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Refer to Form DPH-INF0003-1 PH Terminal Environmental Ground Monitoring Well Inspection for details.
Accep
tabilit
Item y
Item Acceptance Criteria Comments/Remarks
# N
X /
A
Does the Asset meet the acceptance
Criteria?
0.0 Example If It meets the criteria mark “”
It if does not meet the criteria marl “X”
If not applicable mark “N/A”
1. Monitoring Well Label
Ensure presence of established reference water level measuring Stuck up cover outer casing
point at the inner casing material. It is important to measure cover, unable to inspect the inter-
nal.
water level consistently each time.
7. Vented Cap
Stuck up cover outer casing
Check for presence and condition of the inner well cap vent. A
cover, unable to inspect the inter-
vented well cap equalizes atmospheric pressure resulting in more nal.
accurate water level measurements (especially in wells screened
in clay).
Other Observations -
Note:
Surveillance Overall Results ( the appropriate box)
No follow up actions identified as a result of this Surveillance exercise.
Actions have been identified as a result of this Surveillance and will be followed up as appropriate per
the Maintenance Execution Process. Identify action and describe follow up in space below
Completed By Reviewed By
Name: Mark Darrel E. Aranas Name:
Title:
Date of Surveillance- 14Aug2023 Date Reviewed/Approved-
Appendix A