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- - - - - Y - BLAINE <br /> 1513a KC is AVENUE <br /> -WELLIM -T- ` 8PEC'I'I�I''>f�0gF <br /> SAN JOE- CALIFORNIA 96112 <br /> TTrCN SF-RVICZS— I409?5TZ-7 i 1 FAX <br /> Client ..iryt; <br /> (408)573-0536 PHOME -- <br /> Sae Address!rt lid llC rr IGH <br /> �( Tecnrncan -a,' c <br /> T <br /> Date ._ld�G/lam <br /> I Lia on box? 6 Cssrrra secure% 12 Water standing in seffbox7 15 'Neff(--o fvncaona-? <br /> 2-Lid broken? 7 Canna cut levet-, 12-�L Stamina acove the trio of casino 16 Can=a be puileo loose? <br /> 3 Ltd bolts msssma? 8 Deons sn tvellbox% 12b Sianarng be'aw the trap of aasma% 17 Can can secs out Water-, <br /> 4 Lia bolts srnpped7 9 werlbox ss tog F anave groe3 12c Water even wrrs the ton of msrna7 18 Pactodr present? <br /> 5 Lid seal inmcr% 10 WeQL-ox is too far befaw orace7 13 Weil can present? i9 Psolockk suncmna? <br /> 11 Weilbox ts uvsnedldarnanen7 Id Well CM- lostna Se=e? <br /> Check box if no deftclencles were found Note below aencfencies you were able to correct <br /> Well I D Deitmency Corrective Action Taken <br /> i <br /> i <br /> I� <br /> 1 <br /> I� <br /> i <br /> JI <br /> I <br /> I <br /> Note below ail aellertcfes that could not be correctea ana still nead 10 be coneyled <br /> BTS Office ass.ons or Date Dale <br /> `Nell I D Pers,stlnv Dellelenc� aeters Correction 10 asslaned corrected <br /> f � <br /> I I <br />