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General Information
Well Name
Well Number
Lease Name
Operator
Location
Surface Equipment
Wellhead in good condition
Valves and fittings not leaking
Aboveground piping in good condition
Pumping unit / engine in good condition
Tanks in good condition
Containment areas free of leaks
Safety
Correct warning signs posted
Proper safety equipment available
Access road in good condition
Environmental
No spills or leaks observed
Proper disposal of waste
No excessive noise or odors
General Observations
Additional Comments