DATA SHEET - WELL CLEANING PROGRAMME

1/17/2005

1

District

2

AGA Division

3

Location (GPS)

4

Owner

5

Address

6

Presence of Debsi               Yes / No

7

Water Level

a. Before Tsunami

b. Before Pumping

c. After Pumping

8

Diameter of Well

9

Total depth (from ground level)

10

Rechange

Height

12"

24"

36"

48"

60"

72"

84"

96"

108"

120"

Time mts

11

Quality

Parameter

PH

Conductivity

Turbidity

Before Pumping

After Pumping

12

Date and Time

13

Distance from Sea (Approx)

14

Colliform test result             Yes / No

15

Chlorination                        Yes / no

16

Field Officer Name

17

Date