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IN <br /> SITE INSPECTION CHECKLIST • <br /> Client - LC' Date <br /> Site Address 7�� <br /> Job=Number o ot-1 f=j'3 -7 Technician <br /> Site Status 3 L6 It Branded Station Vacant Lot Other <br /> Inspected 1 Labeled 1 Cleaned - All Wells on Scope Of Work <br /> Inspected 1 Uearmd Components AaT Other Idontiifable Wells Q N/ <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order(s) ,7 <br /> Completed Repair Data Sheets(s) Q NIA <br /> Inspected Treatment 1 Remediation System Compound For Security, © NIA • <br /> Cleanliness and Appearance <br /> Inspected Vacant-Lot-for Signs-of Habitation,=Hazardous-Materials-or�Q �/A <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 I Comments {In addition to other Issues,note all SOW wellboxes that,by design,are not securable) <br /> 4!,f'• ,y ' 1-7 - l:d[ ne I,—A. q 6.1 �akis S, <br /> r J "lClr N <br /> V <br /> PROJECT COORDINATOR ONLY <br /> Checklist Reviewed Notes <br /> Initiall0ale <br /> 91.AINE TECH SEROUS INC SAN JOSE SACRAMEPITO 1 nc;AwrR GS 4arnern hha nn/wrA rnrt. <br />