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ENVIRONMENTAL WELL,REMEDIATION COMPOUND,AND SITE INSPECTION FORM Page of <br /> INCIDENT# ADDRESS <br /> 0 3q —('�'fdJ5 <br /> DATE: CITY&STATE e— I <br /> : :_ Ohseiveticrts llpoitjlnivaT .. .. <br /> Well Cap <br /> _, MariWaj/Cover Type Condftlomw*lze- <br /> Pefntud -ripper) <br /> P Condition <br /> 1�j1n.h) <br /> Ptalliff" Flush [T,) P N R R NLYi <br /> P <br /> <t!5`5-dP'p� Flush P 6 N R R NL P ON <br /> ndP Flush 0 P Oy N R R NIL P y N <br /> Y N <br /> Flush & CY <br /> P 6 IN R R NL P <br /> Flush G P N R NIL P Y <br /> -dPP e) 3 <br /> Wro(in.11) <br /> Sd-P-10 Flush P y N QV R R NIL G P <br /> Y. <br /> Flush 6;) P N �G R R NL P y <br /> Flush t'G-'% P N R GG R NL P y <br /> HP-(o —j _ Re I <br /> HLLN -� Flush OG P a 11...1 -79 <br /> Ct.n d>p, (0 N R R 111. P y <br /> a" och) <br /> 8tilini—dPIPR;�FlUsh GP 6 N R R NIL P y <br /> sue Pnehi <br /> Stand Flush N Sr R G R NL -a P y <br /> TOTAL S REPLACED= J9 TOTAL 0 OF LOCKS REPLACED <br /> Condiilon dryad eodrlg Pefclies <br /> G P (WA. <br /> Y N <br /> ............. <br /> 'W;9W. , <br /> cfearting't <br /> 71 'Ra paG7PNlnit4ti L' <br /> NA <br /> Building <br /> Buildm9wFF.Mecomp.] 0 P �NIA G P NfA G P NIA y N NIA y <br /> Forroadcompound <br /> Tmn.r <br /> ion ConeOtiy and COffYlrm proms <br /> Drilln.Lor.t.d I.Ain <br /> Ohms Dnslm Sous o(ffie Contents' Nlndn La tESe Onun.Cond(ticn (!elated to Basin <br /> o.slntefforonce <br /> EnVirOnmontai <br /> N NIA N NIA P NrA N <br /> i <br /> G=Good(AccaptabJe) R=Replaced All environmental wells and the remedlatlon compound were In good canditlan, <br /> P=Poor(needs attention) NL=No Lack Required locked,and secured upon my departure(unless Otherwise noted above). <br /> Note,All.,[ hell mlee sand tl ry I Ma oval dor ore <br /> Version 2.4.Meroh 2M or <br /> 9%1A.rs.nn;9�.(A1t.,t�..p. <br />