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WELLHEAD INSPECTION CHECKLIST Page or f <br /> Client UP' Date 3~ZL-0j— 01 <br /> Site Address 1 WrJ F <br /> Job Number o3�03 7V 0e j Technician <br /> Well Inspected- Water Bailed Weltbox lather Action Well Not <br /> No Corrective From Components Cap Lock Taken Inspected Repair prder <br /> Well ID Action Required Wellbox Cleaned Replaced Replaced (bexplarn (explain submitted <br /> elow) below) <br /> f)ww�1r <br /> t?1A w-I V <br /> AMw- <br /> p�tv r _ <br /> ort V, <br /> Qry►w- <br /> 62- <br /> NOTES 1b47 1�rr1 <br /> BLAINE iEGH SERVfGES INC SAN,IpSE SACRAMENTO l05 ANGELES 510.N oiEG4 vnxve blainelech can <br />