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:: PF OR INi IN BL •~K INK r •CCEV iED NT u~ILED ~ESi OWNER'S EOPY COLORADO DIVISION OF WATER RESOURCES 818 Centennial Bldg., 1313 Sherman St. Denver, Colorado 80:7.3 STATE OF COLORADO COUNTY O F _- _ CU>T1I1i501? i SS _~ STATEMENT OF BENEFICIAL USE OF GROUND WATER AMENDMENT OF EXISTING RECORD LATE REGISTRATION PERMIT NUMBER X18-F IE AFFIANTiS) _ _WeSte271 Slope Carbon, 3.nC. ose marl ing dress Is _.___ P. O_Box 1526 _ _ _ ,y - - ___ Salt Iake City, Utah _ ~ ~ ... RECEI~/ED NOV 3 01978 ri'ATFB BESOt1RCES ~>~ FNGIIIFF9 AFFIDAVIT ~7. LOCATION OF WELL f~lnlllSOn -- _--_ _-- --- i. ~r .r. ~ --- i. s•r 11 i_o -135_ o-~ _90 - - W 6th v w --~ ~ ~ .-. .ng duly sworn upon oath, deposes and says that he (they) Is (are) the owned s) of the well described hereon, the well .s rated as described above, at distances of _2815 -feet from the ~?~1 sect ion Ime and 1560 fee' fro^. the East section Ilne, water from this we)I was Lrv applied to a beneficial use for the put po see s) de scribed herein on the 17_ y of _ 90VP~r 19 ?8, the mo.lmum sustained pumping rate of the well is _9.66- gallons per minute, the pumping .fined hereby rs .- 9.66 gallons pct minus e, the total depth of the ..ell is _ ZO___fcc+, the average annual omcunr water to be drvened Is 4 oc re~feet, for which clam .s hereby mode for Industria purpose(s), the legal de scn ptron of the land on which the water from this well is used is The t~ F}g of the NLtP;, ~ NE; SEL Sec. 11, T 13 S R 90W, 6th P.M. & th~ F>~ of the NA:, b the 1•TFn of the NFP:, 6 the Nl•r< SW; of Spec. 12 T 13 S, RSOW, 6th P.M. 6 the SE, and the E15 of which of thy. 2, T 13 S, R 90 W, 6th P.Di. S the SW; of Sec. 1, T 13 S, R 90 W, 6th P.M. 0 acres are irrigated and which is illustrated on the map on the reverse side of this form, that this well was completed in rmpliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he :,ey) has (have) r od the statements mode hereon; knows the content thereof; and that the same are true of his (their) knowledge. COMPLETE REVERSE SIDE OF THIS FORM) gnnrwe'sl . 1s1~~'[r~ ~b sCrrbed Cn sworn /~ .~ p FOR OFFICE USE DNIr belore me on this ~~_ ay of /CGQ~~/,~~~ 19 ,L.Q Q Cowr ~aa N~ _ / Commrsuon e+rprre s: S~d~/_~ a'.S ~Q` .... P,.o, uo Dor _ v, .., .... ,. a. D, .. C.,. CCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO URSUANT TO THE FOLLOWING CONDITIONS. `" ---- -- " - --- y, THAT THOSE CONDITIONS OF' APPROVAL AS STATED ON THE IT AHE COI~LIED WITH. w.ll U.. v..r -- ao..^ wow o.' _ -__ UG 0 9 1979 ~~ ~~ - ~ At r r,vli s : ^ ... , ..., .. - ~~~-,~~. r.,