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<br />LOG AND HISTOltY
<br />
<br />.~~.
<br />
<br />ClS~7
<br />WELL LOG
<br />
<br />Ground Elevation
<br />
<br />Type Dr illing
<br />
<br /> Waler
<br /> Frorn. To Type of 1\I"teri,,1 Loe. Perl.
<br /> -
<br /> . .=1./ // /J i
<br /> ~{/" / ..,t.1 ,,[ {;:// ' '? I
<br /> '- ~ .//t('i'1 L.l' ( . /
<br /> / .~',
<br /> " 1
<br /> '-1I .. I 'I
<br /> / {O'.! I. . ( /
<br /> I C. L- (, ...... ' , ,
<br /> -' .
<br /> " j (
<br /> '.1 ( , ,/-L ,.
<br /> !.:.: I L L' ., ( .. L
<br /> ..~ , \ " <. ..
<br /> . <
<br />r
<br /> .
<br /> .
<br />
<br />Use additional paper if Ilccessal'y lo eomplete
<br />log anel allael!.
<br />
<br />...... ..
<br />D:lle Slarled /(t' 'j I I 'J
<br />( I
<br />( f
<br />Dale Completed C (' ,
<br />
<br />
<br />WELL DATA
<br />jL7/-/1
<br />I. II (. il
<br />I I
<br />
<br />Hole Dl:lmd.er: 1/
<br />.I LJ. in. from / '1/. ft. to) : ."ft.
<br />. ,
<br />In. f"om ft. lo [t.
<br />in. frum ft. to ft.
<br />1\'.,. T. /- .' ,)
<br />
<br />CA~e~~el:;~,T~.l(;n' ;1/ > :,," I '(~'/ I" r. .
<br />Plain CaSJl1g'
<br />Size_> IroIlL_ll. to _ It.
<br />
<br />Size_, kind_from_ ft. to_ ft.
<br />Size_, k.ind_ (1'0111 _It. tl)_ ft.
<br /> Perforated Cas in;.;
<br />Size_, kind_frotn_ft. to_ ft.
<br />Sizc_, kind _ from_ fl. t()_ ft.
<br />Size_I kinel_ from_ fl. to_ ft.
<br />
<br />TEST DATA
<br />Date Testeel
<br />Type of Pump
<br />Length of Test
<br />Cons tan t Y ie Id
<br />Dr:lwelown T
<br />
<br />
<br />PU~lP DATA (To be fiJJed \n)' (
<br />Type of PUll1j} C'~,,, [, '- f""\"'"
<br />Outlet Size (. .:" c' ,
<br />Driven IJY ~,. ~ t. ,.., "" '" . .'. -j ,: ",.
<br />llorsepower .~j,':;, C, fJ ,
<br />t ;i
<br />DEPXB TO WATER "'\ II. If
<br />, "-'
<br />TOTAL DEP'l'H I ::.. . J t; _'
<br />
<br />WELL DHlLLEltS STATEMENT
<br />
<br />Stale of Colorado
<br />COlU1ty of El Paso
<br />
<br />) ss
<br />) I. I ,
<br />:,,( .,~ .", ..)~(.. y.....LC"Tr.. being duly 511'01"11, deposl's ~nd
<br />says'. he is the rlrillcr of the ~bove described well; he h' s read thc ~bove map and st~tel11enl, l;no\l's till'
<br />eontellt then'of, ~ncllhc sume is tnLC of his oll'n knOw1eclgtJ A I / / ! J' , ~ /
<br />
<br />t-J4A-/A. ( I':!tf/J:t "lJt/j ~-< <'~p7~ /'- , "
<br />(,. [Ii tiJ.:
<br />License No';j 'l.~ tL' r?"~y'l,..\ f(.{:::;O"""".L. L 1" (.
<br />(!-'LL' <''''J-J. )
<br />December
<br />
<br />
<br />Subscriber. and sworll to before me this
<br />
<br />30th
<br />
<br />illy Commission l!xpires
<br />
<br />6/13/71
<br />
<br />.19_.
<br />
<br />day of
<br />
<br />> 19~.
<br />
<br />/.~ "
<br />Notary I'Llblic
<br />
<br />/' J_)
<br />/
<br />
<br />1/" , "
<br />
<br />fORhI TO of hL\DE OUT IN QlIADR UPLlC\ TE,
<br />Ori;ill;J] \rJlITE (h~~th ~iJcs) 0 Ti"ll'li..:alt.-' GREEN Copy 111USt be fded with tht? St;Jte EIlf.illl~er within 30-cbys after w,,:>l] i~ COlll]1lcteJ.
<br />Dupli..:31l' PI.i\K '-'~~11Y is [or th~ Owner /,.; Y.El.LO\V cop).' for the Driller. WHITE FORi\-l 1\.IUST BE AN ORIGIN^L COPY OJ\: BOTH
<br />" IDES ..\I'D :;IG:\ED,
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