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WELLHEAD INSPECTION CHECKLIST <br /> Page of�� <br /> Client k LAI Date ^-,7 <br /> Site Address ILI (d t,J <br /> .tat} Number �'-4,0,=i Z Q'-- nct__S � Technician <br /> Well Inspected- Water Hailed Wellbox Olher Action Well Not <br /> NoCorrecbve From Components Cap tock Taken Inspected Repair Order <br /> Well ell I D Action Required Wellbox Cleaned Replaced Replaced (explain (explam Submitted <br /> below) below)— <br /> INok <br /> w <br /> V,,k" -q <br /> IM-&J 'S X <br /> NOTES <br /> ELAIr3E rECHSERVICES OIC SAN JOSE SACRAMENTO LOS AFIGELES SAN(AEGO VAYLWDIZIMCW;n Ccm <br />