1. Well no. __________________ Serial no. _________________

Carried out by: ________________ Year: ____________________

Owner: __________________________________________________

Address: _________________________________________________

              _______________________ Telephone: _____________

2. Sketch of well position:

WELL:

Surface level _______________________m

Top of well casing level
(reference point) ___________________ m

Depth to bottom,
m below reference point _____________ m

Well bottom level ___________________m

Casing, diameter ___________________ m

Screen diameter ____________________ m

Screened interval ___________m -_____ m

1. Sketch of well construction:

Accessibility to water-level measurements: _________________________________________________________________

_________________________________________________________________

Measurement

data:

Date of measurement

Water level, m below reference point

Water level

Localised by: ___________________________________ Date: ____________

Site: ___________________________________________________________

Carried out by: __________________________________ Date: __________

Well no.

Reference point

Water-level,
m below reference point

Levelling data

Notes

Water level

Bottom

Top of well casing (refe-
rence point)

Terrain

Bottom

Water level

Site: ____________________________ Date: __________ Well no. ____________

Drilling contractor: ________________ Sample collector: ____________________

Drilling method: _____________________________________________________

Borehole diameter: ________________ Depth to water table: _________________

Soil-type description

Odour-colour

Strata
-------
Depth

Description

Sample

Screen
-------
Bottom

Description

Sample

-

--2

-

--4

-

--6

-

--8

-

--1.0

-

--2

-

--4

-

--6

-

--8

-

--9

-

--2.0

-

--2

-

--4

-

--6

-

--8

-

--3.0

-

--2

-

--4

-

--6

-

--8

-

--4.0

-

--2

-

--4

-

--6

-

--8

-

--5.0

-

--2

-

--4

-

--6

-

--8

-

--6.0

-

--2

-

--4

-

--6

-

--8

-

--1.0

-

--2

-

--4

-

--6

-

--8

-

--9

-

--2.0

-

--2

-

--4

-

--6

-

--8

-

--3.0

-

--2

-

--4

-

--6

-

--8

-

--4.0

-

--2

-

--4

-

--6

-

--8

-

--5.0

-

--2

-

--4

-

--6

-

--8

-

--6.0

Site:________________________________________________________________

Borehole diameter: __________________ Screen size:_______________________

Sampling method: ___________________ Collected by:______________________

Well no.

Date

Well bottom, m below reference point

Water level, m below reference point

Water column, litres

Purge volume, litres

Notes