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WELLHEAD MAINTENANCE LOG <br /> Client 9H4F/-L Site 14/ Al rl- pex'AbP _Well W-I Date / zz- _1 <br /> ST+xkTOi✓ <br /> Does the utility box have a lid?165 <br /> Is the Iid broken or damaged enough to warrant replacement?_YO 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? y.1f C ,61"reA1 VAI Vr,O,� <br /> What kind of tool is needed to open it? "ZI A 5-oc,4-E7- <br /> Were screws in place?� a <br /> Do Screws need to be replaced? oY <br /> Does the threaded receptacle need to be repaired? 90 threads? /,f 7 eld? At 0 <br /> ar <br /> 7-HP- GOc,c WA.5- r' FN 71e:-'A v✓/ Tt� *� 7 3—T77 <br /> Is the well lockable? Kf Is there a lock? Y-�-_5 What type of Lock?/V/'S ��'_ # Z� <br /> Was it locked?y�5S' Will it unlock easily? yv5-5, Does it need to be replaced? y5 <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? S <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? Al 0 Did you replace it? <br /> Is there water present in the bottom of the box, below the top of the wellcase? Md <br /> Is water standing at the level of the top of the well case? ,J0 <br /> Is water standing well above the level of the top of the wellcase? <br /> Do you need to bail or suck out this standing water? NO <br /> Is the top of the well itself, cracked, belled or deformed so a plug will not seal tightly?h/O <br /> Is any portion of the well itself, loose or able to be readily unscrewed or pulled loose? 1\1a <br /> Are there cracks or other signs of damage to the well, the utility box or the concrete seal? nlCl <br /> Is there a passive recovery device (skimmer) installed in the well? 140 <br /> Does it prevent a watertight seal from being installed? <br /> Is there an installed pump or other recovery device installed in the well? IV6 What? <br /> Does it prevent a watertight seal from being installed? <br /> Are special instructions needed for gauging or sampling this well? IVO <br /> NOTES <br /> file Wellhead sam <br />