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WELLHEAD INSPECTION CHECKLIST <br /> Page of <br /> Client Date g <br /> Site Address <br /> Job Numberlot ! Technician <br /> wen Inspected- water Bailed Wellbox Other Action Well Not <br /> No Corrective From Components Cap Lock Taken Inspected Repair Order <br /> Well ID Action Required Wellbox Cleaned Replaced Replaced (explain (explain Submitted <br /> below) below <br /> w-� <br /> �-3 <br /> NOTES <br /> ELAINE TECH SERVICES INC. SAN JOSE SACRAMENTO LOS ANGELES SAN DIEGO www hlemeleeh com <br />