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• SITE INSPECTION CHECKLIST <br /> Client 5l ew Date Y Z 8/0r-/ <br /> Site Address _ ,Zy9y <br /> Job Number Technician /4(4 a.., /,4 <br /> Site Status Jh Branded Station Vacant Lot Other <br /> Inspected I Labeled I Cleaned .All Wells on Scope Of Work <br /> Inspected I Cleaned Components -All Other Identifiable Wells ❑ jA" <br /> Inspected Site for Investigation Related Trip Hazards U <br /> Addressed All Outstanding Wellhead Repair Order(s) 1:3 <br /> (29 <br /> 51 <br /> Completed Repair Data Sheets(s) <br /> &C, <br /> Ispected Treatment 1 Remediation System Compound For Security, <br /> leanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or lA <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 1 Comments (In addition to other Issues,note all SOW wellboxes that.by design,are not securable) <br /> PROJECT COORDINATOR ONLY <br /> heckiist Reviewed Notes <br /> infhal/Date <br /> BLA►HE TECH smviuS INC SAN JOSE SACRAMENTO LOS ANGELES SAN D*GO ;'w%blelftlech an <br /> ,i <br />