2011-11-09_PERMIT FILE - C1981012A ‎(3)‎

• Permit No: C1981012A
• IBM Index Class Name: Permit File
• Doc Date: 11/9/2011
• Section_Exhibit Name: EXHIBIT 11 WATER WELL INFO PART 3
• Media Type: D
• Archive: Yes

PUMP INSTALLATION REPORT
Pump Make~~e„,~r~ ~-~'~=
T~ 5iimarlc,6/s
Pod by 4.1,~..~5 ~,sa4s.6:HP
Pump Serial No. ~ ~~
Motor Serial No. ~ a ~ ~ ~~ ~ ,/
Date Installed ~~° ~ ~~ ~ ~ y
Pump Intake Depth d`~d`/~
Remarks / h rLL /S 6~~" W r /~ /~ 2 C'Li.±.!
WELL TEST DATA WITH PERMANENT PUMP
Date Tested '~~`~~ ~o' ~ ~
Static Water Level Prior to Test ~~
Lt h of Test ~ ~ ~" Hours
Sued yield (Metered) ~O GPM
Pumping Water Level ..~D
Remarks
CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon; that he has read the statement made hereon; knows the content
thereof, and that the same is true of his own knowledge.
Signature
u
State of Colorado, County of
Subscribed and sworn to before me thisl4
My Commission expires:
Dee®ber 8
License No. ~~_
SS
day of 1~Y , t~
1974 .
Notary Public^-~- Q"'~"~"`~""
Marguerite J. 1lobeike
FORM TO 8E MADE OUT IN OUADRUPLIGATE: WHITE FORM mutt be an original coPY on both sides and signed.