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SITE INSPECTION CHECKLIST <br /> Client SHI.t. Date z -ce-off <br /> Site Address ��l E. �ni+►+� SY, I~tra0 <br /> ,fob Number oho to —f m.y Technician T. Mu t,t,BY <br /> Site Status S N r~t✓ Branded Station Vacant Lot Other <br /> Inspected I Labeled 1 Cleaned -All Wells on Scope Of Work d <br /> Inspected I Cleaned Components -All Other Identifiable Wells NIA <br /> Inspected Site for Investigation.Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Orders) :NIA <br /> Completed Repair Data Sheets(s) NIA <br /> Inspected Treatment I Remediation System Compound For Security, NIA <br /> Cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials orNIA <br /> Terrain, Overgrown Vegetation and Security <br /> PLEASE BE ADVISED THAT,UNLESS OTHERWISE INSTRUCTED,NO REPAIRS ARE PLANNED FOR THE ISSUES DtSCRIBED BELOW <br /> Outstanding Problems I Comments (In addition to other issues,note all SOW wellbues that,by design.are not securable) <br /> den OIl+ties4 aMPe%tj o $txEs 1.SlaV SoA? t,vu.M13 fot CPew�csrl <br /> 1ItjD14rYAl,jf$wL1& D(SPi w okqs voos TNsiQj� <br /> bn&TO u1J 0 Iw p w rhe t5 a,} v F& �a�vN� • Cb"tit•o wP h a T LoG p <br /> 5W-1- IF Zrn Is WA€160 po s Nod Elr FMfERLY STI(AC-Stke 1I14 lock TFtt' K too <br /> PROJECT COORDINATOR ONLY <br /> Checklist Reviewed 1- Notes <br /> J <br /> iliailDate <br /> BLAINE TECH$ERViCE$INC. SAN JOSE SACRAMENTO LOS ANGELES SAN OIEGO <br /> www.b{$ine[erhiow <br />