Laserfiche WebLink
I <br /> SHELL WELLHEAD INSPECTION FORM <br /> ( FOR SAMPLE TECHNICIAN ) <br /> Site Address t -L c Date r ( / =s i 6z <br /> Job Number t,, i ( a3 - ;-_( Technician _ (.,,, _ Page t of <br /> Za g <br /> ,2 w c p �'- o Weil Not New Previously <br /> '�° m m — Inspected Oeficlency Identified <br /> m .o 15 d (explain in Deficiency <br /> Notes <br /> U 0 in `m 3 �U' notes) Identified persists <br /> Well ID 3 <br /> X <br /> i <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 : <br /> BLAINE TECH SERVICES, INC. SAN JOSE SACIRAMENTO LOS ANGELES SAN DIEGO SEAT TI[ vnw+.01airn3iecl.com <br />