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SITE INSPECTION CHECKLIST <br /> Client �/�P.1.� Date -2'/ZZ'/ay <br /> Site Address 25S T <br /> Job Number p�1aY.zg-may Technician <br /> Site Status 64 Branded Station Vacant Lot Other <br /> Inspected 1 Labeled I Cleaned -- All Wells on Scope Of Work <br /> Inspected / Cleaned Componente -All Other Identifiable Wells - NIA <br /> Inspected Site for Investigation Related Trip Hazards Qr <br /> Addressed All Outstanding Wellhead Repair Order(s) El NIA <br /> Completed Repair Data Sheets(s) N! <br /> spected Treatment ! Remediation System Compound For Security, 0 IA <br /> eaniiness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or [] 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 / Comments (In addition to other Issues,note all SOW wellboxes that, by design,are not securable) <br /> A*Y"* <br /> ® lrJ� ✓Qcc.�f +�i7f �-S Can•raf 6C 5�rcd �-- ads!��. <br /> ~./z V& I.T Aex ..,I, .fa,ac 4olvs- <br /> �iu <br /> kr eCrA14 Zz yb w&' Ax6 &,P vctufy I.,W. <br /> PROJECT COORDINATOR ONLY <br /> leck:Ust Reviewed �-� yJ � Notes <br /> Initial/Date <br /> BLAINE TECH SERVICES !NC SAN JOSE SACRAMEMTO LOS ANGELES sm DIEGO www blameWCA-Cdn <br />