TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: /gy/7 

Date: 3/n)jkJoe> 

Address: 

Remediation Contractor: Coastal Environmental Group Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Stiramary 

y EPA-provided property sketch 

Signed Access Agreement for subject property 

D Si^ed Access Agreement(s) for adjacent property 

V^ Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

Y Confirmation data 

Y Photographs bmjf j ^ nanflY*. ^ cVrl^ ^ ­

y As-built sketch 

Y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA iy-^iff^^^YD "J 

•a Description ofareas not meeting ROD cleanup criteria 

/ 

Utility clearances 

Property information from Douglas Coimty Assessor's Office 

Y 

Y 

D 

3/iiJjma 

signature 

40317138 

Superfund 
Final Report Property Check List (Pieasc place with each

H^r d Cop y Informatio n

A . Property Check List j 

Y ^ Site Woricing Drawing Map 

-1. EPA originals Map 

'• ^ Douglas County Assessor's Map 

^ Property Contact Sheet 

A«»reemcnt 

y\. Access Agiecmcnl 

^^^Restoration Agreement 

IMisceltaneous Documents 

1, Final Map from the Field 

^.^^hange Orders 

^^rXRF Data 

y4^Any emails or PO a)rresp()ndences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

^ . Property Completion Agreement 

(0^ Any buyout info or reiinbursement info 

WT'heck or inoney order copies 

jZ.J^.Vt\ Property Close Out Form 

-^^^Attached Begin Video 

Electroni c Documentatio n 

Drawings 

\^ EPA original 

*S^ Working Drawing 

r " AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

' X;^ During/Excavation Photos 

X ^ Sod Photos 

\ 30-Day Sod Photos 

Scanned Documents 

' Final Documents 

 Executive Summary 

Videos 

Begin Video 

My Movie 

file) j 

 /i nCL ^ ::)^0'^ 

^ O'' ^ ^ ^ ' 

2
( » > 

Property Access Checklist 

Property ID: 7M7T 

D WORK STARTED ON: / / 

Property Address: yd^ ;^g_ <^ X) ^ C . P 

n WORKCOMPELTED ON: / /" 

Renter: pOyJxS' a .Address 

Phone: i;^/);^) J^ ^ ^ ^,/5>p. 

Fax: 

Cell/Pa"er: 

L ^ Notification Letter 

L ® .Access .\}:ieenient 

j<1 Restoration Agreement 

j O Topsful .Sampling (if applic Ihle) 

I n Disposal Samplinji (if applii :ahle) 

O Garden Sampling (If applic ahle) 

-H ' I'tility Clearance 

SSi Nideo/Photos (Before) 

• Video/Photos (Durinj;) 

• V ideo/Photos (After) 

n Nideo/Photos (30-Day) 

• Property Completion Agreement 

1 1 Final Report 

.Air Monltorin<i (as applicahle) 

O Community n CrcM i On:

Results:

1 1 Community n Ci-e» On:

1 Results: 

n Community D Crew On:

Results:

_ Phone: 

Fax: 

Cell/Pa<;er: 

.Additional Informvition: 

Sent:^/^/^* ^ B>: Ctf ^

 \ 

Sisjned:^/; ^ iOl - By: akar^

 i 

Y\'zni^a:Q_&0 /0 > B>: a^ei-s i 

/ / By: 1 

/ B>: [ 

/ / Bv: • 

Called:/^/A/d ^ B>: JoJs^/^Bo Z'Zd3^Z^ 

On:^:J> ^ O-^ By \^CrtS'Cutr' i 

On: 

By: 

On: / / By 

i 

On: B\. 

* 

Signed: / / By 

Issued: / / By 

/ ! B>: 

1 

/ / 1 

1 

/ / . IB> : i 

I 

Omaha Lead Site 
Douglas County Account lnfi|Mjation [asme Page 1 of 3 

Dougla s County , Nebrask a Propert y Recor d ­ R073444000 0 

Information is valid as of 2007-8-24 

Values not finalized until after Board of Equalization Treasurer' 

Print Report 

View on Map 

s Tax Report 

Owne r 

PARTIDA RODOLFO 

9309 POLK ST 

OMAHA NE 68127-0000 

Propert y Informatio n 

Key Number: 

Account Type: 

3444 0000 07 

Multiple Res 

Parcel Number: 

Parcel Address: 

Legal Description: 

0734440000 

1922 S29C R 

OMAHA NE 68105-0000 

BURR OAK ADD LOT 42 BLOCK 0 50 X 150 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$0.00 

Improvement 

$83,400.00 

$26,900.00 

$26,900.00 

$26,900.00 

$26,900.00 

$0.00 

Total 

$90,200.00 

$33,700.00 

$33,700.00 

$33,700.00 

$33,700.00 

$0.00 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

2006-08-10 

WD Book: 

$0.00 

Federal Home Mortgage Corp 

Rodolfo Partida 

2006 Page: 092141 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

2006-05-18 

TRD Book: 2006 

$0.00 

LINDQUIST ERIC H 

FEDERAL HOME LOAN MORTGAGES CORP 

Page: 063855 

Sales Date: 

Deed Type: 

1996-01-25 

D Book: 2024 Page: 406 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountao=R07... 9/26/2007 
Douglas County Account Infiajmatio iaaric n Page 2 of 3 

Price: $30,000.00 

Grantor: 

Grantee: 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.17 7500.0 50.0 1.0 150.0 50.0 No 

Lan d Attribute s 

Attribute Attribute Description 

Negative Influence Traffic 0 

Improvemen t Informatio n 

Building 1 

Meiium Wood Dect. 

s a 3B0' 

T2tr 12D­

/ 5 0 Second ROOT io- First Floor ^} 998 0 sq.ft. { 998.0 sq.ft. 

iorr irrr 

:ieo 

jnir offl SiahRoofC-rf ! ; 198 0sq (t I 

2 STORY 038 0 ^ tt 

Ul|.IJI)l.l»I.I.M.l.BMH.-W.III.'U'F^3iaa-! 

Click to Enlarge Image Click to Enlarge Image 

Square Footage: 1996.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Fair 

Owner Occupied: No Condo Square Footage: 0.0 

Built As: 2 1/2 Story Unfin Rooms: 8.0 

HVAC: Central Air to Air Units: 2.0 

Exterior: Frame Siding Baths: 2.0 

Interior: Drywall Bedrooms: 4.0 

Roof Cover: Composition Shingle Stories: 2.0 

Roof Type: Hip Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1910 0% 1910 97 

Detail Type Detail Description Units 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountao=R07... 9/26/2007 
Douglas County Account Infiamation Page 3 of 3 iataacia 

1 Appliance 

Basement 

Basement 

Fixture 

Fixture 

Fixture 

1 Porch 

Porch 

User 

1 User 

Allowance 

Bsmnt Block 8 ft 

Walkout 

Additional Fixtures 

Base Fixtures 

Bath Full 

Slab Roof Ceil 

Wood Deck 

Apartments 

1-80 noise 

1.0 1 

998.0 

1.0 1 

1.0 1 

1.0 

2.0 1 

198.0 

300.0 1 

2.0 1 

1.0 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 9/26/2007 
^l^^-L 

^i^^ I V Q p^kK Total Quad^^Square Footage to be Excavated =1319 

Property Classification: 800 Total D^^^ne Linear Footaqe to be Excavated = 79 

\P\0^ 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant. Bl. backyard left-hand quadrant, B2, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation ofthe house). 
CONTACT FORM 

Property ID # miL 

Property 

Address: y/y? Y pyYrr 

Initial Contact: Date: 9/-^/<:)>Time: Action: flfp^ 

Second Contact: Date: Time: Action: ^' 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
COASTA L ENVINONMINTA L 

CROUP . IN C 

Consent For Acces s To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environmental Protection Agency (EPA) or Its authorized representatives, collectively 

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

following described premises: 

'^o7)Z<yFtO

Owner's Name: Daytime Phone: JO ^ ' C>^ Q 2 . 

Z^£T/ZX ^ 

Address of Property 

covered by this /•^Z^ Y> Y?(^/ ^ 

Agreement: 

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 performed, 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 ENVIRONMENTA L 

CROU P IN 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; 

• Water and maintain replacement vegetation. Including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• 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. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT T O INTERFERE 

The Grantor agrees not to Interfere or tamper with any ofthe 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 (877) 234-6270. 

C^S-J grant access to my properties 

• I do not grant access to my properties 

£ = ^ 3JAI oiz. Sign 

Date Signature Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property' prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property owner and the United Slates Environmental 

Protection Agency (EPA). 

PropertylD: j "Y) ^ Z 

Property Address: /^/; 7 <, f6 f C// P 

Owner: ^ QjyQ ^f^^ ) Tkr^^YTTA 

Phone /yo7')^<y:^'^^7^ 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e.xcavation. location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

\}e^^^Tz^^c>>^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

\}m^TAr^oJ y 

Item: 

l-c<c ^ 

Item: 

|^AiLi2QMTig 5 

Item: 

bJca i y IV "P(LATFO ^ \Y 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

3c^ 

5Q>IL/ , 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

-

Item: 

Item: 

1 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diaineter 

Number of Sprinkler 

Zones. Control Valves. 

Timers, Heads, etc. 

.Anach a sketch of the 

sprinkler la\oui. 

Number of and size of 

each garden/ flower bed 

area. 

,-\uacli a sketch of relaii\e 

^izes and locations. 

Square feet /3f3 

P Each 

Each 

ZZ Each 

I 

Each 

Square Feet 

1 

Page 4 of 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

\ouche r to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketcli of were 

each plant will be placed 

b_\ the contraclor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a skeich of liic 

area(s) to be I'eplaced \\ith 

gras,s sod. 

Area of City or County 

propert>' to be landscaped 

per their requirements. 

Include a vkeicli ol ;hc 

ai-ea (s) 

Easement ,Area. to be 

excavated 

0 $ 

^ 

Each 

• 

SF 

1 

SF 

SF 

Page 5of. 
COASTA L ENVIRONMENTA L 

CROUP , INC . 

Additiona itionall Comment Commentss // Instructions Instructions:: r<'A4^^rz> _ ry//^-Y&^ ^ 7-^ A..0>T7^^ , ^ 

yhicj ^£OAjh e^i7^^y/^ y / ^ y^'^r2 - <^^^ 

y^Hyi<»y- p.^rm'^'^^ ^ Lfyt>yy^y ^ 

/>^ 5 <j<:n- (^^^^y-^; ^-^ ^ 72<oYyie^ 

UJ. 

-L }AJt T-^^T^^MT^A^. ^ 

• Check the box if Ovi/ner does not w/ant CEG to docunnent interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

'iQ^I agree un I do not agree 

^o/c> y « - ^ M27 Owner's Signature Date Contractor's Signature Date y < 

Page 6 of 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID lO-llo-bl 4^/&^/-7 

Property Project Omaha Lead — Fixed Price Address l U Z S 2"? C^A 

Measurement 

XRF ID 0107-51 Count/Time 

Field Shots 

Shot * Reading Sample Area Shot * Reading Sample Area 

733: 3 1 2 l^-^v 

i>**i\-i- £xitt2.QV 

jZil . f i '^-to 

J4 ^ M 

.Ci\f l>^J>\T 

Sample Area ^o-Si^d^i 6fts/ 

Aliquot 

1 

I n Situ 

Readinq Composite Readings 

(Bag) 

Composite 

Average 

(Baq) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 ^ i 

3 

4 

5 

^ L ^ k XRF Corrected Value - > 

(use calibration chart or add 

Hb 

^3 2 0 % to value) 

Sample Area K>7. it-H# Pass/Fai l ? 

Aliquot 

1 

I n Situ 

Readinq Composite Readings 

(Bag) 

Composite 

Average 

(Baq) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 //)V 

3 

4 

9 i 

Wv XRF Corrected Value - > 

97 

b (use calibration chart or add 

2 0 % to value) m 

Sample Area F^l M-<^ Pass/Fail ? 

Aliquot 

1 

I n Situ 

Readinq 

Gi 

Composite Readings 

(Bag) 

Composite 

Average 

(Baq) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

5 

"H 

17 

(f' i 

V 

ioi 

UL 

T ^ XRF Corrected Value --> 

(use calibration chart or add 

2 0 % to value) 

10 

38 

Sample Area \^-L l^'U Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 1^1 (Bag) Sieved) 7 

2 'Sfc ^ 3 Vfi tfCi 

4 l \ •76^ s% XRF Corrected Value - > 

5 (use calibration chart or add ^ H 2 0 % to value) 73 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 

2 

3 

4 

XRF Corrected Value-;0:__ 

5 (use calibration ch^rto r add 

2 0 % to value) y y^— -ir^ ' 

DSF AODinOHA L SHIFI S I t 

XRF Technician's Signiture KFFDFO 

\J 

L 
Page 1 of2 

» I ^ 

Create Anotfier Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 1912771. 

Original Call Date: 10/12/07 Time: 1:30 pm Op: LORI18790 


Work to Begin Date: 10/16/07 Time: 2:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1922 Street: S 29TH CIR 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD EXCAVATION 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: UNSURE IF CORNER: EXTENDING WORK 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name 

Alt. Contact 

RITA 

NONE 

Phone: (712)352-01^ 

Work Being Done For: EPA 

Depth of Excavation: 36 IN Corner Lot: Y

Involves Tunneling or Horizontal Boring : N

 Front: Y

 Explosives: N 

 Rear: Y 

CXCATV LEVEL3 MCI MCLEODNE MUD02 OMAHACOF 0PPDGPR6 


QLNNEIF QWEST2 


Service Area 

CXCATV 

LEVEL3 

MCI 

MCLEODNE

COX COMMUNICATIONS, 

INC 

LEVELS 

COMMUNICATIONS, LLC 

MCI 

 MCLEODUSA 

Contact 

HEIDI 

NA 

NO CALL PER MEMO 

DO NOT CALL OUT 

EMERGENCIES PER MEMO 

Utility Phone Number Type 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

Day: 8002893427 


Alt: 


Emerg: 8002893427 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULT... 10/12/2007 
Page 2 of 2 

MUD02 

OMAHACOF 

OPPDGPR6 

QLNNEIF

QWEST2

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

 QWEST LONG DISTANCE

EDWINA 

RON 

NA 

 NA 

 SARA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 


Emerg: 8887289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

Day: 8002834237 

Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/12/2007 
i^^^D^-o Omaha Lead Site—Fixed Price EP-R7-07-05 i(tk' ' ^^^Zo Coastal Environmental Group Inc. x^^^ r 

>T^'^T ^ www.coastalhazmat.com 

%«,oi* ^ COASTAL ENVIRONMENTAL 

C H o U P , INC . 

EXECUTIVE SUMMARY: 

18417-1922 S 29 CIR 

'x\ No Issues or Concerns [^ Issues/Concerns 

Detail Explanation 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated - 1319 

Property Classification: BOO Total Drtp Zone Linear Footage to be Excavated - 79 

Property extends 

3 feet to the West 

' t- OLS#: 18417 

Date Excavated: 10/13/07 

Date USEPA Signed Off: 12/6/07 

^;rv;;]--|ej^ffi^^|kr ^:^ivy 

South 29 Circle 

Legend North Arrow Omaha Lead Site 

Concrete Omaha. Nebraska 

ZZ Excavated Area Property Number 

OLS-18417 Existing Structm Scale 

Fence 

Property Address 1 Inch 3: 20 reet or 1 gnd « 5 x 5 ft 1922 S 29 CIR Permanent Landscaping 

Qiiadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary Fl . B2 Play Area 

F2 OZ Easement 

K.? Tree/Shrub ^: : Bl " Garden Other 

Description erf post excavation area& f 1 front yard lett hand qiAdrant F2. front yard ngfit-tiand quadrant Bl. badtyard left.tiand quadrant. B2. backyard n^ t hand quadrant. 

DZ drv zone (13 foot area of sol around ttie foundation of ttie house) 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contract: #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
SiK. EPA 

EPA Property Close Out Form 

Property #: t^Ari V Property Address: f f jj Q S SU l C,Y. 

Date/Time Owner's Name: p^.c^j^ , PrtT^f,' cl a . 

Quads Excavated: Contractor Croup f^r. c-fgt/ f^n^j: i/oO^rviertJCLI 

Excavation Yes No General 

I. If necessary, were the correct quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas of drip zone excavated and restored? Y 

Grading Sod and Vegetation Yes No 

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

y from the Iiouse? 

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

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

y day time period) 

4. Are sodded areas generally firm and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day u time period) 

6. Was the property graded such that water will not pool on the property? y 

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) A/A 

2. Were all gates or fences taken dowTi during restoration activities reinstalled? (Ifapplicable) vy 

3. Was damage to gates or fences avoided? (Ifapplicable) y 

4. Was damage to retaining walls avoided? (Ifapplicable) AJA 

Foundation, Siding and Cutters Yes No 

1. Was damage to the siding or trim avoided? y ^ 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? y 

5. Was daraage to downspouts or downspout extensions avoided? y ^ 

1 

Sidewalics and Driveways (Concrete) Yes No 

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? t y 
Owners comments: 

Inspection notes: 

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

EPA'^t^^l^s,^v^^\^^t JZY..Iy?L. Y£^r ^ UY ^ Date: /Z^ 4 J Y J 
Property Completion Agreement 

This agreement documents the compietion of remedial activities performed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the ftiture, except those items listed below, if any. 

Property ID: | 0 ^ y^J 

Property Address: 

msA ^_a5 caz 

Q-"^^= Rodol-fo pnchd c 

Phone: ^6( 0 -^A-p^ a 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I agree restoration is completed, except as noted 

I I do not agree restoration is completed 

Owner'r's Signatur Signature Dat Datee Contractor's Signature

I