Laserfiche WebLink
WELLHE�._ INSPECTION CHECKLIST AND Rt-, AIR ORDER <br /> q s <br /> r - <br /> Client -� l Inspec#ion Date v <br /> Site Address D � C© C,� �7�"�� <br /> n �y t pl cted By C SS <br /> 1.Ud an box? 8. Casing secure? 12. Water standing to waiibox? 15.Well cap functional? <br /> 2 Lid broken? 7. Casing cut level? 12a.Standing above the top of casing? 16.Can cap be pulled loose? <br /> 3.Ltd bolts missing? 8. Debris In wellbox? 12b.Standing below the top of casing? 17.Can cap seal out water? <br /> 4.Lid bolts stripped? 9. Wellbox is too far above grade? 12c.Water even with the lop of casing? 18.Padlock present? <br /> 5.Lid seal Intact? 10.Wellbox Is too rar below grade? 13. Weft cap present? 119.Padlock functional? <br /> 11:Wellbox'ls-rrushedldernaged?-1W. Well cap found secure? <br /> Q Check box If no deficiencies were found. Note below deficiencies you were able to correct. <br /> Well I.D. Deficleng Corrective Action Taken <br /> i <br /> i <br /> Note below all defiencies that could not be corrected and still need to be corrected. <br /> BTS Office assigns or Date Date <br /> Well I.D. Persistinp Deficiency defers Correction to: assigned corrected <br />