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INCIDENT# � ADDRESS <br /> DATE: fa`,,»_!f CITY&STATE /^"• �.- <br /> lY� Tie. <br /> '7%A� ,� s � v i.. �A �eOR I X i •R..re,..tt a w x I � .a zt �. <br /> size( nl .. '. il ? �U�bx. rYY+P1 nF3trou �vw� Y �.�,... <br /> Standpipe f lu G `P) plicw- N G R G - .�"" NL rG P <br /> pp siu Mcn) rev R NLv, ��yaC•t. pvvF. cilas•H Q'(el'r �r4.5dH Y i"�i <br /> f ,_ Stpf,�pl�ye Flush G rF'�j L# Y wG R `G/ ,} i P <br /> size inch) C•,��{.+,r„PY�;! CFxt!" Y <br /> — '7 S11SA ipe Flush G CF ry, ,i N G —'R /-( R NL G P <br /> /,+, size Ilrwnt 1 <br /> yf N G 1, "Fi :'G? R NL G P Y <br /> St pipe Flush G iJ C� ,•'�•; I / - <br /> slze(Inch) `.•. N+i fgft.l ry,Gi �] <br /> . k! Sta�Pipe Flush G i�) ,} ..V\ N .,-G�, R /C'' R NL /-r- P '^� Y <br /> size(inch) n" J- (:%.�'P,.�ysti Efts:+S Y f'T <br /> r Sta�iijpipe <br /> Flush G ) Y. N G '.R, Gli R NL G P <br /> size(Inch) f <br /> Std Plpe Flush G �Mv N G -%'R ! G R NL G P Y rN� <br /> 1 <br /> sue(inch) I /'•. <br /> Y <br /> Sta� pipe Flush G �Pv7 .,y. Mt N G -'"'� /� R NL G P 1 tN1 <br /> t^ <br /> size(inch) <br /> � q Standpipe Flush G !� �l ry,i N G --R `✓ R NL G P Y (�1 <br /> 1 :Jcc 9z.p.,h �\ R%)I m'ok' C.w.a(*` Y ..RR <br /> U Stand IPe Flush G (P. ,/ "v N 'G«ll R R NL i„Ga P '� <br /> 7 <br /> size(inch) Y <br /> q <br /> Standplpe fYus�(t iG1 P a 'YI N T`. R �G1 R NL Gr/ P ,.N <br /> TOTAL#OF LOCKS REPLACED <br /> TOTAL#CAPS(„REPLACED= $• ,.t <br /> s b1�bM4>;,otC� v N <br /> MCI, i G P '{/IA.) B '� �5 + n�& e�le <br /> 'REfl6 5 kel F f TYA *L <br /> NA <br /> Building <br /> Building w/F.nc.Comp. G P SIA', G P N/A G P 1Q]A'I Y N NIA Y N <br /> I ! <br /> Fenced Compound <br /> Trailer <br /> ILI <br /> z r <br /> µ �; � t � •� y�r tl ..'� �rrw�lrao yNy .�.. � e " " v � }, �'�. _ �"x. <br /> Y N ...N t✓ Y N IN/A' G P A Y N Y N /N7A� Y N.. <br /> All environmental wells and the remediation compound were in good condition, <br /> G=Good(Acceptable) R=Replaced <br /> locked,and secured upon my departure(unless otherwise rtotedabove). <br /> P=Poor(needs ahenllon) NL=No Lock Required <br /> N All In k hh shell PN a.wevel priori.Etc-" <br />