Laserfiche WebLink
PUMPINSTALLATION REPORT <br />Pump Make i~~A--flowino <br />Type <br />Powered by <br />Pump 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 ~~A <br />Static Water Level Prior to Test <br />Le^nth of Test <br />Sustained yield (Metered) <br />Pumping Water Level <br />Remarks <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 at he scene is true Is own knowledge. <br />Signatu ~ t -J ~ License No. //t~7 P <br />L~Jyo qq 11 <br />State of r ,bounty of ~,(~~ 12pna„ SS <br />s«~oc «~>.=xsoc <br />Subsc: ibed and sworn to before me this ih day of I.~c~ve.VJ~nr , 19 Donna L. cr:m:, - Nolary i•ublic <br />County of ~~~ Jrete of <br />My Commission expires: clear a-`~ 19 ~t4 Natrona ~~+'~~,7 Wyoming <br />~~ M9 Commission E:.pires FcS. 29, 1984 <br />Notary Public\ w lo.~.a~ ~ ~~ eK+aR!wr.*aae~*~e+~~ <br />HP <br />Hours <br />GPM <br /> <br />FORM TO BE MADE OUT IN OUADRUPLICATE~ WHITE FORM must be an original copy on both sides antl signed. <br />WHITE AND GREEN copes must be tiled with the $ta to Engineer. PINK COPY is for tha Owner and YELLOW COPY is for tha Dr,ller. <br />