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WELL LOG <br />r-- <br />From <br />To ,_ <br />Type &. Color of Material <br />Water <br />Loc. <br /> iG <br /> <br /> / <br />~_* ~ C, r~y i ~ ,~.~..~~f <br /> ~~ <br /> ~ r <br />' <br /> C <br /> f <br /> ,~ ~ ~ ~r, Z/ ?- , <br /> <br />. _. <br />,.,. , <br />.` <br /> ~. <br /> `~ , <br /> Use addi:ional p9per if necessary to complete log. <br />WELL DA iA - <br />F~ Y- <br />Type Drilling •` ~ %.f'~ {.-~~ <br />HOLE DIAMETER: <br />.,. <br />~ <br />_in. from ~ ~ ft. +. <br />to_~... <br />in. from- ~ ft. to ~ •. <br /> in, from- ft. to <br />CASItQG RECORD - <br /> Plain lasing <br />Siz~~ ( <br />? <br />ft <br />kind~~from to~ft <br />. . <br />, <br />__ <br />. . <br />Size-, kind from ~ ft. to f;. <br />Size-, kind from I ft. to f;. <br /> Perforatr ~ Casing , <br />~7// <br />Size2, <br />kind '1G-1L__from ft. <br />to_.L.~f:. <br />Size-, kind from I ft. to .:. <br />Size-, kind from I ft. to `;. <br />GROUTING RECORD <br />Material Lam;, •' .r ;~~+- <br />Intervals ~ % ~. <br />Placement Method.~c~.,e <br />GRAVEL PACK RECORD <br />Size Intel <br />TEST DATA <br />Date Tested r'r <br />Type of Pump.~.c~L <br />Length of Test ,1 ~'+-:% <br />Sustained Yield (Metered ~ <br />Drawdown <br /> <br />_ I <br />9~ ,.- <br />WELL DRILLE <br />The undersigned, being d <br />says: he is [he driller. o'. <br />described; ne has read t' <br />knows the content thereo <br />of hi~syown kn~o`wledge.~ <br />+ sworn, deposes and <br />:e well hereon <br />statement made hereon; <br />and the same is true <br />State of Colorado, County offc~~~ /~~/ ) ss License No.~_ <br />Subscribed and sworn to before me this- ~•`+` ~ day of~; G~-~/ , 19 ~ <br />My Commission expires-- ~ ~ t '~~a~ ~~ ^-'~"'' <br />Nntarv Pith lir <br />