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MW-Sun2 <br /> FORM NO. WELL CONSTRUCTION AND TEST REPORT For Office Use Only <br /> GWS-31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER <br /> 412012 1313 Sherman St.,Ste 821.Denver,CO 80203 CEIVED <br /> Main 303 866-3581 Fax 303 866-3589 w r. co.us 'vR� <br /> ELL PERMIT NUMBE; <br /> 2.WELL OWNER INFORM ON <br /> _ ^ 'JAN 2„�, �13 04 20q <br /> NAME OF WELL OWNER: � <br /> MAILING ADDRESS: uvhINEER S <br /> CITY: STATE: ZIP CODE: WV% �G N LO• <br /> TELEPHONE NUMBER w/area code: Q 3 <br /> 3. WELL LOCATION AS DRILLED 1/4, 1/4, Sec., 2.1-Twp.% I~ N r S, f 1 Range..._ 0 E or W E- <br /> DISTANCES FROM SEC.LINES: 63tQ —ft.from i-(9 or F S section line and jrQ& ft.from ❑E or 1` hl section line. <br /> SUBDIVISION- , LOT , BLOCK . FILING(UNIT) _ <br /> Optional GPS Location:GPS Unit must use the following settings: Format a UTM,Units Owner's Well Designation:MW-Sun2 <br /> must be meters,Datum must be NA083,Unit must be set to true N, t"' one or II Zone 13 Easting:, aQ S(L�,$! A <br /> STREET ADDRESS AT WELL LOCATION: North' !5A 9270,06 <br /> 4. GROUND SURFACE ELEVATION feet DRILLING METHOD O v <br /> DATE COMPLETED TOTAL DEPTH feet DEPTH COMPLETED feet <br /> S. GEOLOGIC LOG 6. HOLE DIAM in. From ft To ft <br /> Depth Type Grain Size Color Water Loc. poi /y O ,-� b <br /> (o 3/y' �_ 735' <br /> SOOerx C001r9a. 7. PLAIN CASING: <br /> rev' OD(in) Kin Wall Size(in) From(ft) To(ft) <br /> O— At ` — � 01A6S�crQ <br /> PERFORATED CASING: Screen Slot Size(in): <br /> PyL adlI qi _ "75Y <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material SfW r0 Type <br /> Size lorIo 3oil0 <br /> Interval 737-7oo 7di-7c pe th <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> Remarks: <br /> 11. DISINFECTION: Type Amt. Used <br /> 12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br /> TESTING METHOD <br /> Static Level Date/Timemeasured: 1146 0- j)ao Production Rate U.l. gpm. <br /> Pumping Level ft. Date/Time measured f� i l Test Length(hrs) �2__ . <br /> Remarks: <br /> 13. 1 have read the statements made herein and know the contents thereof,and they are true to my knowledge. This document is signed(or <br /> name entered if filing online)and certified In accordance with Rule 17.4 of the Water Well Construction Rules,2 CCR 402-2. The filing of a <br /> document that contains false statements is a violation of section 37-91-108(1)(e),C.R.S.,and is punishable by fines up to$5000 and/or revocation <br /> of the contractin license. If fillno online the State Engineer considers entering of licensed contractors name to be com lance wiithh�tRule 17.4 <br /> C W�m/.el hon r .!: /� L'ce/ry q r6?l <br /> Mailina A :�3 ltdw <br /> e <br /> Sig e r nline) Pri e a T l <br />