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r1 i <br /> SITE INSPECTION CHECKLIST <br /> Client Date <br /> Site Address <br /> Job Number Technician <br /> Site Status Branded Station Vacant Lot Other 0"W (.ra1Inspected I Labeled 1 Cleaned -All Wells on Scope Of Work 0 <br /> Inspected 1 Ciearind Cnmporen -fi": Other Identifiable Wells 0 NIA <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order(s) [] Ip► <br /> Completed Repair Data Sheets(s) EN NIA <br /> epec-ted Treatment 1 Remediation System Compound For Security, [] NI <br /> Cleanliness and Appearance <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or E <br /> Terrain, Overgrown Vegetation and Security <br /> PLEASE BE ADVISED THAT,UNLESS OTHERWISE INSTRUCTED,NO REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> Outstanding Problems I Comments On additlan to other issues,note ad SOW wellboxes ftt,by deslon,ara not som abte) <br /> PROJECT COORDINATOR ONLY <br /> Checklist Reviewed Notes <br /> InldaWate <br /> BLAINE TECH SERVICES INC ,AN JnSR 4ArRAjAFf4M 1 nt;AtaCFt FS +SAKI nlmna MYW hlnmelrch com <br />