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5 <br /> I <br /> WELLHEAD INSPECTION CHECKLIST <br /> - - - page <br /> Client S�{t—�.� Dale S <br /> _Site Address _ _of���1�`,�.. � p��'=S t,__Job Number Number p uvts— 1 Technician <br /> Well inspected- Water Balled Wellbox Other Action Well Not <br /> No Corrective From Components Cap Lack Taken Inspected Repair Order <br /> Well ID Action Required Wellbox Cleaned Replaced Replaced (explain (explain Submitted <br /> below) 6�Q1 yr <br /> ir- <br /> NOTES <br /> 6RAIM TECH SERVICES.INC SAN JOSE SACRAMENTO LOS ANGELES SAN OIEW <br /> wNty hlsui8leth cam <br />