-W^^-^ y •- , 7 ' yi.'"mft Tti^WFrW-^.yJ'WJU" •.^•^^''W"'' ^ J?*^.' 

TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FIL E FOLDE R 

SAID#: y27>//^ J • Date: J^//4/dB 

Address: 1^/3 N//ltdm S/" 

Remediation Contractor: _Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

\l7 Video of property (DVD) 

M Executive Summary i . 

M EPA-provided propeily sketch 

K Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

IS^ Confirmation data , 

y Photographs • '.''' • 

W^ As-built sketch 

M Satisfactory restoration signed by Property Owner 

K Property close-out check list signed by EPA 

Wr Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D . 

• ^ . •• ^ • • •- • .yy- ' 

/?yy/^^^C^'/^A;:^^ ^MI^ ^ 

ignatur^ 

40317865 

Superfund 
-^ ^ V

Q

y^ 

\ 

AFinal Report Property Check List (piease place with each file) 

Jlard Copy Information 

\ Property Check List 

• ^ Site Working Drawing Map 

^ EPA originals Map 

4 \ Douglas County Assessor's Map 

V Property Contact Sheet 

Agreement 

\V Access Agreement 

S. Restoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

Exchange Orders 

^^}CRF Data 

.Any emails or PO correspondences 

Property Completion 

Ov Executive Summary 

KJAS BUILT 

Xj'roperty Completion Agreement 

4. Any buyout info or reimbursement info 

5. Checlc or money order copies 

^^ EPA Property Close Out Fonn 

'^Attached Begin Video 

Electronic Documentation 

^Drawings 

. \ EPA original 

X. Working Drawing 

Na/^AS Built.vso 

N ^ AS Built.jpg 

Photos 

Begin Photos 

 During/Excavation Photos 

 Sod Photos 

 30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

Begin Video 

 My Movie 
' Property Access Checklist 

Proi)crty W: _c^^/ ^ oi - D WORK STARTED 

ON: / /_ 

ON: / / Property Address: /</ / Q ' j,^^ ^ -//^-^^ST ^ ^^^ ^ COMPELTKD 

Owner Renter: 

Addies.s Phone: 

Fax: 

Cell/Pawr: 

Additional Information: 

M/%L^ >^6 l/siW^ 

^yyiJ^_yyny7Lz^2s^\ 

Fax: 

Ccll/Pii"ei-: 

II' ^ Notification Letter 

<Q^ Access Aj»recmcnt 

c0 ^ Restoration Agreement 

1 1 Topsoil Samplinj; (if a|)|)Iical)lc) 

O Dispo.sal Sainplin<{ (if ap|)lical)le) 

[U Garden Samplin" (if applicable) 

]SC Utility Clearance 

" ^ Video/Photos (Before) 

1 2 Video/Photos (Duiinj;) 

Q Video/Photos (After) 

D Vi(leo/Photo.s (3(»-Day) 

S Property Completion Agreement 

n Final Repoit 

Ail- IVIoniloring (as applicable) 

O Community • Crew On: /

Results: 

II n Community O CICM On: /

Results: 

1 Cl Community Q Crov On: /

Results: 

Sent:/^/^7l^5> ­

.Signed:^/^^ ^ 

Signed:/^/^ ^ 

/ / 

/ / 

/ / 

Called:jf^/J^/^1 > 

On:/ 0 y^l^^) ^ 

On:yi_^l ^ 

On:ii_/i5/JD! ? 

On: ,/ / 

Signed: 02./J6-/-0 7 

Is.sued: / / 

/ 

/ By: 

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By: 

By: 

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B.v: %\cK 

By: 

B.v= Ch^ y 

By: 

1 

1 

Omaha Lead Site 
i• Total Quadr(^Htiuare Footage to be Excavated = 1389 Property (Classification: 800 \ Total Drii^Cne Linear Footaae to be Excavated = 0 

1 1 1 1 i t , , /?.--. /\j:>hc ^ 1 ^ 1 

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Legend NorthArrow Omaha Lead Site 1 

^i ^ Concrete Omaha, Nebraska 

y 7

^ 1

•—•— •

 Excavated Area 

 Existing Structure 

 Fence 

N 

Scale 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

Property Number 

OLS-20162 

Properly Address 

1413 WILLIAM ST I 

• uuaarant boundary Post Excavation Concentrations (ppm) 

c) 

- Street Boundary 

T ee/S hrub 

1* 1

\ "iVrto ^ y 

= Hv.,i.-,r,...,i,.,,,,! „ F1

F2 

B1 

 B2

Garc 

Ui. _ 

Jen_ — 

 Plav Area 

CdS t 

Othe r 

Desaiption of post excavation areas: Fl, front yard left-hand quadrant; r2, frontyard 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 of the house). 
Name: J^J^ S Xr Y Omaha Lead Site Date: (0 /" / <> 7> Nortti Arrow 

Address: / V / i ^ / /// ^ /». Site Sketch Time: =? /^^ 

Phone: 7 ?/- 2 s>7 h 

Team Vg^ 5 J/erm^r^ BVID# 2o 1^ Z XRF Code ^<^t^ 

Sample Number Lead Concentration Confirmation Sample 

/?/y9/^/^Ji ^ --^ig^y^ 2_ /7 Yes C] No ^3­ fiV^i^y^/ ? ' -z^^y^- No E ­ ^ yycy/^7^jr/ ^ '^zipy^ ^V:LJ^g V ppm 

— /•z^Ye s n No B ^ ^ ppm M^ res >—' /^7^y:/^X ^ -z.£>J^ \ 5^^?f^:z ^ No » ^ ppm y7.Yes ° 

ppm Yes CIl No O

No 1=] ppm Yes a 

No • ppm Yes • 

/7J O g I 6fc Z>Z-3 

iy^\p/ Ll/|LL|/?'^ ^TKEkT 

Omaha Lead Site 46130 
Douglas County Account Infonnation Page 1 of 1 trajmc 

Dougla s County , Nebrask a Propert y Recor d - R151897000 0 

Infonnation is valid as of 2007-10-10 

Values not finalized until after Board of Equalization 

Print Report 

View on Map 

Treasurer's Tax Report 

Owne r 

JURY JAMES J 

ETAL 

6120 3 48 ST 

OMAHA NE 68117-0000 

Propert y Informatio n 

Key Number: 1897 0000 15 

Account Type: Residential 

Parcel Number: 1518970000 

Parcel Address: 

Legal Description: 

1413 WILLIAM ST 

OMAHA NE 68108-0000 

KOUNTZE 3RD ADD LOT 3 BLOCK 8 25 X 150 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$900.00 

$900.00 

$900.00 

$900.00 

$900.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$900.00 

$900.00 

$900.00 

$900.00 

$900.00 

$0.00 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.08 3750.0 25.0 0.0 150.0 25.0 Yes 

http://douglasne.mapping-online.com/DouglasCoN e/static/accountinfo.jsp?accountno=Rl... 10/27/2007 
CONTACT FORM 

Property ID # &/b a 

n 

Property 

Address: 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA 0 Other Action: 

Zomment: 

her 

Zomment (s): 

Site 

2oodiator 

Zomment (s): 

COASTA L ENVmONMENTA L 't t PRO-"-' CROUP , IN C 

Consent For Access 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: 

^ 7^ • 3// / Owner'sName: vy^J^liTl^ ' Daytime Phone: 

73/• 2 ^ V 

Address of Property / 7 3 iyy7^s^ sr 

covered by this 

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 
fc^^"*^^j»- .. o* r COASTA L n A s T i I

ENVtRONMENTAl . 

C R 0 U r , t N 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 ofthe 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 (877) 234-6270. 

JE/i grant^ces s to my properties D I do not grant access to my properties 

Dato^ ^ Signature Date 

O 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 of the property prior to 

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

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

Protection Agency (EPA). 

Property ID: 207&7. Property Address: 7^/ ^ / 7/// / .57 

Owner: 

Phone: (^7^v^9/^ y3/' -^5T/ 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, 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 retum of these items is the Owner's responsibility. 

Item: 

-Q\^ ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Paget of < ^ 
COASTA L iNVlROHHSMTAI . C R O U F , INC . 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: o 

Lj3iAai2r/'Kex^^'Soei>^3e Ttfoooi^^ ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 6^ 
COASTA L • M VIROMfiBNTAI. O • O U P , IMC . 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

oD 

Item: 

y tSlUItem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 7 ^ 
COASTA L • MVIHONMNMTML GROUP . IMC . 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

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 diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

\?0^ 

Z 

<?> 

0 

Unit 

Square feet 

Condition/Type/Species 

Each 

Each 

Each 

Each 

Square Feet 

~ .^ ^ f\ N n ll 

yi^^-r ^ y , 

Page 4 of 7 ^ 
COASTA L • MVIRONMKNTA L CROUP . IMC . 

Item 

Agreed upon value of 

plant materials not to be 

replaced by contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreetl upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

0 $ 

7) Each 

[^>7 SF 

SF 

SF 

Page 5 of f/' 
C O A S T A L • MVIROMHS NTAL GROUP , IMC . 

Additional Comments / Instructions: 

IZl Check the box if Owner does not want CEG to document 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. 

n I do not agree 

lohn ^ 

Contractor^ Signature Date 

Page 6 of. 
# ' PROPERTY CLEARANCE WORKSHEET 

1 

Date 'Q-^'bl Property ID 2.0 1^2. Property Project Omaha Lead -- Fixed Price Address iii ^ UJilUmi 

Measurement 

XRF ID 0107-51 Count/Time 

Field Shots 

Slio Sample Area t # Reading Sample Area Shot # Reading 

5-7-? ?.v? R2 n-iH 

S78 / u 2-2 li-lW 

Sample Area KZ-/2-W 

I n Situ Composite Composite Analytical 

Aliquo Lab Analytical t Composite Readings Readinq Average (Dried & Spilt Sent Number Results (Bag) 1 (Baq) Sieved) ? -25"? 

2 7-7 <!> %v 

3 f</Q 2£r^ 4 236 2 Y 1 XRF Corrected Value --> 

5 zn (use catibration chart or add 

2 0 % to value) 3Z0 

Sample Area firic^Y Pass/Fai l ? 

I n Situ / Composite Composite Analytical 

Aliquot Lab Analytical 

Readinq Composite Readings Average (Dried & Spilt Sent Number Results 1 (Bag) (Baq) Sieved) ?

2 13 

3 f</3 /27 4 I h i 

XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to ualue) 

151 

Sample Area Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) ? 

2 

3 

4 

XRF Corrected Value —> 

!5 (use calibration chart or add 

2 0 % to ualue) 

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) 7 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

i n i AIIDIIIOUM SHIfl-i I I 

XRF Technician's Siqniture HI ni l 11 
Page 1 of2 

tsimmons@lkgs.he.net 

From: "NE DIGGERS L" <info(gne-diggers.com> 

To: <tsimmons(gcoastalhazmat.com> 

Sent: Tuesday, October 30, 2007 12:54 PM 

Subject: Re: NE-Diggers.com - LOCATE Contractors Request Form 

DIGGERS HOTLINE PRESENTS THE'NO WAIT' N.I.T.E.S. TICKET ENTRY! 

Avoid lengthy wait time - Immediate ticket number response - User has access to all issued tickets. 

FREE training sessions. Contact Connie or Lisa at 402-330-1866 for further information. 

************************************************************ 

Ticket #1925448 

Work to begin date: 11-01-07 at 115pm 

The utilities we will notify are...at&t-CITY OF OMAHA TRAFFIC & SEWER, COX, MUD, OPPD, QWEST, 

level3-mci-mcleod-qwest long dist. 

If there are any other utilities besides those mentioned above, you will need to notify them yourself and any 

privately owned lines will not be located. 

Original Message 

From: tsimmons(5)coastalhazmat.com 

To: info@ne-diggers.com 

Sent: Tuesday, October 30, 2007 11:59 AM 

Subject: NE-Diggers.com - LOCATE Contractors Request Form 

NE-Diggers.com - LOCATE Contractors Request Form 

Name: Rita 

Alt. Name: 

Phone: 7123520188 


Alt. Phone: 


Email: tsimmonstgjcoastalhazmat.com 

Caller ID: 18790 

Company: Coastal Environmental Group 

Type of work: lead excavation 

For Whom: EPA 

How Deep: Oft. 36in. 

Explosives: No 

Corner Lot: No 

Front of Property: Yes 

Rear of Property: Yes 

Tunneling/Boring: No 

10/30/2007 
Page 2 of2 

County: Douglas 

City: Omaha 

Address: 1413 William St 

Directions: 

Where on Property: 

locate entire property 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

10/30/2007 
/^tt^' o

g ^N^^ , °

S^^^^f

%n,oTe^

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

 Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L ENVIKONMENTAL 

GROUP . IN C 

EXECUTIVE SUMMARY: 

20162—1413 WILIAM ST 

X No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

rotal Quadrant Square Footage to be Excavated = 1389 Property Classification: BOO Total DriD Zone Unear Footaae to be Excavated = 0 

O^^S —^_i:_ _ ^ n 

G Z - IZ / r-rivi 

@14" 

B2 = 256 PPM 

& • ^ . 

-

1 

~ -—— _______ 

1 1 1 

' ; 

^^^^^^^ ^ • 

y \ ~ 

< > 

o 

: 

y \ V• . y 

•h 1 

y j y 

1 

, * .. " \m ' ' ' i / * ^ • OLS#: 20162 

Date Excavated: 11/7/07 ', 

. ^^ 

Date USIEPA Signed Off: 12/5 07 i " •

jrrr - ri..i 'f __^ _ 'rryr __ '•->»— • 

. - . . • -'••''c';,:i :'.7y/-''--^-/'j--''y-:y7'.--i.'y:'.--[ ''7-' '' '''^-:-7''y7- : '. ' ' y 

Legend NorthArro w Omaha Lead Site 

Omaha. Nebraska '^/ M Concrete 

Property Number 

Ky i Excavated Area N OLS-2016 2 Existing Structure Scale • Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft • Fence 1413 WILLIA M ST • s 

- uuacjrant Boundary Post Excavation Concentration 5 (ppm) 

- Street Boundary ,\Q-,y HG L Fl B2 Plav Are !'^..''1IV,C>..:JU..I..- h.: 

Tree/S hrub im^ i ­ \_/ ..' \ '•'•fPraW y " Bl Gan den I — Othe r 

Description •( post excavation sceas Fl, frontyard lett.hand quadfant, F2. frontyard right-hand quadrani, Bl tjackyatd left-tiand quadrant B2 backyard right, hand quadrant 

DZ, drip zo n (1 -3 toot area (jl so! arourd the fbundatron of the hottsej 

Legend 

Area not Excavated /y/) Dripzone Excavated KXX3 Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
Siit^ EPA 

EPA Property Close Out Form 

Property #: ^ C\ \ Cy Z . 

Date/Time: n / a<^ 

Quads Excavated: 

Property Address:

Owner's Name:

Contractor Croup

 1^1 ^ \AJ .'(|,'OLV W

 ^/^.^rv^P.<;. T>J<~Y 

 T o ci s'^'^V 

 Si" . 

Excavation General- Yes No 

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

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

Grading Sod and Vegetation 

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

from the house? 

Yes 

^y 

No 

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 

day time period) 

y ^ 

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

5. 

6. 

Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

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

y 

y 

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

Gates, Feaces and Retaining Walls Yes No 

t 1. Do gates open and close freely? (Ifapplicable) y 

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

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

4. Was damage to retaining walls avoided? (Ifapplicable) 7 

Foundation, Siding and Gutters 

1. Was damage to the sidmg or trim avoided? 

Yes 

^ k 

No 

2. Was damage to the foundation avoided? ^k 

3. Was damage to windows avoided? 10)^ 

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

5. Was daraage to downspouts or downspout extensions avoided? 

/i/A 

0 k 

Sidewalks and Driveways (Concrete) 

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes

\ / 

f/^ 

 No 
Owners comments: 

Inspection notes: 

Jii 

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

EPA Representati>e-r^::2^ ^^ . jL ^ Date: 
Property Compietion Agreement 

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

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

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

PropertylD: g^Q I (o 2 . 

Property Address: ) 4 ( C^ \^f^\\\<L.m S t 

Owner 

T<3.yY\es—"J">-^<"^ Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Additional Comments: 

I agree restoration is completed, except as noted 

I do not agree restoration is completed 

ay 

Contractor's Sigrtature