PERMFILE49145

• Permit No: M2005080
• IBM Index Class Name: Permit File
• Doc Date: 6/13/2006
• Doc Name: Applicants comments
• From: EAI
• To: SEO
• Media Type: D
• Archive: No

OONSTR~ i ION AND TEST REPORT
` `'" "' --WELL
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F- i ~ -or O!P.ce Use Only
~~ ST.ATC GF COLORADO, OFFICE OF THE STATE ENGINEER
1. ' riEl.L PERMlT NUMBER MH"A-6101
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2. i 0`ni\ER PIAME(Sy Alten Drilling, Inc
i f~laiiny Address Post Office Box 396
Citt St Zip Fairptay, Colorado 80440
i P~tane 719 836.2672 _ I
3. 11NELL LOCATION AS DRILLED: NE ti4 Nb": i±4, s=c. 14 Mp. 10 South ,range 77 West
DISTAN ;S FROM SEC. L'IvES' -
ft. irorn Nott!r Sec. Ine, a id 1500 R from West Sea line. U'R
<25
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y (nosh or soutr,` (aast or tivest)
I SUBDIviSIUN: NA ~! Lot Bi Filing(uniy
.STREET ADDRESS AT WELL LOCATION.
4. GROUND SURFA::E ELE'rATION ,-~-- ft. DRtL! ING METHOD A%r Rotes
.Total Depth LO ft. Depth Comoleied 20 ft.
DATE COMPLETED
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5. GEOLOGIC LOG: r 6. HOLE DtfihA. {ir.) From (ft) TO (ff)
Oeptn ^ascnc!io^ cf FAaterial %T/pe, Size. Colpr. W"atsr Location) 9 7i$ ~ 20
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0 - 20 Send 8 Greyel Alluvail ~
_ ~ - V 7. PLAlN CASING
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__ MuNlorin Hole #t ____ OD Qnl Kind Wail Size From(ft) To(ft) ~
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1
Stauc Levsl . 1 T6
~ 7 Steel 136 +1
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~ PERF. CASING: Screen Sfot Size:
A32 _
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7 Steel 188 16 20
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~_-___-____ _______ _____~ 16. FILTER PACK: 9. PACKER PLACEMENT:
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11 Materizl --- N;A Type ~ N/A
,_ -____ JJ Size
~Interval ~ Depth
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--___-~y_~ f 10. GR7iiT!NC~'rZECORD:
M2terizi Ar count Cen;;iri tctarvai Placament
REMARKS: _-___ _____ _~___ ~ Cem?rt 9 c` 15 fi - 96 - Pourad/
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r12 YY ALL TEST `~AT.4: Check t)nx if lest Data a submitted or Form tdo. ;;LN'S 39 Sueplemantal YVe9 Test.
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TcSTING METHOD PJ/A
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j :?.eilc Le+el 1T6" f;. Deie/Tir~ti rneasvlred --_-----_-_-~_-- , Produc:;on Rats _
NIA 9om ,
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F :~n~iny Leee'
N,'A ft, Date/`ilrr,e neaeurev
.Test Ler.ytt {hrs.)
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pe:r~h~ks _ _ _
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13. ~ ,hay e;eac the statemen~s made herein acd knew the ;enteats !!'rtrvof, ord tna! ihay sr; trse ;o m5 ksnmte~dge. ;Puauant to Ser,! nr 24-4-7;4 (13) i
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~• k `. :~'P IDc~~.bis pf hlse Sla:efilenf5 hP-f eih GCnStItu4!; p9rJ'JPJ ii the 5°^.Cfid d@~ree and I_ ppn~ShdGe 99 9 ;IS: i t fiV5C8RIe0fPJC
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C,CNTF',AC'fVR All~r_Drilling fi. cxcavatinc Ccmoan . iy .nc. - Phen? j7?9)_836~~672 Lic. No._ 763
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hdaaing Adaress ?est :ffc= Box 338. Fai;alav Colo. 80440
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N'a+retTit a {r'fease type or print) Signature ,Gate
Jn.~k All?~• ! Presitlr nt. j /~ ~~ ~ 5110?
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