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ELAINE Isea RC 3AVII IVE d.R �JPECTION <br /> 5A14Jti5t;CAUFQRNiA ?5112 <br /> TE---H SIF-mess— (40 81.�r3-=1 FAX <br /> fo (408)573-O555 PHONE <br /> �f r <br /> Slee Addre��/ � <br /> 1'�'r''hniciaf159 �10 11111111 11 <br /> ��/jI C� <br /> r <br /> �!1 c Date <br /> A Ar <br /> 1.Lid an box? 6. Casino secure' 12. Weser stens g in mgbox 7 15.Weif co hmatonai? <br /> 2 Lid broken? ?_ Casing cut leve?? 12a.Sterna W3WIR_'he.tno.af c'a f :1&..Ean:co 6e puiled Taas2?" — <br /> 3. Lid bolls missing? &. Debris in�vellbax 7 Mb.St ndino below the hop of came? IT Can can sej aut wmr! <br /> 4. Ud bolls stripped? 9. Weilbox is too far zoove grade? 1zr-Water even wig the too of ca-�ina7 18. Padlock presanr? <br /> 5. Lid seal intact? 10.WeI is loo I&below orade 7 13. Weft ca present? 19. Padlock funcdonQV <br /> 11.Wellbox is k r ohedldarnane:i? IT4. We+9 ca found Se--me 7 <br /> Check box if no deficiencies were found. Note below deficiencies you were able to correct. <br /> Well I.D. Defidencv ,l Corrective Action Taken <br /> i <br /> ll <br /> I . <br /> ff� <br /> i <br /> I <br /> f <br /> l <br /> I <br /> Note below all defiencies lilat could not be correcled and Still nef--J to be cvrre-led. <br /> BTS Offic$ assianS or Date Date <br /> Weft I_D. Persistina Deficierlc-r deters Corrertiort to: aysianed corrected <br /> f <br /> � I <br /> f <br />