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�3 0 <br /> Well Condition Form <br /> Date: / Field Crew: Cs--A--t-c— C l� <br /> Project Name: Kearney-KPF,Stockton name initials <br /> Project Number: X/64-" C&tv <br /> name initials <br /> If"No," note action needed and if remedied during visit. <br /> Well Label Well Completion Bolts Present/In Gasket for Well <br /> Locking <br /> Well ID Free of StandingWorking Lid Clean In Mechanism(s) In Well Cap In Good <br /> Legible g Clean/in Condition Additional Notes <br /> Water Condition Good Condition <br /> Condition <br /> ��x� j ✓ / V A10 <br /> AJ <br /> c, <br /> V p V ✓ N) V. Ian � � �pO�( o <br /> OUh.Wt w� <br /> . vkw- ✓ ✓ � ✓ � <br />