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ENVIRONMENTAL WELL,REMEDIATION COMPOUND,AND SITE INSPECTION FORM // //�� Pape of <br /> INCIDENTo 71gl o34( ADDRESS r 0-r �ry tLaksQ,C //mol, <br /> / CITY&STATE I lYti , <br /> GATE: � /��j/ �j3 <br /> -�{ �� , Ohseryadons Uikn ArYtval 9' ` Note Repairs Med§ PhoWs oR rRePaUb"eia.: <br /> �� ' o >x Well Lab@! / y1101f,Cep : Well Pad/ <br /> Detailed Explanatloti oRMafnfenance Recommended Wally-0' $fid.PlYf <br /> i <br /> Wetl D ManYtay Coyer;9Pg Condom( on&SKe Pd(M0t1 tGn Per) Wall Lock Condition Surface arta P-er'Iormed CondWhlt, tnl�ials <br /> D . •,, PriopOtly" ' Conddon. - _ Condition ^" ' <br /> sm oN (MG' Y <br /> S andPlP Flush P O N R V R NL <br /> tP <br /> sla Oaanl Y <br /> tantlpt a Flush CG,� P NOGROGRNL © P <br /> sue Caen) Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> sub(anon) Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> w»(u,anl Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> silo(moN Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> stn Cnehl Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> T.(inah) Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> sim Cnon) P Y .. N <br /> Standpipe Flush G P Y N G R G R NL G <br /> sub(ingot Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> 5w&6)1 Y N <br /> Standpipe Flush G P YN G R G R NL G P <br /> TOTAL#CAPS REPLACED= <br /> V `'r'f''' =TOTAL#OF LOCKS REPLACED <br /> CPndide aIS61C i rihpPatches,o, l ' t>; Y <br /> G P N1A iQ.PoT) aa�lir LocaBort33saotlpdon <br /> .Aaandonall MatliNrgig.Viena d " .. r���a`���t�oJ�x�. f° <br /> iRemi>dufrWt`�om Hund TtFpd <, r Z'ofitlXt�ofto,($1ma p�w¢K '� "1 'i � .,'Em2rp'e¢ey'Cq'iitaetbdd tl T tiR Pgin Ra¢a'mhter'A1„Wamt ConduetA(d: �� '�p�� <br /> P� ?:Ga�a146nnjEnclosure Enelibio g6tnpo,md8a"WJ(ty VlpWid' r° <br /> CYd nh <br /> adti: <br /> ., <br /> NA <br /> Building Y <br /> Solid in9 w)Fence Comp• G Ila G P JI G P Y N <br /> Fenced Compound <br /> Traitor - '"664 da: <br /> � Rfio(as of <br /> '• . 'r ) 'Cer(rtmt O),Stlgax pj'umel.ae{tdd�tdMln RemdQW/retn <br /> Nwnberof( DpegMel,abel RoVoal Na La�61ed'CormtdY and ' gmefCC,d7ddlblt Rota(Qd to 8ua(M dMd:f n De[a'Ied ExPlanotbn or Any lssuos ResalVod Omm^ see <br /> pramClnsi[e "soilre6'ef Ne canlonv Wi11tr�LPdIW( .: .:'P.rwlronmemal- :_ <br /> c n <br /> lJ <br /> Y N N NIA �1 N NIA LIS) P NIA O N /c([p(&QQU G{✓"GC2l l.hf7r(x Oh SQ Y <br /> All environmental wo)!s and the remedlatfon compound era in good condition, <br /> G=Good(Acceptable) R=Replaced fucked,and secured upon my departure(unless otherwise noted above). <br /> P=Poor(needs attention) NL=No Lock Required <br /> Nell, h iF M tld i 4M1 PMa row Doer to reealr 64:4 <br /> f,3 <br /> -:Greunawaer mmiitPd,qnenw.em mvat ee pNmetl ane totxlca in acrumanm vdw aaorcebte regweeone <br /> Part or pe NaTpf Field Personnel tient Company <br /> Verc.2.4,Mm 2WO <br />