2020-06-25_REVISION - C1981035 ‎(34)‎

• Permit No: C1981035
• IBM Index Class Name: Revision
• Doc Date: 6/25/2020
• Doc Name Note: King II App 4‎(5)‎ DWR Data Sheets
• Doc Name: Proposed Revision Materials
• From: GCC Energy, LLC
• To: DRMS
• Type & Sequence: PR10
• Email Name: JHB
• Email Name: THM
• Media Type: D
• Archive: No

WELL CONSTRUCTION AND YIELD ESTIMATE REPORT ,t3 For flce Use Only
Form No. State of Colorado, Office of the State Engineer
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GWS-31 L)1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 t�'r75: '
02/2017 www.water.state.co.us and [e-mail] �' AUG
1. Well Permit Number: 303359 Receipt Number: 97039211 W1 0 g
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2. Owner's Well Designation:MW-3-MI 87';s E 3RC�s
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3. Well Owner Name:GCC Energy, LLC COLOIN�ER
4. Well Location Street Address:NA
5. As Built GPS Well Location (required): OZone 12 ❑Zone 13 Easting: 752345.0 Northing:4124429
6. Legal Well Location: N 1/4, S 1/4, Sec., 3 Twp.34 N or S©, Range 12 E or W[:j::L NM P.M.
County: La Plata
Subdivision: NA Lot NA , Block NA Filing (Unit) NA
7. Ground Surface Elevation:7417.5 feet Date Completed: 03/04/2017 Drilling Method: Rotary Air Hammer
8. Completed Aquifer Name : Unspecified Total Depth: 400.00 feet Depth Completed: 375.00 feet
9. Advance Notification: Was Notification Required Prior to Construction? Yes M No, Date Notification Given:
10. Aquifer Type: ❑Type I (One Confining Layer) [a7ype I (Multiple Confining Layers) ❑Laramie-Fox Hills
(Check one) []Type II (Not overlain by Type Ill) ❑Type 11 (Overlain by Type 111) ❑Type III (alluvial/colluviat)
11. Geologic Log: 12. Hole Diameter (in.) From (ft) To (ft)
Depth Type Grain Size Color Water Loc. 12.0 0.0 38.5
0-30 weath'd sandstn sand gryish orang NA 6.9 38.5 400.00
30-320 siltstone/sandstn silt/sand It to dk gray NA
320-330 sandstone sand light gray NA 13. Plain Casing
330.330.5 coal coal black NA OD (in) Kind Wall Size (in) From (ft) To (ft)
330.5-351 sandstone sand med gray NA 8.625 STEEL 0.188 -3.35 38.5
351-353 coal (A-seam) coal black NA 2,375 PVC 0.218 -2.98 359.65
353-354 siltstone silt gray black NA
354-375 sandstone sand med It gray NA
375.376 coal coal black NA Perforated Casing Screen Slot Size (in): 0.020
376.380 Garb shale clay gray black NA OD (in) Kind Wall Size (in) From (ft) To (ft)
380-390 silty sandstone silt/sand dark gray 380 2.375 PVC 0.218 359,65 375.00
390-400 shale clay dark gray NA
14. Filter Pack: 15. Packer Placement:
Material Silica Sand Type NA
Size 10-20 NA
Interval 356.20.376.00 Depth
16. Grouting Record
Material Amount Density Interval Method
Remarks:Monitoring well. Dry drilling method.Drilling services by OAK Drilling-TX TX 0.5'cement 3r8'bentomte chips 9.5 sacks NA 376.0.400.0 poured
pad installed around locking wellhead Annular seal is 14 gal potable water per 1 sack grout 114"bentonste pellets 2 pails NA 356.20-350,35 tremie poured
for 30%bentonite solids. SS centralizers installed top bottom of screen section and every
40'on casing. Damp cuttings at-380'. Free water entered borehole overnight. EnyiroPluiz Grout 35 sacks 10.2 lb/gal, 0.00-351.65 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: bailer
Static Level: 237.10 ftbgs Estimated Yield (gpm) 0.5
Date/Time measured: 3/8/1716:13 Estimate Length (hrs) 3
Remarks:monitoring well development by bailer surging Et 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. [e-mail] [phone] NA
Mailing Address:101 W 11th 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