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PUMP INSTALLATION REPORT <br /> Bump to be installed others. - <br /> Frump Make P � <br /> type <br /> Dowered by HP r`Yt ♦ �+ <br /> Nimp Serial No. <br /> {. < WATER <br /> Motor Serial No. �> > �W lABLE <br /> !: W F W <br /> Date Installed ar N J <br /> ., <br /> Pump Intake Depth <br /> Remarks <br /> d / <br /> ♦ :'i / <br /> WELL TEST DATA WITH PERMANENT PUMP a <br /> H <br /> Date Tested a z /CONE OF <br /> N a. ,' DEPRESSION <br /> Static Water Level Prior to Test <br /> s:• <br /> Length of Test Hours _ <br /> Sustained yield (Metered) GPM <br /> Pumping Water Level <br /> Remarks <br /> ;n• <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 ��� License No. 1Q64 <br /> State of Colorado, County of Grand SS <br /> Subscribed and sworn to betore me this 10 day of Jannar: , 19 J39 . <br /> My Commission expires: April-3 , 19 2 . <br /> Notary Public <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 tfta Ownar and YELLOW COPY is for the Driller. <br />