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( I <br />Name _ /(!Q- ?, <br />Address -- j •-yf , ? -?----- - _ _ Date ?Home hone# CityZ:? Zip <br />P _ Wor Cell# _ Fax# _ <br />Start time End time Truck- Service persons _? <br />Casin size (ID) & -?T' '-? ?`""''" • <br />Casing ( type - upper lower _ other? Driller <br />Permit # _ GPS _ _ - <br />Total depth _ Static water level _ Punip intake_ Pumping water level gpm <br />Drop pipe size & type Drop cable size & type _- __ Pitless size <br />New pump model _ Manu Serial # _ __HP. V&Ph. Date code __War#_ - <br />Old pump model Manu _ HP V&Ph _ Date code <br />Trench length. Trench pipe size & type _ Hydrant Y/N, Trench wire size & type <br />Indoor offset Pressure tank _ Pressure setting _ Fuse size _ <br />Amps reading - Ohms to ground - Ohms = Y to B Y to -R R to B <br />Meter Manu_ Serial # --- <br />-- _- _`__------_-_-_ Readine <br />NOTES: <br /> QTY ITEM <br /> DESCRIPTION RATE UCE <br /> _ PI <br /> <br /> <br /> <br /> <br /> <br /> <br /> j <br />---??LL. <br />? <br />T?-? <br /> 7 <br />j'YJ tiyyy??? <br />/? <br />l?'? <br />w <br /> t? --? - <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ra <br /> <br /> <br /> <br /> <br /> <br /> <br /> SUBTOTAL <br />' - <br />17 <br />, TAX <br />7 t' c?xs <br /> <br />21 f <br />s ?-- LABOR <br />f' 4 <br /> -- TOTAL r? ?? <br />v i/vn -ra t r LICENSE # 1184 • FAX 303 • 637.9986 <br />90221 EAST 120th AVENUE, HFNDE950N, COLORADO 80640 -A 303*037.9977