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

~~~"" `."' ? WELL CONSTF lION AND TEST REPORT
' ~" STATE CF COLORADO, OFFICE: CF TH STA?E ENGINEER
_ I ____
~J ;WELL PERMIT NUMBER MH «6101 i _
~ ~r OtTCe use r~~ty
2. C'/'/NER NAh1E{S) Allen s?riliing, inc
t : Mzi!ing Address Post Office Eiox 398
~ CP.y. St. Zip Falrplay, ColoraQo 8(1440
~Phdne (719) 836 872

_
~
3. J'. cLL LOCATION AS DRILL_D: NE 1i4 Nth' 114, sec. 14 twp. 1C South ,range 77 Wes'. I
I DISTANCES FROPA SEC. LINES: ~
1320 ft. from _North Sec. line, and __2635_ ft. frorn West Sec. line, OR
tnerth or south} (east or west}
SU6CiVISiON' N!A Lot Bi Filing(unit}
; S''REETADDRESSAT WELL LOCATION:
_
a TcFti)UND SURFACE ELEVATION ft. GRILLING METHOD Afr Rotary
ATE COMP! ETED .Total Depth 2t ft. Depth Completed 21 ft.
_
5 GEOLOGIC LOG:
Cepth Cascrio^.on or V~atenal (Type. Size, Color, Wate: Lowtio .j
L 0 -:, _ Sand 3 Gr2vel Alluvia4 __-
- 6. HOLE DIAM. {in.) From {ft) TO (ft)
j n 7!B 0 21
v
y--- _--
~ 7. PLAI'1 CASING
__
Monitoring Hote ~2 _ OD (in) Kind NJaA Size From(ft) To(ft)
--
Static Leval - 21 Ft 7 Steal 188 +1 16

-~
-
~ ~
r
^ ^ PERF. CASING: Screen Slot Size: - .032
r-__~--~ --
i-- 7 Steel 136 Iii 21
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__

~_
_ ____ -
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' 8. FILTER PACK: 9. PACKER PLACEMENT:
_ Malaria N/A Type
N;A
__
_
---- ---
~_ `---_---_-----
i-
-
j _
Size t
Interval De th
- -
_
-
--- - 10. GROUTING RECORD:
_ -(
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~REMy;RKS. __ _ _ _
___! Material Amount Density interval Flatxntent
Cement 3 c' 15 0-16 Pouredi
_-
~
l _.__ ~
-- -------- Viorated I

--.-.. Hi Early i"ic ~
~_ ~. ---
~- ---------- i~ -- i
?7~; UiS<flFr{iT;ON: tpce;--_--_-_ _Arr, t. tJSed: f
12 ' '~NE..t,~._'E°T D,aTt+: =' Chec,t oae :f Tsst Da',a s su~miaed on Form Pio. Gt'VS 39 Supp!emectal N/ell TesLi i
TESTING r.1ETHQ: N;:4 _ _ _
_ i
f Srat:r. Level 2 ft. Da:s(f;me neesured , Preducticn Rata NrA gpm ~
r Pumpino Lava! - - --~ ~ fi. Date; Tune rneas~red -~- --- .Test Length (hrs.} N/A_
I ,,---' -~_ -'
. ~~. !have 'eac i^r: satsmants made eerein artl ksov. ;he ~:crients tha~acf, and Nat toay are true :e my know7edye. (:ursaant ro Section 26>-104 i~?1
~~~
~.'l. $..:hB nt3RIC~ O! fei5e stete!'leeb Gereln CAtstitutl:3 pe QJry ~L the SeCJod da9ree and 3 OUfI a'i`n~~e as d Ga55 1 1ni509nle3rpf.'~
COhtTR=:~TOR Allan Dr;!Lrg3 Excavafn~CoTranv. Inc. Phone (T1 B) 836-26i Lic, Nc. 763
Nantei Title (Pleesa r;pe dr ,:nn[) !Signature „ Gain
Jack Allan! Presider', ~ ~~ ~~: ' 15!t/06