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MM NO J WELL CONSTRUCTION AND TEST REPORTGN153l <br />Tom+ STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />3 e an 818, env 80203 <br />1. WELL PERMIT NUMBER 220908—A <br />For office use only <br />RECEIVp) <br />MAR 13 2000 <br />wArr.RRc. <br />STATCOCO <br />2- OWNER NAME(S) WILLIAM H. PORTER <br />Mailing Address 5240 CR 56 <br />City, St. zip LAPORTE, CO. 80524 <br />Phone( 970 ) 221-0057 <br />3. <br />4. <br />WELL LOCATION AS DRILLED: NW 1/4 NE 1/4, Sec. 24 Twp. 8 N Range 70 W <br />DISTANCES FROM SEC. LINES: <br />603 ft. from NORTH Sec. line. and 1508 ft. from EAST Sec. line. OR <br />SUBDIVISION: <br />I <br />LOT BLOCK FILING(UNM <br />STREET ADDRESS AT WELL LOCATION: <br />GROUND SURFACE ELEVATION ft. DRILLING METHOD AIR PERCUSSION <br />DATE COMPLETED 1/20/00 TOTAL DEPTH 200 ft. DEPTH COMPLETED 200 ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type, Size, Color, Water Location) <br />0-16 CLAY SOFT <br />6. HOLE DIAM. (in.) From (ft) To (ft) <br />10 0 20 <br />6 20 200 <br />16-30 BROWN SANDSTONE KED <br />30-45 GRAY SANDSTONE KED <br />7. PLAIN CASING <br />OD (in) Kind Wall Size From(ft) To(ft) <br />6 5/8 STEEL .188 0 2 <br />4 112 PVC .237 10 1 <br />PERF. CASING: Screen Slot Size: .032 <br />4 1/2 PVC .237 140 200 <br />45-60 BROWN SANDSTONE KED <br />60-150 RED SANDSTONE MED <br />150-180 GRAY SANDSTONE MED xx <br />180-200 BROWN SANDSTONE MED <br />e testing ot pro uc Ion of Water- <br />from this well, as reflected by this <br />report, is fatally depen ent upon <br />a FILTER PACK: <br />Material <br />Size <br />Interval <br />9. PACKER PLACEMENT: <br />Type <br />Depth <br />c ndi ions existing as of the date of <br />testing and does not reflect any pfo- <br />jection as tnfiltu:e nvindiirtion This <br />is depot dQAt cnQriitinQS <br />10. GROUTING RECORD: <br />MAmount Density Interval Placement <br />C 3 BGS 18 GAL 20FT MIXED 6 PRDREMARKS: <br />1 DISINFECTION: Type DRY HTH Amt. Used 2.5 CUPS <br />12- WELL TEST DATA: Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD AIR LIFT <br />Static Level 35 ft. Date/Time measured 1120100 Production Rate 120 gpm. <br />Pumping level 200 ft. Date[Fime measured 1120100 Test length (hrs.) 2 <br />Remarks <br />3. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section 244104 (13)(a) <br />C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] <br />CONTRACTOR INGRAM DRILLING, INC. Phone9{ 70) 586-4542 Lic. No. 1099 <br />Mailing Address P.O. BOX 342 ESTES PARK, Co_ 80517 <br />Name/Title (Please type or print) <br />STEPHEN E. INGRAM PRES. <br />Signature_ Date <br />3/9/00