PERMFILE62861

• Permit No: C1981012
• IBM Index Class Name: Permit File
• Doc Date: 7/28/1986
• Section_Exhibit Name: EXHIBIT 11 WATER WELL INFO PART 2
• Media Type: D
• Archive: No

PUMP INSTALLATION REPORT
Pump Make
T•ipe
Powered by
Pump Serial No. _
Motor Serial No. _
Date Installed
Pump Intake Depth
Remarks
WILL TEST DATA WITH PERMANENT PUMP
Date Tested
Static Water Level Prior to Test
Length of Test
Sustained yield (Meteredl-
Pumping Water Level
R~:marks _
'i ~
':i ~ ~~
-. ~
WATER
TABLE
GONE OF
DEPRESSION
~J
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of
pump installation descrit~ed hereon; that he has read the statement made hereon; knows t
thereof, and that the saT~~tr?-iz ue of 's ow c ledge.
Signatufe~l~r'ii License No. ~
State of Colorado, County of Las Animas SS
Subscribed and sworn to before me this25thday of April , 19 90 . I
Wly Commission expires: March 21, ~g 92,
Hours
GPM
HP
well or
content
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fWpta(y~Pi ~Iblic 1lg . , l s ~ 1 ~T/3~ do-~Yt.X ~.rn 1
~~~fr 7.16 west Kansas, Trinidad, Colorado 61082
FORM~~ I~itDE OUT IN DUADR UPLICATE: WHITE FORM must M en original <opY pn both fide t id signed.
WHITE AND GREEN copms moot be Lled wnh the 5[a to Engineer. PINK COPY is /or the Owner and YELLOW COPY rs' v [ha Drillo.