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'1 Y <br /> WELLHEAD INSPECTION CHECKLIST Page ] of � <br /> ' Client l4ry��F ar fit,%-,- Date t9Gfa5/ -- <br /> Site Address t�,&r r� f 6,Jr N _ ,�rL 6n <br /> 1i <br /> Job Number o r-v -i Technician <br /> i <br /> ' Weil Inspected- Water Bailed Wellbo) Other Action Well Not <br /> No Corrective From Components Cap Lock Taken Inspected Repair Ot der <br /> Well ID Action Required Wellbox Cleaned Peplaccd Replaccd (explain (explain 5ubmtHed <br /> below) below <br /> I <br /> L4 <br /> NOTES N TE I <br /> ��4)-'+ �a k7ck4-y VVIy^51rti ,M,,� - t s/'L `1�ih5 r +t4.-.� 'r•_ bs1�, t., 5� U� �,��, <br /> eLA1ik1E 1ECI f 8CPVICC5 RIC 5,J)JOSE S/.CR,1.t=_11TO LOS A1tGELES S JJ nIFM . v htiincu cn cant <br /> 1 <br />