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1 <br /> ' WELLHEAD INSPECTION CHECKLIST page of t <br /> ' Client Date 6-3(Z J' <br /> Site Address Aoj YiW vn G,,, 6ra In igle„r r <br /> ' Job Number 65 6121-617 , Technician <br /> ' Well Inspected- Water Bailed Wellbox Other Action Well Not <br /> No Corrective From Components Cap Lock Taken Inspected RepalrOrder <br /> Well ID Action Required Wellbox Cleaned Replaced Replaced (explain (explain Submitted <br /> below) below <br /> ' M -Z <br /> 1 <br /> 1 <br />� 1 <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> ' NOTES <br /> 1 <br /> ' eLAINE TECH SERVICES INC SAN JOSE SACRAMENTO LOS ANGELES SAN MECO www 6Mmneleth corn <br />