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INCIDENT# -:^' yam _ <br /> ADDRESS " <br /> DATE: f �r <br /> f']' CITY&STATE . c:rC if•'r--��� � ' <br /> e -•t C <br /> Flush <br /> Si[0 p4 h) Y lg <br /> .4{,,— 't•"] StantlpiPe us1 G P N �. : ., <br /> ��c''''�� `Z sm poen) ^ � - Y `?•7; <br /> Standpipe rlusN /G 1 P Yi N .01 / .,. <br /> .7 t i ��; `Y ��% R / G j R NL G ) P <br /> Y i <br /> St2ildp�pe Flush �G P / <br /> L-� it i�) NG R G`,' R NL P <br /> Y res <br /> sae( ) <br /> 77 �� <br /> Standpipe 5#i G� <br /> NL J�Gi p <br /> Y Ni <br /> L Siu Unca) <br /> Standpipe Flush G P Y N G R G R <br /> NL G p <br /> sizo(into) <br /> Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> size!Inco) <br /> Y N <br /> Standpipe Flush G P Y N G R G R NL G P <br /> Y N <br /> Standpipe Flush G P Si.0.h) Y N G R G R NL G p <br /> sae linen) <br /> Y N <br /> Standpipe Flush G P Y N G R G R NL G <br /> sue p on) <br /> P Y N <br /> Stantlpipe Flush G P Y N G R G R NL G <br /> P Y N <br /> TOTAL#CAPS REPLACED= TOTAL#OF LOCKS REPLACED <br /> +« •.f a �6 r G P trN/) � 'iib x , x o`r+ �'a� `._. <br /> t <br /> Building <br /> Building w/Fence Come. G P �N/A( G � ' '...;r _ <br /> Fantod Compound _� Y N <br /> { <br /> Toiler <br /> oo'• u 4 H ¢' �/ <br /> Y N /"1 Y -T� - - �X t-.�a•r a rzi °.>, <br /> JJ/q N (N/A G P �N/A' Y N Y r` N N/A. • <br /> G=Good(Acceptable) R=Replaced <br /> P=Poor(needs attention) NL=No Lock Required All environmental wells and the remediation compound were in good condition, <br /> NO : All ehMi oZM tbal loci n w h a1 ",,t, locked,and secured upon my departure(unless otherwise noted above). <br />