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SITE INSPECTION CHECKLIST <br /> Client S4 Date .6�:y _ <br /> Site Address G!1 �au',�i'Gc� 5- <br /> Job Number _ f�Y�W26_ 3 TechnicianA� <br /> Site Status Branded Station Vacant Lot Other <br /> Inspected 1 Labeled 1 Cleaned - All Wells on Scope Of Work El� <br /> Inspected 1 Cleaned Components - All Other Identifiable Wells E�r NIA <br /> Inspected Site for Investigation Related Trip Hazards El— <br /> Addressed All Outstanding Wellhead Repair Order(s) NIA <br /> Completed Repair Data Sheets(s) F N!A <br /> Inspected Treatment 1 Remediation System Compound For Security, N!A <br /> *cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or (:N/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 wetiboxes that,by design are not securable) <br /> Gaa <br /> �Y/(�i771 4(irt <br /> cp'"'jkC a v�i.f ySn.t <br /> PROJECT COORDINATOR ONLY <br /> hecklist Reviewed u 4-ZS-01Notes <br /> InihailDate <br /> BLAINE TECH SERVICES #zC SAN JOSE SACRAM0170 LOS ANGELES SA14 DIEGO Y-M."Naalnelmh can <br />