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�. <br /> WELLHEAD INSPECTION CHECKLIST page t or t <br /> • <br /> Client ---7kAL Date 'LjLt FL, <br /> Site Address _ 17- -7 Gown+r� CA u6 _,_ -,710 <br /> Job Number 000 Z z3 - Q— R Teohnlclan 4�6=owa--t <br /> Other ActionWell <br /> Well Inspected- water Baited Wellbox <br /> Na CorsecWe From Components Cap Lack 'taken Inspected Repair Order <br /> Not <br /> No <br /> Required W From <br /> Cleaned Replaced Replaced (explain (explain Submitted <br /> Well ID betaw <br /> 5 - 1 x <br /> IS-n2 X <br /> S �K - <br /> 5 <br /> NOTES <br /> BLAINE EECH SERWES INC SAN JOSE S,CpAurrarO LOS ANGELES SAMMECO .vw..4w nA1Cd`C� <br />