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*oA, STATE OF COLO ON omo+u..ony <br /> $� OFFICE OF THE ENGINEER <br /> a.~;� r,rr C�wiid lidp..iy+a�tw++ws fit..a.�w+r.rob�.ae rcaai <br /> ` raoal lbra4r� <br /> FOR INS'MUOMONS, SEE FEVERM SIDE <br /> STATEMENT OF BENEFICIAL U.SE. <br /> WELL PrzRMrr N RECEIVED <br /> 1. WE 2WNER Ail <br /> NAME(S) A&G Partnership _- Attn:._Alan Parkerson DEC 3011 <br /> Malllrtg Address 3324 E-1/4 .Road. WATERY Errit <br /> Ohy, SL ZIP Clifton, CO 81520 sTA,,r <br /> J <br /> Phone L2030 242-8134 <br /> Z, AELL LggA-n= COUNTY Mesa OWNER'S WELL DESIGNATION Orchard Grow <br /> ww�� Industrial Park Pi <br /> SE1/4 SWltt��/4, Section 5, and 1-��I zo <br /> NE 1/4 wvw NW 1/4. $a&- 8 Twp.� N. a L2L!S.. Range 1 L7 E. w 10 W. Ute P.m <br /> art rrt Seed n ------Ft. from[] a U a: Line. ----- Ft. from❑ E. «�W. Line. <br /> 3. The well is being LwW for the following ptuPose(s): evaporation losses st suppression, <br /> dewaterinq4 and lasses associated with removal of aggregate roduct. <br /> 4. Wiler from ft well w&o $Cst used ben4feu* for to &bows Purpos (s) on Anorox_ April 15 _ 19 91 f <br /> 5. The pumping rate dahtrted is N/A gelloft per minim. k <br /> a. The average annual whom d water d verted i$ 83 P= teat. (See..Exhibit A) <br /> 7. The land Berea irrrg>tt4d_(watered) by water from this well W. N/A ❑Acres or [I Square tees. <br /> descrlbed w; N/A <br /> �D.�rx�peen) <br /> o� as N/A won Lot(s). Bock FIGngNnk <br /> IL Well drilled by: N/A Lio. No: <br /> Pump wMaw by: N/A Lie. No: <br /> 9, Mager Mfg. by N/A So" No.: Dag Inswied. <br /> I ") have read the$==moms made herein, know the c omertm tnereot, and state V=they are true to rW (our) <br /> knowledge. [Pursu=to Section 24-4-104 (13)(s) C.M. tine making of false s=ernenm herein conmitutes pwjury <br /> In Me sooDnd degree and is punishable as a Cfass 1 misdem42nor. <br /> G Name/Title rwm v"or P" ignstuti we <br /> Mark A. Hener & a <br /> ,[f 112 <br /> Turner <br /> Williams, Turner Holm s <br /> P.D. Box 338 FOR OFFICE USE ONLY per,, <br /> Grand Junction, CO 81502 <br /> (303) 242-6262 <br /> o.. <br /> Cow Case N C <br /> No.� Dlw. � o. WD Basin MD us* 0!Cl <br />