Laserfiche WebLink
SHELL WELLHEAD INSPECTION FORM <br /> (FOR SAMPLE TECHNICIAN) <br /> Site Address 1210-7 orvwj-p-q CUJ)3 Date ! 3 0 8 <br /> Job Number Og({031 Technician ( WLE5S Page 1 of <br /> Z O H O p B <br /> m v a Well Not New Previously <br /> y s a E 5 TS n Inspected Identified <br /> m m � v Deficiency <br /> z v m E 5 m Cn °' tr a: (explain in Deficiency <br /> o cr ',' - s Identified <br /> ed,� N v o n6leS) Persists <br /> Well 1D <br /> U 3 U 0 <br /> S• 2 <br /> S• 3 ✓ <br /> S•S <br /> S• (� <br /> S•�d � <br /> S •,Z I � Nv '� <br /> S • ( 'S `� u 0 jr,F, <br /> S x o mt <br /> S•!4� '� �v Tn�c-t <br /> 'Well box must meet all three criteria to be compliant: 1)WELL IS SECURABLE BY DESIGN(12"or less) 2)WELL IS MARKED WITH THE WORDS <br /> "MONITORING WELL" (12•or less) 3)WELL TAG IS PRESENT, SECURE,AND CORRECT <br /> Notes: c� S PPS e-C, t`F- <br /> BLAINE TECH SERVICES,INC. SAN JOSE SACRAMENTO LOS ANGELES SAN DIEGO SEATTLE VNAV.blainelech.com <br />