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BLAINE 1680 ROGERS AvE'luE WET 3A—D h^ °P CrION <br /> C <br /> TECH SERVICSa SANJOSE CALIFORNIA 95112 <br /> (4oe)573-r i r 1 FAX Client <br /> (408)=73-0555 PHONE V — - <br /> t° 9de Address &131 ��f+i�o� <br /> $ r A <br /> l echniman oo-�4_e A/ <br /> r <br /> Date_ g 75z) <br /> I Lia cn bo-x7 6-Casing secure 7-- - 12--ylater stanamg in veffbax7— 1r-'Nell MID funcb0nal7 <br /> 2- Lid broken? 17 Casing cut levet+ I la.Stamina above the mo Of Csrna% t6 Can=v be pulled Eaose� <br /> 3 Lid bald mrssmg7 8 l?ebns m wetfCox7 12b SFanaino befow the tup of casino17 Can c--o seW outwater <br /> A Lid bolts stripped? 9 Welfbox is too!tet above aurae 7 12c Water even wrdl the top Cl C,-srno 18 Paa3o t present? _ <br /> 5-Lid sea)rntactl -- 10-wel[bvx rs!on far betovi grde� 13 Weil caD present? 19 Paolock functeonaP <br /> I 1 'Nellbox is crusnedldamaned% 14 Wef(cm louno se=e? <br /> Check box if no deficiencies were found Note below deficiencies you were able to correct <br /> Well l D Delicienca Corrective Action Taken <br /> I <br /> F-I <br /> J I <br /> f)ofe below all defiencies Ifial could not be corrected ano still need to be corrected <br /> BTS Office assigns or Dale Dale <br /> 'Nell I D Persisfino Deflclenci deters Carrection-lo assioned- -corrected_ _ w <br /> I t <br />