Laserfiche WebLink
vvtLLHt--/. INSPECTION CHECKLIST AND R 'AIR ORDER <br /> Client Inspection Date — 00 <br /> Site Addresa Inspected By <br /> Im on box? B Casing secure? 1Z Water standing In wellbox? 15.Well cap functional? <br /> 2.Lid broken? 7 Casing cut levet? 12a Standing above the top of casing7 16.Can cap he pulled loose? <br /> 3.Lid bolts missing? 9 Debris In wellbox? 12b Standing below the top of casing? 17 Can cap seat outwater? <br /> 4.Lid bolts stripped? 9. Wellbox Is leo far above grade? 12c.Water even wrih the top of rasing? i8 Padlock present? <br /> S. Lid seal intact? 10.Wellbox Is top far below grade7 13 Well cap present? 19 Padlock functional? <br /> 11.Weflbox is c=haMamaged7 14 Well cap found secure? <br /> 0 Check box if no deficiencies were found. Note below deficiencies you were able to correct <br /> Well LD Deficiency Corrective Action Taken <br /> rf fol <br /> Note below all defiencies that could not be corrected and still need to be corrected. <br /> BTS Office assigns or Date Date <br /> Well ! D. Perslstin Deficiency defers Correction to: assigned corrected <br />