2018-02-08_PERMIT FILE - C2010089 (6)

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DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 821, DENVER, CO 80203 Main: (303) 888-3581 Fax (303) 868-2223 dwroermltsonRnel�state.co.t GENERAL PURPOSE Water Well Permit Application Review Instructions on reverse side prior to completing form. The form must be computer generated, typed or In black or blue ink 1. Apallicant Information Westem-Fuels-Colorado, LLC P.O. Box 33424 state rip code - CO 80233 255-5800 E Construct new well Ll Use existing well ❑ Replace existing well ❑ Change or increase use ❑ Change source (aquifer) ❑ Reapplication (expired permit) ❑ COGCC Well Other. 3. Refer To (if applicable) _ weft pormts wow court case 0'—__ WA N/A osiVoted soon st Well name «# DW12-1 Montrose I SW 11401the SW 1/4 Sedan Townstip Nor S Range E or W PrinnpW Mandan 25 47 0 1 C31 16 1301 N.M.--- Distance of wall tom sec lon fines (seWon fin to typioWly not property lees) 452 FLtanL7N[MS 301 Ftft=UE®W «raptaoemait web only- dislanCe and drodon from old well to new wall �— — feet direction 1Ak11 loestlon address (Include City, State. Zip) ❑Check if well afdress is same w m tlem 1— optional: GPS well location information in UTM format You must check GPS unit for requied "ngs as follows Fonnst must be UfM 3 zom 112 orifa Zoe 13 units mat be Metas Dram must be HAM ural mW be ser to true noM was GPS unit docked for Own? 5. Parcel On Which 1 (04/2012) MAR 04.2013 WAI t n��vunk;ES STAT ENaN"ER 6. Use Of Well check applicable boxes- Attach a detailed description of uses applied for. ® industrial ® Dewatering System ❑ Municipal ❑ Geothermal (production or reinjection) ❑ Irrigation m Other (describe): Dust suppression ❑ Commercial Matomum unxputg rate ----- i Annual iff io R m be wlthdrawn (In comgination w/gpm D7IN12_2 & Dwlz-3)_ 800 'See Attachment B acre-feet Total depth AWrter 85 feet ;Bedrock/Coal 8. Land On Which Ground Water Will Be Used Legal Description of Land �meybeprovidedasenenachmem) - West 1/2 of Section 25, Township 47 North, Range 16 West of the N.M. P.M. (H used for crop irrigation, attach a scaled map that shows irrigated area.) A p Acres B. owner - 3_20 See A_ ttachment A C. List any other wells or water rights used on ttas land--- )thers wells and water rights operated under Case Nos. LOCW208 and 09CW171 and related SWSPs. 10. Sign or Entered Name 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. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof Wdd state that they are true to my knowledge_ sign « r p« suturrrong appircesoe Gate (rnrvddryyy+ h/l3 it suing pnm name aria use Easting irks i4cr ]AN Northing Office Use Only - - ' Remember to out Datum to NADBS USGS map name DM noP no Will Be Located ----- A. Legal Description (may be pmvtded as all attad,rne t): West 1/2 of Section 25, Township 47 North, Range 16 West of the N.M. P.M. B. ! of saes in parcel C. owner 320 1 See Attachment A D. Wit Nebo to onlywall an this parcei4YES xM NO (H noNa oter wells) Others Wella operated under Case Nos. 20CW208 and 09CW171 and related SWSPs. E. state Parol ID0 (opftw): ----- --' Receipt area only -ruT "Lc ISS V N Ws r r +i a, i.�,� \'`r O rMr A-A_.t n^ { i �.�tt, 4,�,•^ Vav` µf61,; - AQUAMAP _�--•- WE Date: 3412013 4:36:38 PM — WR Transaction Tote $300.00 cwcs CREDIT CARD $300.00 TOPO MYLAR r, q �O se5 DIV WD BA _ MD _