2019-04-18_HYDROLOGY - M1982121

• Permit No: M1982121
• IBM Index Class Name: HYDROLOGY
• Doc Date: 4/18/2019
• Doc Name: Exploration Drilling Completion Notice
• From: Rocky Mountain Resources
• To: DRMS
• Email Name: ACY
• Media Type: D
• Archive: No

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Form No STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use Only
GWS-09 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 I
www.water.state.co.us and [e-mail]
03/2017
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells, monitoring and other holes. Type
or print in black or blue ink. Instructions and plugging standards are on reverse side
1. Well Permit Number of plugged welt or MH File Number MH- 58912
Owners Weil Designation- 1E Receipt Number:
2. Individual/Company responsible for plugging and sealing the well:
Name(s) Leo Gilbride /Agapito Associates, Inc. License# Colo PE# 33329
Mailing Address 715 Horizon Drive, Ste. 340
City, St., Zip Grand Junction, CO 81506
Phone ( 970- ) 242-4220 - - Email [e-mail] - ---_-_-_ --
3. Well (Hole) Owner: Name(s): RMR Aggregates, Inc.
Phone: ( 720 ) 660-3279 Email: [e-mail]
Maiting Address, City, St., Zip_ 4601-DTC Blvd., Ste. 120
_.
4. Well Location Address: 1001 Transfer Trail
5. GP5 Well Location: County Garfield
UTM 7 Zone 12 or QZone 13 Easting 300512.5 Northing 4382575.2
6. Legal Location: _1/4 of the 1/4, Sec 36 , Twp 5 ❑N or S ■❑, Range 89 ❑ E or W Q 6th p,M,
Distance from Section Lines — Ft. From ❑ N or S Ft. From E or W ❑ Line.
Subdivision Name Lot Block , Filing/Unit
7. I/we report the existing well/hole was plugged and sealed on 11/06/2018 (date) for the following reason(s):
0 The well was plugged and sealed as required under Well Permit Number MH-58912
❑The well was not in use and was plugged and seated.
[]Other (please explain)
8. Aquifer Type: ❑ Type I (One Confining Layer) ❑Type I (Multiple Confining Layer) ❑ Laramie-Fox Hills
(check one) ❑ Type II (Not Overlain by Type III) ❑Type II (Overlain by Type Ill ❑Type ill (alluvial)
9. Intervals of Casing Removed/Ripped:
from feet to feet, from feet to feet, from feet to feet,
from feet to feet, from feet to feet, from feet to feet,
10. Amount and Type of Material Method of Placement Interval
Cement Shovel from 0 feet to 3 feet
Cuttings Shove! from 3 feet to 129 feet
from feet to feet
from feet to feet
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I have read the statements made herein and know the contents thereof,and they are true to my knowledge. This document is signed(or 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 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$1,000 and/or revocation of the contracting license. If
filino nnlinp the Ctatp Fnoinppr rnncieiorc the Pntry of the lirpncpel rnntrartnr'c name to hp in rmmnlianrp with Redo 17 d
11. Signature(s) Please Print the Name, Title, Ex License No. Date
Leo J. Gilbride Leo Gilbride,VP & Principal 1 212 0/2 0 1 8
Colo PE#33329
It is the responsibility of the well owner to have the welt/hole properly plugged and sealed. The Well Construction Contractor is
responsible for notifying the owner of this requirement in writing.