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' • v vvn -r&~ LICENSE A# 1194 a FAX 303 . 637.9988 <br />10221 EA6r 1?20th AVENUE-, HFN0EK90M, COtOKA00 80640 ..&, 303.637.9977 <br />Name <br /> <br />- <br />- - <br />Date <br />% <br />- " <br />Address ?? , <br />Zr 's . Cih' - <br />_ - -- <br />Zip <br />Home phone# <br />__ _ <br />Start timeLC?, End time j" ;t ;: ,._ Truck!__ Cell# Fax# <br />Service persons C <br />k <br />Casing size (ID) & type -upper _ lower other? , <br />Driller <br />Permit # GPs - ---- - <br />Total depth <br />Drop pipe size & type _ <br />Static water level _ __ Pump intake _ Pumping water level _ gpm <br /> <br />New pump model __ _ Drop cable size & type <br />Manu Serial # _ _ <br />HP. <br />V&Ph. <br />i Pitless size <br />Date code War# <br /> <br />Old pump model <br />Manu __ <br />_ <br />HP _ <br />V&Ph <br /> <br />Trench length _ <br />Trench pipe size & type _ <br />_ <br />Hydrant Y/N Date code <br />Trench wire size & type <br />Indoor offset Pressure tank Pressure setting Fuse size <br /> <br />Amps reading - <br />Ohms to ground _ Ohms = Y to B _ <br />Y to R R to B <br />Meter Manu_ <br />NOTES: <br />QTY ITEM - <br /> DESCRIPTION RATE PRICE <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> /I ?' • LCD-•-s-- /---r1._CA ;>n /'• <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />V <br />?- <br />L SUBTOTAL ? ., <br /> _ <br />TAX c X 78 <br /> <br /> -f` LABOR <br />- TOTAL <br />'- rP?