Laserfiche WebLink
f <br /> WELLHE�D INSPECTION CHECKLIST AND RQPAIR ORDER <br /> Client l�G r rJ _ Inspection Date — <br /> Site Address A0 - eAke- liew, c Inspected By <br /> 1 Lid on box? 6. Casing secure? 12. Water standing In WBlibox? 15.Well cap functional? <br /> Z Lid broken? 7. Casing cut level? 12a Standing above the top of casing? 16 Can cap ba pulled loose? <br /> 3 Lid baits missing? a. Debris In Wellbox? 12b Standing below the top of casing? 17 Can cap seal out wafer? <br /> 4 Lid bolts stripped? 9 Wellbox Is too far above grade? 12c Water even with the top of casing? IS Padlock presenl7 <br /> 5 Lid seal intact? 10 Wellbox Is too for below grade? 13. Well cap presenl? 19.Padlock funcilord <br /> 11.Wellbox is crushedtdamagad? 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 defiencies that could nDt 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 />