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B.Z. Service Station Maintenance, Inc. <br />630 Houston Street — P. O. Box 933 <br />West Sacramento, California 95691 <br />Phone (916) 371-2380 <br />Lic. # 433159 <br />Site Survey <br />To be performed upon arrival <br />Date: (LZ–(sz _G <br />Site Contact: <br />Any spill at site: Yes or koDWhere: <br />Were all Lids bolted down and in place: 7Qr No <br />-- -A-re AXl -Seals-4- n--pface: <br />Condition of Concrete and Asphalt: <br />Were all spill buckets in place: es r No <br />Drums on site: Size_2-(_How many_L—Content/Labal: �� S <br />Any other problems to report:,` <br />Upon Leaving Site <br />Are all Lids bolted down and have bolts: 15or No <br />Are all Gaskets and Seals in place: Oeor No <br />Any Spills at Site: Yes or 4) Where: <br />Any thing else to be to <br />Signature of Site Conta <br />Signature of Surveyor: <br />