2020-04-21_PERMIT FILE - M2019054

• Permit No: M2019054
• IBM Index Class Name: PERMIT FILE
• Doc Date: 4/21/2020
• Doc Name: Comment Acknowledgement/Response
• From: Uinta Mining
• To: DRMS
• Email Name: SJM
• Media Type: D
• Archive: No

PUMP INSTALLATION REPORT . !-V ;
Pump Make " '+�'
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Pump S!kci.J No. --, ' Mfr ''• Id
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Motor Serial No. _ �___��_ %r: `,` w w \TABLE
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Date Instal leo *4,. ',,r• Ta Nts V) ;� ` IslIX NPump Intake Depth '� ni
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Remarks •_ 4 'r
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WELL TEST DATA WITH PERMANENT PUMP A. t w �' '
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Date Tested — _ CONE Of
• a. i; •`F' DEPRESSION
Static Water Level Prior to Test e? g ;,
Lelg+h rF Test`h • :.*I\ \ _ ......„,\
Hous 'rti.er.
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Sustained yield (Metered)__.___ __ GPM
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Pumping Water Level dillit
Remarks __ _ __ _. `', 4
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CONTRACTfek$.T4'TEME NT\
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon• that he has read the statement made hereon; knows the content
thereof, and that the same i true o his own knowledge.
•
Signature Ay.N "�._ L/L�-- 44.-'-k.k,- License No. . 7 Y
� I n of /"!dFi'�� S
S ate eo oqa o, fYou ty S
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'Subscribed and orn to betore me this Z day of._1 &O , 19 .
,:,,,,;..,t1/4.,. ..14. My Commission Ez ires May41985
41 M�Commissipn expl es: P Y
N ryiIb Icy —__ \=
FORM TO EyMOE UT IN OUAORUPLICATE• WHITE FORM must be an original copy on both sides and signed.
WHITE ANO GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller.