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168019C VE`JUEr <br /> ELAINE 5ANJOSa CAUFORNtA 9511 �� � �PEL �1OCHEC.RLISIT <br /> TECH ScRV1c'- (400)a73-7;,1 FAX Client � 1 <br /> (409)573-05HE PHONE <br /> 46 �a She Adaress D <br /> z <br /> NI Te-chnician <br /> Date <br /> 1 Lro an box 6 Casrna searre' 12- Water starving m,venbax7 15 'Neff aao(onc5anaj? <br /> 2 !id broken? 7 Casing cut lwjel7 122.MMdrna anave the ton of casng <br /> 16 Can c-.n be pulled foase:) <br /> 3 Ltd hafts mrBwnu7 8 peons m weilbox7 la Stanoinq below the top of czmrr 17 Carr caD sea!out Water <br /> 4 Lia baits sarppea7 a Werlbox is tea fa Wove arace2 12c Water even with the loo of Casrng7 18 Paolodt pnesent? <br /> 5 lid seal mtecr7 10 Wellbox is too far Wcw orae2 13 Well=n presents 19 P-.010Ct luncuonap <br /> 11 We!lbox is arasned/damaaed7 id Well cn founa ser.,.Ve7 <br /> Check box if no deficiencies were found Note below aeticlencles you were able to correct <br /> Well I D Deric.encr Corrective Action Taken <br /> f I <br /> 77 <br /> I <br /> I � <br /> C <br /> I <br /> Plate betow all ae,terlctes that could not be corrected ano still need to be corrected <br /> BTS Office asslons or Dale Date <br /> Well 10 Persrstlnci De,tcjenci defers Correction to assioned corrected <br /> f I � <br />