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INCIDENT# `! <br /> cJ �� i.. ADDRESS <br /> DATE: <br /> j cin a STATE <br /> , <br /> �,/((✓ --�'�-SXsnd pe Flush G�� P C r N G i_G R NL i . .P x2,Paxfi..a (rf'SA(J V N <br /> /" aixa finch) <br /> Standpipe us` G F�`= q Y ( G`.1 R G,, R NL G•1 p iysxv�¢ / <br /> Size(inch) <br /> S RjPe Flush G P oy Cy I N G -^R R NIL ;•7,t P GRf 5'S y <br /> i 'vs€-Eros. > t'cif_.. ;^yi,)•z S1i <br /> .�� � .? SM.(inch) <br /> f� jJ Sfand(}ipe Flush G t P j V N j G G R } R NL <br /> l r f' y <br /> G (✓ <br /> !s, Six.(inch) <br /> —167 S ndpipe Flush (G 4 P l4 N .-'6j R ; R NL 'G'y P <br /> �..-,_, Size(inch) - <br /> W Stantl➢4pe Flush G ;P u N G R !G' R NL P ;,� Y r <br /> /i 1... .. 1� l_J .✓ <br /> ,� .I-(hwh) <br /> y <br /> iii Flush G ��+, ^ ` <br /> ti N iG) R (�(i R NL ,G: Fs y .. <br /> S <br /> {� Size inch) <br /> Standpipe �FIUSh V P 1 ' N i_G+ R ;Gj R NL �Gi P <br /> .JJ Y Cf) <br /> Su,.ncch) v <br /> Standpipe 9-h P I r!rp, N ! R li R NL P y <br /> LM <br /> ,.fes--7, <br /> S 7r <br /> Standpipe 6 P t7 Yi N R �Gj R NL G1 P y . <br /> f ! <br /> � size finch) <br /> San`dpipe Flush j P e"€j'x` V ,�G', RYC} R NL ,'G P y 1 <br /> % CN <br /> A . F <br /> TOTAL#CAPS REPLACED= *xet e'' <br /> =TOTAL#OLOCKS REPLACED <br /> yFl t'„7;r4' <br /> ar7 .�. 6` xa ✓^. G P ,�A 1 � _ ^�'.4i.-..�". +4',y�,, €..�ybT.. :�.3t <br /> r <br /> .7s,� <br /> Building <br /> 1 <br /> Building wl Peace Comp. G P jfa%l G P :NIX) G P /NIA i y N <br /> Fenced Compound <br /> Tran., <br /> Y N )UA V N N Aj G P j NIA Y N Y N jN�A'i y N <br /> G=Good(Acceptable) R=Replacel-• -" All environmental wells and the remediation compound were in good Condition, <br /> P=Poor(needs attention) NL=No Lock Required locked,and secured upon my departure(unless otherwise noted above). <br /> New All nael,. her onel Sha I A <br />