Multi Well RTA Site Inspection
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Surface Location
*
Number of Wells on Location
*
1
2
3
4
5
6
Well #1 UWI
*
Well #1 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Well #2 UWI
*
Well #2 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Well #3 UWI
*
Well #3 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Well #4 UWI
*
Well #4 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Well #5 UWI
*
Well #5 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Well #6 UWI
*
Well #6 Licence Number
*
Were bubbles detected from surface casing during 10 minuite test interval?
*
Yes
No
If yes, how many bubbles per minute?
*
Land use
*
Cultivated
Grassland
Is accessibility an issue
*
Yes
No
Notes on location accessibilty
*
Surface Equipment
Equipment and risers present?
Risers on location
Equipment on location
Not Applicable
Pictures of Equipment / Risers
*
Take Picture / Upload Files
Cancel
of
Comments
Reclamation
Required reclamation (after surface equipment and risers removed) - include photos
*
Minimal disturbance
Partial Build
Full build >$25000 dirt work required
N/A
Pictures
*
Take Picture / Upload Files
Cancel
of
Reclamation work required after abandonment with rough costs
*
SCVF Testing
Is surface casing vent accessible and in good condition?
*
Yes
No
If no what is required?
*
Submit
Should be Empty: