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' <br /> LaiNE 1680 RG .5 AVENUE WELLIMA *ry�P�:C�I )i'•I C?mclul, 3' <br /> SAM JOS..C.>,UFORNIA 95112. <br /> TECH (408)573--r7 Fax <br /> Client {' <br /> - .� .. • .. <br /> (408)573-n5SE PHONE1' <br /> TU a Y <br /> p y # 4* • ,. U7 _ 5-Re Addres S�lyS,ll. f�.' 1...,►., �.�r .57�r� <br /> Te, Y <br /> 1.Ud en box? 6. Casino se=te,- 12, Water smndino in:reilbax? 15-'Neil c--o tVncdonap <br /> 2 Lid broken? 7. Casing art fevei? . IZ3 Stmoino above tha to of=sins? 16. Can=-n be pulled too SR? i <br /> 3. Lid baits missina? W s. Debris in weifbox. Iib.Stamina belcm ttte tap of=lno?." ' .7 17.Can'cu sem outwaMf <br /> 4. Lid bails stripped? 4. Weilbox is toa far ai;ove gratin; Y 9 t^,r~Water even wiih the too of c---irzc?; 16 Psdloc�c mesenO <br /> 5. Ud sed intact? 10. Wetlbox is too far beiow grade? 13. Wel ro'present 1 g- Padfac:uncdanai7 <br /> 11-'Neitbox is ausnerldarrisaed% Id. We+!r_n found se—ire? <br /> * _ <br /> Check box if no deficiencies were found. Note below deficiencies you were able to correct_ <br /> 'Nell I.D. Defimencr Corrective Action Taken <br /> +�Fw- <br /> C41:11- AMC 4 <br /> L f., <br /> t <br /> I � <br /> f <br /> r• � <br /> ('Note below ail defiencieV that could not be corm cled and.stifl need !o be correr--ted. � ,m r <br /> :BTS OHica assians cr Cafe -:1 -t`Date <br /> 'Neff I.D. Persistino Deiiciencv -'de!ers Correciion to:' "` _ a siorled " corrected-,! <br /> ---------------- <br /> l� <br />