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I', <br />11) Event Date: Chevron #9-4054 Site Address: WELL VAULT Pictures Manufacture/Size/ # of Bolts Taken Y 47) , <br />1 <br />tl <br />7 4 <br />tA <br />— <br />.i <br />1 <br />---J <br />tti <br />C), <br />,i <br />----te <br />_ <br />VI LOCATION OF DRUMS: MA Vi <br />......... <br />Z <br />w u a <br />UJ X V <br />IL <br />0 1 /&4 #: 1 Ni DRUMS PRESENT ONSITE? Y t4- jARE DRUMS PROPERLY LABELED/ Y / N Casing (Condition prevents tight cap seal) ( A A A /4\ A p <br />f\ <br />TO E re ra. <br />U) o .c - u <br />S' i 47 p <br />0 — <br />c 1, <br />2 t .t= „, ii d <br />c.) o m Bolt Flanges B=Broken S=Stripped R=Retaped ,4 c• <br />c=0 <br />_ A to Bolts (M) Missing (R) Replaced A <br />, <br />(\ Gasket/ 0-Ring (M) Missing (R) Replaced C <br />5 g S <br />C, o fzi, <br />4 <br />cI WELL ID 3.13 <br />...... ..... <br />Ji,.i <br />_. <br />1 I 1