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ti <br /> e <br /> SITE INSPECTION CHECKLIST <br /> i <br /> '.hent Date r--1 - 1 -03 <br /> 3tte Address 10 -71 N --•-7 1 f. <br /> lob Number Technician 13rojL, <br /> Site Status e_I I ' Branded Station Vacant Lot Other <br /> nspected 1 Labeled 1 Cleaned -All Wells on Scope Of Work Q <br /> nspected 1 Cleared C=rnporjents -A" Otf:er ieontifiable Wcl's - ONiA <br /> nspected Site for Investigation Related Trip Hazards Q <br /> %ddressed All Outstanding Wellhead Repair Order(s) NIA <br /> ,oinpleted Repair Data Sheets(s) 0 <br /> nspected Treatment ! Remediation System Compound For Security, &A <br /> 'ileanliness and Appearance <br /> nspected Vacant Lot for Signs of Habitation, Hazardous Materials or /NIA <br /> terrain, Overgrown Vegetation and Security <br /> PLEASE BE ADVISED THAT, UNLESS OTHERWISE INSTRUCTED,Pio REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> )utstanding Problems / Comments - (in addinon to other Issues,note alt SOW weltboxes chat, by design,are not securable) <br /> C+?Gf• re— <br /> PROJECT COORDINATOR ONLY <br /> ;hecklist Reviewed Notes <br /> Iridal/Date <br />