Laserfiche WebLink
BLAINE 1686ROGERSAVE74UE ��ELLHLAD hNSPECT'.ION C ECKUST <br /> SAN JOSE CAUFOSMIA 95112 <br /> TECH SERVICES 14091573-7771 FAX Client <br /> rN <br /> Goal 573-0555 PHor1E rift ��!!b,ft <br /> Sile Address_ -er.o 43. <br /> Technicia>i��l�rir,., <br /> Date_,— JRIM/On _ <br /> AID �- <br /> I Ud on box? 6 Casmg se=e'f 12- Water slandmg tro wellbox7 15 Weil cap ftmcuonal? <br /> 2 Ud broken? 7 Casing cart fevel7 12a-Standing above lite by of rasing? 16 Can cap be pulled Iome7 <br /> 3 Ud bolts missmg7 9 Debris In weMox7 12b standing below the top of casino? 17 Can rap seal out water? <br /> 4 Lid bolts stripped? 9 Wellbox is too lar above grade? 12c Water even with the top of casing? 1a Qadlot*present? <br /> 5 lid seal intact' 10 Wellbox is too far below grade? t3 Well cap present? 19 Padlock trmctionaf? <br /> 11 Wellbox is aushedldarnaged? 14 Well cap lound serattre? <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 defiencles that could not be corrected and stili need to be corrected- <br /> ` BTS Oftfce assigns or Dale Dale <br /> Well I D Persisting Deficient deters Correction to ass ned corrected <br />