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Ft;:-n~ E (Re c)~ 1 1 I~t)I <br />~=57%5M STATE OF COLORADO I~~~jG~O~~® <br />Index No. y_ DIVISION OF WATER RESOURCES <br />IpWS~ OFFICE OF THE STATE ENGINEER i+~V 2 ~ 1~~ <br />Regisler~d(~~11___~ GROUND WATER SECTION ;ROUND WATER SECT, <br />Cards Trwd ________ COLORADO <br />• LOG AND HISTORY OF WELL STATE ENGINEER <br />PERMIT NO. r ~3//-~ <br />Lic. <br />Drilled by p~~ yjiff ZZ,S No. ~~ WELL LOCATION // <br />Co LO F EL .3fO <br />Owner ]~~ ~1,; Zd j%/1 /= - ~ /~dj?•~c~ ad - County/ <br />Address L3/J•t' /g?/) ~f/'li~E~ /~i)Z(, ~C ,i-, of ~ ~ of Sect. <br />Tenant Twp. 3 8 Rge. ~ ' PM <br />~_~ ~~ ~ <br />Used for /~ /~//,S % /P~ /{_ z f///~~pyt-S LOCATE WELL ACCURATELY <br />IN THE SMALL SQUARES REP- <br />on or by ~~jp /p /9 ~ / PRESENTING 40 ACRES <br />(description of site or land) <br />Date Started iQ-/j~ `~ p 19 lp/ <br />'Date Completed SAP ~ 19/¢ / <br />Date Tested ~ / yam' 19 /C / <br />'~Yfeld S~ gpm ~i¢~~~/~cfs <br />Pump type fj~~Q 71ifz.butlet Size S' <br />• Driven by /~~ HP @ RPM <br />Depth to Water~Ft. Draw down~~Ft. <br />~D <br />Depth to InletA~~ Ft.; Bowl 9l~ Ft. <br />Size and Kind of Casing: <br />From~~to~_Type~~Wt. ~ °.~ <br />From~_to /JJ1J. Type_ ~~~ Wt.~ <br />From to Type Wt. <br />Perforations: Size and Type <br />N <br />W <br />I <br /> <br />--T -- I <br />1 <br />---i -- <br />I <br />e <br />~ I <br />I <br />I <br />---(-- <br />I <br />I I <br />I <br />-- rt'- - <br />I <br />I <br />S <br />If the above is aot applicable <br />fill in: <br />E <br />Town or Subdivision <br />Street Address or Lot & Block <br />From to Type Size Ground elevation <br />/i (if known) <br />From~to B'd. Type,~}ze <br />6/STS How Drilled: <br />From J/ to /!~!~ Type = Size~r ~ ~~,/,ej- ~ ~~ j' 7k~ 7 Q' <br />Well description: Total Depth /DD Ft. <br />Hole ( %~ <br />(from ~ to /Lid Sj'r' in. <br />Diam. <br />(from to in. <br />TO BE MADEIOUT IN QUADRUPLICATE: Oz <br />State Engineer's Office, White copy to Owner, <br />REMARKS <br />Cementing, Packing, Type of <br />Shut-off, Depth to Shut-off, etc. <br />PUT LOG OF WELL ON RE- <br />VERSE SIDE <br />ow copy :o Driller <br />