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WELLHEAD MAINTENANCE LOG <br /> Client LLL Site f.Z-jD Q, C441ae'{E 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? :j� <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?�J <br /> WFia� kind of tool is needed to o en it? —� <br /> Were screws in place? Do Screws need to be replaced?— <br /> Does the threaded receptacle need to be repaired?_�threads? � welds`' <br /> Is the well lockable? Is there a lock? What type of Lock? v-r-- # <br /> Was it locked? —Nil] it unlock easily` ---� Does it need to be replaced? <br /> Does the type of lid`a3 plug have the potential to kee urface runoff water from entenng the <br /> well?st Does it appear that the plug or cap is tight enough to actually seal out water? <br /> If sealed with an expanding 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 tip of the wellcase? <br /> Is water standing at the level of the top of the hell case? ,j <br /> Is water standing well above the level of the top of the weilcase? <br /> Do you need to bail or suck out this standing water? •,,� <br /> Is the top ofthe v�ell itself, cracked, belled or deformed so a plug will not seal tightly? <br /> Is any portion of the 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? J <br /> Does it prevent a watertight seal from being installed? <br /> Is there an installed pump or other recovery device installed in the well? —'What? <br /> Does it prevent a watertight seal from being installed? <br /> Are special instructions needed for gauging or sampling this well? <br /> NOTES <br /> file Wellhead sam <br />