This structure has been inspected (as Date ___________________________ indicated below) and no apparent structural hazard has been found. Time ___________________________ Inspected Exterior Only Inspected Exterior and Interior Report any unsafe condition to local authorities; reinspection may be required. This facility was inspected under emergency conditions for: Inspector Comments: ________________________________ __________________________________ (Jurisdiction) __________________________________ __________________________________ Inspector ID / Agency __________________________________ ________________________________ ________________________________ Facility Name and Address: ________________________________ __________________________________ __________________________________ __________________________________