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WELLHEAD MAINTENANCE LOG Client. ,(l Site ( �Y srt'J�r �iF� Well: __/& T� Dater Does the utility box have a lid?l Is the lid broken or damaged enough to warrant replacement? Did you replace 0— It is a Si le Utility box with lift type lid (non-loclang) It is a ecurabie type Utility box wgth screw fasteners What brand? &4rU -S:,C What kind of tool is needed too en its % 6 Were screws in place? Do Screws need to be replaced? /y Does the threaded receptacle need to be repaired?,/L.,/ threads? -weld? Is the well lockable 1 Is there a Iock? K What type of Lock?f��-r 4.235`-) Was it lockea? ��WiII it unlock easdy��_Does it need to be replacea?__/t-/ Does the ty a of lid or plug have the potential to keep surface runoff water from entering the well? Does it appear that the plug or cap is tight enough to actually seal out water?� If sealed with an expa g plug, is the plug tight enough, in the top of the well to resist being readily pulled out? Did you decide that the plug should be replaced?.AZ Did you replace it? Is there waterresent in the bottom of the box below the to of the wellcase? � P p Is water standing at the level of the top of the well case? Is water standing weiI above the Ievel of tl-e top of the wellcase? Do you need to bail or suck out this standing water? •- Is the top of the well itself, cracked, belled or deformed so a plug will not seal tightly? /�{v Is any portion of the well itself, loose or able to be readily unscrewed or pulled loose?_ c� Are there cracks or other signs of damage to the well, the utility box or the concrete seal? /v Is there a passive recovery device (skimmer) installed in the well?-Az Does it prevent a watertight seal from being installed? ,- -- Is there an installed pump or other recovery device installed in the well?What? Does it prevent a watertight seal from being installed? - Are special instructions needed for gauging or sampling this well?-�—/ NOTES: file: WeIlhead.sam