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Yvv.1 I.IRr <br />Form~~ ev_) wNOY 2 <br />Index No........ 6~~-.--..... j <br />IDWD. ~ETy-.~Q.... - ...... '' 02 <br />se......V.~m-?~-c. ~/ <br />egistered...7.-. ~.'.~~. <br />'Owner <br />S~ OF COLORADO <br />DIVISION OF WATER RESOURCES <br />OFFICE OF THE STAiE ENGINEER <br />GROUND WATER SECTION <br />Use of Water <br />. D <br />On or By~OT #-~ `~ - Ncres <br />(deraiprion of rife or land) <br />Date Started ~~-ri ~ ~ lq (, 33 <br />Date Complet~ ~ 19 ~! 3 '~ <br />Yield o2 t~ GPM or CFS <br />WELL DESCRIPTION: <br />Depth to Water ~ / ft. Total Depth '~3v ft. <br />(merrured trom ground rurfrce) ~~ <br />from_~fr, tot ~ ft., 3~Or <br />Hole ~ from ft. to ft., in. <br />~iameter <br />from ft. to ft., in. <br />TEST DATA: - <br />How Tested Pump or~~ailed <br />Date Tested, 19 6 33 Length ~ hrs. <br />Rate SS GPM Drawn Down 7 fr. <br />.PUMP DATA: <br />Pump Type . iL.o~Outlet Size in. <br />Driven by l/ HP 3~~ <br />CASING RECORD: <br />Plain Casing ..//.. <br />Size S ~ 0~; Kind from .a ft. to ~f,.7y ft.. <br />Size ,Kind from ft. to ft. <br />Size ,Kind from fr. to ft. <br />~ 6 ~ ~ P~e-rf/oJrated Casing <br />.~ize~oc=~t±rKind~-u from .3 1 fr. to ~`~ ft. <br />Size ,Kind from ft. to ft. <br />Size ,Kind from ft. to ft. <br />Twp ~ 3 S Rge.~xo-Lim , ~-PM <br />LOG AND HISTORY OF WELL JUL 11963 <br />PERMIT NO~~~ 3 o d, ~R'~UND WATER $FC~ <br />./ COLORADO. <br />:. Na. ~/` G 7 WELL LOCATI~jE <br />r~¢..` -~ (~yi-vm-e.,a, 3Gcounty <br />~~~ r <br />~~'/a Of~r/4 Of Sect ' 3~' <br />Wot Ear <br />~~~~o~~~ <br />North <br />, I <br />i <br /> <br />~ <br />i <br />~ <br />___y1MrW __ .___NEi~___ <br />, . <br />~ ' <br /> <br /> <br /> <br />i i <br />~ , <br /> <br />---sw~v.---- ----sE•~w---- <br />~ <br />i <br />i i <br />~ <br />~ <br />- foWh - <br />ABOVE DIAGRAM REPRESENTS ONE FULL SEC- <br />TION. LOCATE WELL ACCURATELY IN SMALL <br />SQUARE REPRESENTING 40 ACRES. <br />or <br />If the above is not applicable fill in: <br />D _ No. ~, e ry ~ ~ ~ Sr~~ <br />city or Town <br />or <br />Lot ~~ 7 ~ ,Block <br />Subdivision <br />(include filing or numher) <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 />