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SITE INSPECTION CHECKLIST <br /> Client Date <br /> Site Address i131YWo &-loo �Tix.Li+S►,� <br /> Job Number Technician <br /> Site Status tSA i,&,C Branded Station Vacant LU 'Other T rn <br /> Inspected 1 Labeled 1 Cleaned -All Wells on Scope Of Work <br /> Inspected I Cleaned Componente - All Other Identifiable Wells - ❑ IA <br /> Inspected Site for InveLstigatron Related Trip Hazards r r <br /> Addressed All Outstanding Wellhead Repair Order(s) ❑ <br /> Completed Repair Data Sheets(s) A ❑ '' <br /> Inspected Treatment I Remediation System Compbund For Security, ❑ ICA <br /> Cleanliness and Appearance _ _ _ _ _ • <br /> Inspected Vacant Lot for Signs of Habitation, Hazardous Materials or ❑ <br /> -Terrain, Ovecgeown Vegetation ft- Security <br /> W PLEASE BE ADVISED THAT,UNLESS OTHERWISE INSTRUCTED,NO REPAIRS ARE PLANNED FOR THE ISSUES DESCRIBED BELOW <br /> Outstanding Problems I Comments (in addition to other issues,note all SOW wellboxes that,by design,are not securable) <br /> 4 <br /> ti <br /> PROJECT COORDNATOR ONLY <br /> Checklist Reviewed Notes <br /> Initial/Dale <br /> BLAINE TECH SERVICES IHC SAN JOSE SACRAMENTO LOS ANGELES SAN DIEGO th nwec coin <br />