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Haldorson 9703236851 p.6 <br /> <br />~"Q <br />~ ~a~ WB1 ti0~7[I'i101~1 MID LEST FI1~URf <br />STATE OF COLOiTAUO, OFFICE OF 11'~ STATE ET3T For otBee use a+lv - <br />.. ` <br />,. wets. err "a 5 y 1a7~ <br />2 i>aNAME(S) F~aff~orSOH nn0f Sens Y..... <br />MatTrlg AddrGSS i. D . 73nX /019 <br />Cfty,StZip /11'en~.^a. Ce. ~+It{D~ <br /> x(970) <br />3. YYELLLOCATI~NASORlT.ED: SE t/4 SE 1/4,Sec.~_Twp.~ N .Flange /0 LJ <br />DLSi/ddCE$ FROr13EC. !.li1B9: <br />~,~ tt trrnn ~sec.1Qle. and / e S / $ tram- line. OR <br />b'UBDNt L:fJI'_T3LOCK FlLJNG(UNIn <br />STREET AOOREBS AT tAlEli. LOCATION: <br />4. GROUND SUF~ACE 9.EVATIOW R DF2BJJNG METHOD A'i 12oi-n ra. <br />DATE COMPLETED 1- 1 ~. - o ~{ .TOTAL DEPTH f' $ DEPTH c~MPLEiID_~e 0' R <br />S GEOLOdC LOG: <br />~ Dagipltp~ d tlMeed (type. ~ Cak4 lN~ +) & HOLE DlAM. (n.) From (!t) To Qt) <br />B „ ^~ 3. 5 " <br />~` 3.5 G/• <br />d - R yre~r ~ Ie., C..r I <br /> <br />g - ~Y <br />~ - b~.a.... r ~_ 7. PLAIN CASING <br />~ OD brr) Kind Wes! Stze Fram(h) TgIR) <br />- >v GS/fr" rTfc~/ ./S'P X1.5 - .S <br /> ,2 •,. Pyc .150 + ~• S <br /> <br /> <br /> PBTF. C0.SING: Screen Slot der , 0 3 a <br /> Ovc .d50 /D' <br />~ <br /> - <br /> <br /> <br /> <br /> 8 flLTEii PACK: 9. PACKB3 PLACEMENT: <br /> Material ~. ~,....! Type <br /> Size 3/8 <br /> 1rWenrd! <br />g' +a LO' Depth <br /> _ <br /> t4 Gl70171TNG Fi~[:ORD: <br /> Material Amourrt Density Ir>terv-al Placetnertt <br />RHIIAAKS: - ~ Ltw'++f 3 ~os 62T/ (t,s„p_~L urc <br /> <br />T 0lSMFEGTiON: T t/7f/ -4 57. Amt Used /oo P/.n 4Jed .'n d..'//.>. ~.afrr <br /> W~ 7, Fes' UgTA: Check bmc M Test Da?a is subnalted on Farm No. GYVS 39 Serrtai We9 Tes[. <br />TESTING LIETHOD A%. -!: Ff. <br />Static Level a ~• R Daoe/T'Ime mer~aed f - t2-A4 3:ea r.p Flnduction Fite ///p_ _gpm. <br />Pum{Iing 1911e1 ~ $ Det~ime rrA~lred 1- la - oV 3: 3e i.MTest (t[rs.) ((a <br />P.emadm r C n. <br />3. 1 hma ned tLe ewfsnrri vads fnwin and lmaw tl» aanEgN ewrear. ~ ena0aq a¢ tue m ey hwawMdea. (Puwoal to SeeSen 21+tat 081( <br />GAB. the ertdnp tR}We e~dmmb MBn ooaYYRes perjury in tlr woend d.yw W s ysrWbic a a dens t mkdemeenor.7 <br />CONIRACPOA • ~d u t fh~ /i f Tnc. Phone 47a h56 -!o SP 3 L.ic No. 18 _ <br />0 / <br />Nmngliide (Please type OJ PinU <br />T'+,!! !J. ~:'rsrier ~~ieJe'are.+>`'~ Sigr~ae <br />~t ~ ~aH-y Date <br />/-a't-D'f <br />