Inspection_Report_(page_2)_RCT_12022016.pdf

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ALTERNATIVE FUELS SAFETY

To""' Cr/ee,.-, Acronym: INSPECTION REPORT County:

PAGE I DI/ I GPS: N ,.../ w ./ I )(LPG DCNG D LNG

Site ID: Site Name: C-n,od f R//(;Iµ..- //,'r (P-1'<' < g« ~e / f,'rc I ro1:..1:'-"

Mailing Address: '30 I ( 0/7'14r cA e T rc:t ,'I &Pl',,./ f e//t?P- Zip: 76'70</

Geographical Location:

,, Zip:

"' ~~ 'J,. Noncompliant D Compliant Number of Forklifts Inspected: ,/ w a. " ., -' c.

i.n Q) It)~ SAFETY ~ *Please note that any citation(s) marked Notify Supplier, must be corrected by your <('<:!'<(a: "' RULE ~ LPG/CNG/LNG supplier or another person licensed or registered with the Railroad CL. a: CL. 0

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REFERENCE Commission of Texas to perform applicable installation or repair activities. zoza: z

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TJJ. I .., I '10~. 2 ~-C/ , /qq '>- • V'vv-", Inspector: Ct.t,//J .- _ ~· J . I I

/)-)-It' . ,, lo>pectoc Phooe ~ / ] _ <:j 1 J _) q <jVf Date Inspected: .

Discussed With/Permission Granted By (X) :· -, /~ ("Z . ,,,,;.:/ Contact Ph No:

7JL;' t~v .. ·(~2~ Printed Name: {; {(~ (f!· I Fonn 4 #.,.-- / I

_/ .._ ',...1 yYt e '"'\ I 17,, ,_,...a 1.,..,/ Driver:

E-Mail: / / I

RAILROAD COMMISSION OF TEXAS VIN#: / ALTERNATIVE FUELS SAFETY

PO BOX 12967

AUSTIN, TEXAS 78711-2967