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WELL CONSTRUCTION MID 1 EST REPORT For otrtoe Use wdy <br /> nws�r <br /> 1,"4 . STAI E OF COLORADO, OFFICE OF I HE STATE ENGINEER <br /> 1. WELL 13EnMl•I' NUMBER _ /bi K- 3558 <br /> 2. OWNER NAME(S) /-io�NK-m :nNc. <br /> Mallintl Address Soa Co Pry..�(�' 12 p <br /> City,St.Zlp _ �c,�ce Co ki R lZ2tp <br /> Plrone (7/9) <br /> a I/Eta�OCAi p s U(jILLED SE im SE 1/4, sec. /7 TWI).0 S <br /> DISTANCES MOM SEC. LINES: <br /> �_It. born so—?'k Sec. line. and 7-5-0 11. born e4slt" Sec. line. OR <br /> -1nonivarooutnr ---tsa"Mosw <br /> SUBDIVISION: _ LOT BLOCK _ FIUNG(UNM <br /> STREET ADDRESS A7 WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION_4DS3•64 It. DRILLING METHOD a I r- -- Y•o�'�r•y/ <br /> —T <br /> DATE COMPLETED 8 -Z.Z-- 9 8 TOTAL DEPTH 74) IL DEPTH COMPLETED 7 it. <br /> 5. GEOLOGIC LOG: G.HOLE DIAM. (In.) From (11) To pg <br /> Uoptii Dowiptlon o1 Matedal(type,Size,Color,Water Location) S d <br /> 2 -2 5 114. 4C, _ ra;„ 7. PLAIN CASING <br /> e e ,.i s•N1 S o�� OD (In) Kind Wall Size From(Il) To(IQ <br /> C o o <br /> 2 S- 2!�' S-.,.c PVC _-&L- f62 110 <br /> o -'7 o r••. v .c.t- -Ve ®---��— <br /> PERF. CASING: Screen Sto Size: o.o►o ;.,� <br /> !7 <br /> &FILTER PACK 9. PACKER PLACEMENT: <br /> Material 511f ice s4-a Type <br /> Site /o-2.0 <br /> Interval - �— DepUi <br /> 10 .OROUTINQ RECORD: <br /> Material Amount Density Interval Placell" <br /> HEMARKB: a"--ad- /o <br /> sM. o -jc� T�• <br /> 1 DISINFECTION: Type—� Mama- Amu. Used <br /> DATA: tU Check box II Test Data Is a6mitted on Farm No. GM 39 Supplemental Well Test. <br /> • TEMG METHOD )VA <br /> StaW Level 1,7.85 IL DateMme Production Rate Olpm. <br /> punq*g level IL Dateqkne measured y, ` ' .Test length Qm) <br /> Rtstoks , <br /> 3. I haw i*W 9*statements made herein and kmw tine contents Owed,end tlyd Owy are 6w to nW knowledge.(Punuant to Section 24.4-104 (13)( <br /> C 1.&,the making of I a statements herein consWutee perjury In the second degree and Is punishable as a class I misdemeanor.] <br /> CONTRACTOR Leo ci cq �.✓c. Phone 7� �3�-o zZ�"i LIc. No. <br /> Maming ss �'/t.+.a ve. C or r.•.� Cv oyo <br /> 4ame/Tltle (Please type or print) Signature Date <br />