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F <br /> t' <br /> VVELLHEAD hNSPECTION CHECKLIST AND REPAIR ORDER <br /> -- ?nsPection Date f—,0 <br /> Site AddressInspected Bv <br /> i. Lid on )ox,? I ;rsir.� <br /> Vvater standing in ..eil^ v7 <br /> 2. ._i� '�oken-� � .25?riC .,� �v`✓;I% I �-'cx t.�.. VV e: CaR rUnctl---- <br /> 3. Lid belts missinc A Debris in xeifbox'% I t 2?. .S,a. d g aoDve the fco`if casing? 7;. Car-, cap be pulled!Gose? f <br /> 127. .7`c."moi^.^,ii81[)!•i k <br /> 4. 1-1d boars striped? o V,: I Gr op of canine? Ii <br /> N e!.t�cx is' •� !_� abv r= --_•�_: � C,.r! ..8p Seal u�.lt ti+vater? I <br /> !I�c -` wen .viEl a <br /> !rll-ct' V V . - th top r f can€nc.? , <br /> 5 r-ca 4!1 �.n:cl'h�x og IOQ i - .� -��7 I Pod!ock present? <br /> C ++ <br /> Il,cap_prgssr. ? _ <br /> t9padlock fel^,C!ivn�i7 <br /> ail Cal f_ <br /> p ^ir:d sec 1 <br /> I <br /> Check box if rio deficiencies were frond. Note below deficiencies you were able to correct. <br /> Well I.D. Deficiency Corrective Action ►amen <br /> CC, <br /> I Y <br /> I <br /> I <br /> Nate below all def:encies that couid not be corrected and still need to be corrected. <br /> QTS Office assigns cr Date sate <br /> Well I.D. Fersistina Deficinrrcy defers Correction to: <br /> ass;iened corrected <br /> r <br /> ------------------------ <br /> I <br /> I } <br /> i <br /> 1 � I <br /> 1. <br />