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FORM NO. WELL CONSTRUC'T'ION AND TEST REPORT <br />G S 31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />412012 1313 Siwnrwm 81., Ste 821, Dw, wr, CO 80203 <br />1 Fax 966-MM <br />I. WELL PEWDT NUMWR: I Y <br />For <br />RECEIVED <br />MAY 17 203 <br />^ /ATER RFSOURCES <br />STATE ENGNEER <br />COLO. <br />Z ' <br />NAME OF WELL ONYP�R: Yftbm Fuels- Cdorado A Limited Co MPW <br />MMY-0ADDRE88 1100 W. 118th Avenue <br />CITY- E STA CO ZIP CODE $0234 <br />TELEPHM MJNMR t7rftm code. 303-254 -3208 <br />MAIL LOCATION AS DRIL! EDAW 1/4, M-114, Sea., aL_ Twp 47 Bell N or 8, 13 RwW-16 _ ® E or W N <br />DISTANCES FROM SEC. UNES 770 a from C❑ N or 0 s swum line and Go- It. from 0 E or MW section tine. <br />SUBDIVISION: , LOT--. BLOCK- _ FILING (UNIT) <br />Opdon d OP8 Location: GPS Unit must we the foolowtng seftW Fomret must be UTIK Urfa Owner's W04 Deeigrre0on: GW-68 <br />must be meters, Dstam must be NAD83, Unit must be set to true N. 13 Zone 12 or IIA Zone 13 Ea ": <br />STREET ADDRESS AT WELL LOCATION: 2600 Rd. & AA Rd., Nude, CO 81424 NoMnz <br />4. GROUND SURFACE ELEIIATIONX122 —, feet DRILLING beTHOD <br />DATE 12 TOTAL DEPTH 67 feet DEPTH COMPLEtFD 62 feet <br />GEOLOGIC LOGS.- <br />6. HOLE DIAM ruil From To <br />Dam <br />T <br />Grain Size <br />Color <br />Water Lee. <br />3-3/4" 0 B7 <br />S� <br />0-5 <br />T &ft <br />I <br />tine <br />drk red <br />5-10 <br />eftle <br />redrom <br />10-10 <br />sftkm <br />red/bm <br />7. PLAIN CASING: <br />00 (in) Kind Wall Size (n) From (tt) To (ft) <br />4 Sch Alts 0 <br />PERFORATED CASING: Screen Slot Size (rn): •030 _ <br />4 -- - Sch 40 47 87 <br />8. FILTER PACK: T 9. PACKER PLACEMENT: <br />Mafierw Type Soft formation - packer <br />Size <br />Interval Depth 47 fL <br />15-20 <br />auk <br />drk bm <br />20-30 <br />NNIMM <br />bm <br />30-M <br />8—hole <br />drk bm <br />ArrlY <br />4 <br />It bm <br />55.67 <br />swe <br />drk brnfury <br />$2-87 <br />0. GROUTING RECORD <br />Material Amourd Derwity interval Placement <br />BentQ)e 10 slel. 3fir oft 57-67 pour ____ <br />11 10 - 6z sour <br />Cement 0-10 pour <br />Rerinarkx <br />11. DISiNFtECTiON: T Arnt. Used <br />12. WELL TEST DATA: E3 Check box 9 Test Data N submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level. ft. DateMme measured: Production Rate gprr <br />Pumping Lever ft Date/Time measured Test Lrino (hrs) <br />Remarks: No well toot perhymed <br />18. 1 frays read tiro seatnawrb made herein and know lire eonlerris ttrvreof, and they are true to my lawwisdge. This doaumerd to signed (or <br />now ordered i1'ttll "onlhw) and cw=W in accordance with Rule 17.4 of the Water Well Conabucdon Rues, 2 CCR 402.2, Tha fMng of a <br />dncrrmsrd flat cordalrrs false stalernentr is a violeflon of section 37-81 108(IX , C.R.S., and is pradehabie bylines up to $600o andfor nmocadon <br />oftheconbaclimliceass. N ardins Iha SUM rear considers eniw#w of 8csnss 1 conbwW usurer to be lance with Rude WA <br />Company Narne: Phone w/area code: 7LICenae Number. <br />Western Fuels Association, Inc. 303 255-G808 <br />Math dress: 12050 N. Pecos St. Suite 100 Westminster CO 80234 <br />Sign enter nerve N e) <br />-- — <br />_ <br />, <br />w em me and Trtiee W ! 7 � � t -Date .20 3' <br />