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01/08/2010 10:07 FAX 916 371 2380 BZ SERVICE STATION 2009 <br />B.Z. Service Station Maintenance, Inc. <br />630 Houston Street — P, 0. 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: �-() -�� <br />Site Name: (I <br />Address: <br />J. <br />Site Contact: <br />Any spill at site: Yes o1ro where: <br />Were all Lids bolted down and in place: Yes o <br />Are All Seals in place: Yes o <br />Condition of Concrete and Asphalt: <br />4 <br />Were all'"'spill buckets in plac�,)Y�i' or No <br />.0 <br />Drams on site: Size ow many—Content/Labat <br />Any other problems to report: <br />Upon Leaving Site <br />Are all Lids bolted down and have bolts: Yes 0� 11---") <br />Are all Gaskets and Seals in place: Yes 0�- o ' <br />Any Spills at Site. yes d� here: <br />Any thing else to be to report: N�. � - <br />Signature of Site Contact: <br />Signature of Surveyor-: <br />Qw <br />