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

# , : L^ M Date : \\' ^ \u\ 0 Address : ^ ^ t^^^^^ ^ ^ ^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200 & SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S ( /

Vide o o f property (DVD ) \ ^ ' tyoCf^^il< ^ M Executiv e Summar y s /

EPA-providedproperty sketch i ZSigne dAcces s Agreemen t for subjec t propert y -£ ' Signe dAcces s Agreement(s ) for adjacen t propert y S

/ Restoratio nAgreemen t <3
- Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) -B " Confirmatio ndat a 

### B

/ Photograph s \Vc ' tT^^^V.&v [ i c f^^A^fttlt^ ^ s /

As-built sketch 0 Satisfactor y restoratio nsignedb y Propert y Owner ^ 

### Propert y close-out check lis t signedb y EP A -B
- Descriptio no f area s not meetin g ROD cleanup criteri a 0 Utilit y clearance s aPropert y informatio nfro mDougla s Count y Assessor' s Office

3005525 8 

# M l Superfun d

### Propert yAcces s Checklis t Propc,T,ID:/^q^Oq f D WORKSTAJlTtD O N / / PropcmAddre»:f3|H<2 ^ ^)o,^ ^ ^ ^ D WOR K

COMPELTE D ON : Rcnier . 0>vnc. : Xctphn ^ N'ippfi. r Addres s Phone : 

### *5cirr\je . PiLv : Cell/Pager : 

### Phone : 5Q5^-L^<^; D Additiona l Inlnrmiition ; F<-i : CclL/Page n D Notificiitio n L«llc r Sent : / / By : E fAcces s Agreemen t 

### Signed : % / 22. 1 0 1 B> - flOdaKA O [ 0 ResiomtlO D Agreemen t 

### Signed : 8-^22/13 9 

## ^y\ftr\-W\ f 1 O Topsoi l Samplin g (i f applicuble ) 

### / / By :
•Disposa l Samplin g ( Kapplicable ) 

### / / By : D Ciirdc n Samplio g (i f applicable ) 

### / / By : - ^ Utilit yClearanc e 

### Called : J^/^/C ^ By : P Video/Phofo s (Before ) On : / J By :
•Video/Photo s (During ) On : / / By : n VIdeo/Pholo s (Aher ) On : / / By : D Video/Photo s (30-Day ) On : / / By :
• ^C^Propcrt yCompletio n Agreemen t Sifncd : f ^

/

'Z - /^ ^ By : D Fina l Repo n Issued ; / / By : Ai rMonitorin g (* s applicable )

D Communit y [~ ) Cre w / / By : RciiuJis : D Comrouniti ' C D Cre w On : / / Bv : Remits : D Communir i D Crv^ y On : / / Results :
Omati a Lea d Sit e

## CONTACT FOR M Propert y I D #toM^D ^ Propert y Address : 

# ^)H S R]nn^( ^ <;4
- Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action: _ Fina l Contact : Date : Time : Action : Fina l Action : Transmit to EP AD Other Action : D

Comment : Owner Comment (s) : Site Coordinato r Comment (s) :

### Dougla s County Accoimt InfonjMdo n Pag e 1 of 3 ril|i c Dougla s County , Nebrask a Propert yRecor d - R084290000 0 Prin t Repor t NE WFaatur e - Parce l Dimension s avaiiabi e 1 ^ scal e 0-5 0 ft wes t o f52n d S t - VlOWO n Ma p Informatio n i s vali d a s o f2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e ^ - » ^ Aut o Sale s Searc h Owne r NIPPE R ZAGHAR YG 5143BL0ND0S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 429 0 OOO O 0 8 Accoun t Type : Residentia l Parce l Number : 084290000 0 Parce l Address : 514 3 BLOND O S T OMAH AN E 68104-000 0 Lega l Description : COUNTR YCLU B DIS TLO T1 0 BLOC K2 3 5 5 X 11 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $13,600.0 0 $134,400.0 0 $148,000.0 0 200 8 $13,600.0 0 $134,400.0 0 $148,000.0 0 200 7 $13,600.0 0 $134,400.0 0 $148,000.0 0 200 6 $13,600.0 0 $134,400.0 0 $148,000.0 0 200 5 $13,600.0 0 $134,400.0 0 $148,000.0 0 200 4 $15,100.0 0 $87,500.0 0 $102,600.0 0 Sale s Informatio n Sale s Date : 2002-09-2 3 Dee d Type : W D Book : 222 2 Page : 55 5 Price : $113,000.0 0 Grantor : Grantee : Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 1998-12-3 0 Dee d Type : D Book : 211 5 Page : 42 6 Price : $113,000.0 0 Grantor : 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accotmtno=R08. . . 8/14/200 9

### Dougla s County Accoun t Inforn^io n Pag e 2 o f 3 rn^ K 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 3 6050. 0 1. 0 110. 0 55. 0 N o Lan d Attribute s Attribut e Attribut e Descriptio n Negativ e Influenc e Traffi c1 Improvemen t Informatio n Buildin g 1 1 1/ 2 Stor yFi n 514 3 Blond e S t

WHeCta * tasg n

a » avundFtau r 45tC5 q F T •O f aor . MHC M i?( r2 0 IS O S a n it o U B : B O « • 1 aitnaip i

CLIC KTO ENLARG E IMAG E aai»ip*wW H CLIC KTO ENLARG E JMAG E Squar e Footage : ! 1480. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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 : 5. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : 3. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : 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 192 9 0 % 192 9 8 0 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Woo d 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.. . 8/14/200 9

## Dougla s Count y Accoun t Infornutio n Pag e 3 of 3 rn^ c Applianc e Applianc e Applianc e Basemen t Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Porc h Use r Allowanc e Fireplac e Masonr y SecuritySyste m Bsmn t Bloc k 8 ft Finishe d Bas e Fixture s Bat h Ful l Attache d Ope n Sla b Sla b w/Step s Woo d Dec k Traffi c 1. 0 1. 0 1. 0 1024. 0 450. 0 1. 0 3. 0 180. 0 144. 0

96. 0 120. 0 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.. . 8/14/2009

### Pag e 1 o f 1

[ Creat e AnotherTicket__j] [ _jagk.to^lilllJntjenri-Q l .-_. | } [ Sen d Emai l J



### • YOURTICKE T NUMBE RI S 2348616 . Origina l Cal l Date : Q/2i/0 9 Time : 5:4 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/26/0 9 Time : 6:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 514 3 Street : BLOND O S T Twp : 15 NRng : 13 E Sect-Qtr : 07-SE-SW,18-NE-N W Twp : 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 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 : (877)662-421 1 : UNSUR E O F CORNE R LOT S 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 Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 http://wwvi^.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 8/24/200 9

# • • ^ ( PAs-Buil t Drawin g ^ ^ COASTA L 

# Omah aLea dSuperfun dSit e
6480 9 Omah a Lea d Sit e Exteno rPain t Nort h Arro w Sit e Sketc h • Goo d |~ | Poo r Samplin g Address : 514 3 BLOND O S T [ 3 No t pain t Sampl e Numbe r Lea d Sampl e L A B Sample s Collecte d Concentratio n Collecte d Fimi ; F^ APg-A J RYASCPXA-64S0 9 F l pp m 

# n Date : /,-g-<?' 7 RYBSCPXA-6480 9 F 2 *1 1 o pp m 

# n Tim e I P 1 3 A M RYCSCPXA-6480 9 B 1 I H pp m 

### D 

# i Sample s Analyze d RYDSCPXA-6480 9 B 2 1-12 . pp m 

### D RDZSCPXA-6480 9 D Z 2.<^2 . pp m 

### E f 

# n XR F Unit : IDSfo'Z . Book : Z H / ROZSCnX A6480 0 Ggr - pp m 

### D 

# n Date : 

### 7-o^-g ? RP2SCPX A6'180 0 -432 . 

### — pp m 

# n Tim e 

# n Staff : 

### /^<v^ / Numbe ro f Sample s = | £ > \ \ Q | Legend : F l = Fron t Left . F 2 = Fron t Right . B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A l quadrant s ar e a s vie>A« d fro m th e street , facin g propert y OLS#:6480 9



### Legen d 

# • m 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 

### Contract ; # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

### 6480 9 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e SIcetc h • Poo r Samplin g Address : 514 3 BLOND O ST 1 3 Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm . FP APg-A, 7 RYASCPXA-64e0 9 F l pp m 

### D Dat e A-g-g- ? RYBSCPXA-648a 9 F 2 H I O pp m 

### D Tim e II - 1 5 A M RYCSCPXA-6480 9 B 1 

## i y _ pp m 

### D Sample s Analyze d RYDSCPXA-6480 9 B 2 

### \i z pp m 

### D RDZSCPXA-6480 9 D Z pp m 

### S i D XR F Unit : ID8fe ^ Bool < ZH I RCZSCPX A6<1800 Sg - pp m 

### a Dat e 7 - OZ-O f 

# n RPZ6CPX AfiiiaOO PS - pp m 

### D D Time : Pr n Staf f Numt^e ro fSample s = | 5 I | Q | 

# n w Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A l quadrant s ar e a s viewe d fro m th e street , facin g prcpert y

2 . 

# I'

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### 6480 9 Omah a Lea d Sit e Sit e Sl(etc h Samplin g Address : 5 1 i 3 BLOND O S T Exteno rPaint n Goo d • Poo r ( 3 No t pain t No^r i Arro w

Sampl e Numbe r f?vASCPXA-e4ao 9 RYBSCPXA-64e0 8 RYCSCPXA-6480 9 RYDSCPXA-6480 9 RDZSCPXA-6480 9 nCZGGPX A6460 0 I^PgSCPX AS'lBQO Lea d Concentratio n

tt» ^ pp m Hi O pp m

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Numbe rofSample s = $ Sample s Collecte d ft> APg-A. T 11
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Dat e 7 ­ OZ-Q ? Tim e Pf ^ Staf fn^w Legend : F 1 = Fron t Left . F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden . P Z = A J ouadranf s ar

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## 6480 9 Omah a Lea d Sit e Exterio rPam t Nort h AiTo w Stt e Sketc h • Goo d n Poo r Samplin g Addratt : 514 3 BLOND O S T Q No t pain t Sampl e Numbe r Lea d Sampl e Samples Collecte d 

# I I LA B Concentratio n Collected Fimi : F=J> AMAr r RYASCPXA-€4809 F l pp m 

### D Date : A-e-t? T RyBSCPXA-6480 9 F 2 **' 0 pp m 

### D Time : l|:1 5 A M RYCSCPXA-64809 B 1 

### U L - pp m 

### D Samples Analyzed RYDSCPXA-64809 B 2 pp m 

### D RDZSCPXA-64809 D Z pp m 

### D 2^2 . XR F Unit : lOBfi ABook: 2*1 1 nOZeOPX A64800—62 - pp m 

### D Date : 7.02-0 ? 

### D RPZeCPX A6<I80 0 PZ- pp m 

### D Time : 

### P ^ 

### D Staff: . 

### Al W Numbe ro fSample s = | $ \ \ Q | Legend : F 1 = Front Left , F 2 = Front Right , B 1 = Bac k Left , B 2 = Back Right D Z = Dri p Zone , GZ = Garden , P Z = Pla y A l qmctait t ar e u viewe d fro m tt wstreet , fadn g propert y

/

RwSIO t Croud : tO-F«l>4 »COASTA L INVfRONHEHTA L C I 0 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 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 :

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 , ^N\\ \ contac t th e Granto rin-perso n t o discus s th e wor k t o b e perfomied , 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 y ha s bee n remediated . ENVIRONMENTA L RESPONS 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 fperfomnln 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 f2,! , ,•<' " »r< f

>COASTA L • >•< P ENViaONHENTt L

" t PRO'' * 5 a o u r . I Kc 

### e Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e 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 ; e

Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; e I fth 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 fth 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 fth e wor k activities , o rwit h an y o fth 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 fsai d propert ywhic 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 you hav e an yquestion s abou t thi s program , pleas e contac t Coastal Environmenta l Group , a t (402 ) 991-119 9

[

^

gran t access t o m ypropertie s D I d o not gran t access t o m ypropertie s 

# s-n: ^ Signatur e

Dat e
G 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 f2COASTA L c * o u p -M r 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e properl y prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : 

### Q^ H Propert y Address : ^{4 ^ ^ LV HO O ^ X Owner : ZA<H*^A ^ 

### Ki^(?p«5V ^ I Phone ; ^ O I
- ^Yf e 4 t 1 Q O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y an dVideographicsJl y documen t th e existin g condition s ofth e property an dth e basemen t i f necessary . 

## Item s t o b e Remove db y th e Owner before Start o

f

Remediation : Th e lenoval . stora.ge , oi&posal , and/o rretur n o f thes e item s I s th e Owner' s responsibility . Item : 

# Am ^ 3yyanJ i plQ^) ^ Kem : Item : Item :



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d Mo t Replace d Kem : 

# AyNv ^ ^m^ Wpl0>fi ^ Wf t U>.V\\K ^ item : Item : Kem :

Pag e 1o f - ^COASTA L 

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

# ^ \ V 

# -^", 

# V z Hem : 

# S/1 0 fi F: ^ Kem : Item : 

### Landscap e Inventor y (tern Quantit y Unit Condition/Type/Specie s Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwithgrass . 1 Numbe r o f tree s > 2 inc h trun k diamete r 

# F2 . Quadrant s Eac h Numbe r o f tree s < = 2 inc h trun k diamete r Eac h Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Aiiat h.- I skcic hol th e Eac h

Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Alliith; i skcicl i 1) 1 a-!;ilivi. ' ' ^i/i' S mi dloc;ili(iM' . Fjjrh Squar e Fee t Agree dupo nvalu e o f plan t material s no t t o b e replace db y contractor . i

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### < Additiona l Comment s / Instructions :

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• 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 preexistin g damage . B ycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o th e interio rofhouse , includin g foundatio n crack s o rfissures .



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## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www.coa8talhazmat.co m COASTA L eNVmONHIIITA l g n o u p , IN C 

# EXECUTIV ESUMMARY : BVID #64809-(514 3 BLOND O S T ) No Issue s o r Concern s | ^ Issues/Concern s Detai l Explanatio n

### S» L 

# E P A EPAPropert y Clos e Ou t For m Propert y # : UMgCjf l „ Propert y Address : Date/Time : Owner' s Name : Quad s Excavated ; ^\^2 ^ Contracto r Grou p Ye s N o Excavatio nGenera l 1 . i f necessuy , were th e correc t quadrant(s ) excavate dan drestored ? U ' " 

# T:; ^ 2 .If necessary , were th e correc t area s o f drip zon e excavate dandrestored ? Gradin g So dan dVegetatio n Ye s N p 1 .Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y fromth e house ? , ^ ^ 2 .Ha s so dbee nlai dL nail area s tha t wer e excavated ? 3 .

Doe s the so dappear to b e generally healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 

# V day time period )^__ _ 4 .

Ar e soddedarea s generall y fu man devenly graded ? 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 tim e period) ____ . 

# V ' 6 .Wa s the propert y grade dsuchtha t wate r will no t poo l o nthe property'* ! 

# 17 ' L^ ^ 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wail s Ye s N o 1 .

D o gate s ope nan dclos e freely? (If applicable ) I .Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinsulled ? (If applicable ) 

# V 3 .Wa s damage t o gate s or fence s avoided ? (If applicable ) 

# 1^ ^ 4 .Wa s damage t o retainin g wall s avoided ? (If applicable ) Foupdation , Sidin g an dGmicr s Ye s N o I .Wa s damage t o th e sidmg o r tri mavoided ? ^ 2 . Wa s damage to the foundationavoided ? 

### l y 7. Wa s damag e to window s avoided ? 1 / 4 . Wa s damage to window s o r doo r screen s avoided ? L / ^ 5 . Wa s damage t o downspout s or downspoul extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) 

### Ye s j( o 1 .Wa s damag e l o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ?

## Ov*'ners comments :

Inspectio nnotes :

Remova l an drestoratiop-ii^livate s complete i^cli|din g the 30-da y so dwarranty : EP ARepresentativ e LJCP ^ / >?/^ic ^ Date : /t)/ ] / O f

## Propert yCompletio n Agreemen t Tills agreement docuinenl s th e completio no f remedial activilie s perlbrmec l o nm y property . M y siginKur e wil l designat e Iha t I amsalislie dwit hth e restoratio no f m y property , an dtha t n o item s ar e i nqucstion.s , nnw , o r at

any tim e i nth e fulure , excep t thos e ilem s liste dbelow , ifany . Piopc t t yII) : /^ q <go ^ 

### I'ropcrt y Address : y| M 3 ^UrvD o S- V Owner : 'ZoLfJrvfpu- v 

# ^^^£ = J'honc : 

# Moa-s^?-qqi o Restoratio n Item s i n Question :

Item : 

# < 6 d

# /^ o 

# f<i ^ L t ^ o *-•/ ? ( C^C C ^ 

### ' n fyi^^ c Item : Item : Item : Hem : Item : Additiona l Comments : 

## -j—-'^
- ^'t ? ^ ^ ^ ^ ^ l<^ t ^^ ^ Cel l S'O ^ S'lyr^l^ J 

# L 

# J

TJNf cI ajirc crrstoratio n i s completed , excep t a s note d I I I d o no l agre e restoratio n i< s complete d

Ownciw xSiRnnhir c 's Signature Date Contmcrof' s Sii^natiir c ' Date