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Form no.s2F-TR-HSE-IC-010 Ihev.00 lpoect: ZF 023 stem) Pwr mns mom: 5 |wednescay- 2 |sunaay- 3 froneay- 4 frucstay 6 | mursday 7 |encayGregs otloben. ain] 10010} as0y tsou wud prenbajes open a saige> Kes 2049 dum pu Payer! su su 950 pusunutosy am "paen 9 (Geuyanes me) sbujcno Make and year: ‘Walk Around Inspection “uray as] popenug (asuessas you Saeed yi eusicu] 2») pare povepiel 257 2m oor buon} ‘pawuesip ne 950 18 a ‘ein0p 20K wai 38 "np oye 2) jae pontaicusoa aon von ‘paanar Buta joa ayn prone os suk te passaiduis e180 194) ‘ono ox: pus ves 9 Bueno a suypew a oar ouput sossbidued aye passasduns 8 Jo u>tas Ti pazunsava seul as04 ae pessai0wo>o powucasipowasye ona fea Thick: ‘Ste Supervisors name and Signature: = “oyoag 29 eusiew 990] lat seyoue oan wu 250 pavpene Asda] re passaiduos ye eu 9] JACKHAMMER INSPECTION CHECKLIST Sb “pabeuee jou ate suns ‘ys pur a4 passaiduns ay 349 9904 ‘ies dpa 9 ep "9 § ojo au 2ue spiené pue swiaunpen “avaueduco ye sins 2512) 200 [Qt [1/200] ¢ Meusin ate inspected lecation: fin Khaled, SF.J%) Z-ro Form No 2F-TRG-MSE-IC-010 feev.00 jpresecr:, ZE_ On? 1 |Soeurdoy 2 |suncay- 2 [money 5 |weanesday: 7 |rncay- 5, Unsatisfactory =U, or not applicable = N/A INSTRUCTIONS: Check al tems indicated and indicate 2; satisfactoryRemark [Month 7 uogaeuuosasou on asey pu Tooter ary ajesod suet prontajas 0 parn 21 sores ayes po us pe unuuuooos am “Dash ase (Soaycno> me) stunod "se esiatun saroue4] “Buny ose apeeay (sous: pal Baexecwoo yum eusieu} 1) as pavapse 25a 03 Sout spavvonsip nb aso Walk Around Inspection gop moh waiy 05 "sn ojdexa 10 0 ove passanducn aan ora pain Bn 0 2 pone os) suohu 30 Jessnah 350 ate possasduo> ©} 14a wo dois pue ue aun unen A anew a3 pay vou pue sossarduD9 2 aye possaado> 9430 "any pazunssed 3 3643 350 se passestivn ‘pouuepep of 1eusHe J y uoyorg ago ep ew a9] an soypue asi uo a wn [Mate and year + Seed 1 passesdwo> ye 1 ou JACKHAMMER INSPECTION CHECKLIST pata 2 pue 2s passoi0wo9 94 14) oH Yn sie fon @ usar 2 upe awed ain ase Te ‘21 spuend pu sivaupen 'siuouodoo ie insu, suteed ha AL wouke ve, Ze ods dp -oase| S el 5-19-04 — |2b-1o—ve J4-0? Date inspected room no.s2F-TRG-HSE-IC-010 lrev 00 Ixem| 1 [saturday 2 |sunday- 2. | money N/a U,or not applicable - Unsatisfactory factory S& aaa a a & = INSTRUCTIONS: Check ll tems indicated and indicate a 5 Ss S 25-10 dae 4 | Toesay 5 |weanesday Thurstay- 7 [rida 6 [emerr maa ena