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PUMPINSTALLATION REPORT <br />Pump Ma~Cg,,. ~" <br />Type ". ~: ~ <br />Powered by HP Z <br />Pump Serial No. `~ ~v <br />Motor Serial No. ~~~~ <br />Date Installed ~F u `'~ ?< <br />~ 5 ~ <br />Pump Intake Depth <br />Remarks '~ <br />WELL TEST DATA WITH PERMANENT PUMP <br />Date Tested ~'~ ° "' 7 ! <br />Static Water Level Prior to Test <br />~ hG .~,t <br />Length of Test <br />Hours <br />Sustained yield (Metered) /` GPM <br />Pumping Water Level <br />Remarks ~' ""~ <br />J-~ <br /> <br /> <br />u <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 conterit <br />thereof, and that the same is true of his n knowledge. <br />/~i <br />Signature ~~`~'3~/` ~'~-'`~ License No. <br />State of=Colorado, County of <br /> <br /> <br /> <br /> <br /> , <br /> W mss <br /> j , <br /> `I s <br /> <br />F <br />Subscribed and sworn to before me this _ day of <br />My Commission expires: <br />Notary Public <br />,Z1 <br />19 <br />SS <br />19 _ . • <br />\`. <br />3 ~ WATER <br />~ ~ TABLE <br />~ J <br />N <br />z <br />d <br />GI , ~ ° <br />i <br />^ <br />I <br />GONE of <br />DEPRESSION <br />FORM TO eE MADE OUT IN QUADRUPLICATE' WRITE FORM must he an original copy on both sides and signed. <br />WRITF ANA GREEN coo~es mua. be filed wnh rh. Cur. Fnnfn... PINK rrev :. r,.. .n. n,......._+ von ~ r....-nov .. ._. .._ ... ~.. <br />