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ELAINE IMCI <br /> ASANJSc iS AVENUE <br /> ORMA 3 112 <br /> Tc-r-H Sc V1C (448). --,-rT1 FM <br /> Cfiertt <br /> (4081573-055=PHone <br /> Sr a Adarlas <br /> ? 11 � <br /> l t3-ch nlcian <br /> r�t� T fate <br /> �N7 OO�•v <br /> 1 !ro an bax7 6 C�sma secure 1Z Water standing in vetibox7 1E Well cao funcnonm7 <br /> Z Lid 6raken 7 7 Cana cJt le•!e% 122-9101oinrs anave the too of cas no% 16 Can=o beff <br /> Fu ed 1aose7 <br /> 3 lid baits mrssaj-7 B Derns rn%ve!fbox 7 17-b Stamina below the top of casrm% 17 Can r O se2f out+wMr 7 <br /> 4 Uo baft stnppea7 9 wedbax rs too far aCM8 eraoe.7 1Zc Water ever Hirth the too of casino' 18 Faaloc�<present? <br /> 5 Lid seal rntacO 10 Weilbox rs Loo tar berow grade,, 13 Wer?r=v presents 19 Paolodc funczend7 <br /> III Welbox rs cmmnedldamso-+? 1d Well cm fauna se^.-ne7 <br /> 0 Check box d no deficiencies were found_ Note below deficiencies you were able to correct. <br /> Wel) I D Deiic.encl Corrective Action Taken <br /> / c <br /> 1 <br /> Nole berow all ce-iehcies illat could not be correcyea ano still nem to be correyted <br /> BTS Qf cS ass-ons or Dafe Da1e <br /> We+(-I D—Pers�stlna-Dertcserlc-/ defers-Corrertion to aSSuned corrected <br /> f 7-5 -T'o <br /> i <br /> 1 <br /> r <br />