REV09620

• Permit No: M1977526
• IBM Index Class Name: Revision
• Media Type: D
• Archive: No

07/27/2005 15:05 FA% 3037219298 GREYSTONE
JUL-2i-05 12;00 FR06FDIUISION DF WATER RESOURCES 8098862223
G
FNSrALLATiON REPORT
Pump Make
Type
Powered by --.~ HP ~.
Pump Serial No.,. .,-
Motor Serial NC, ..,~ .._
Date Installep _
Pump Intake Depth „_~
Remarks ~, _.
WELL TEST,DATA 1MITN PERI[MetEPrT PYMP
Oate Tested _ „__
Static Water 4evel P ~ior to Tess _~ . _ __
l:engdt of Teat _ ~..... .. Hour,
Sustained yield (Metered) pPM.
Pumping Water Level _ .. _.._.
Remarks - _ _ _.
~ 008
T-828 P.05/05 P-008
R ,, `•
f~', o'r:. ~ ~ ..
r
Lr w ~
. 1
•w ~~ .
®•J id- ~
~.'
~;
y
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~ .
w•
., i ~~'.
_ .,..._.._ .F .. +
w~7ER
Te6r.E'
-~.-
' ~ i
txftf of
treANESSrOer

COrrTRA¢TOifS STATEMENT -
The underaigne~L being duly sworn upon oath, deposes anq ya thot he is the conuacsor Of the well or
pump instatlatiarr dascritred nareon; that h th to mace her9on; knows the comHq
thereof, and sh[ t she a of his o
~,
SigriaTUre
1~ scot~T n~ - P
Stag at Colorado. County of ~.
Sul~cribed and awoT to before me sFria31__ d
My Commission expires: _ . , t9._ .
Notary Putdk
THOZfAB 1t. 8L80
PORM Tq eE MAtle our In wrapR[~Neafe: VPnITF iORM ~ a ae eu
surnta ano Gtteer: wwn muse e^ [naa.~itn moStW fia9raar. r[ws:eorr bfer en 0'
~~Tw.....,~.:
~ wcanae Pio..~.9c1__
SS '
- . TB.~S.
RMr a ieaa nma oea :iyeoo.
ml YEL6ow COPY liter un flare.