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,• SITE INSPECTION CHECKLIST <br /> 4 <br /> Client Date 0 3 <br /> Site Address h L.-nc Ft <br /> Job Number 031W -SB-1 _-- Technician I3ro�-jM <br /> Site Status Ae-I 1 Branded Station Vacant Lot other <br /> Inspected ! Labeled 1 Cleaned -All Wells on Scope Of Work ] <br /> Inspected ! Clear Dd C-_mporjenC, -.A_!' Otter Idontifable WC11's <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order(s) ❑ N/ <br /> Completed Repair Data Sheets(s) C] NI <br /> ,jWspected Treatment 1 Remediation System Compound For Security, Q NIA <br /> Cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or NIA <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 wellboxes That by design,are not seCurabfe) <br /> PROJECT COORDINATOR ONLY <br /> Checklist Revlewed ML .,, Notes <br /> IniUaMate <br /> BLAINE TEcm sERvcFs INC SAN JOSE SACRAMENTO LOS ANGELES SAN DIEGO www htamefech mm <br />