Laserfiche WebLink
SHELL WELLHEAD INSPECTION FORM <br /> (FOR SAMPLE TECHNICIAN) <br /> Site Address 35-1.5- 4�,L ✓ b-- S c-V-Ion 1,.4- Date <br /> Job Number l(!>n Technician Page _ of <br /> o E p <br /> o i e �, f3 WeII Not Previously <br /> a �' 0 E m s $ m a Inspected p bGency Identified Notes <br /> © E 5m <br /> m a' m (explain in Deficiency <br /> = t lj u m m rya notes) Itlanlifled Pemists <br /> 0 K V J <br /> Well ID <br /> mw-3-7 <br /> 10 W-33 X <br /> i <br /> 'Well box must moat ail three criteria to be compliant:1)WELL IS SECURABLE BY DESIGN(12"or less) 2)WELL IS MARKED WITH THE WORDS <br /> "MONITORING WELL" (12"or less) 3)WELL TAG IS PRESENT,SECURE,AND CORRECT <br /> Notes: <br /> BLAINE TECH SERVICES,INC. SANJOSE SACRAMENTO LOS ANGELES SAN DIEGO SEATTLE vi+.w.hlatr,eleth.Com <br />