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SITE INSPECTION CHECKLIST <br /> Alem �1 _ L--0 <br /> 3 <br /> Date <br /> site Address 31~11 5. / tl -7 J t <br /> ' a <br /> lob Number- v 30Lf 61- 7-5 -3 <br /> Technician 77" 13 ro'J., <br /> iite Status <br /> . - Branded Station Vacant Lot Other <br /> aspected 1 Labeled I Cleaned -AlI Wells on Scope Of Work Qj <br /> nspected I Ue3r,zd Ccrtponent - M" Other Id-o!tiflable Wclls NE <br /> nspected Site for Investigation Related Trip Hazards j <br /> ,ddressed All Outstanding Wellhead Repair Order(s) 1 N/A <br /> :ompieted Repair Data Sheets(s) 0 N/A <br /> 'I*cted Treatment/ Remediation System Compound For Security, 0 NIA <br /> .leanliness and Appearance <br /> aspected Vacant Lot for Signs of Habitation, Hazardous Materials or <br /> 'errain, Overgrown Vegetation and Security <br /> PLEASE BE ADVISED THAT, UNLESS OTHERWISE INSTRUCTED, NO REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> )utstanding Problems I Comments on addition to other Issues,note all SOW wellboxes that,by design,are not securable) <br /> TETE c•rlG�:.>tclrc `� r� a rJLf <br /> V <br /> PROJECT COORDINATOR ONLY <br /> hecklist Reviewed Notes <br /> InivallDate <br /> SLAINE TECH SERV ICES.INC. cnnluscc carR46dGMrr1 iYteatiir_ccc Cr.u,n,Crn nlom=frhram <br />