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Pump Make <br />Type <br />vered by Electric t4otor FiP 25 <br />~mp Serial No. 2FH8C38274 <br />Motor Serial No. 1C88A32599 <br />Date InstalleD 5-10-88 <br />Pump Intake Depth 529' <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUMP <br />Date tested ._ 5-24-88 ____ <br />Static yJa:er Level Prior to Test _ 300' <br />Length of Tes[ _?4 Hours <br />stained yield IMeteredl-__~4~__ GPM <br />PGrnping Watcr Level Snn __ <br />Remarks <br /> <br /> , <br /> ~ <br /> W , <br /> Y • <br /> Q , <br />2 <br />Z <br />F- - <br />~~ <br />V <br />~ ~_ <br />~~ <br />CONTRACTORS STATEMENT <br />The undersigned, being 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 statement made hereon; knows the content <br />thereof, and that th r~e+~s true oihis own knowledge. <br />Signature ~ U!~"/ _ _. <br />SuDtrersible <br />State ofiColorado. Count <br />Subscribed and sworn to betore me this _ day of <br />My Commission expires: <br />• Notary Public <br />_ __ 19 <br />_.___.. ._ License No. <br />_____- SS <br />.,~~.~, <br />_ '~~_ <br />3 J WATER <br />~~ TABLE <br />~;, W <br />~ J <br />N <br />61 .'~ <br />i <br />i <br />~ `: <br />' ,qr <br />'~ CONE OF <br />.)' t>EPRESStOR <br />19-. <br />FORM TO BE MADE OUT IN QUADRUPLICATE: WRITE FORM rnufl be an oriq~nal copy on both rrdrs and rrgnrd. <br />WRITE AND GREEN coO~n mu4t be Ided w~lh IM Slalr Engmpr. PINK COPY q for rM Ownrr and YELLOW COPY n for thr Dndu <br />