PERMFILE105386

• Permit No: C1981013
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: EXHIBIT 08 WATER WELL INFO
• Media Type: D
• Archive: No

Pump Make
Type
Not installed
Pr -ed by _
P~Serial No.
Motor Serial No
Date Installed
Pump Intake Depttl
Remarks
G

HP
WELL TEST DATA WITH PERMANENT PUMP
Date Tested ~______.___
Static Water Level Prior to Test
angth of Test __.__ Hours
.I red yield (Metered) ___ GPM
Pur~g Water Level
Remarks
`~.

~~~
~~•-
~- _
3 ~ ' WATER
~ ~ TABLE
F W
J
N
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r
CONE OF
DEPRESSION
CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the same is true of his own knowledge.
Signature ~ ~ _ - License No. LL~
State of Colorado, County of ~ GGZ C.??2-L »2.~~/-~ SS
Subscribed and sworn to before me this ~~day of ~` 19 71' .
My Commission expires Octobe '15, 1
MY Commission expires: _119 ~ .
• Notary Public iL~ ~c-~-~- ~ u
FORM TO eE MADE OUT IN OUA DR UPLICATE' WHITE fORM mysl be an or rq~nsl copy on both srdn rrnd rign~d.
WHITE AND GREEN coP~~s must be IJed warn nc~ Sl:.ie Cngme~~ PINK COPY r~ Iw the OwMr and YELLOq COPY n ror Ib Ontler