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11
<br /> `!�PaYf�� .z� ,. .' •�' c�:t.4'�h?er� _ No. 1303. P.
<br /> {. X5/9
<br /> Prop i{y`a�d :, y 3 d -Its aJ;J - Inspect"'or initials to
<br /> rvH .i ;5ia,e,mr .us asI•�9t.,Fa:w:,7 a.>T ;d.. i ::5'� L82 f: :i 7 ';i...i �vei6i,t�in:attp,na'"fwx�rrttf;s
<br /> 41-gS t Sdoardtf6h-complianc#component#4 of 5
<br /> G U. rtvnm vii:' ti
<br /> �h Vorifca on mtaNta.d`s.);m
<br /> in, pWWanicV / IhiMilt WFeod' rage '�` NO r 9 x tic
<br /> :� gin , FIs; ,k,;• :u ,. ,H,,t�,i,�. � ., :� Of/,observa8ondo�s RXpFM'�f�"r, r � s
<br /> 4 observadone by tw i pa ares ,
<br /> bm Ilance criteria' unless site aondfions have been abred or local
<br /> r .. .
<br /> Pr Vnofi�ity iis' i'�or to 1, ,and -N-Yes- 0 No- .. . requirements dHXer,
<br /> PI Conducted sou obsen►ation(s)(Afbacb being loge)
<br /> Protecftn Area or,hd'aeift a wn�i(4 3•o 0 Two previous verifications(Aped,boring bp)w,
<br /> Pte,belre�d�ffrfbl�`6�l�/t�nt:- -- _. 3 G _. __._�._.....,....._ .__ ..__
<br /> - .. ., a Not appiicaitle(How+en►Ks),no dralrrfie/d)
<br /> Cc''� infidd'�tnasleest er4N+o�ooE IEeI clo�S, "��
<br /> separallQ�distpoee from periodical
<br /> is d Unable to verify(See CammenfalEicplerieBai) __
<br /> L.hq tilrB eli t1'DS df0t' Y rrreu t1 n; „3 nu O Other:(See Go►mnerNalEnplanadon) F►,a, 3.E'.
<br /> Non-performance sysbems,buON 1, ❑Yes ❑No CounnentSExplanAW.
<br /> Pr
<br /> 1,100 do
<br /> r.xAP*W4QD "Oka ,j &a
<br /> beiiera ,or lodgdng blishmegf :_. 0.
<br /> Prop.g
<br /> as a th v '�"?L Inspv,.Ior initiaiis/Date:
<br /> _.
<br /> _..
<br /> ,eaturaited soil or,bedrock.`-
<br /> 4 r.:. L
<br /> •t*i"dMentar°, °Other",or ' ; ce=vM 0 YesW ON Indicate de of elevation$
<br /> IV Q U�rix u,Yrn �ie7iF�1 7tf°; t , 3 91�•p 1,41 S�►S+aee.
<br /> A. Bottom of distnbi fion I A�p
<br /> � � piedra SKr y 9 •O .l..
<br /> ' 80.F4O d l dor Q Ye!s .;rail vx.'4irrr: r I.;aes no qxp re. A f a
<br /> �;, cense required) ' r "fr lent
<br /> am
<br /> Rance c a' '
<br /> :. Mee= —
<br /> ti6n i r
<br /> 3 1
<br /> t 1D iu3A 1i I Fr::: ®Yet N S a - C"),
<br /> r g ti3(Ip r�rfl6iell+;o t I Condl-jct Sol observation(s,( acl't[,� tags)
<br /> ReqUired a se
<br /> p@Qrfi CBtAS w,, ,� utul�t ?4ty Local
<br /> f
<br /> -J lr�iVik
<br /> %. .'erity(See Ccmtirerrls/Faplanstiprl)
<br /> seperr,tlon distance Pram pen iceii j
<br /> L a
<br /> Other( Cvfnmentaeplanaflon)
<br /> 5.l n BjMR�— tpNaAse component#5 of 5 ®Not applicable
<br /> arr-pe ►mance s s ems ur r : es ^vc� tr; rre � . �._;r on'
<br /> Iq s yq� a
<br /> 'ng Pe Yes ❑No I�`'y ;osu, �e�ow ie required
<br /> I �i�t f iiltr l ns P? ❑Yes No If"yes",B below Is required
<br /> n310 o;r re®.�c ise,vin a tend .
<br /> be�BlDfbtEte►s s) fed the system design
<br /> rrcs Wd h w''�Wdie "no , section does not neW to be comploAW,
<br /> p�ratldn�Jistancefrom�rfodicet - -=- --_
<br /> "Exp Me aT' `G Pe r� ncr en ' rli? ! In" y �$ of eDeyatlons
<br /> --.. • w
<br /> ,4K VI d 1iu in ? !� flat +•an meadia • ., CIO
<br /> .;, of I ( vancetl rl (1?C).
<br /> ,�t�� trer indicates once Ilance.
<br /> �. �'e�irvl�c,- sYj i'ed 9aitiliadrw.:ic '.fie �.� J 't I
<br /> f3rainYrew meem die d"1 rata vaitl 1 1 s •'" 3,!
<br /> $ C. u n IrL r . i
<br /> __xT _ _ s a,
<br /> r ti ' d` •
<br /> riceft - I E�; VL:� —
<br /> •.
<br /> 15.65)Alrjoq kwt throat to puW(mIM and sahq►(IT1�IS)mustGo ,rep/amsd,pr Its use
<br /> o Ihls portae or,wlMln a slater iE�udrifd # Is ruing
<br /> oto prefect
<br /> eAK
<br /> rpareBortiNliirernr omr
<br /> mss>~ TINs pb illCllbea rrot apply to systems M sbox*ne areae,
<br /> fiV Prat ion Arae o fhpse ln wff mflon with Wd,bsveretge,.wd/odging asmbl'Win eftas"dellrietlln le w.
<br /> sic tplierible
<br /> -0/1N-�i7^NM.•.......T`-.^ MF1FrY'h''!M'fMq`#/SRR'
<br />
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