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aldorson 9703236851 p,6 <br />%0 YiIBL I:OKSI%lCiION N'1D T~"r R~'ORT <br />STATE OF COI.OR4D0, OFFICE OF THE STATE B~GN•IEJ~i Fa ors uc. mk <br />,. we.~ Purr a s v ~7 8 <br />L NAME(by fFaldorSen a.,S Sons T_c. <br />9 Adtin~s P. O . F3 ex 10 / 4 <br />C~, SL ~P y'!] .., ire a <br />(' e . RI ~f Oa. <br /> ~ <br />Phone (9 0) - S <br />a WB.L LOGTION As Q ~~ t!4 t/ 1la, Sec~_ Twp._g-,,,,. N ,Range ! D W <br />DISTANCES FROM 9EC. LNES: <br />1ka ~ R from s~sac rme. mte Ca ~ ~_ R Iran E~ s . Gam. Ord <br />s~onnsloar LoT_sLOCx FL19dG(UNrp <br />STRE4=T ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVAT'I~J R DR4.IJNG METHOD f~: ~- Re fa ri. <br />6A'iE COMPLETED -1 0 .TOTAL DEPTH R DEPTH COMPLETED D' tt. <br />S iiEO1,001C LA4 <br />OaGth Detdption al McLeW StYP~ S'Fre, Cofer, trmer I.or~ord 6, HOLE DIAM. (n.) From (ft) 70 (it) <br />S •' O 3. S <br />L •' 3. S <br />-a•s• <br /> <br /> <br />- T_ PLAIN CASIQG <br />~ OD (61} Ind WaN S¢0 From(tt) To(tt) <br />S7 '- G S/' ///( ~itr elea/c - se li G f/8'• T'fr.~/ . !S'R f /.5 - <br />~ ~~ p/C .a O f r•S -13 <br /> <br /> <br /> PEfiF. CASNG: Screen Sla Size: . 03a <br />I .2 •• .Pr/G .ssn ~~. <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PIAC:EMENT: <br /> Material Pta~ & ~n,,r~/ TYPB <br /> y~g <br /> IratBlVal /o to !r 0' GPm <br /> <br /> td GROUTWG RECORD: <br /> Matetid Amount Density Interval Placement <br />f~MAiilGS: !t - Y r c <br />~e <br />h. Gan+arrl' ~.5(~ ~S9o.~~Z ~aul~ <br /> <br />t ~~~ezr.~an <br />w~ <br />DISNFECTtON: 7 /+r"1 N - G ~ !O f\Ird Lbed /d 0 pM/y Y St6 i %1 (1~,71,ti1 ~'P.r <br /> N+~ ~t ss pATA: Ch~k bmc 7f Test Delia is sr~rnitted ore Form No. GWS 39 Supplemer~cal Well Test <br />TESTING METHOD .R,. -1/~ . <br />So~9C few! 4I• R DeOeJTine measrred_ f- /3-oyc /~ ors im. Production Rate ~/~0 9Pm. <br />Pumpirep lerll /. e' R Dale/Tlste RIBe9tAed 1 -/7-d'/ /] :41 r. we. Test Larlgm (tus.) /z <br />FIYf11arIL8 / w <br />3 ~ haYa and tM afalsaam+ made bnia and 6ierr tba oantam Iharaof, aed tlmtthsy amlrus m my lRaau.m m Sec6en zaa-toe n3) <br />CRS,. dw nwlEay d A!r dslsowO INnin wrNti7~aa peryyry in the aaeead degree nd ie gridr6b m a aeoa 7 miedemm~r.] <br />CONTRACTOR [~/%d0cat Or.l1.nc ~ ~~n Lnc. Phone (478 ] fd56-LSB.3 L.ic.No.l.2P5~ <br />Mail Addrass~.0.8. ' / <br />NameJTitle (Pleose LYPe a P~~ <br />.7! !J. k.1.Ttau ~P~ES,d~~) <br />>~ Datc <br />(-eZ(-v'f <br /> <br />