Laserfiche WebLink
Form No. <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />For Office Use Only <br />GWS -09 <br />821 Centennial Bldg.,1313 Sherman St., Denver, CO 80203 <br />RECEIVED <br />4/2012 <br />(303) 866-3581 Fax (303) 886-3589 dwrnermitsonlinetQtate.co.us <br />SEP 112013 <br />WELL ABANDONMENT REPORT <br />Use to report pkrigging and seeling of permitted wens, monlionng and other holes. This form can be <br />WAFER Rt:btyuRGt <br />computer generated, typed or printed in biadk or blue ink. Instructions and plugging standards are on <br />STAT ENNGMEER <br />reverse side of form <br />COLO <br />Well Permit Number of the well being plugged 77131 - or <br />MH File Number MH- Hole 1D #/Name Dl V12-1 <br />indiyidual/Comnany responsbte for plMggigg and sealing thg well: <br />Names) Western Fuels Colorado. LLC <br />Mailing Address PO BOX 33424 <br />city, St., Zip Denver, CO. 80233 <br />Phone (area code & no.) 303 255-5800 Ema[t: <br />Well (bole) Owner. <br />WME(S) Weston Fuels Colorado, LLC Phone (nclude area code)1303 255 5800 <br />Meiling Address, Crty, St, Zip PO SOX 33424, Denver Colorado 80233 <br />WjUAL WELLLOCATION. County Montrose <br />Property Address, City, St, Zip <br />§V l _1 /4 of ihej,-M1/4, Sec. 25 . Twp. _47 ® N or Gi S., Range 16 © E. or Q W. New Mexioo p M, <br />Distance from Section Unes 480.6 Ft. from it N or W S., 392.1 Ft from JE or 0 W. Line. <br />Subdivision Name New Horizon Ngrth Mine Lot_ Block . Filing/Unit <br />Optional: GPS well location Information in UTM format You must chedk GPS unit for required settings as follows: <br />Format must be UTM, zone 12 T1 or zone 13 f l ; Units must be meters. Datum must be NAD63; Unit must be set to true north. <br />Easting Northing <br />I (we) report the existing well (hole) was plugged and seated on the date of 08/22/2013 for the following reason(s) <br />0 The well was plugged and sealed as required under Well Pgm►it Number <br />0 The well was not in use and was plugged and seated <br />R Other (please explain) Well DW12 1 (Permit # 771311 was dry and was therefore olu ged and abandoned <br />The well was plugged with the following materials placed at the indicated intervals <br />Amount and Type of Material; Method of Placement Interval <br />6.5 inch hote,13 bans of bentonite chips pour from surface from 19.5 feetto 70.5 feet <br />10 in cs-c-h 10 sks Portland tl w/6 als H20/sk pour from surrace from 2.5 feet to 19.5 feet <br />from feet to feet <br />Intervals of casing removed/ripped in feet from 0 feet to 2.5 feet <br />Report the well owner if person is or <br />best signedrk or that <br />the intentsthereof, <br />by person whoerein, m <br />know the oerformed <br />(ewe) have read the statements made hred <br />not reachable and they are e to ((our) <br />Sign enter full namesigning print name & title Date (mmlddlyyyyy) <br />Q' Ha- rc� <br />,� /," % <br />V-A <br />n0 15 eq9/0 z 013 <br />It is the responsibility of the well owner to have the well/hole properly plugged and sealed The Well Construction Contractor <br />Lis responsible for notifying the owner of this requirement <br />