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PUMP;iNSTALLATION REPORT <br />pump Make . _S// / ~T - ~~[ /~~ <br />I~YPe ~l~Gf 7~ M ~ l' S l 1~ 1 ~ <br />1 <br />Powered by T ~ l T HP <br />Pump Serial No. <br />Motor Serial No. <br />Date Installed ~ -~~ - ~!n <br />Pump Intake Depth <br />~~ / <br />Remarks <br />WELL TEST DATA WITH PERMANENT PUMP <br />Date Tested l _ /G <br />Static Water Level Prior to Test ~ / / <br />Length of Test ~ Hours <br />Sustained yield (~leeere~ ~~ GPM <br />i -. <br />Pumping Water Level 07 8 <br />Remarks <br />~, .-- <br />y ,\ <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 own knowledge. <br />Signature <br />License No. ____L_ <br />State of Colorado, CounOty of ~Q~ SS <br />Subscribed and sworn to of re me this ~~9ay pf _~~~ , 19 Z . . <br />~Y ~ommission expires October 1979 <br />My Commission ex/p}i~res: _ , 19 _ . <br />Notary Public;~2/~~ ~ ~~" ~ <br />ORM TO BE MADE OUT IN OUADR UPLICATE: WHITE FORM must he an original COPY on both side and signed <br />