2020-06-25_REVISION - C1981035 (34)

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WELL CONSTRUCTION AND YIELD ESTIMATE REPORT Z-i;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 1�MS �EC �� 02/2017 www.water.state.co.us and dwrpermitsonline@state.co.us .0 1. Well Permit Number: 303357 Receipt Number: 9703921G �`. A uca�� 2. Owner's Well Designation:MW-3-A V14?T l�2 3. Well Owner Name:GCC Energy, LLC S7 TE 61VG� � 4. Well Location Street Address:NA OOtt) k 5. As Built GPS Well Location (required): 0 Zone 12 ❑Zone 13 Easting:752341.0 Northing:4124423 6. Legal Well Location: Nt 1/4, 1/4, Sec., 3 Twp.34 N or S©, Range 12 =E or WE], NM P.M. County: La Plata Subdivision: NA Lot NA Block NA Filing (Unit) NA 7. Ground Surface Elevation:7418.0 feet Date Completed: 03/07/2017 Drilling Method: Rotary Air Hammer 8. Completed Aquifer Name : Unspecified Total Depth: 380.20 feet Depth Completed. 355.00 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes QNo, Date Notification Given: 10. Aquifer Type: []Type I (One Confining Layer) Type I (Multiple Confining Layers) []Laramie-Fox Hills (Check one) ❑Type II (Not overlain by Type III) ❑Type II (Overlain by Type III) ❑Type III (alluvial/colluvial) 11. Geologic Log: 12. Hole Diameter (in.) From (ft) To (ft) Depth Type Grain Size Color Water Loc. 12.0 0.00 40,00 0-30 weath'd sandstn sand gryish prang NA 6.9 40.00 378.10 30-315 siltstone/sandstn silt/sand It to dk gray NA 315-330 sandstone sand light gray NA 13. Plain Casing 330.330.2 coal coal black NA OD (in) Kind Wall Size (in) From (ft) To (ft) 330.2-350 sandstone sand med gray NA 8.625 STEEL 0.188 -3.5 40.00 350-352 coal (A-seam) coal black NA 2.375 PVC 0.218 -3.00 352.15 352-375 sandstone sand med It gray NA 375-376 coal coal black NA 376-380 carb shale clay gray black NA Perforated Casing Screen Slot Size (in): 0.020 OD (in) Kind Wall Size(in) From (ft) To (ft) 2.375 PVC 0.218 352.15 355.00 14. Filter Pack: 15. Packer Placement: Material Silica Sand Type NA Size 10-20 NA Interval 351.65-355.60 Depth 16. Grouting Record Material Amount Density Interval Method Remarks:Monitoring well. Dry drilling method.Drilling services by DAK Drilling.3'X 3'X 0.5'cement 3/8'bentonite chips 9 sacks NA 380.20-355.60 poured pad installed around locking wellhead.Annular seal is 14 gal potable water per 1 sack grout 114-bentonite pellets (2)5-gal pails NA 345.50-351.65 tremie poured for 30%bentonile solids. SS centralizers installed top/bottom of screen section and every 40'on casing. Hale dry at time of TD. Free water entered borehole overnight. EnviroPtug Grout 35 sacks 10.2 lb/pal 0.00-345.50 tremie pumped 17. Disinfection: Type NA Amt. Used NA 18. Well Yield Estimate Data: Check box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: baiter Static Level: 297.35 ftbgs Estimated Yield (gpm) 0.5 Date/Time measured: 3/27/17 12:00 Estimate Length (hrs) 4 Remarks:monitoring well development by bailer surging Ft production 19. 1 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: Resource Hydrogeologic Services, Inc. info@resourcehydrogeologic.com (970) 764-4920 NA Mailing Address:101 W 11 th St#103 Durango, CO 81301 Sign (or enter name if filing online) Print Name and Title Date: Landon Beck Landon Beck - Principal Hydrogeologist 08/17/2017