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RADO For Office flee onN <br /> iTATE ENGINEER <br /> .7313 Sharman St, Dames, Colorado 80203 <br />LAMENT REPORT <br />nd saa~Rnp Waasl <br />IGGED WELL N A CP. cFe~ ice- ~ <br /> iPONSIBLE FOR PLUGGING <br /> er. Jn..~ /~ S ~Co., .ANC. <br />~ <br />{ <br /> ver L4.~e_ <br />~e~ Cl <br />o - <br /> '}' Cp So /3z <br /> S'Z <br /> Coulunr Frc~aN~t- <br /> D SC~~- I'~ia~.~c.v lZD~ F/ere,ac2 ~ ~~~3Z <br />~ <br /> lStata) f7ipl <br />drascl ICityt <br /> / ? Twp.~_ ~ N. ®S., Range Co 8 ^ E. <br />©W. 6~ P.M. <br /> ffvv~~ <br />(~ Ft. from ^ N. ®S. Line, 3vr'o Ft. from1~1 E. or ~ W. Line <br /> g well was plugged and sealed for file following reasonts): <br /> id sealed as required under the coruGtions of <br /> ~o. <br /> The well was not in use and was dogged <br />and scale <br />d. <br /> / <br />n <br />t <br />® Otfier (lease explaiN ~/¢Zo.xG~r r-~ u.D4.~+~e u el 7 0 o.~(ow ~ e..o_r.^ <br />[ <br /> I ) / <br />0. Y'24 'TO a bG- ~R ~ t.J 0 1fL.{ Yd A7 QTC. •[ <br /> <br />4 Tire well was plugged and sealed acceding to the Water Wetl Construction <br /> Rufes on F ~ Z(o , ty3?ml. <br />5 The weU was plugged with the following materials placed at the irK&cated irrtenrals: <br /> AMOUNT AND TYPE OF MAT@ilAt INETtiOD OF PLACEINEIH7' INTERVAL <br /> ~eN-~ti ~ t.~ 4,•e..-I- ~~- 3 v 4 /(a.~.s~ ~De....-ed free O feet to Meet <br /> S; I :cr,. Sa...d ( l 6w~) Do4rcc~ from !a feet to Z~ feet <br /> from feet to feet <br /> from fee[ to feet <br /> INTERVALS OF CASWG RENIOV®JRIPPED W FEET from- o.S feet tot 3 feet <br /> from feet to feet <br />6. 1 iwel have read the sgmrrlarts made hendrl and latovr the corrterrts thereof, arm that they an: true m my (our) <br />lurovrledge. [Pursuant m Section 244104 l13)la) CRS., the rrlaldrrg of false staternerrts heron constitutes perjurl <br />n the serbnd and is ~ a loss t misdmrlearmr <br />Name/Title (Please type or pried dune Oats <br />oNa~~ ~ T rwei- /~-~. fro _ !~ r. . 3 /S-o / <br />I-INFORMATION- It ~ the ~ of the well owner to have the weN properly dugs old sealed. The Well <br />Constrtrcfiar Carrtracmr is responsirle for notifynrg the waU owner of the phrp~ and ~n8 aetprirerr~ent. <br />This form may be r~roduced by PPb or word processerg means. <br />