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

WELL CONSTRUCTION AND YIELD ESTIMATE REPORT For Office Use Only
Form State of Colorado, Office of the State Engineer
GWS 31 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581
02/2017 www.water,state.co.us and dwrpermitsonlineoa state.co.us
1.Well Permit Number: MH-58917 Receipt Number:
2. Owner's Well Designation:11
3.Well Owner Name:RMR Aggregates, Inc.
4.WeII Location Street Address:4601 DTC Blvd., Ste. 120
5, As Built GPS Well Location (required): []Zone 12 Q Zone 13 Easting: 30D512.5 Northing:4382575.2
6. Legal Well Location: 1/4, 1/4, Sec., 36 Twp.5 N or 5 ED, Range 89 E or WE], 6th P.M.
County: Garfield
Subdivision: Lot , Block' , Filing (Unit)
7. Ground Surface Elevation:6761 feet Date Completed: 11/16/2018 Drilling Method: Rotary
8. Completed Aquifer Name : Total Depth: 127 feet Depth Completed: 127 feet
9. Advance Notification: Was Notification Required Prior to Construction? rj Yes No, Date Notification Given:
10. Aquifer Type: QType I (one Confining Layer) []Type I (Multiple,Confining Layers) []Laramie-Fox Hills
(Check one) ❑Type II (Not overlain by Type Ili) []Type II(Overlain by Type III) ❑Type III (atluvial/colluvial)
11. Geologic Log: 1 IL Hole Diameter(in.) From (ft) To(ft)
Depth Type Grain Size Color Water Loc. 4-inch 0 127
0.43 Limestone
43-110 Dolomite
13. Plain Casing
OD (in) Kind Wall Size(in) From (ft) To (ft)
4 PVC Q 5
Perforated Casing Screen Slot Size(in):
OD (in) Kind Wall Size(in) From (ft) To (ft)
14. Filter Pack: 15. Packer Placement:
Material Type
Size
Interval Depth
16. Grouting Record
Material Amount Density Interval Method
Remarks: Drilled @ 60' Dip
17. Disinfection: Type Amt. Used
18. Well Yield Estimate Data: Check box if Test Data is submitted on Form Number GWS-39,Well Yield Test Report
Welt Yield Estimate Method:
Static Level: Estimated Yield(gpm)
Date/Time measured: Estimate Length (hrs)
Remarks:
19. 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 filing online
the State Engineer considers the entry of the licensed contractor's name to be compliance with Rule 17.4.
Company Name: Email: Phone w/area code: License Number:
Agapito Associates, Inc. [e-mail] [phone] Coto PEft 33329
Mailing Address:715 Horizon Drive, Ste, 340, Grand Junction CO 81506
Sign (or enter name if filing online) Print Name and Title Date:
Leo J. Gilbride Leo Gilbride, VP lx Principal 12/20/2018