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a�Ei—i_l r�t� IfiSPEGTIOf i HEK.KLIST AND REPAIR ORDERClient <br /> Inspection Date 77 <br /> Site Add,esS Inspected By <br /> 1^cn t3J! (,aS111Q"Mire 7 '2 wat,- .r ianc inn Irr,wellboL ? 1� 'Js'c'{I cu^flint fla Hai r <br /> ..SCI b"rk�n; � Ci75'llf!r.�i'�uC'.I' 12a Ura-C'"C �rOvs the top of cas,nQ% l�' C-)n ci ip bC p'Wed loosp? <br /> Lid bolts mis�nu"` = 4J 'l� i='.-x 12" S`anilln hPlovr the top cf r'a51ng' 17 G8n cap Seal ostt vfa*e <br /> 4-Lid bolts slgppE yi7 WI:IIIa�lf I;_.i =� sr�t^m 12 c " hIe'-r-en Vltn the'Cin�f c2sinoQ 1P Pr3CilnCN pr-stent? <br /> 5 l Irl,C ;Intarr' 1,i %A1p I,',n`(';rCh�a"i,al�n,r�rn,l$ 'Altll Cflp OrFS�`I'!i? 11) rFir�'��V tIJrICi!'In�j� <br /> 11 Y/�1g�}bC77 !" f JSheC r�2IT}7;..1 i--i_,l'i We{I C=p fo ind,cE cur^7 <br /> j C neck box If no cleficiencies wei e found Hate below) deficiencies you were able to correct <br /> Well i D Dsfl3iencyGariectl�e ,4ction Ta;cen <br /> 1Jc�c l - r — _+_m*j <br /> 1 � I <br /> I — <br /> I <br /> Ncts below all dcfi{ncieF that could not be con erted anal >ttil �,er tU be ctrl 6?cted <br /> BTS Office- assigns r r Dat- Date <br /> Well I r.] P rsishna Deficiency defers Co,l ection to assigned corrected <br />