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�J <br /> BLAINE 113130 ROGERS AVErJUE WELLHEAD 'LNSFEC d IO (—'HF(--'KL <br /> I,9'1, <br /> I,9'1' <br /> SA <br /> TECH SEFJi ICES,z hlJOS[ CALIFORh1JA 95112 <br /> (d08)573 777 f FAX Client --,L ' <br /> T Mjpo (408)573 0555 PHONEam <br /> Site Address 7- O 5 Cu,v�,� <br /> IL r <br /> -` -fec,ltnrctan <br /> ^ILO <br />' 1 Lid eii bOx7 5 Casing secure' 12 Water Standrnq in we1ibax% 15 WPIC r1,p funchonai' <br /> 2 Ltd brel�en% Cas rrg cut IPvef" 12a Starrdrng above the top 01 cas ITg 7 Ig Can mp bp pulled Icr�-a <br /> Lid belts rn:ss�np' R Debris rar wellbox' 12b Standrng belo v the lop of casmrj I- Can-3r' ;P�1 out w,l�i <br /> 1 Lid boll;tapped- 9 4Ve rbox is loo far a 3ove grade' 12c Water even wrtlo Ilre top p(casing 8 Padlock present' <br /> 5 f Id 5 1 ntnrt% M Wmfbox is too far be1aw gr@dP' 13 Welf cal)present? 19 T,;dfcck hmchonal- <br /> I I Yle,rbox is crushed damaged, f 4 Wert cap found secure <br /> 1 l�lieck boy If no dpflclencres }rlerP found �lote below deft renr n <br /> c _ _J1?S y_U were �blt= to correc.i <br /> 1 Well I D UehuerJcy �,orrecftve Acflon Taken <br /> 1 - <br /> _- <br /> ! <br /> r� <br /> i <br /> 1 <br /> 1 <br /> t Jcle bPlow ail delrencles Mat could nnl be corre-ied and silll need to be corrected <br />' 5 T OHICC nssunS or Date Bale <br /> Well 1 D Perslstmo DeflClency clefers CorreCllon to ass. ned corrected <br /> 1 <br /> E i I <br /> I <br />