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BLAINS 1680FIOGER7AVETrVE -'VELLPEAD iviSPECTI€7�''rT C ;�+4, <br /> TECF1 St�fiVTCES.� SAffJOSE CALIFORNIA 95112 <br /> t 100)5733-7T-74 FAX <br /> 14081 573-0555 PHONE <br /> 20 a She Addfess lof3f Pu,;r ,e_ <br /> TeChnlCtarr_. r <br /> T Date 0511 tQ eo _Y -- <br /> \` <br /> Fd on box' S Casirru Sarre 1 12- Waterstandingintiveflbox7 15 Well cap funchonaf7 <br /> d b�oken7 r Casmg cut fevef7 12a.Standing above the top of msmg7 16 Can cap be pulled Ioose7 <br /> d bolts rnissin0 7 8 Debris in welltrx7 12b Standing below the top of casino% 17 Can rap seal out water, <br /> id bolts stripped% 9 Wellbox is too fol above grade 7 12c Water evert with die top gf casino7 16 Padlock present? <br /> 5 Lid Seal intact' 10 Wellbox rs hm far below grade? 13 Well cap present, 19 Padlock lunctione17 <br /> III Wellb=is crushed/damaoed% 14 Well cap lound secure? <br /> Check box if no deficiencies were found Note below deficiencies you were able to correct <br /> Well I D Deficiency Corrective Action Taken <br /> Hole below all defienctes ilial could not be corrected and still need Io be Corrected <br /> BTS 011ice assigns or Dale Date <br /> Well I D Persisting Deficiency defers Correction to ass, reed Corrected <br />