2014-05-12_PERMIT FILE - C2010089 (8)

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COLORADO DMSION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES Office Use Only Form GWS-45 (07/2009) 1313 SHERMAN ST, RM 818, DENVER, CO 80203 phone - Info: (303) 866 -3587 main: (303) 866 -3581 fax 303 866 -3589 hltpJtwww.water.state.co.us GENERAL PURPOSE Water Well Permit Application Review Instructions on reverse side prior to completing form. The form must be completed in black or blue Ink or typed. 1. A Iicant information 6. Use Of Well check applicable boxes Name of appicant Attach a detailed description of uses applied for. Western - Fuels- Colorado, LLC ® Industrial ® Dewatering System ❑ Municipal ❑ Geothermal (❑ production or ❑ reinjection) Msnm P.O. Box 33424 ® Irrigation Dust suppression and sediment ® Other (describe):control, including but not limited Commercial to storage in pond for these uses. City Denver State CO C( 23p code 80233 7, Well Data (proposed) Tetaptrers # E -mall (303)255-5800 1 (Optional) Mawmum pumping rate 897 9pm amount Annual aunt to be withdrawn 600 acre -feet 2. Type Of Application (check applicable boxes) ® Construct new well ❑ Change source (aquifer) ❑ Replace existing well ❑ Reapplication (expired permit) Total depth 125 feet Aquifer Bedrock /Coal 8. Land On Which Ground Water Will Be Used ❑ Use existing well ❑ COGCC well ❑ Change or increase use ❑ Other: Legal Description (may be provided as an atradaaant): See Attachment A. 3. Refer To (if applicable) Well permit # Water Court case # 10CW208,09CW171, 88CW55 Designated Basin Detenninmiton # Wag name or # New Horizon 2 Mine (if used for crop Irrigation, attach a scaled map that shows Irrigated area.) 4. Location Of Proposed Well Inn ortantl See Instructions county Montrose NW 114 of the SE 1/4 A. #Acres 828 B. owner See Attachment B Section 1 Township N or S 46 ® ❑ Rarpe E or W 16 ❑ 01 PrindDal Meridian N . M . C. ust any other well or water rights used on tiia land: Not Applicable Distance of wait from section tine. (section it= are tyWAy not property lines) 1247 Ft. from N ❑ S 2105 Fl- from ❑ E ® W 9. Proposed Well Driller License # o tional : For replacement wells only - distarme and direction from old wall to new wet feet direction 10. Signature Of Applicant(s) Or Authorized Agent The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. Well location address (Include city. Stets, Zip) Cho& if wait ad&-- is same as in Item i. 24-4 -104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge. Xust be a/ efg re) Data Optional: GPS well location infom►ation in UTM format You must check GPS unit for required settings as follows: 2 — ly Format moat be UTM ❑ Zane 12 IM Zone 13 Unita moat be a Maters Datum must be NAD63 Eastlng Northing Print rams & title C.wtrudod er' 4eL P WA+04" G A 3-0A Jf ^ ^ct �+ d' { �rC.q•r+ Office Use Only USGS map name DWR map no. Surface elev. Unit mast be set to true north Was GPs unit dsdwd for above? ❑ YES Remember to nit Datwn to NAM 5. Parcel On Which Well Will Be Located Receipt area only (YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL A. Legal Description (may be provided as an attadmsnt): See Attachment A. AOUAMAP B. # of saes In parcel C. owner 828 See Attachment B WE WR D. WIl thta be tie only wed on tlYs parcel? []YES ❑NO (if no - list other wells) Not Applicable cwcs TOPO MYLAR E. state Parcel ID# (optional): SB5 DIV WD BA MD