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FORM NO. <br />c va-31 <br />4/2012 <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1818 Um man n Sk. ft 821. Deaver, CO MW <br />Mein 888.3581 fax 888.3689 is <br />Far ors use only (A <br />(0 <br />tp <br />RECEIVED <br />MAY 17 2013 <br />WATER RESOURCES <br />STATE ENGINEER <br />COLD <br />1, w&L Per nlwi�; Z1 I <br />2. W8JL 0 INER WIFDRMAT0N <br />NAME of we t oN++NER: western Fuels- Colo►Odo A Limited Liablity QpMpqny <br />MAILING ADDRESS: 1100 W. 118th Avenue <br />CRY: ftsftnindar STATE: CO ZIP CODE: 80234 <br />TEL.EPtME 11111.111111111M gees codes. WS- 254 -3208 <br />3. WELL LOCATION AS =L.LED :2L J/4, x..114, Sec., &.-... Twp.7. 0 N or S, ll Rsnp-U— ci E or W <br />DISTANM FROM SEC. LINES: 782 R from O N or Is S secton ko aid 56 R fi+om ED E of (lE W section line. <br />SUtBDMSIM LOT , BLOCK. FWNG"n <br />Optional t1PS Lode kwx OPS Unit must use the Fo mft sedhW: Format must be WK Units Oz's Well <br />must be 1rtw%M Dan mart be NAQafS, tW must be set to bias N. C3 Zone 12 or M Zone 13 Eat <br />STREET ADDRESS AT WELL LmAncti~ 2500 Rd. & AA Rd., Nue lk Co 81424 Northin <br />4. GROUND SURFACE ELEVATION 9712 test DRILLING METHOD <br />DA COMPLETED Q§U=2 TOTAL DEPTH 85 .00 _ feet DEPTH COMPLETED 8 .0 feet <br />. GEOLOGIC LOGS: 8. HOLE DIAM of From M To ft <br />Galin Size <br />Color <br />Water Loa <br />86 <br />0.6 <br />L022LA & day <br />floe <br />drk <br />5-10 <br />re ftm <br />10- <br />redlbm <br />7. PLAIN CASINO: <br />oD gn) lftrd Ws9 8t m (ire From (M To (ft) <br />4 PVC Sch Off 0 . _ _71 <br />PERFORATED CASINO Screen Sic! Site (in): .030 <br />4 Sch 4O 71 85 <br />16-20 <br />shda <br />I <br />dik bm <br />20,30 <br />ndm <br />lbrn <br />dik bm <br />35-46 <br />8111119M <br />rev <br />ismomm <br />R bm <br />55-70 ISM& <br />drk bm! ry <br />W70 <br />70-75 lShWe <br />w/0. 5 coel <br />di brn/)lk <br />75.80 <br />biac:k <br />7 <br />80435 <br />cow_ <br />black <br />FILTER PACK <br />Material <br />S[ze <br />interval <br />8. PACKER PLACEMENT: <br />Type Soft fomm tion Pacdcar <br />71 R <br />0. GROUTING RECORD <br />Material Arnount DensBy Interval Placement <br />.. 10 seed. 3ff Rh M - 71 Hour <br />Drill cto 10 - 71 your <br />Cement 0-10 pour <br />11. DISINFECTION: Two I Amt Used <br />9, WELL TEST DATA U Check box if Test Data is submitted on Form Number G3WS 38 Supplements! Well Teat. <br />TESTING METHOD <br />Static Level ft DateMme measured: Production Rate 9Fan- <br />Pumping Level R DateMme measured _. Test Length (in) <br />Remarks: No well <br />1E. 1 have road tin made herein amt know the contenla ttwoof, and they are true to my knorrlsdge. Thte doCemruK Is signed (or <br />name entered N fill" online) and cedltled In accordance with We 17A of fin warner Welf ConalitUction Ratan, 2 CCR 402.2 The fang of a <br />docrarrerat that contahw false statlsaeeata Its vlobdon cf section 374K401(1Ky, C.R.B, and is punhawbftbyf&w up 1u slSIM analor revocation <br />at the convacdag Moons, Itaft online the I A, Ewmimm emaiders of ttoeoaod enactor nswwto be car Yanee whit Rule 117A <br />Company Nalw Ph" w/ar a code: <br />Westem FuelsAssocafion, Inc. 303265-5806 <br />tkense Number <br />_T <br />fiftVing Miress. 12050 N. Peons St. Suite 100 Westminster 00 80234 <br />Sign ( name If fib ine) <br />96M Name and Title <br />v Q. .-r-a. W -!% C4 w s 4 i <br />D&te <br />a o!3 <br />