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BL4INE 1884 Fit 13 AV1=VURUL, t �IjPECT OI;F C E , ST <br /> 5�1 Jo �C.;uFnRMIA 95112 � `.-" <br /> 11 rsa;-�vt s.� (408)VM-;r ' FAX fk <br /> Crent 4- <br /> `!(40a)6i3-053:�ptiorlE •y <br /> She Address 1161 P t^4,.f J <br /> Technidati Z & -%- Or.•,,, -� <br /> r Elate <br /> 1 Lm on boz7 e? 12. Water st�nc9ng m+mflbox7 15 'Nell=a kmctaona,7 <br /> 2 Lid broken? olevel*; � 12a.Stmnaina above die mm <br /> o of casino 15 Can csA be pafled Iuase7 <br /> 3 Ud bolts n=sM 7 B_ G e�Jbox 7_ 12 Ztandma below the top of c nal 17 ZM(mmo seal out W,-W7 <br /> ai <br /> 4 Ua bolts spped7 9 Y elibox Is 11V far T a'�¢e Ito.Water even vndi the Iota of-�,97 18 Pmladc present? <br /> 5 Ud seal iniad? 1a WRgbcx is too f�be Qv� e7 r 13 Welt cm present? k 19 Psaloa itmcxond7 <br /> 11 We+Jbox m rs�rshedld�nane i 14 Wed can found se=67 s <br /> Check box if no deficlencles were roPd ,Note below deficlencles �otr were able to correct. <br /> Weil I D Deiic:emc Coriecilve Action Taken <br /> I <br /> I <br /> 1 <br /> r� <br /> • � F <br /> � 1 <br /> +1 Note below aU deJencies that could not be corrected arta still need to be correcied <br /> ` BTS Office assigns or Dale Date <br /> Well 10 Per--ztlna ❑ericsencv de+ers Carrectlon to- assloned corrected <br /> I <br /> 7-1 <br /> I ! <br />