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ream t~Nlvl <br />s-ez <br />r <br />Index No.......... ~4.7....... <br />IDWD .........2-~9 <br />Use ....... ....... . ~"........ . <br />Registered....4.-(:L-6s , <br />~. , <br />Driller_ <br />Owner <br />Street? <br />Tenant. <br />Use of <br />On or <br />Date S <br />OG- 4 ~, <br />Counfy <br />i.~)u, ;., ~ ~ <br />~` JY~'% of"s~-'/a of Sect <br />19522 <br />19~~ <br />WELL DESCRIPTION: <br />Depth to Wate~fr. Total Depth~ft. <br />(measured from ground surface) <br />( from~ft. to~fr., ~_in. <br />Hole 111 from ft. to fr.; in. <br />Diameter <br />fro n ft. to ft., in. <br />EST DATA: , / <br />How Tested u,~' Pump or y' yyBailed <br />Date Tested__/ ___~, 19~ Length~_hrs. <br />Rate S~ GPM Drawn Dowrl_{~ft. <br />PUMP DATA: <br />r <br />Pump Typ utlet Size ~ In. <br />Driven by ~~ HP <br />CASING RECORD: <br />Plain Casing ''__ ~~yy <br />Sizes ~ Kind~from~ft. to~ft. <br />Size-, Kind~from_ Z_2_ft. to~fr. <br />Size ,Kind from ft. to ft. <br />Perforated Cagqsin~~g <br />Size, Kind~Lfrom~_ft. to~ft. <br />. Size KindTfrom ft. to ft. <br />Size ,Kind from ft. to ft. <br />STATE OF COLORADO .Y <br />DIVISION OF WATER RESOURCES <br />OFFICE OF THE STATE ENGINEER <br />GROUND WATER SECTION <br />~ i <br />_ r <br />t.. ,..~r'r~~.1: .`North ., .. <br />wl.t <br />~ 1 <br />I <br />l <br />----Nwv~-- ----Nr,te---- <br />1 <br /> <br /> <br /> <br />~ <br />x ~ <br />~ <br />I <br />~ <br />~ <br />___~d!_ __. .___~.~____ <br /> r ... . <br />1 I <br />~ <br /> <br />_ <br />-.. <br />Eut <br />savfh <br />ABOVE DIAGRAM REPRESENTS ONE FULL SEC- <br />TION. LOCATE WELL ACCURATELY IN SMALL <br />SQUARE REPRESENTING 40 ACRES. <br />If the above is not applicable fill in: <br />No. ~ Str!!t~ <br />City or Town <br />or <br />.. -... <br />Lot Blodr <br />Subdivision <br />(include filing or numtxr) <br />TO BE MADE OUT IN QUADRUPLICATE: <br />Original Blue and Duplicate Green Copy <br />must be filed with the State Engineer within <br />30 days after well is completed. White <br />copy is for the Owner and Yellow copy for <br />the Driller. <br />FOR WELL LOG USE REVERSE SIDE <br />lOG AND HIST~ORY~ OAF QWELL <br />PERMIT NO ~z 3 0 9 <br />~_ <br />al -1'I 131J.I~iI~, <br />VUuli~' U ~u-: <br />APR 121965 <br />GROUND WATER SECT <br />COLORADO <br />ST~Tfi ENGINEER <br />WELL LOCATION <br />.. No <br />Date Completed ~-' , <br />Yield ~~ GPM or <br />