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PO Box 24581
Pittsburgh, PA 15234
Phone: 817-271-0204
Fax: 412-774-1634
E-Mail: info@aquastream.com
Aquastream Online Questionaire
Name and address of the
well owner/operator:

Your E-Mail Address     Physical location of the well:  
Contact person:     Phone number:  
Well identifying name/number:     Fax number:  
Date Drilled:     Method of drilling:  
Is the well screened and/or gravel packed?     Type of screen:  

Static Water Level
when originally drilled:     current:  

Pumping water level
when originally drilled:     current:  

Original specific capacity:     Current specific capacity:  
Pump location:     Pump size and type:  

Pump design capacity
when originally put in operation:     current:  

Depth of well:     Diameter of well:  
Location of well screen/perforations:     Is a video survey of the well available?  
What rehabilitation techniques have been used on the well?     Is a chemical analysis of the water available?  
Has the well been tested for biological activity?     Is the original well drillerís log and design sheet available?  
Describe the nature of the well problem:     Sand content in produced water (ppm):  
Are sand separators being used?          
What other information is available regarding the well history?