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• 4 <br /> SITE INSPECTION CHECKLIST <br /> Client Date <br /> Site Address 1-1,31 s G1. ff'ril, (lel Vo" <br /> Jab Number 03o 11 l-T f3 `'f Technician 'ZF 6 ey j-i <br /> Site Status , Branded Station Vacant Lot Other <br /> Inspected 1 Labeled 1 Cleaned -All Wells on Scope Of Work ` <br /> inspected I Ciears:)d C;;mparents Other- Idontifiable Wclls - ❑ N! <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order(s) ❑ N/ <br /> Completed Repair Data Sheets(s) ❑ N/ <br /> ir&cted Treatment I Remediation System Compound For Security, ❑ <br /> Cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or ❑ &1A)I <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 t Comments (In addshon to other Issues,note all SOW wellboxes that,by design,are not securable) <br /> rG� -),h <br /> Aft <br /> PROJECT COORDINATOR ONLY <br /> checklist Reviewed Notes <br /> Initiallbate <br /> 9 AMIC TCI`1.1 PCrnll!`GC r1.1P` -. . -� .. -... � .r.. r... ..� rn .. w�.... •. .. <br /> 1.[ .nernrh r-nm <br />