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�1 +i <br /> LA1>`lE 16130 ROGERS AVEs 1UE WE+LLPEAD INSPECTION uCTIO�1 CTS`-CKLIS x <br /> TECH SEnVECcc.� SAt I JOSE C LIFOflt flA 95 f 12 ''nn <br /> (aoe)sfa-7771 FAx Clfen[ CQu( V14 <br /> (408)573 OE-53 PHONG <br /> �� <br /> Site Address_$ft A.) C1r-qrAe' M sr1 t-Y,:; C, <br /> i Technician y/ <br /> Date <br /> I Eta rn oux 7 6 Casrng secure 12 Water standing in wefibax i 15 'Neil r-o lunctfonal? <br /> 2 Lid broken +7 Casing cut levei? 12a.Stanarno anove the to of caGrng•' 16 Can Cap be pulled loose-, <br /> 3 Ltd baits mrssma_% 13 Decns in veYbox: 12b 5ranomo below the top of Casino? IF Can ca❑sepal out water <br /> It tad baits stripped, 9 'Nefibox is too far above grade 7 14c '!Vater even With the top r3f Casino 16 Padfoc"present- <br /> 5 lid seal intact-, 10 Weilbox Is too tar below grade 3 13 `Nell c--D present^ 19 Padloc!s functional? <br /> 11 'Nellbax is crushedldamaged? 14 Well can found secure <br /> FCheck box if no deficiencies were found Hate below deficiencies you Were able to correct <br /> 'Neil I D Deficlenca Corrective Acflon Taken <br /> Hate belovr all defiencies (hal could not be corrected and still need (o be correr-led <br /> BTS Office assigns or Date Date <br /> 'Neff 1 D Fersisiina Deftciericv defers Correction to asslaned correcied <br /> .ee 7V UVAW., <br /> f <br /> I <br /> r <br /> r <br />