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<br />.Faint STATE OF COLORADO For ofliee Uu only <br />~No. OFFICE OF THE STATE ENGINEER <br />~'~ 821 Centennial Bldg., 1313 Sherman SL, Denver, CO 80203 <br />06rOD (303) g66~358/ Fax (303) 8883$89 <br />WELL ABANDONMENT i2EPORT <br />Type a print In black irik <br />Well PermN Number of the vrell bueing p ulul gged ~~0 7~~ RECEIVED <br /> <br />~~yy)d~.mN(`.xr.,a rnxrondhte for t9uer~,~rwl tealtrto Nte wain ~ DEC 0 4 2002 <br />~ Ra'-,- Ii.=tom; 1 J~A?F Q!l71 <br />NAIUE(3)~vt Sri t~I' Ws ~~ 9 . <br />. <br />~ <br />toAO <br />i <br />*~ <br />9~ V . <br />~ <br />~T <br />Melrrp Addreae <br />. <br />i <br />st.np -Golc~a•;, <br />~ f1a'fR'i.-~.~ <br />cxy <br />~ <br />, <br />. <br />Pttorro (~03_) - 650 ~'a 3~u9 ~ . <br /> <br />ACTUAL WELL LOCATION: (booty ~ ~. . <br />I~mperly Address /08'08' Hsi .. -S'3. ~ Go1.s/err Co. ~~S'o3 <br />'' <br />tadaraes) . tcey> <br />Ismce) cao> <br />1 <br />2 U <br />SW <br />~~ <br />~ <br />s~ <br />® <br />,7wp. <br />N.a <br />S., Fia <br />~g <br />Ea1S1W., <br />P.M. <br />1/4 of lhe <br />e <br />i/4, Secy <br />'-' <br />l <br />~ <br />g <br />~,( <br />. <br />pkfMSe rtom seatlon Lkree 7 ~y 3 FL Fmm ~ N. aC~ S.. ~_.(„=~ FL From ©E. or IJ W. Wie. . <br />Suhdwtsbn Name ~t/~iQ tot ~ Block ~. Fang/Unx ~ . <br />I (we) report tlral en edsang weA win phgged end eeeled for the toeoxirg rdesan(s): ~ ~ . <br />^ The well was plugged end sealed as required undo Web Permtl Ntanber <br />gad and eealed. . <br />^ The well was rrM 4r use acrd was plug <br />// <br />r <br />n~.l Other (please eiylehr) orJ/7bi-i G,/e,(~ a6exi~ant°r~ q„{~a~Y/- ~ ~e ~>~ <br />s~/e osz~~e <br />G,iL/~ Gt~s tz~e .+. ~ r6 a rsa <br />~Js~4~~-to'r- <br />. <br />g <br />the date las well was plugged axerl8rg-to the Weler Well t:ort><tructlon ITtdee was ~- / "'~ Z- <br />~ <br />. <br />The well was plugged vdlh the krfbwing ritetedeh placed at aw tttnaatea Irttervsts: ~ <br />Amount and Type of Me~te~al / of FlaEement Interval <br />S <br />' <br />~ <br />P <br />z <br />o <br />Crot <br />~ .from IZS. ~feetto <br />`~ <br />~d1S /6/YO .57/87 <br />feet . <br />p <br />~ <br />~ <br />S U,~or h09~/~ ~C ham z.0 taetb~_feet . <br />s ~ ~r~lc from `/'/~ Teerto-~ ~ rear <br />ahe. at cede ~+%' rmm3 <br />O teetro 2.0 .teat <br />> <br />Intervals of casing rem v-edMPPed in tea! ~ ~ ~ fromJ.O ksl to ~ ~ feet <br />1(we) trove read the Metemenb made herein. ktow fhe cotdetd5 tltereo4 pod Drat they are true to my (our) gravAedge. <br />F~ease prird me Sigrtels IJttme a Tine Signatltre(s) Dace <br />Steven R. Schiwwavnht ~~ <br /> ,, . <br />Reaity Officer // / o L <br /> <br />I[ is the responsibllay of the well owner to have the web properly pitx~ged end sealed. The Wall Cottshudton CdttraGftir (s <br />restionsible for notlfyirxl the owner of tMs requlrentent. <br />