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Pump Make ~~~~ ~ZrE <br />Type SLC6MGi-SiO/~ <br />~ered by E ~~-° ~T~" t ~ HP _~ <br />.,s. - :~ <br />-'~ == ~~ <br />Pump Serial No. <br />Motor Serial No <br />Oate InstalleD _~~~ <br />OG / <br />Pump Intake Deptlf o O <br />Remarks ____ <br />WELL TEST DA 7A LYIiM PERMANgENT PUMP <br />Date Tested _ . ~/~/(~ / -_ __ _-_ __- <br />Static Water Level Pnol to Test _ _/_°_?_/ - _ _. <br />Length of Test . __~ ~ U_K?_~"_5 _ Hours <br />~tained yield 1•~.edl ._ _ o~..~-. _ __- GPM <br />Pumping Water Level ~~ / _ _ _._ <br /> <br />, WATER <br /> • <br />~;:. <br />~' ~ i TABL.E <br /> . ~ w <br />~ <br /> J <br />Q <br /> K I y~j <br /> , . <br />' < <br />' _ •- z , <br /> 1, <br /> = <br /> ~ I i ~ <br /> <br /> <br /> <br />x <br />~ <br /> <br /> <br />~ <br /> <br />f~ <br />~ <br /> <br />_ <br />=• <br />r~ l <br /> <br /> <br />~ i <br />~ <br /> <br />a <br />~ ;~ <br />o <br />~ z ~~ '~ CONE OF <br />H d `; '" DEPRESSION <br />Remarks ._ _ _ _.. <br />CONTRACTORS STATEMENT <br />The undersigned, beiny 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 stetement made hereon; knows the content <br />thereof, and that the same is true of his own knowledge. <br />Signature _ j~¢.~-[{}'17 _ -- License No. y~ <br />State of Colorado, County of 4~.w2 SS <br />Subscribed and sworn to before me this G~iday of . 19 .~ ~. <br />h1y CGr:;rr~i~sio^ t:xpi;" vnrob~• :i, ly>, <br />. My Commission ex/p~ir-es: -. .__ T5 <br />Notary Public.~t! _!~~-~~~4`y cam!}/ <br />FORM TO 6E MADE OUT IN QUADRUPLICATE. WHITE FORM m~~f be an orpm~l <oYY ~~ bolt, fide •nd f•gned. <br />WHITE AND GREEN cao~n muu be IAed wnh fbe Sf~le Engmee~. PINK COPY .f lo• ro~ Ownu ana vELLOC: cUPV n for tM Drdbr. <br />