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"a"'"' <br />ras*Z ` WELL CONSTRUCTION AND TEST REPORT <br />$T'ATE OF COLORADO, OFFICE OF THE 3TA ~ fnr Olfloe ua. aiy <br />RECEIVED <br />,. wEI.L PERMIT NUMBER '~ 3 <br />[C <br />2 OWNER NAME <br />(S),l..'/6e~.s r-vt ~ Tns.. U. Ltr.. <br />MalpngAddreas Ao. Qe. x.73 <br />Cky, St ZIP [3rd,.r`~ ee AoyyL <br />Phone ( ) 1 1 1995 <br /> <br />wAi6tPESOIttCES <br />STA <br />3. WELL LOCATION AS DRILLED: x_1/4 ,./E 1/4, Sec., Twp.~ ,,,~ ,Range 7 [ ~_ <br />DISTANCES FROM SEC. ONES: <br />1P/r ^ R hom ,r Sec. line. and ~e3o ft from s~st Sec. line, OR <br />SUBDIVISION:Granl~ D:~idt N~.d Letf'~rat Ge. '° LOT_/~BLOCK FIUNG(UNfn <br />STREET ADDRESS A7 WELL LOCA710N: <br />4. GROUND SURFACE ELEVATION 1 ft. DRIWNG METHOD ~ ~ r ~c'f a r V <br />r-= <br />DATE COMPLETED o _r3_ .TOTAL DEPTH r R DEPTH COMPLETED '1S' R <br />5. GEOLOGIC LOG: <br />ppN puriptlon or McQarlil (type, Size, Cola, WaHr leoatlon) B. HOLvE DIAM. (in.) From (ft) To (ft) <br />QT` O _ 3-S <br />~ ~ <br />~~ <br /> <br />`~ .T1: ~ o to !'r/ Q M ~' aL R w.0. V. ~ _ <br />_ <br /> <br /> 7. PLAIN CASING <br />jj <br />2fJA1QM SS' -looP(/1 O <br />D <br />(m) Klnd Wall Size From(ft) TO(ft) <br /> ' <br />y <br /> P/< .goo <br /> <br /> <br /> PERF. CASING: Screen Sbt Size: p,.: Il. d r <br /> uy, Pv ~ , moo ~,~ <br /> <br /> <br /> <br /> <br /> & FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Type <br /> S¢e <br /> {marvel Depm <br /> <br /> 10. GROUTING RECORD: <br /> Material Amoum Derlsny Interval Ptacemem <br />REMARKS' e e ],$~,ry ~[~t' f~sK' P,T <br /> <br /> <br />, DISINFEC710N: T e Amt Used Z. o <br /> ,WELL TEST DATA: ^ Ch box if Test Data is submitted on Form No. GWS 39 Supplemental Well test <br />TESTING METHOD ~- L ~ f r <br />Static Level eft. DateRme measured o~r3- r ''ooP Production Rate_/~ gpm. <br />pumping level ~_ft. Date~me measu2d_ 1e - r~ -e .Y - L_ ; e o M Test ~ngth (hrs.)_ <! <br />Remarks <br />3 I have road Ns stittemsms made herein end know Ne eomerds Nered, and that Nay ere true to my knawbdge. (Pursuant a Section 29+104 (1~( <br />G0.S., Ne making of false sffibmerds herein cotatitutes perjury in Ne second degree and ro punishable a a elnse 1 miedertaarror.] <br />CONTRACTOR m~ 1JJ, rto,. 7ri ll..ta C., Phone (~f7n] AFB-394._7 Uc. No.~T <br />' Addr .a o <br />Name/TRle (Please type or print) Si natur Date <br />~ ~;y~t- t2-~-45' <br /> <br />