Laserfiche WebLink
WELL HEAD INSPECTION CHECKLIST AND REPAIR ORDER <br /> Client ;5hel l Site# 20`4-15714- 15-V1 Inspect:on date J-7-7-13 <br /> Site address Ll I M. 91 Dorado Inspected by- V00 6- <br /> 54mk4oelI CA• BTS Event# q8 O jZ z'S-Z- <br /> 1 Lid on the box? Yes No 5 Water standing in the well box? 7 Can cap be pulled loose? <br /> 2. Lid whole? 5a. Standing above well top? 8. Can cap sea[out water? <br /> 3 Lid secure? 5h. Standing below well top? 9 Padlock present? <br /> 4 Lid seal intact? 5c. Water even with top of well cap? 10 Padlock found locked? <br /> 6 Well cap/plug present? 11 Padlock functional? <br /> Check box if no derrciences were found. Note below deficiencies you were able to correct <br /> Well I.D. Deficiency Corrective Action Taken <br /> Note below all deficiences that could not be corrected and still need to be corrected. <br /> BTS Office assigns or Date Date <br /> Well I.D. Persisting Deficiency defers Correction to: assigned corrected <br /> Office review and assignments made by11t C �' - date ��'�r <br /> Blaine Tech Services, Inc Fie WELLCHK s <br />