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B.Z. Service Station Maintenance, Inc. <br />n 630 Houston Street — P. O. Box 933 <br />West Sacramento, California 95691 <br />Phone (916) 371-2380 <br />Lic. # 433159 <br />Site Survey <br />To be performed upon arrival <br />Date: D - 0 ? T <br />Site Name: <br />Address: M—,) E. V,�-�r 11,,�j <br />Site Contact: C,, <br />Any spill at site: Yes olao Where: <br />Were all Lids bolted down and in place: Yes o No <br />Are All Seals in place: Yes oNo ere: _ , t t..._ <br />Condition of Concrete and Asphalt: = 5 , r : + <br />Were all spill buckets in plac Ye ` or No <br />Drums on site: Size a'a> How many Content/Labal: < ; <br />Any other problems to report: hs� <br />Upon Leaving Site <br />Are all Lids bolted down and have bolts: Yes o To� <br />Are all Gaskets and Seals in place: Yes =' <br />Any Spills at Site: Yes dLNl 'Vhere: <br />Any thing else to be to report: Mi) <br />Signature of Site Contact: <br />Signature of Surveyor;, <br />