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WELL WNSTRWHON AND I EST REPORT For coke um off► <br /> + . 81-Al 6 OF COLonADO,OFF"CW THE STATE ENQINSER <br /> I. waL NCmr Numam-" - s B xL A�--o <br /> MI&V Adrk'en eo Qo <br /> ' 04yo st.Z%)_ o v fz <br /> 3 =LLQwM&2 d S, 1l4 SE i14,sea. J 7 Twl)._ 17 A-�Range 6 a <br /> QlBTANCES FnOM SEC. LINES: <br /> GCO ^k.from� ec, lime. and (l.from�saww" bra. OR <br /> euwNml6N: L:DT BLOB FIUNQ(UNTf) <br /> STREET ADDnEbe AT WELL LOCA110N: <br /> 4. GROUM SUAFACE ELEVATION,92:U-6Z Ile DAUJNQ METHOD oi.1 <br /> DATE COMPLETED 8 -T Z-- 9 TOTAL DEPTH 70 IL DEPTH COMPLETED N <br /> caEOLOaf0 Lock a.HOLE DIAM. (In.) Rom QQ To (ft) <br /> Dspill Dosm4*on of M•lo#W(rypo,Size,Color,WAm l000dorj <br /> 7.PLAIN CASING <br /> c►�... s..,., ^ _ � �O.(D�..1.1 Md G W Fr pm� TaN <br /> Pg9F.CABN�K�8oreelt SI�8� a.a f o s.,. <br /> fie F LTER PACE: &PACKER PtAOBMW t <br /> eke <br /> k"rval r <br /> 191, -G#KXnM FECOW.- <br /> .r: <br /> iAoietla� AMOL" oam*y btorvat PwAwn" <br /> 1 DORVEC'nM Melt.UNd <br /> Ili ' Y&MOT!!: Gawk b x l Twt Dalm k submitted on Fom tU t111fYS W&vPw>wdd Wit Teat. <br /> SU*Uwd ge a DAWTI'— .0 9-a-Tom ;wtaduaion fwa <br /> PuuoV Iasi It.09*Tkns nua KUd ' ' -Test bmvm�It10 j <br /> p"Wb . <br /> II I bm tNd to*bleufu t6 haol mW Maow Ito owW*M*94 mW 1W ill we 6w b e7 bwxbdoo.(Puawd fie Body 244-104(tad( <br /> 0JU4 on ra+h0 d e Ni�wi Iwab owoft b w pv*xy In On nem/dopno oW M pr*&Mo w a doe I ok4 wmm4 <br /> CONTRACTOR � c ,Phone, �/ c 2.Z4 LJc.No. <br /> - <br /> CONTRACTOR a...e s Aiwa s O C1 <br /> 4a rrW Mte(Please type or print) Signature Date <br />