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Date of Installation

Area

District

GPS

,     see on map

Pump no.

Dist. from Factory (km)

Village Head / Group Village Head

Contact (phone no.)

Previous Water Source

Installation Type

Well Depth (m)

Water Depth (m)

Pump Length (m)

Dist. from Furthest Household (m)

No. of People Served

Pump Dedication / Donor

Wells for Zoë Donor TBC