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SITE INSPECTION CHECKLIST • <br /> Client sL1zla Date S/1 9/Oy <br /> Site Address 13/3 E 44ar/4- LcJ� S <br /> Job Number py0519-1U41 Technician <br /> Site Status Branded Station scant Lot ther <br /> Inspected I Labeled I Cleaned -All Wells on Scope Of Work <br /> Inspected 1 Cleaned Componente - All Other identifiable Wells ❑ S <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order(s) ❑ QNZA) <br /> Completed Repair Data Sheets(s) 0 NIA <br /> Inspected Treatment t Remediation System Compound For Security, Q jE4 <br /> Cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or [DA NIA <br /> Terrain, Overgrown Vegetation and Security <br /> PLEASE BE ADVISED THAT,UNLESS OTHERWISE INSTRUCTED,NO REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> Outstanding Problems 1 Comments on addition to other issues,note all SOW wellboxes that,by design,are not securable) <br /> PROJECT COORDINATOR ONLY <br /> Checklist Reviewed Notes <br /> Inihal/Date <br /> BLAINE TECH SERVICES INC SAN JOSE SACRAMENTO LOS ANGELES SAH DIEGO www hlamel"Gtr r�rn <br />