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BLAINE ISS RC c AVIEEArUvlA ?5112 vEI1�,I�EAl ySPECr�'Orq C'M'QRLIST <br /> Tec" s1=.�f. n•. (408)�r-3- 1 FAX Cgent •, <br /> (408)873-0553 PHM?r= <br /> 3fte Adams <br /> J echnlc-an_ ._ i9�, <br /> T Date lD/f P"610art � a <br /> 1 Lla on box? 6 Casum se=re,' 12 Water stamina rrt r+e ibox l 15 Well r--a functOn-d7 <br /> 2 Lid broken? 7 C--ma cut leve,-, ML Stmdind anave the ton of castnal 16 Can ma be potted loose? <br /> 3 Ltd boils missing? 8 Deans m tvelibdx7 17b Standing below the tap a!m.sma 17 Can can seal out Water? <br /> 4 Lia bans str[ppen7 9 Wetlbox is too tat=ove Vie] 12c.Water even vmh the loo of CS,na7 i8 Psofod-present? <br /> 5 Ltd seal mractl 10 Welbm is too lar below arsdeI Is Wea=n present? 19 Padlock f-mctonas7 <br /> 11 Wei ss=ishedfdamaaea? Id Well c=- fdsntd sc--ze 7 - <br /> P�z Check box IT no deticlencles were found- dote below aeficltericles you were able to correct. <br /> Well LD Degc.enac Corrective Action Taken <br /> i <br /> Mole below all detlenctes that could not be corre-clea arta still need to be corrected <br /> BTS Office ass,ans or Date Date <br /> Well 10 Pers.stlna Derlcle9c., de+ers Correction to asslaned corrected <br /> f F <br />