HYDRO23447

• Permit No: M1999002
• IBM Index Class Name: Hydrology
• Doc Date: 6/19/2000
• Doc Name: BASELINE GROUND WATER CHARACTERIZATION REPORT 7-1-99 THROUGH 4-30-00 CONTINUED
• From: AMERICAN SODA
• To: DMG
• Media Type: D
• Archive: No

FORM M°.
~'3t
tvvo ~ WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEE.9 For aRteau.. «w

AECEIVEt,•
WELL PEAMR NUMBER ~'/ (o ~ Y ~, ~1~1Y 2 7 1999 ~

OWNER NAME(S) C- 1 e `" --2-
Mailing Address
City, St Zlp '
Phone ( ) , _
s
STaTEEncwEEPS ro
~O Go°
3 WELL LOCATION AS DRILLED: ~ jLt/4 J~F 1/a, Sec.1LTwp.~ l!~ , Range~~
DISTANCES FROM SEC. S' -
,~ 7~ 3. R, from o ~ SeC, fine. and 17 N 3 ft from ~_Sec. fine. OR
pwre+ or wwy (..~[ u .,..q
SUBDIVISION; LOT_BLOCK FiL1NG(UNIT)
STREET ADDRESS AT WELL LOCATION:
a. GROUND SURFACE ELEVATION q R DRIWNG METHOD A ~a ~AP~
DA i c COMPLETED ~ Z!y ` / , TOTAL DEPTH lO D R DEPTH COMPLETED OD' ti
5. GEOLOGIC LOG:
rLaal o~lbmll d u.d11.f Rrv+ r~ eae, wmr tralonl ~ OLE DIAM, (n.) From ([q To (tt)
~~ "~
r" -/9 - 00
e-fi TrOSei/.
~
L
f! .Z Y 7. PLAIN CASING
- ~ ~
~ OD (n) Kind Wall Siz From(ft) To(tt
~
-~ sra e~ ~._ t1 -~

o- i _ ~
a-
S e: o
PERF. CASING: Sue
e
n
,
~
~
y,
C - /p o
~J I/ G , -~~-- -

li FILTER PACK 9. PACKER PLACEMENT:
Material O Type
Size
Irnenral Depth

1A. GnOUTING RECORD:
--
REMARKS: aterial _Amount De^^=~tv iR!vNa1 P!atd*-'*_
Gor~p.,/ ~fAcK~'!o - 9~ ~_

i DlSlhr•cCT10N: T pe G C Q 1I~291mt Used t~(ii
WELL TEST DATA: ^ Check box if Test, Data is submitted on Supplemental Forrn.
TESTING METHOD f T •'
Staric Level ,z~ 1L Date(i'une measured _ - Production Rate~_gpm.
Pumping level h. Date/Time measured ,Test length (hrs.) y~~,
Remarks
-f Ilw~ IYA M at~11W,p Ind lurwn Ilp IO4w Ou COr4~IlO Y1Y~OF. Ib QYl Qlry N Ta• b 11,1' 101p,.4d0t IAl~ItlC 9e $~~~ 2{+1G 1171 W GA3. QM
d hir mrMllrm lr~ill o~ D~Iillry ~ Rb s~mM dplw uld i puliluy~ v ~ dm 1 mid«Irr+or.l .
CONTRACTOR .e ~ r c~ phone 8~ li - ~ ~ ~Lic. No./t 3q
Mailing Address D o0
Name/T~tie (Pleaseype or prim) Signature Date