Laserfiche WebLink
f - r <br /> WELLHL,K,j INSPECTION CHECKLIST AND REPAIR ORDER <br /> L <br /> Client ,�t V!j _ — n )nspection Data 27/o <br /> SiteAddress rU. l�t��t 4 ✓�,--5 Mck I" _ Inspected 6y-.X l6dr� ---- <br /> 1 Lid on box? ti. Casing secure? 12. Water standing In walibox? 15.Well cap fund3anal? <br /> 2.Lid broken? 7. Casing cut level? 12a.Standing above the top of casing? 16.Can cap be pulled loose? <br /> 3 Lid bolts missing? 8. Debris In weliboV 12b.Standing below the top of casing? 17.Can cap seal out water? <br /> 4 Lid bolts stripped? 9 Welibox is too far above grade? 12'r-'Water even with the top of casing? 18 Padlock present? <br /> S.Ltd seal Intact? 10.Wellbox Is too far below grade? 13 Well cep present? 19.Padlock functlonsl? <br /> 111.Wallbox Is cwshed/damaged? 114. Well cap found secure? <br /> Check box if no deficiencies were found., Note below deficiencies you were able to correct. <br /> Well I-D. Deficlency Corrective Action Taken <br /> Note below all defiencies that could not be corrected and still need to be corrected. <br /> BTS Office assigns or - Date Date <br /> Well I.D. Pers!sUM Deficiency _ _ defers Correction to: - - ass# ned- - corrected -- <br /> t <br />