PERMFILE123238

• Permit No: X198316908
• IBM Index Class Name: Permit File
• Doc Date: 8/30/1983
• Doc Name: WELL COMPLETION AND PUMP INSTALLATION REPORT
• Media Type: D
• Archive: No

PUMPINSTALLATION REPORT
Pump Make
Type
Powered by
Pump Serial No.
Motor Serial No.
Date InstalleD _
HP
Pump Intake Deptll
Remarks
WELL 7EST DATA WITH PERMANENT PUMP
Date Tested _._H/8
Static Water Level Prlor to Test
Le^~th of Test
Sustained yield (Metered
Pumping Water Level
Remarks
Hours
GPM
CONTRACTORS STATEMENT
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WATER
TABLE
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CORE OF
DEPRESSION
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~t at he_ y~me is truP.af his own knowledge. ^
I (/y ~~~
Signet a !!!!~ ' / / ~ ,CHIC License No. ~~
State of N7 ,County of ,~3TRnno. SS
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Subsc: ibed and sworn to betore me thisQ day Of ~c~utryrlOer , fg Dona L Cnwm - Notary Public
County o! T~. orare of
My Commission expires: c ~1_ fg~`L , Nettone ~ wy~;;,lnr
M Commis>IOn E+pins Fcb.?3,1994
Notary Public ~tlrw~s~, ~ `~ ""^~'~"~>«>~
FORM TO BE MADE OUT IN OV ADRUPLICATE~ WHITE FORM must be an original copy on both sides and signed.
WHITE AND GREEN copies must be Bled with the State Engineer. PINK COPY is for the Owner and VELLOW COPY is for the Driller.