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PUMP INSTALLATION REPLY. f <br />Pump Make <br />Type <br />Powered by <br />Pump Serial No. <br />Motor Serial No <br />HP <br />I Date Installed <br />Pump Intake Depth <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUh1P <br />Date Tested <br />Static Water Level Prior to Test <br />Length of Test Hours <br />Sustained yield (Metered) GPM <br />Pumping Water Level <br />Remarks <br /> <br /> <br /> <br /> <br />J <br />Imo. <br />W ~ <br />FFY ~~ <br />ZI <br />.,:~~: <br />. _ ~- <br /> w~ 3 ~ WATER <br /> w w TABLE <br /> >I U > <br /> W F W <br /> I <br />J Q J <br /> R 0 <br />l 41 <br /> <br /> <br />_ <br />_ <br />_ _ .. . <br /> <br />u <br />~ <br /> <br />z <br /> a ; <br /> <br /> d <br />_ I <br />' / <br />• i <br />•. .:1 <br />~' ~ CONE OF <br />' ?' DEPRESSION <br /> <br />4 <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 true of his awn knowledge. <br />,~'~ / ~ <br />Signatu~ ~ /--ys"/~ ~ License No. ~_ <br />State of Colorado, County of ~~~'~~~~ SS <br />_~! ~ ~ ~. <br />Subscribed and sworn to before me this~~ day of ~"=^" ~' 19 ~~ . <br />My Commission expires: ~~ ~ ~ '~ 19 ~ ~_ . <br />i <br />Notary Public 1 ' ~" "1 ~ " ~~`" <br />7-R_~a <br />L J <br />FORM 7o BE MADE OUT IN OUADRUPLICAIE' WHIiE FORM mill E~ •n or iy~n ~I coPY on Oolft r~tln end IBC^~tl <br />WHrtE AND GREEN coP~n marl pe iJetl wiln 1nr Suu Enq~nn•. PINK COPY a 1^r IM O.~nu end YELLOW COPY .. for Ib~ Dr~rlm <br />