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PUMP INSTALLATION REPORT <br />Pump Make Jamod. <br />Type leottf tat <br />Powered oy Z@02&=-:k - NP ,,31 <br />Pump Serial No. Old - <br />Motor Serial No. -� <br />Date installed i&x x$•75 <br />Pump Intake Depth �51 <br />Remarks _ <br />WELL TEST DATA WITH PERMANENT PUMP <br />'Date Tested saw (7:16-751_ - <br />Static Water Level Prior to Test U1 <br />Length of Test — 2 _ Hours <br />Sustained yield {Metered 59 GPM at 3D STPM <br />Pumping Water Level <br />Remarks _ <br />r•• <br />A. I <br />WATER <br />s TA" <br />e9 <br />r rrn' <br />r <br />rr' ' <br />IL <br />i <br />r <br />GONE QF <br />DEi�i�S3tON <br />CONTRACTORS STATEM &T <br />The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or <br />pump installation described hereon., that he xegW^a statement made hereon; knows the content <br />thereof, and that the`aanpa.is -trl e <br />Signalurre �F License No. <br />State of Colomd'"ounty of SS <br />.Sqbscribed and sworn to before me this day of , 38 <br />Ry.pommission expires" My Cm- mirjos- e4fes My 16, ?l�6 <br />NotaV Public <br />FORM TO BE MAOE OUT IN QUADRUPLICATE: WHITE FORM court be an orisinei copy an boat sides end si"W. <br />WHITE AND GREEN oepies must be Mad with the State Enninear: PINK COPY is for the owner and VILLOW COPY b sor'tft Driller. <br />