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141t-T 7 <br /> Y Date Installed ' <br /> Pump Intake DeI th <br /> Remarks <br /> a <br /> WELL TEST DATA WITH PERMANENT PUMP - <br /> 0 <br /> r; <br /> Date Tested _ -j x' cart{ c- <br /> ed-J a� r-ET s 7,1 <br /> Static Water Level Prior to Test i,. <br /> Length of Test ____ Houi s I <br /> Sustained yield IMetered) - _ GPM i *F�'• ' <br /> z umping Water Level <br /> IF <br /> Remarks <br /> i <br /> CONTRACTORS STATEIMENT <br /> The undersigned, twi ty duly sworn upon oath, deposes ar+ci says that he +s tht, rirttrZc'tvr of t'fl vw+ l +yr <br /> =. pump Installation described hereon; that he has read tote St.)temr�nt mane h,-f on, <br /> thereat, and that the iarne is true of his own know1kAg!. <br /> Signature 1.+eat;-,, No lr�� <br /> :State of Ccslor^.10, County of to t.0 <br /> x �ii bxtibed and,';"orn io !)0—f— +re this --day of <br /> MY Cor-r'r'ti:ff, n r-,-.wtsx, <br /> ^ Notary P, "'i;c <br /> r?t ttt "tax$ e r •� f'r1'Ga ;s�4 _.� <br /> WIT '•t :a.' 't � ^r! � °ifa's; •.Tra ;'.z,q� � <br /> t <br /> S <br />