## TRANSMirrA Lo f

OMAH ALEA D SITE SOILREMEDIATIONFILEFOLDE R SAID#:y52.3?.__

_Date: l-\!b-|2
- Address : /\o.7Z!D^CjOHt:\.^i)c\LQ.\)^ ^ . — Remediatio nContractor : Coasta l Environmenta l Group ^ YearcSlOl ^ SOI LREMEDIATIO N PROPERT Y FIL EPOLDE RDOCUMENT S A/ik x Vide o of properl y (DVD ) « Executiv e Summar y LVT : EPA-providedproperty sketc h

. .-rvii^^==Signe dAcces s -Agreemen t fo r subject propert y

- ISj]^
- wSigne d.Acces s Agreemeni(s ) fo r adjacen t propert y y Restoratio nAgreement ^I PSettlemen t document s (i.e. , fo r damag e o r t

o replac e plants , etc. ) ^ Confinnatio ndat a 

# fi/ Photographs ^^fpKC(x\xiAdl5:Xccx\tx{)0[\ , ^ ^ s y As-built sketc h [% /

SatiBfactor y restoratio nsignedb y Property Owner ^ Propert y close-out check lis t signedb y EP A lij A Descriptio no f area s no t meetin g RO D cleanup criteri a Ai ^Utilit y clearance s \

/ Propert y informatio nfro mDougla s Couniy Assessor' s Office

^ ^ ^ 

## 13it e Superfun d^ \ 

## Propert yAcces s Checklis t Property ID : L)fi2 ^ 3,; ^ PropertyAddress : ^^;^< ^ /V.^Vv>I l Al l D D WOR K STARTE D WORKCOMPELTE D ON : ON : / / / / 

# ^""^••^ffl5(xrVfUa[ob(i s Address : •\ . V I 

### Phone : Fax : 

# eo7 0 ?jf)i-Mnv i Cell/Pager : 

# Al-Himirriif ^ Renter : Phone : Fax : Cell/Pager : Additional Information :

n ^ 1 ^ D D i~ 1 D D n n n Q D

Notificatio nLette r Acces s Agreement Restoratio nAgreement Topsoil Samplin g (if applicable ) Disposa l Samplin g (i f applicable ) Garde nSamplin g (if applicable ) Utilit y Clearanc e Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After) Video/Photo s (30-Day ) Property Completio nAgreement Final Report Sent : / / Signed : ^/2a/Zl _ Signed : J2_/23/IL / / / / / / Called : / / On : / / On : / / On : / / On : / / Siened : / / Issued : / / By : By : By : By : By : By : By : By : By : By : By : By : By : Ai r Monitorin g (a s applicable ) r~l Communit y E D Cre w Results : On : / / 

### By : 1

nCommunit y Results : Q Cre w On : / / 

# 1

r~ 1 Communit y Results : E HCre w On : / / By :

Omah a Lea d Sit e

### Dougla s County Accoun t Informatio n Pag e 1 of 4 Dougla s County , Nebrask a Propert yRecor d ­ R234020000 0 Prin t Repor t Informatio n i s vali d a s of 2011-3- 8 Vie wInteractiv e GI S Ma o Treasurer' s Ta xRepor t Ne wFeatur e ->-»- » Subdivisio n Sale s Searc h Owne r VILLALOBOS-ALTAMIRA N ET ACESA R 622 5 CAMPBEL L AV E OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumber : 402 0 OOO O 2 3 Accoun t Type : Residentia l Parce l Number - 234020000 0 Parce l Address : 622 5 CAMPBEL L A V OMAH AN E 68107-000 0 Lega l Description : UPLAN D HOME S AD D LO T9 BLOC K0 IRRE G 4 0 X 126. 2 Valu e Informatio n Lan d ; improvemen t Tota i L_.-^. . -.^. . -•.^ a .^^. . __ $ 74,900.0 0 $ 80,000.0 0 $ 88.100.0 0 $ 88,100.0 0 $ 88,100.0 0 $ 78,^00.0 0 $ 78,600.0 0 Sale s Informatio n Sale s Date : 2010-02-2 4 ! Vie wPocumen t Dee d Type : \ W D Book : 201 0 

# T ' Page : > o 1696 7 Price : j $80,000.0 0 Grantor : | SOUT H O JO E LL C Grantee : \ VILLALOBOS-ALTAMIRAN O CESA R ETA L Valid/Invalid : \ vali d Exclusio n Reason : • Sale s Date : : 2010-01-2 9 Vie wPocumen t Dee d Type : \ W D Book : 201 0 

### Page : ! 01261 1 Price : ; $38,000.0 0 Grantor : \ sZARK E MILDRE D M 

### httn://doiipla.sne.manning-online.com/DouelasCoNe/static/accountinfo.isD?accountno=R23.. . 3/18/201 1

### Dougla s Count y Account Infomiatio n Pag e 2 of 4 Grantee : SOUT H 0 JO E LL C Valid/Invalid : Vali d

1 Exclusio n Reason :

Lan d Informatio n Acre s S F 0.1 5 i 6930. 0 Unit s ~: 1. 0 1 1 Dept h '• 126. 0 Widt h 55. 0 Vacan t N o Improvemen t Informatio n Buildin g 1

Rarc T622 5 Caripbd l Av e

e .6 . 1 1 I 1. . 1 1 .•< ' 'i » - r. • - ll . „ift»ii.u.»jiH;«ii.iiMi.i.«4iiiii.*i.-m!o m CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 764. 0 Percen t Complete : 100.0 % Perimete r 0^ 0 Quality : Fai r Uni t Type : Condition : | Averag e

Buil t As : Ranc h Cond o Squar e Footage : ! 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : ! 4. 0 Exterior : Fram e Viny l Units : i 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k I Sprinkle rSquar e Footage : 0. 0 

## r Yea r Percen t Adjuste d Yea r I Yea rBuil t Physica l A^ e Remodele d Remodele d Buil t \ . i 194 1 0 194 1 

### 69

_0% _ Oeta/ 7 Typ e Unit s Detai l Descriptio n 

# r Ad d O n Fenc e Chai n Lin k 1. 0 [ Applianc e Allowanc e 1. 0 ; Basemen t Bsmn t Bloc k 8 f t 696. 0 

# r Basemen t Minima l Finis h 200. 0

Fixture Bas e Fixture s 

### 1. 0
httn//flniialasn e manninp-nnlin e r.nm/DoiiplasCnNe/.sfatic/accoiinttnf n isn?accountno=R23.. . 3/18/^0 1

### Dougla s County Accoun t Infonriatio n Pag e 3 of4
Fixtur e Bat h Ful l 1. 0 Garag e Detache d 800. 0 Porc h Sla b w/Step s 56. 0



### httn7/Hniipla.<5ne.manninn-nnline.r.nm/noiipla.<?CnNe/.static/accountinfo.isn?accountno=R23.. . 3/18/20 1 1

# As-Buil tDrawin g OLS : 4523 2 

## ^

. COASTA L DAT E EXCAVATED : 8/16/201 1 

## EnvironmentarGroup , DAT E USEP ASIGNE D OFF : 8/25/201 1 

## Inc . 

# Omah aLea d Superfunc l Sit e ARE ASODDED : 22 0


### 4523 2

Omah aLea dSit e 4613 0

CONCRET E DRI P ZON E EXCAVATE D QUADRANT S EXCAVATE D
ARE AREPLACE D WIT H ARE ALEF TBAR E ARE AREPLACE D WIT H SO D ROCK/MULC H 

### CONTRAC T# : EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC .

# yyzyz i 4523 2 

# M 

# y ^ ^ 0 Exterio rPain t Nort h Arro w Owne rName : ANTON E J SZARK E 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h Address : 622 5 CAMPBEL L A V • Poo r

W : Phone : ^ • 

# I [ J No t paint

Omah aLea dSite 461.1 0

# lill i Iilllill l 4523 2

Omah aLea dSite 4613 0

## 4523 2 Exterio rPaint Nort h Arro w Omah a Lea d Sit e Owne rName : ANTjON E J SZARKE ^ • Good Sit e Sketc h Address : 622 5 CAMPBELL A V • Poo r Phone : H : W : 

# I [3 ^ No t paint Sampl e Numbe r RYASCPXA-4523 2 RYBSCPXA-4523 2 RYCSCPXA-4523 2 RYDSCPXA-4523 2 RDZSCPXA^523 2 KbZSCP > ^A=452 : F l F 2 8 1 B 2 D Z Lea d Sampl e Concentratio n Collecte d



# 2 ol'c > pp m L P n pp m 

# R

. pp m

. pp m 

## .'ZyiW. n pp m .pp m .pp m Numbe ro fSample s = '

^rl/0-l£ £ - )

< o 

## c. c 

# u Z D D ^ W 

# is?-- Sample s Collecte d LA B Firm : 

## D Date : 

## //y/^y c 'C V 

## D Time : ly/ O 

# n Sample s Analyze d 

# n XR F Unit : % \ \ Book : in ^ 

## D Date : 

# a Time : Staff : 

# ENTERE D

- NO V1 7 20U 4 

# .B y

t c »« • 

# r J>Z.~39LL C

C/J,yi/>sy/ cy f ^

Omaha Lea d Site 46130tlltllONnlNU c cI 0 u rI I t c 

# y yu\s^^ ^ C^oiisic^ii i fo rAt:c:(iSi' - 'l o ['ropcit^ ' 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 : 

## r" '

Owner' s Name : jf^ V \-C}/^{<'OC i Dvv'tim e Phone : 

### Si.(c:.:>_a..^...,.... _ Addres s o f Propert y covere d b ythi s 

# (^ZZ ^ Cd^W<& U Av; ^ Agreement : 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 f Coasta l Environmenta l Group , contracte d b yUSEPA , 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 wori ( 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 r t i s compiet 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 ACTIOIM 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 fperformin 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

### '•/ii L ^ 

# v^SI= ^ C O AS I A L C « 0 U . 1 1 1 c


### « Remov e obstruction s includin g boats , Uailers . vehicles , playscap e iiems , 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 leplacemen 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 yo f th 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 (402 ) 991-119 9 I gran t acces s t o m ypropertie s D I d o no t gran t access t o m ypropertie s 

# ly^.i L Signature Signatur e Date Date Q ! woul d lik a t o b e presen t durin g an yssmplin g tha t b required .

Page 2 o f 2COASTA L C k

O u V , I • • C 

# Restoratio n Agreemen t Th e purpos e o f thi s agreemen i i s t o provid e a mutua l agreemen t a s t o condilion s o fih e properl yprio rl o remediatio n activities . Thi s wil l ais o serve a s documentatio n fo rth e purpos e o f assurin g that restoratio n activitie s ar e complete d t o ih e satisfactio n ofth e propert yowne ran d th e Unite d Stale s Environmenta l Prolectio n Agenc y(EPA) .

Propert yID : ^C , ^ij/ l Propert yAddress : 

### \fi1yV ^ CO^^\M.\ ^ hM U Owner : O&ft- r 

### \li\\fl,loV)*v S • AWANv-. r *v. A Phone : 

## i o i •^\--\n( ^ O n th e attache d diagram(s ) indical e area(s ) t o excavate , surfac e structure s an d landscapin g feahjre s an d acces s location(s ) t o be used b yth e contractors . Indicat e distances , depths , materia l types , elc . Photographicall yan d Videographicall ydocumen t th e existin g condition s ofth e propert yan d th e basemen t i f necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility . Item : 

# ^MAL U 

# PZ.AAJ K Item : 

# lA/^o^ur ^ LtGHr^^" ^ Item : Item :



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d

Pag e 1 of .

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

# ^^^fS^ Z Item : Item : Item : 

### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrani s tha t will b e excavated , tha t i s covere dwii hgrass . 

# f \ Number of tree s > 2 inch Eac h / trun k

diameter Number o f tree s < = 2 inch Eac h trunk diameter ^ Numbe r o f SprinkJer Zones , Contro l Valves , Eac h Timers , Heads , elc . Attac hasketc ho f the / sprinlde r layout . Number of andsiz e of eachgarden/ flowe r be d Eac h area . Squar e Feel Attac hasketc ho f relaliv e size s an dlocations . Agree duponvalu e o f plan l maierial s not to b e replace dbv contractor . Not e thi f valu e wil l b e use d( 0 issu e aplan t vouche r to th e prop9rt> ' owner . Easemeni Area . l o b e Eac h excavate d 

# A J 0 Pag e 2 o fAdditiona l Comment s / Instructions : Th e cit y of Omah a ordinance s ma yprohibi t yo u fro m usin g dir torgrave l area s on you rpropert y as driveway s orvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma y be removin g an d replacin g soi l underlyin g a grave l ordir t are a on you rpropert ytha t yo u ma y be usin g as a drivewa y orvehicl e parkin g area . If thi s is th e case , yo u shoul d understan d tha t thi s removin g an d replacin g of soi l doe s no t mea n tha t an yillega l drivewa yorparkin g are a on you r propert y is mad e legal . To th e contrary , yo u ma ybe cite d byth e cit y if yo u us e a grave l ordir t are a as a drivewa yorparkin g area , no t withstandin g an yremova l orreplacemen t ofsoi l byth e EPA . If yo u hav e an yquestio n abou t legalit y ofa certai n drivewa y orparkin g area , yo u ma ycontac i th e cit y of Omaha' s Plannin g Pepartmen tat (402 ) 444-5150 . [ 0 Pleas e chec k thi s boxif yo u understan d th e informatio n outline d above .

ED Chec k th e bo xif Owne rdoe s no l wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio rof house , includin g foundafio n crack s orfissures .



### [ 0 I agre e ED J do no t agre e

l r^ntrasior' (^ntra^^or' s Signature^ Signature^^ Dl e / er' s Signatur e Date Oat Pag e 3 ofBVI D 

## ^JySfZjff L XRF PROPERT Y SAMPL E SHEE T Dat e Project , 

## 9-^^y / Omah a Lea d ARR A Addres s Sampl e tim e XR F ID # 3^;2. ^ sampl e lengt h Shot # Readin g Sampl e are a Shot #



# s ­ ^i ±/ I 

# n c ^ 

## 3 7 i IZ i Dept h 

# 7 s-o-t a 

# u Averag e 

# ^ r i / a Averag e

Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e 

# a . 

# ^/v ^ Signature. , 

### Prin t l^a^'.f l ft I- L ua.^i _ ^Z 2 5 - Oki^fihet fyJV f am/p m 3 0 se c Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 8 Mod e Soi l Tim e 2011-08-1 6 16:3 3 Duratio n 90.2 1 Unit s pp m Sigm a Valu e 2 Sequenc e Fina l Flag s AVERAG E Av g o f5- 7 ADDRES S 622 5 Campbel l a v QUADRAN T F l DEPH T 6 " XR F TEC H KIN G MIS C confirmatio n NOT E confirmatio n
Erro r P b 45.84 6 12.82 2 Supervise d By : pp m 

# r(2j2 ^ ^y\r ^

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 49.95 1 Supervise d By : 5 Soi l 2011-08
­ 30.0 5 pp m 2 Fina l 4523 2 

## Certificat e o fVerificatio n

1 6 16:3 2

622 5 Campbel l a v F l 6 " KIN G confirmatio n confirmatio n

± Erro r ± 13.23 2

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 49.95 1 Supervise d By : 

## Certificat e o f Verificatio n

5 Soi l 2011-08-1 6 16:3 2 30.0 5 pp m 2 Fina l 4523 2 622 5 Campbel l a v F l 6 " KIN G confirmatio n confirmatio n

± Erro r ± 13.23 2

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 50.20 1 Supervise d By : 

## Certificat e o f Verificatio n

7 Soi l 2011-08-1 6 16:3 3 30.1 0 pp m 2 Fina l 4523 2 622 5 Campbel l a v F l 6 " KIN G confirmatio n confirmatio n

± Erro r ± 13.11 1

# ili ^ ii^^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 § J^^^ ^

° Coasta l Environmenta l Grou p Inc . \y^j ? www.coa8talhazmat.co m

'*tp„ott.'> " COASTA L • H«l>OIIIIINT« l s • o u r . INC . 

# EXECUTIV ESUMMARY : BVID #45232
- (622 5 CAMPBEL LAVE ) No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation:^



## Propert yCompletio n Agreemen t I In t iififecmtr wrlucuineni." . lh e LOinpIc i lOn o l icmedi?. ! aciivme s peiibimcf l n n m) - properl yM y.>;igii?iui c ivil i rle.sijjnai e iha i I ai rsaii.^fie d wit h ili e rc.";io/alio n o fm ypioperiy . an d iha i n n iiein s ai e m rjue.'iiion s now . o i a i an ynm e m ih e fulurr . excep i ihos e iiem s lisie d below , ifan y

Properl yID : L i C O T o Propert yAddrc^. : (g2^ rQJUmpV ^ \

i Av I 

# Phone:4QX - 'bo\ - ^n ^ Restoratio n Ilem s i n Question . Item : (lem ;

Item : Item ; Addiliona l Comments :

Ty J I fii;'r ri rMo i ?lio n i i cnmplrltd , ne t p l m nnlcr i I J I r| o n m S|!ir i irMOralin n i. vcoiniilclrr l



# S-2V ' l l yy/yy^ ) g-w- u ipnalii i p Dai r ("iml i Riio i ' j Si fnalii i < • Oai r

## EP A Propert y Clos e Ou t Form Propert y H : _ ^7.?- ^ Propert y Addresr . _ V '-f^ f S——- ^ Datc/Tlnie : 75-2^-1 1 IO I T OwVer' . Name : ...J f H^l'^h. ? S ^y^H-^r'' ^ ^ Quad s Excavated : Contracto r Crou p Cx^'ji ^ ^ 

## - £ l Ye s N o excavatio nGenera l 1 .

I f necessaiy , wer e th e conrc t quadrant(s ) excavate dan drestored ? 2 .

I f necessary , wer e th e correc t area s ofdri p zon e excavaie dRo drestored ? 

# y Gradin g So dan dVegeiatio n Ye s No I .Doe s Ih e gradin g aroun dth e perimete r orih e hous e inexcavate darea s generall y slop e away fromibe houie ? 2 .Ha s so dbee nlai dmal l area s tha i wer e excavated ? .\ .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da i a3 0 da y tim e period ) 4 .

Ar c sodde darea s generall y fir man devenl y graded ? 5 .Ar e thejoint s betwee nth e so dsirip s generall y tight ? (Onl y evaluat e i f inspecle da t a3D day 

### y i

_tim e period ) 6 .Wa s th e propert y grade dsuc hthat waie r wil l not poo l onih r property' ' I7 . Wa s damig e l o landscapin g o r plan t maierial s avoided ? Gates . Fence s aa dReuinin g Wall l \n.Ni l 

# r y ! .D o gate s ope nan dclos e Ireely ? (I f applicable ) 2 .

Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsialled ? (I f applicable ) i .

Wa s damag e l o gate s o r fence s avoided ? (Ifapplicable ) 4 .Wa s damag e 1 0 retainin g wall s avoided ? (Ifapplicable ) 

### r Foundation , SiJiagan dCuller s Ye s .No y I .Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o Ihe foundatio navoided ? 

## y

—• Wa s damag e l o Mrindow s avoided ? I 

## y 1 4 Wa s damag e t o window s o r doo r screen i avoided ? 

## y Wa s damag e l o downspout s o r downspou i exlension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Yc s N o I .Wa s damag e l o drivewa y surface s avoided ? 

## y 2 .Wa s damag e l o walkwa y surface s avoided ? 

# y• A . 

## OM'ncr s comments :

fn.spectio nnotes :

Reniova) andrestoralio nactivate s complel e includin g lhe 3U-da y .so dwarranry : L^P A Representaiiv e 9^ ^ Da,e : • [ . .