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WELLHEAD MAINTENANCE LOG <br /> Client s � Site CZ.0 Q e,4Ljfj--j1:,__ Z_ Well Date <br /> Does the utility box have a lid? � <br /> Is the lid broken or damaged enough to warrant replacement? Did you replace it? � <br /> It is a Simple Utility box with lift type lid (non-locking) <br /> It is a Securable type Utility box with screw fasteners What brand'? <br /> Wt i kind of tool is needed too en it? � <br /> Were screws in place'?� Do Screws need to be replaced?_� <br /> Does the threaded receptacle need to be repaired??threads'? weld? <br /> Is the well lockable? Is there a lock? What type of Lock? :�► # ���� <br /> Was it locked? - WiII it unlock easily? Does it need to be replaced? <br /> Does the type of lid or plug have the potential to keep surface runoff water from entering the <br /> well? Does it appear that the plug or cap is tight enough to actually seal out water? <br /> If sealed with an etpanding plug, is the plug tight enough in the top of the well to resist being <br /> readily pulled out? <br /> Did you decide that the plug should be replaced? Did you replace it? <br />`. Is there water present in the bottom of the box, below the to of the wellcase? <br /> Is water standing at the level of the top of the well case? <br /> Is water standing «ell above the level of the top of the wellcase'?�_ <br /> Do you need to bail or suck out this standing water? <br /> Is the top of the %Heti itself, cracked, bellea or deformed so a plug will not seal tightly? 4 <br /> Is any portion of tie well itself, loose or able to be readily unscrewed or pulled loose'? <br /> Are there cracks or other signs of damage to the well, the utility box or the concrete seal <br /> Is there a passive recovery device (skimmer) installed in the well? <br /> Does it prevent a uatertiaht seal from being installed? <br /> Is there an installed pump or other recovery device insta din the well? What?—()t C <br /> Does it prevent a vyatertight seal from being installed? \-z-4— <br /> Are special instructions needed forgauging or sampling this well'? <br /> NOTES <br /> 1• <br /> file Wellhead sam <br />