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PUMP INSTALLATION REPORT <br /> Frump Make Pump to be installed by others. 'A <br /> r <br /> type <br /> Powered by HP <br /> Pump Serial No. W <br /> WATER <br /> Motor Serial No, :- W W TABLE <br /> . W 1;W <br /> Date Installea F J <br /> Ar to <br /> Pump Intake Depth <br /> Remarks <br /> ;•i / <br /> W <br /> WELL TEST DATA WITH PERMANENT PUMP a 4" <br /> Fes- „ <br /> Date Tested ae '; CONE OF <br /> DEPRESSION <br /> Static Water Level Prior to Test o <br /> Length of Test Hours <br /> Sustained yield (Metered) GPM <br /> Pumping Water Level ` <br /> Remarks <br /> CONTRACTORSSTATEMENT <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 has read the statement made hereon; knows the content <br /> thereof, and that the same is true of his own knowledge. <br /> Signature '�;eA• � License No. 1g64 <br /> State of Colorado, County of Grand SS <br /> Subscribed and sworn to before me this 10 day of January_ , 19 -89- . <br /> My Commission expires: April 3 19 9 . <br /> Notary Publica�41'1'w7ek� <br /> FORM TO-BE. MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. <br /> WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller. <br />