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KOCH ENVIRONMENTAL HEALTH, INC. <br /> PO Box 2S3, Morrison,Colorado 80465 <br /> Phone 303-932-8484 <br /> PRE-CLEARANCE VISUAL INSPECTION FORM <br /> DA E KEN PROJECT* LOCATION: WORK AREA: <br /> lq 1 e�3o©z-1G6 C11."Y A VPI elfvle �ousr <br /> TIME: '[CLIENT: CONTRACTOR: LAI2 KEN REP: <br /> FOREMAN: V+ <br /> INSPECTION: F►V RST INSPECTIOV RE-INSPECTION <br /> FULL CU"J"A!NMF.NT SECCNDARYCONTAINMENT <br /> The Abatement contractor hereby certifies that the designated representative identified below has v Ily irspected the wor area and ha found <br /> abatement to be c ornpl ted in accordance with CDFHE Requlatidn#8 _ Other W,Iof-A,••w a►Irr SoW ,yoaau that no <br /> is le dust/debris rem i in the work area. <br /> C OR Fl)RL`MAN/RE' EN TIVt: SIGNATURE: <br /> _X This wrn•k a a has 13V found to meN visual clearance criteria for the documents referenced above;clearance sampling may proceed. <br /> Clearance sampling may not proceed un the tollowing corrective actions are taken (describe): <br /> KEti REPRESENTATIVE* �}�. _ SIGNATURE: <br />