### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : Ocfki^T , Date : l/^bjO ^ Address : _23(n ^ ^'\CX C C
. 'r k Remediatio nContractor : Coasta l Environmenta l Group

_Year ; _200f|
_ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S / 

### Vide o ofproperty (DVD ) Executiv e Summar y N

/ EPA-provide dproperty sketch 2 : SignedAcces s Agreement fo r subject property >)G ^ SignedAcces s Agreement(s ) fo r adjacen t propert y / T Restoratio nAgreement ^9 r Settlement document s (i.e. , fo r damag e or to replac e plants , etc. ) 0 ^ Confirmationdata C Photograph s 2" ^ As-built sketch 0 Satisfactor y restoratio nsignedby Propert y Owner APropert y close-out check lis t signedby EP A Descriptio nof area s not meeting RO D cleanup criteri a 

# y Utilit y clearance s <

PPropert y informatio nfro mDougla s Count y Assessor' s OfTic e [ I 

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WORK STARTE D WORK COMPELTE D ON : ON : _/ / /_ / 

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applicable ) Q Gnrdc nSamplin g (if applicable ) i 0 ^ Utilit y Clearanc e 1 ^ Video/Photo s (Before) \ ^ Video/Pholo s (During )

nVideo/Pholo s (After) D Video/Photo s (30-Day ) D Propert y Complelio nAgreement D Fina l Report Scnl : / / Signed : (j j / fo / D 9 Signed : i^/iZ,/(2 1 / / / / / / 

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Omah a Lea d Sit e

## CONTAC T FORM Property I D U Property Address : IT ) 2- S % U ^
W4 P\-^rO. ^ S'V ^ Initial Contact : Secon dContact : Final Contact : Final Action : Date : Time : Date ; Time : Date : Time : Transmi t to EP A D Action : Action : Action : Other Action : D

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) :

### Dougla s County Accoun t ition Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R221821000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f52n d S t - VleW f O n Ma p Informatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e - • ^ - • Aut o Saie s Searc h Owne r SCOT TEDWAR D 256 9 PIERC E S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 182 1 OOO O 2 2 Accoun t Type : Residentia l Parce l Number : 221821000 0 Parce l Address : 256 9 PIERC E S T OMAH AN E 68105-000 0 Lega l Description : SHULL S 2N D AD D LO T4 BLOC K8 E 5 0 FT Valu e Informatio n Lan d Improvemen t Tota l 

### 2009 $5,400.0 0 $64,700.0 0 $70,100.0 0 200 8 $5,400.0 0 $65,500.0 0 $70,900.0 0 200 7 $5,400.0 0 $65,500.0 0 $70,900.0 0 

### 200 6 $5,400.0 0 $62,200.0 0 $67,600.0 0 200 5 $5,400.0 0 $62,200.0 0 $67,600.0 0 200 4 $5,400.0 0 $62,200.0 0 $67,600.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 9 8400. 0 1. 0 

### 168. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221.
. . 6/6/200 9

### Dougla s County Accoun t tio n 

### Pag e 2 of 2

,> . First Bo a

103 4 0» q f l 

# '1%^/qT}' ' "1 » » I 1 1/ 2 STOR YFINISHE D ItVlai K CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1604. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

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 : 7. 0 Exterior : Fram e Shingl e Units : 1. 0 Interior : Plaste r Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Blocl < 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 191 0 0 % 191 0 9 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1034. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 440. 0 Porc h Sla b Roo fCei l 165. 0 Use r Atti cFul l Finis h 570. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R221.
. . 6/6/200 9Oj^igfai ] 

### http://www.dhoaoi^jgfaintemet/DHONNoticeOeation/MessageTexL
.
Creat e Anothe rTicke t | Bac k t o Irt h Inteme t | Sen d Emai l


### YOU RTICKE T NUMBE RI S  2300189
. Origina l Cal l Date : 6/22/0 9 Time : 12:5 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/24/0 9 Time : 1:3 0 p m State : N E County : DOUGLA S Place : OI^H A Address : 256 9 Street : PIERC E S T Twp : 15 NRng : 13 E Sect-Qtr : 28-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea mRemediatio n Locatio n o f Work : INCLUD E AL L EASEMENT . LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . 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 Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 

### Utilit y Servic e Are a Contac t Phon e Nunibe r Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A Alt : Emerg : 877366834 4 Day : 402504782 3 METROPOLITA NUTILITIE S MUD0 2 SAND Y Alt : DISTRIC T Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO NAlt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A Alt : 406207149 4

lo f 2 6/22/200 9 12:53 P M

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2 of 2 6/22/2009 12:5 3 P M

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. IH C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO PREMISE S 

### Granto r(th e propertyowner) 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 : _^

Owner' s Name : Daytim e Phone :



# ^DW9d^(x M
Addres s o fPropert y covere d b ythi s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collect soi l sample s an d remove 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 ofCoasta l Environmenta l Group , contracte d byUSEPA , wil l contact 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 opportunityt 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 property 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 , contractors an d subcontractors th e righ t t o ente rth e property , at 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 effect 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

# (A) COASTA L CNViaOMfirNTA l s • 0 u r . I l l c



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remove 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 safetyguidanc e provide d byEPA ; •I fth e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g of th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o interfer e o rtampe rwit h an yo fth 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 fsai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e ofth e Grantee s o rth e environment , o rl o allo wothers t o us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (712 ) 352-018 8

[gig r gran t acces s t o m ypropertie s O I d o no t gran t acces s t o m ypropertie s

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

# 4

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## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s ofth e property 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 are complete dto th e satisfactio no f th e property owne r an dth e Unite dState s Environmental Protectio nAgency (EPA)
.

Propert yID : 2D^bi ^ Property Address : ^C^i^Q ^ y\p^(r^ ^ C ^ Owner : g^^^,^,; ^ 9Cj!yit Phon e 

## aMU-2,MS ^
Onth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f excavation , locatio no f all known utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s Iocation(s ) to b e usedb y contractor , andth e directio no f North
. Indicate distances , depths , materia l types , etc . Indicate digital photo s b

y referencin g th e photo-lo g number wit ha n arro w indicatin g directio no f view
. 

## Item s T o B e Remove d B yOwne rBefor e Start O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretu m ofthes e item s i s th e Owner' s responsibiiity
.

Pag e 1 of
.C O AS T AL o n o u r, I f * c 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary )

Pag e 2 of
.

# 4

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### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) item : 

# f \ J^P^ Item : 

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. Item : Item : Item : item : Item : Item : Item : item : Item : Item : Item : Item : item :

Pag e 3 of
.COASTA L r*<t viHONM t wrAi
. o I t o u r. I M c 

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

## Ite m

Pre-existin g propert y area , that wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h trunk diamete r

Numbe r o f tree s < = 2 inc h trun k diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
.

Numbe r o f andsiz e o f eac hgarden/ flowe r be d area . Attac hasketc ho f relativ e size s an dlocations
. 

## Quantit y



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Eac h

Eac h Square Feet

Pag e 4 of
.COASTA L
< > AO U P ( N C 

## Ite m Quantit y Urii t Condition/Type/Specie s Agree d upo n valu e o f plan t material s no t t o b e renlace d b vcontractor
. Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . 

### » *
Agree dupo nlis t o f plan t material s tha t wil l b e replace db y connector . B e very specifi c an ddetailed
. Includ e asketc ho f were eac hplan t will b e place d b y th e contractor . ^\ ^ .

^ Eac h

Agree dupo nare ao f propert y t o b e replace d wit hgras s sod
. Includ e asketc ho f th e arca(s ) t o b e replace dwit h gras s sod
. ^ 

### S F

Are ao f City o r County proper ^ t o b e landscape d pe r diei r requirements
. Includ e asketc ho f th e area(s ) 

# H ^ S F

Easemen t Area , to b e excavate d 

### S F 

# Ve^di m e£su\ t

Pag e 5 of
.e OASTA L
• MVAkOMMCMTA t « * • V r . IN C


### Additiona l Comment s / Instnictions :

L^Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e preHScistin g damage
. B ycheddr ^ thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , indudin g fbutKiatio n crack s o rfissures.



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

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

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 52 2 Mod e SOI L Tim e 2009-06-2 9 11:1 8 Duratio n 30.3 3 Sequenc e Fina l Flag s BVID # 2086 3 ADDRES S 256 9 pierc e s t QUAD/ZON E F 2 INSPECTO R nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 52 3 Mod e SOI L Tim e 2009-06-2 9 11:1 9 Duratio n 30.4 0 Sequenc e Fina l Flag s BVID # 2086 3 ADDRES S 256 9 pierc e s t QUAD/ZON E F 2 INSPECTO R nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 52.25 8 ±9.89 5 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 52 4 Mod e SOI L Tim e 2009-06-2 9 11:1 9 Duratio n 30.3 1 Sequenc e Fina l Flag s BVI D # 2086 3 ADDRES S 256 9 pierc e s t QUAD/ZON E F 2 INSPECTO R nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 38.16 4 ±8.88 8 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 53 0 Mod e SOI L Tim e 2009-06-2 9 11:2 6 Duratio n 121.2 8 Sequenc e Fina l Flag s AVERAG E 

# S E of^526-52 9 ADDRES S 2'569~plerce ^ QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 

### [133^37 7 ± ^14^539 ^ Supervise d 

## By : ^Ma2Q ^

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

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

pp m P b 127.66 0 Supervise d By : 

## Certificat e o fVerificatio n

52 6 SOI L 2009-06-2 9 11:2 4 30.5 6 Fina l 2086 3 256 9 pierc e s t easemen t nicola s 1 CLEARANC E

d b Erro r ± 14.35 1

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequence Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPLE TYP E NOTE
pp m Pb 127.71 4 Supervise d By : 

## Certificat e o f Verificatio n

52 7 SOI L 2009-06-2 9 11:2 5 30.3 6 Fina l 2086 3 256 9 pierc e s t easemen t nicola s 1 CLEARANC E

Erro r 14.58 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 139.37 7 Supervise d By : 

## Certificat e o fVerificatio n

52 8 SOI L 2009-06-2 9 11:2 5 30.1 4 Fina l 2086 3 256 9 pierc e s t easemen t nicola s 1 CLEARANC E

± Erro r ± 14.61 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 140.99 9 Supervise d By : 

## Certificat e o fVerificatio n

52 9 SOI L 2009-06-2 9 11:2 6 30.2 2 Fina l 2086 3 256 9 pierc e s t easemen t nicola s 1 CLEARANC E

± Erro r 14.61 3

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 60 1 Mod e SOI L Tim e 2009-06-2 9 15:4 0 Duratio n 120.9 2 Sequenc e Fina l Flag s AVERAG E lkyjof597^0 g ADDRES S ""256 9 pierc e s t QUAD/ZON E F l INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

± Erro r pp m P b 48.34 7 ± 9^61 ] Supervise d 

# By : CeCMMSi A

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 50.71 3 Supervise d By : 

## Certificat e o f Verificatio n

59 7 SOI L 2009-06-2 9 15:3 8 30.2 9 Fina l 2086 3 256 9 pierc e s t F l nicola s 6 CLEARANC E

± Erro r ± 9.83 9

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

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

pp m P b 42.48 8 Supervise d By : 

## Certificat e o fVerificatio n

59 8 SOI L 2009-06-2 9 15:3 8 30.1 6 Fina l 2086 3 256 9 pierc e s t F l nicola s 6 CLEARANC E

±

Erro r ±

9.30 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 62.35 5 Supervise d By : 

## Certificat e o fVerificatio n

59 9 SOI L 2009-06-2 9 15:3 9 30.0 7 Fina l 2086 3 256 9 pierc e s t F l nicola s 6 CLEARANC E

±

Erro r ±

10.50 7

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 60 0 Mod e SOI L Tim e 2009-06-2 9 15:4 0 Duratio n 30.4 0 Sequenc e Fina l Flag s BVID # 2086 3 ADDRES S 256 9 pierc e s t QUAD/ZON E F l INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 37.83 0 ±8.79 8 Supervise d By :

### /^|A^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 ^^^ ^

I Coasta l Environmenta l Grou p Inc
. M l ^ ^ 

### \'^^yj f www.c0astaiha2mat.co m

^tPBOi** ^ COASTA L INVIIONHINTA l 0 a o U P , IN C 

# EXECUTIV ESUMMARY : BVID #2086 3 - (256 9 PIERC EST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : NO ISSUES PENDIN G

# ^EP A EP APropert y Clos e Ou t Form Propert y # : 2X^ln? i
. , Propert y Addrc«r.>7fiV?S
. U^'^^' ^ '^• ' Datc/Tlmc : Owner'sName : g.&AltX^'^U , Quad s Excavated : "Fv.Pz
. ContractorGnu'oCfYy^L S Fx^JiCr^Antsnt ^ Ye s N o Excavatio nGenera l 1
.I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# uFl 2
. I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# u- ^ Gradin g So dan dVcgeUtJo a Ye s N o I
.Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e awa y fromth e house ? 

# \y ^ 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3
.

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

# wda y tim e period ) 4
.

Ar e sodde darea s genetall y firman devenl y graded ? 

### \ y ^ 5
.

Ar e th e join u iKtwee nth e so dstrip s generall y tight?/Onl y evaluat e if inspecte dat a3 0 day 

# r? ^ tim e period ) jfiit ^ Tlhtfaf^-C* ^ 6
.Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e propeny ? 7
.Wa s danug e t o landscapin g o r plan t material s avoided ? 

# 33' ^ Gates , Fence s an dRetainin g Wall s Ye s No 1
.D o gate s ope nan dclos e freely? (I f applicable ) 

# h o 

# Ja-tQ S 

# UP I Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### L y 3
.

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4
.

Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## - y ^ Foundation , Sidia g an dGntlcr e Ye s No I
.Wa s damag e t o th e sidin g o r tri mavoided ? 2
.Wa s damag e l o th e foundatio navoided ? 

# I^- * yy ^ 3
.

Wa s damag e t o window s avoided ?
^
.Wa s damag e t o window s o r doo r screen s avoided ? 5
.Wa s damag e t o dov^spout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Conyrele ) Ye s No 1
.Wa s damag e t o drivewa y surface s avoided ? 2
.Wa s damag e t o walkSwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an n s e e so warranty : Kemova i an d dresloratio reslorationactivate activate s complet complete includin including g th th

e 30-da 30-da y y so d dwarra r EP A Represenlaliv e UrO njjTjJLi LDd\e: l 2^1-3 C 

# '.0 1

# p #


## Propert yCompletio n Agreemen t
Thi s agreeme m document s th e completio n o fremedia l activitie s peribrme d o n m ypioperty
. M ysignatur e wil l designat e tha t I a m satisfie d wit h th e restoratio n o f m ypropeity , an d tha t 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 ilem s liste d below , ifany
.

Propert y ID : ^ ^ ^ ^ Propert y Address : ZS' ^ 9 f(€.*-C<:

- J / " 

# <^"""= ' S.«4-\

- CA^c^r- X Phone : J i/ ^ J V T ^ Restoratio n Item s i n Question :

Item : Item :

Item : Item :
Additiona l Comments: ,

\/\\

agre e restoratio n i s completed , excep t a s note d L I I d o no l a(;re cresloratio n i s complete d 

# 3y)k^/r<y33i'^7yy7f f?cCfiH\ioi \ ?//o/o4 Owner' s Signatur e Dat e Contractor' s Signatur e Dal e