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e <br /> i 4 ' <br /> r , <br /> SITE INSPECTION CHECKLIST <br /> 1 <br /> Client Date <br /> Site Address WIYW6-. Ioo <br /> li <br /> Job Number Technician ��� �✓ <br /> Site Status SAe-,6,[ Branded Station Vacant Lot Other <br /> Inspected / Labeled / Cleaned - All Wells on Scope Of Work E j <br /> Inspected / Cleaned Componente - All Other Identifiable Wells /A <br /> Inspected Site for Investigation Related Trip Hazards <br /> Addressed All Outstanding Wellhead Repair Order{s} r <br /> Completed Repair Data Sheets(s) <br /> Inspected Trdatment'/ Remediation System Compound For Security, <C/A <br /> 3 <br /> Cleanliness and Appearance I I V - <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or <br /> Terrain, Overgrown Vegetation and Security �..J <br /> PLEASE BE ADVISED THAT, UNLESS OTHERWISE WSTRUCTED,NO REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> Outstanding Problemsr! Comments �(In addition to other issues nota all SOW wellboxes that by design,are not securable) <br /> PROJECT COORDIFIATOR ONLY <br /> Checklist Reviewed Notes <br /> ' InItIallDale <br /> SLAINE TECH SEPVICC5 INC SAN JOSE SACAAMEi1TO LOS.A113ELES Shrl 011GO <br /> nn:plgrpelgch torts <br />