Laserfiche WebLink
AICD F JAM ORDER <br /> Client Inspection Date 0 it <br /> Site Address N/ C, P inspected BY—/A—, <br /> �/ f/ �^ i <br /> on box? 6. Casing secure? 12. Water standing in wellbox? <br /> Z Lid brniten? $ 15>Wall cap functional? <br /> 7. Casfng cut level? 12a:Standing above the top of casing? 18.Can cap be pulled{Dose? <br /> 3.[rid baits missing? S. Debris In wellbox? 12b.Standing below lite top of casing? 17.Can cap seat out water? <br /> 4.Lid baits stripped? 9. Wellboa is too far above grade? 12m Water even with the lop of casing? 17.Padlock <br /> 5.Ud seal Intact? present? <br /> i0.Wetlbax is too far below grade? i3. Walt cap presanE7 i9.Padlock functional? <br /> 11.Wepbox is=shed/damaged? 14. Well cap sound secure? <br /> © Check box if no deficiencies were found. Note below deficiencies you were able to correct. <br /> Well I.D. Deflcienc Corrective Action Taken <br /> Note below all defiencies that could not be corrected and still need to be corrected. <br /> BTS Office assigns or Date Date <br /> Well I.D. Persisting Deficiency defers Correction to: assigned corrected <br />