Laserfiche WebLink
PUMP INSTALLATION REPLY. f <br />Pump Make <br />Type <br />Powered by <br />Pump Serial No. _ <br />Motor Serial No. _ <br />I Date Installed <br />Pump Intake Depth <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUh1P <br />Date Tested <br />Static Water Level Prior to Test <br />Length of Test Hours <br />Sustained yield (Metered) GPM <br />Pumping Water Level <br />Remarks <br /> <br /> • ~ <br /> <br /> <br /> <br /> <br /> <br />. <br />J '~~ <br />_r <br /> <br />s~ <br />`: <br />[ <br /> <br /> <br />.~ <br /> <br />I <br />;E. ~_ <br /> ''~ <br /> .~~ ~ J I <br /> wl <br /> W <br /> I <br />J <br /> <br /> <br /> -~ - <br />Imo. <br />W ~ <br />FFY ~~ <br />1 <br />ZI ` <br />\~~ <br />~ WA7ER <br />~ C TABLE <br />w \ <br />J <br />--~----- <br />z~ _ , <br />a ; <br />dI/ <br />'/ <br />CONE OF <br />DEPRESSION <br />CONTRACTORS STATEMENT <br />The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the welt or <br />pump installation described hereon; that he has read the statement made hereon; knows the content <br />thereof, and that the samyye~~is true of his awn knowledge. <br />Signatu~~ d`f/~ ~ / License No.~~_ <br />State of Colorado, County of ~~~'~~9~ SS <br />l <br />Subscribed and sworn to before me this~~ /day ofd==~~' 19 ~~ . <br />My Commission expires: ~~ ~ ,~ ~~ 19 ~ % , <br />_ _ -~ i <br />Notary Public 1 ' ~"'I ~ " ~f`" <br />~-B-2~ <br />HP <br />LJ <br />•~~^~ ~ s•~c Zvi iiv V~!/~Vnvr~~l,q ic' WWII[ rV1tM mill p~ •n or ip~n~l COPY On Ool~ r~tln Intl I~gn~U <br />WMrtE AND GREEN coP~I~ m~~l pe files wilt. Iftr Sutc Engm~e•. PINK COPY a lo. Ins O..nu Ana YELLOYI COPY .. for Ib~ Dr~rlu <br />