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rump MaKe <br />Type ._ <br />Powered by <br />•p Serial No. _ <br />motor Serial No. _ <br />Date Installed _ <br />Pump Intake Depth <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUMP <br />Date Tested ___ ___ <br />Static Water Level Prior to Test -_..__~___ <br />Length of Test ___._ _ _.._ Hours <br />Sustained yield (Metered)____._.____ GPM <br />Ing Water Level _._.__ . <br />Remarks --.-.-.---_-- - <br /> <br />:~ i i WATER <br />~I 3 J <br /> <br />.. <br />.i~ ~ h1 ~ ~ `TABLE <br />> <br /> W <br />I <br /> J <br />` J <br /> Ki N <br /> W. <br /> <br />_ _ _ _ _ _ _ <br />_ _ _ I i <br />~ ! ~~' <br />_ ;! _ r. _ _ .. _ _ _ _ _ <br /> <br /> <br />_ ? ~~ <br />, , ~ <br /> <br /> <br />°I ' <br />~ <br /> ~ . <br /> <br /> YW ~ <br />=a ~ <br />' <br /> Q a ~ <br />, I <br />S ~ <br />~ <br />F <br />w <br /> O ~ <br />~ <br />o ~ :. <br />; <br /> l ~ CONE OF <br />~ a I ',_ ~ <br />'~ ~'' DEPRESSION <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 the same is ue of his own knowledge. ~ q <br />Signature __~ License No. ~_L <br />State of Colorado, County of `~o ~ ~~~++.-+T?=~ SS <br />Subscribed and sworn to before me this _~._ day of __ ~sey__ 19 ;~.. <br />My Commission expires: ___/~SIy_-___ , 19 g]- . <br />Notary Public- ~ Conte ~~~y,S~SC:~_ <br />~:.-. \~ <br />:.+' <br />_ ~~-. <br />HP _ <br />FVRM TV eE MApt VVI IN OUAD6'JPLICAIE: WY.I~E FORM muA W m original copy on boN aide e.nd ugnld. <br />WHITE AND GREEN cpprta mutt Dt Lled mtft tnr St~ta Engm~a~. PINK COPY n for tn. Owner ,ne vELEOw COVV n for tln Driil~r. <br />