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PUMP INSTALLA"f10N REPORT <br />Pump Make STA-RITE <br />Type Submersible _ <br />Powered by Electric _ HP ~_ <br />Pump Serial No. <br />Motor Serial No. <br />Date Installed 5/30/9 <br />Pump Intake Depth <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUMP <br />Date Tested 5,[~~90 <br />Static Water Level Prior to Test 8r <br />Length of Test 1± Hours <br />Sustained yield L><eesaatmd0-15 GPM <br />Pumping Water Level l8e <br />Re.narks <br />~~~ <br />~- . <br />3', -. ~ WATER <br />~ ~ TABLE <br />H W <br />Q "'! <br />F <br />N <br />toNE Of <br />DEPRESSION <br />it <br />I <br />~I <br />r 1 <br />fu <br />CONTRACTORS STATEMENT <br />The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of t' a well or <br />pump installation described hereon; that he has read the statement made hereon; knows th :content <br />thereof, and that t!!h}~,e,,~~same is true of his own knowledge. I <br />Signature 1.L~~~ e~7^-"'~Sr License No..I ~~ <br />State of Colorado, County of ~~~ r SS <br />i <br />Subscribed and sworn to betore me this 1~~day of 19 ~ . <br />My Commission expire's 0^ bet 5 1991 ~ <br />My Commission expires: ~ ~_~ ,,`79'_ . r <br />Notary Public~lL~~~ ~ t~~-'~~w ~ <br />FORM TO eE MAOE DUT IN OUADRUP~ICATE: WHITE FORM must be en original copy on both sides en <br />WHITE AND GREEN cop~n must be bled with the Slam Engineer. PINK COPY is for the Owner and YELLOW COPY is fo <br />sipvd. <br />the Orillar. <br />C , <br />J <br />