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DEC 2 2001 <br /> ELAINE 15ao ROGERS AVENUE IVELLBEA]D ]INSPECTION CHECKLIST <br /> TECH 9ERVICF-S.a SAN JOSE,CALIFORNIA 95112 <br /> (408)573-7771 FAX Cllenf <br /> a° o (408)573-0555 PHONE <br /> • �Q$ Site Address ,r <br /> z Technician .44, <br /> Date <br /> ffi 7 6 Casing secure? 12 Water standing rn we!lbax?t <br /> ? 7 Casrn cut level? �� 15 Well coo functtanal? <br /> g 120 Standing above the top of casing? 16 Can cap be puffed loose?issing? 8 Debns in wellbox? 12b Stanaing below the top of rng717 Can cap ttrpped7 9 Weltbax rs too far above ade� saal out water?9► 12o Water even mih the top of csino? 18 Padlock presenRtact? 10 Weilbox is too far befow grade? 13 Well cap present? <br /> 19 Padlock functonal? <br /> 11 Wellbox is Crushed/damaged? 14 Waif cap found secure? ` <br /> Check box if no deficiencies were found Note below deficiencies Mu were able to correct <br /> Well l D Deficiency Corrective Action Taken � {i <br /> Note below all defiencles that could not be corre--iea and s(IR need to be corrected <br /> BTS Office assigns or Date Date <br /> Well f D Perststin Deficient defers Cgrre:.-tton to <br /> assroned corrected <br /> 3, (A <br />