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6 Y1 <br />STA'T1e OF COLORADO <br />COUNTY OR Weld <br />Q Wan RlliaMCM3 <br />IL 818 <br />iia, CCiIi O km <br />WELL ABANDONMENT AFFIOAv 17* <br />ss. <br />I (we) j.tglter )4 er <br />first duly sworn upon oath. dispose and say: <br />That an old welt. located In the NW 1/4 of the <br />RECEIVED <br />OCT I T Sea <br />>at some <br />Rai • MUM <br />81111 <br />NE <br />,being <br />1/4, Section 33 <br />Township — 3 N Bangs 67 W 6 P.H., was replaced <br />for the following reason(s): <br />That the old wsii, witieh was replaced by a new well drilled under permit <br />mobs*. jz.105 750 -RF , was plugged and abandoned according to the <br />rules and regu 1 at i ons of the State Board of Examiners of Water Weil and Pump <br />Installation Contractors by WALTER MAYER <br />' (person (s) or company) <br />on Oct0.per 11 , 1989. <br />That the old well was plugged with the following materials placed at the <br />indicated intervals: - <br />Gravel from 55 feet to 54' f'zs- <br />Concrete <br />from <br />54 <br />Signature of aff tent Cs) erg - <br />WALTER MAYER <br />Subscribed and SWorn - to before me..th i s _ -_._tArth <br />of October <br />i g____ <br />feet to Surface Feet <br />-day. <br />141 . _ A ~, <br />by coanrlssion exe plr,/ /- 99 - - _ = <br />' <br />11 ' Z. <br />*it is the owner's responsibility pursuant to the conditions.of appnova1"tri'sae <br />that the affidavit is returned. <br />Notary <br />(See reverie aide tar Abeadameszt Regulations) <br />