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FORM NO. <br />C rd" <br />42M <br />WELL CONSTRUMM AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1313PAwmw8L.SteM1.l3sm r,CO 0090+ <br />AM MM 8t1 Fax 00 SWIM <br />or olll* lbe 0* <br />RECEIVE^ <br />;MAY 1 1. <br />WATER, <br />STATE 1. <br />r,. <br />Z11 `�8s <br />2. WELLO Troll <br />NAME OF WILL WU W Wester» F A Umked UabW gMM <br />MAIUNO ADDRESS: 1100 W.118tIt Avenue <br />dTY: Wier STATE CO ZIP CODE: 80234 <br />TELEPHONE NUM ER vdlranae code: 300- 254 -3208 <br />:$Mi1 /4, ML 114, Sec.. Z5—Twp4'i 0 N or S. 13 Range -g_ 13 E or W <br />DISTANCES FROM SEC. LINES: 754 It from El N or ® S section Me and 55 it tram ® E or ®W erectlort une. <br />SUBDMSKNI LOT . BLOCK . FILING (UNIT) <br />OpGwW OPS Locallwc GPS Unit trekt use the Mowirp setlings: Format aunt be UTW Una Owner's Wdl DemkInallom G" <br />mustbe tom, Datum must bs NAD69, Urit must be set to true N, Mona 12 or U Zone 13 Eastir� <br />STREET AwRESS AT VVO_L LOGATK?N: 2600 Rd. $ AA Rd., Nude. CO 81424 <br />C3ROt1ND SURFACE ELEVATION s7ia_a feet DRILLING METHOD Rafary�Afr <br />OATS CQMP%K ED 0690=12 TOTAL DEPl'ii 102.0 feet DEPTH COMPLETED 100 feet <br />GEOLOGIC -LOG: <br />IL HOLE DIM From To <br />Doom <br />Tvae <br />Grain Size <br />Color <br />Wvjw I:= <br />f3-3l4" <br />0-5 <br />To <br />Jim IL clay <br />fine <br />4ddS M4 <br />$40 <br />Shde <br />redil m <br />10-15 <br />subime <br />redJbrn <br />T. PLAIN CASING,: <br />OD (in) Kind Wall Size (in) From (t) 7o (f0 <br />4 pyC Srh 40 ,Q_ _ 87.6 <br />PERFORATED CASING Screen Slot Sibs (Inr .030 <br />M _ fich 40 87.5 ino <br />15-20 <br />shale <br />drk bm <br />20.30 <br />Emma <br />bm <br />30--W <br />Shale <br />drk bm <br />slrev <br />ne <br />ft bm, <br />55-70 <br />drk bnV <br />68-70 <br />70-75 <br />shale W/0.5 Coal <br />di kmM <br />70-75 <br />75-W <br />Sandstone <br />]tam <br />bback <br />MA <br />80-86 <br />cow <br />ble ck <br />65M <br />Sandshxw <br />85-90 <br />90-96 <br />drk gM <br />90-95 <br />L FILTER PACK <br />MaWlai <br />Size <br />Inbervat <br />8. PACKER PLACEMENT: <br />Type Soft fir 0n DaC]W— <br />DeA 87.5 ft. <br />96-100 <br />Sandsh" <br />It ftreli <br />1007102 <br />0. GROUTING RECORD <br />Material Amoturt Day Interval Placement <br />Bentft, 10 llaL aff ob 77.5-87.6 pour <br />C" drz4 _. _ 10 - R -5 .mL_ <br />Cement 0-10 pour <br />Refr,a <br />1. DISWFEC71OW T - Amt Used <br />12. WELL TEST DATA Check box if Test Data is submitted on Form Number GWS 39 Supplementel Wall TesL <br />TESTING METHOD <br />Static Level R Datarlime measured:. Pmductbn Rate gpm- <br />Pumping Level R Daten1me pleasured Test Length (hrs) <br />Remarks: No well test <br />13. 1 tam road ow staiemads much bwaln and know Mw emn k alt dwwt and IhW are We In my iaanmr ladgo 7M document to e[ysad (or <br />name ardarod NIMM ongnel amd aeA0 , In aovordamm wr8h Rule 17A ant tha VlAd riRoR Conshu dlon tbrtaa6 2 CCR 402-2. The 1111" of a <br />doamrerrt dad a:otaI m' false 11 a11 1 hs o vhdWon orf oocU xr 37 -trlj *44)K C.R.B., mad i ptn ie br fhwe ep to 46000 and9or rovocadan <br />*fvm=mt=ftwfmw vim mnow the abo ftoRw considers workm d[floeasss oamtraaxer nenlata be wMb Rare i7A <br />Company Name Photo w/area code: License Ntatiber <br />Wedam Fuels AssaciatiOri. hw. 303 255 -5806 <br />Mai : 12050 N. Pecos St Suite 100 WesWtnsta r, CO 80234_ <br />Sign (or name if fift ordine <br />PV Name and Title Date <br />t- era '71'7 4on"h40 3 <br />i <br />a <br />c <br />r <br />