QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 48.25 8 ± 9.35 3 Supervise d By :

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. 

# (M l www.coasta l hazmat.co m COASTA L [NVItONHENTA L C I I 0 U f
. INC
. 

# EXECUTIV ESUMMARY : BVI D #1410 5 - (327 1 SPRIN GST )
I I N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation:

# ^^EP A EP A Propert y Clos e Ou t For m Propert y ff : Date/Tine : /^./.D/S ^ Propert y Address-.

­ '3.^7 ( 7^ ^ ^ Owner' s Name:
. /j^..,,,

- -^^
. . _. j
. MX"
. i i Z• . Quad s Excavated : F 7 P ^ Contracto r Grou p Excavatio n Genera l Ye s N o 1
. I f necessary , were th e correc t quadrant{s ) excavate dan drestored ? 

# y 2
. I f necessary , were th e correc l area s ofdri p zon e excavaie dan drestored ? 

## y Gradin g So dan dVegetatio n Ye s N o 1
.

Doe s the gradin g aroun dthe perimeier ofth e hous e i nexcavaie darea s generally slop e awa y 

### y fromthe house ? 2
.Ha s sodbee nlai di n all area s tha t wer e excavated ? 

## y 3
.

Doc s the so dappear t

o be generally healdiy an dgrowing ? (Only evaluate i f inspecteda t a3 0 day tim e period ) 4
.Are soddedarea s generall y firman devenl y graded ? 5Are th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate i f inspecte da t a3 0 da y time period) 6
.Wa s the propert y grade dsuc htha t wate r wil l no l poo l o nthe property ? 

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

## y Gates , Fence s an d ReUinin g Wall s Yes N o 1
.D o gate s ope n an d clos e freely? (Ifapplicable ) 

# y 2
.

Wer e al l gate s o rfence s take n dow n durin g restoratio n acliviiie s reinstalled ? (Ifapplicable ) y 3
.Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

## y A
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , Sidin g an d Gutter s 1
. Wa s damag e t o di e sidin g o rtri m avoided ? 2
. Wa s damag e t o th e foundatio n avoided ? 3
. Wa s damag e t o window s avoided ? Yes 

## y 

# y y N o

4 Wa s damag e t o window s o rdoo rscreen s avoided ? • ^ 5
. Wa s damag e t o downspout s o rdownspou l extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) 1 Was damage t o driveway surface s avoided ? Yes 

## y N o
2
. Wa s damage to walkwa y surface s avoided ? 

## y

## Oviner s comments :

Inspectio nnotes :

Remova l an dreslorationactivate s complet e includin g th e 30-da y sodwarranty : EP A Representaliv^^^^?:^!^ ^ .^^ ^ Dale : /y/y/o f

## Propert yCompletio n Agreemen t
Thi s agieemen i document s th e completio n o t remedia l activitie s performe d o n m yproperl yM ysignalur e wil l designat e tha t i a m satisfie d wit h th e restoratio n o f m yproperty , an d tha i n o item s ar e i n questions , now , o ra l an ytim e i n th e future , excep t thos e item s liste d below , ifan y

Propert yID : 

# 'A\< y Propert y Address : ^ ^ I S^n ^ r^C^

_St ^ 

## Q""^"Uo^V^\c ^ ^
. g.CA>-oy \ Phone : 

# SBv-s^u Q Restoratio n Item s i n Question :

Item : / >^^vj/-fr»/*/^i< a Sao A'r^.^c^L..t/'ifr f Spnritf
. J U ' ' - 1 Item : Item : Item : Item : Item :

ve e re.<itoralio n ivcomplcled , cxccp l a s nole d I I rio no l aijre crestoratio n \ s complete d 

# yyyy y Kn hi r OWiici ^ Si g Contractor' s Signatur e Dat e ^-- ^ Dal e I