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STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />"WELL PERMIT NUMBER 039618-N <br /> OWNER NAME(S) Holnam Inc. <br />Mailing Address ox <br />City, St. 21p LaPorte, CO 80535 <br />Phone ( 303 ) 482-5603 M~'-3 <br /> WELL LOCATION AS DRILLED: SE 1/a NE t/a, Sec. 7 7 Twp. 19 ~_, Range 68 W <br />DISTANCES FROM SEC. LINES: <br />2300 tt, from North Sec. Iine. and 150 ft, from East Sec. line. OR <br />pe,a w .aural - p.~ ~ `+.o <br />SUBDIVISION: N/A LOT_,.,,_,,, BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL. LOCATION: <br />~~ GROUND SURFACE ELEVATION 5092.7 ft, pRIWNG METHOD Rotary Air <br />DA7E COMPLETED Sept. 13, 1991 TOTAL DEPTH 71 ft DEPTH COMPLETED 71 h. <br />GEOLOGIC LOG: <br />oan p..vlpa d 4urW Rrp., soa od«, w.ew Ioc,monl fi HOLE DIAM, Vin.) From (ft) To (h) <br />6 0 71 <br />~- a careous ., ra 1ne- ra~ne , <br />~ <br />we cemen e . <br /> 7. PLAIN CASING <br />71 bra friable sit sandstone me ium OD (n) Kind Walt Size From(h) Ta(tt) <br />yrained, oosely consolidated. 4 Steel. 1/4" +3.5, ~_ <br /> <br /> <br />1 Standin water at de th of 5 ft. ~- <br />- <br />elev. 5087.7 ft. <br />immesh <br />PERF. CASING: Screen 'Slot Size: <br /> 4 PVC Sch. 40 -Z -71 <br /> <br /> <br /> <br /> <br /> 8 FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Sand Type <br /> Size - mes <br /> irrterva! -2 to - Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />'aMARKS: on for we Cement 0-2 ft. <br /> <br /> <br />'DISINFECTION: T N/A Anrt. Used <br />WELL TEST DATA: ^ Check bax if Test Data is submhted on Supplamemal Form. <br />(TESTING METHOD <br />Static Level it DateTme measured ,Production Rate gpm. <br />Pumping level fL Date/Time measured ,Test length (hrs.) <br />Remarks <br />1 N,w rrA Er abmmwm nttl~ Iwrdn rd (vow On mnwva As~al, a+d OfQ May ~ a,n m mr ImowMdO~- I~~v m Se.tim 24-a-1 W It71(~ C.AS.. vie mav:n <br />d 4W avaonnno n.~in mmdvJer palvy In Ru .ecod dv0~ Fwd i. pn'sheds a ~ dm f maiesnsro..1 <br />I3p(fp,ACTOq N/A Phone ~~ Lic. No. <br />a~fmg Address <br />ne/I'rtle (Please type or prim) <br />ly L. Stienmier/Chief Geologist Signatur <br />~ ~ ~ Date <br />~/~ /S 9i <br />