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.: <br />WELL CONSlRUCTION AND 1 EST REPORT <br />SlAlE OF COLORADO, OFFICE OF TI-lE STATE ENGINEER <br />for Ollloo Uao onlr <br />YfEbk(..OCATION.e&._DRILb.I;.Qi S£ 1/4 S£ 1/4, Sac. /7 Twp. _ _._/-''7.___ S <br />DISTANCES FROM SEC. LINES: <br />, Rnnga_G._8__ W <br />ec::o fl. from ~ ..... -n... Sec. line. and 7 So n. from t!!o.sr Sec. line. OR -(mmlnraumnr -(launsnRJur <br />SUBOIVISIC>N: :-----------LOT __ BLOCI<--... ___ FIUNG(UNll) __ _ <br />STREET ADOREsskr WELL LOCATION: <br />GROUND SURFACE ELEVATION So:£3. ¥ U. DRIWNG METHOD __ o._l_r_-__.:;.y-_o_+_Q..~Y"~j,__ ____ . <br />fl. <br />5. GEOLOGIC LOG: 6. HOLE OfAM. (ln.) From (rt) To (ll) <br />UopU1 Uosclipllon ol Mntodal (fypo, Size, Color, Wator locaUon) B 0 70 <br />Wall Size <br />~"" ¥o :ssJ,.. 'fo <br />From(rt) To(ft) <br />0 <br />9. PACKER PLACEMENT: <br />Type------ <br />·-... :: .. ,·.::,;.· .... ·:. <br />10. . GROUTING RECORD: . . :. :·. . . . - <br />Material Amount DensJty lntesval Placement Riiiwa=:================t ~e:.,. ·s:..J = £' , .. ..~J. It> -1s' · , ........ " --------------------· ar• ... t lr>' .s+J. 0 -to' __ ., __ _ <br />Check box I Test Data Is submftled on Form No. GWS 39 Supplemental WeU Test. <br />NA • <br />........ ~-fL Dale{l1me measured %-H-1'8 . , Production Rale gpm. ___ _.fL Date/Time measured • • · Tesllenglh (lvs.) ______ . <br />1 <br />I • <br />3. I hM fttd Itt etattmenle mldt htrtln IC\CI know tlat oonltnll thereof, IRCI Utat U•Y artlrue· to my knowledge. (Pwsuanl to Secllon 24+104 <br />. . C.R.S..Iht making of alelemenla herein oonalitutee pecJwy In the aeoond degr~e and It punlahable as a class 1 misdemeanor.] <br />•• • • • 9 ' .. • ••• <br />CONTRACTOR . ' . 71 Uc. No. __ ... <br />/