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WELLHIL 1 INSPECTION CHECKLIST AND . ...:PAIR ORDER <br /> i <br /> Client . Inspectlon Date 9kkz- <br /> Site Address(/ Inspected By_ <br /> Ud on box? B. Casing secure? 12.. Water standing in wellbok? 15.Well cap fundknal? <br /> 2.Lid broken? 7. Casing cut level? 12a.Standing above the top of casing? 16.Can cap be pulled loose? <br /> 3.Lld bolts misstng? B. Debris In wellbox? 12b.Standing below the top of casing?- 17.Can cap seal out water? <br /> 4.Ud bolts stripped? 9. Welibox is tno far above grade? 12c.Water even wllh the top of casing? 10.Padlock pnSent? <br /> 5.Ud seal Intact? 113.Wellbox Is too far below grade? 13. Well cap present? 19.Padlock functional? <br /> 11.Weilbox Is crushedldarnaged? 114. Well cap found 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 /> Note below all defllencles that could not be corrected and still need to be corrected. <br /> BTS Office assigns or Date Dale <br /> Well I.D. Persisting Deficlengy defers Correction to: assigned corrected <br />