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WELLHEAD INSPECTION CHECKLIST <br /> Page 4 0! 1 <br /> Client 1( <br /> Date <br /> Site Address 1, ri Y <br /> .lob Number c��P1Z —&3= Technician `� �, <br /> ._ !r C Ar2tc, <br /> Well Inspected- Waler Sailed Wellbox Other Action well ra°t <br /> !!o Corrective From Components Cap �OCh Tatter Inspected Repair{}rdcr <br /> Well ID Action Required Wellbox Cleaned Replaced Replaced (explain <br /> (explain Submrlled <br /> below) below) <br /> 1 iA <br /> W'"ZR <br /> .s� <br /> w- 3A ?C <br /> NOTES <br /> L7LnIpIC 1LrH�ERviCi; IfdG <br /> SAI4 JOS[ SACRAMr'tITO LOS NIGH LS All OTGO tAv"Warm rcm mrn <br />