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If you'd like a recommendation for water well rehabilitation of a water well, please complete the following form:

Your Name:
E-mail Address:
City, State & Zip:
Date well originally drilled:
Type of formation (please describe):
Hole size:
Casing size:
Type of casing material:
Type of screen (Slotted? Wire Wrap? Cut?):
Screen length:
Screen location:
Well Depth:
Pump depth:
Does well have a check valve below surface?
How is your pump powered?
If combustion engine, does it have a clutch?
Does well head have an inspection hole (access to casing)?
What size is the access hole?
Can the pipe be disconnected from the throat of the pump easily?
Are you willing to get the drawdown taken on your well prior to and after treatment?
Are you willing to have the volume tested before and after?
Volume of well when first put on pump:
Volume of well currently (GPM):
Standing fluid depth (feet of fluid in casing):
Pumping fluid level (feet of fluid in hole after continous pumping for at least an hour):
How old was well when first noticeable drawdown?
Have you experienced reservoir depletion?
If so, how much?
Over what period of time do you experience the loss of hydrostatic fluid?
Does the water have an odor?
Have you noticed any buildup of scale, slime on or in any of your pumping equipment?
If so, describe the material as to color, consistency (hard or soft) and thickness:
Are there any discolorations on equipment that water comes in contact with?
If so, what color is it?
What was the type and age of any equipment you have had to replace?
What was the reason for replacing the equipment?
If the well was oil lubricated, is there any oil on top of the column of fluid?
Do you have access to a portable water tank to add displacment to the well?
Does the tank have a pump to assist in pumping water to the well?
Can someone be available to surge the well every 3 to 4 hours?
What results would be satisfactory to you after treatment on your well?
If you have any questions give us a call at 760-610-2412

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