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ewes, NOTICE OF INTENT t0 CONSTRUCT MONITORING HSJ ~ <br />,ms Please type or Print legibly in b(aele ink U X999 <br />I ~T arAYE <br />~, landownersNaroe (Nds"t ^y't`rc• WeUOwner'sName o~N4-"'~~ ~~ <br />le Wt(on: ~~ yG. ~_k. Section 1.~.+ Township ~ N~ Range to B ~~ FNI, County re w .r~ <br />IIp1eJs1 to be Constructed: Number 3 Estimated1DepM /O0 l Ft. Type /{ ~ ~' (~ V ~- OM <br />Purpoat oT Monitoring Hok1s1 4 Yet+N d t~ai.~1 ~ ~ ~ i a/r r~ <br />Approairtate Data of Cm,ateueden DA9ex lic. No. Gt appGoabto) '~ <br />Conaubant er Driller 'Rae ~°d0+-~rce Geosvc+r c¢ .~.re tYtone 17/~~ Go9S-o2z9 <br />Contact oAlnld cT Tw.sG/~_ ~-~ Fax No V/~~63.5"010to_ <br />Address f• ~ ~ l~r ~~~..rc~~ ~ eve. <br />C(ry,State,Zq+ ~' ~ere.ds •~rrat43 ~ 80`?a3 ly _ <br />t.ll+ <br />ACKNOWLEDGEMENT FROM STATE ENGINEER"S OFFICE <br />FoR OFFlCE UsE ONLY <br />35582 <br />MH- /~/y, pttocESSt[o BY /^ <br />DATE NoTw'E Rr#1vED ~~ ~' 1- t DATE AcKNOwLEDGEO ,~ ~ ` r <br />DIV, o~ CouNTY ~,,,aa vuD ,,,~~,_ Cag01)ND EtEU USGS MAP No. <br />CONDITIONS OF MONITORING HOLE ACKNOWLEDGEMENT <br />A COPY OF THE WttITTC~fd N011CE OR AtxtNtiYV4f~6Btli;r(i St1ALl BE AVAAABLE AT THE bRU11fdG SITE <br />!!+[(a+ waq provread to tlw Sqb tydlnq+r +t 0.gae S deye prlW to oansatauMn or AWre~Oltfld 8 obaervaWn Imis(q). <br />Censnuei.en of the halsla) must ba Oompkte0 wilMrt 90 daYS p1 the date pedea ,wan Olrmt to tttq State 6nyL,aer. <br />Tadny +ndder pwePira shag net gXeeed a teen( of 200 Mews unlau priof wllGere apprwol 0. obtained tram the SR+ta Engineer. <br />W+tw dirafted during teatY,d P~ 1L4S tw uwd for t+enslieigl pwp+q+a. TM owner of the hetele) k reaponattds Ter etngh,ing <br />permt[tsl and wmplytng with ad rules and resptbtlom pvtslNna, m Ute dbx:herpe of 1luldc produced durln¢ tasting. <br />All work must comply with thq wgtpr Wsp Cansauction FOdec. Z CCFt 4e2-2 Il~uebMam eenpaueeiolt ttandgrdc must M met a <br />a var)ar,c. ebarined <br />Well t:011aVUedan Ord Tact Repork 16WS~SU muR bs svbmMed to t(im olfiee by tM Seatsed eoneraator a authorised indirrAral <br />Mitltil, BO tky: eT the eompMlien el d,a week. Apptloetiste se permit e0at4,0 montmt•,a and obaanadon Mtas tdwuN roreranae <br />the MM number under whkh the rarer[ was feed a M eecempe,ned try a copy of the raper[. <br />t)rdsaa • weq psrmA is sbtai,ed, tM heNW mace be plugged atd sealed wnhkt ons (t) Year amr wnstruetion. An Abandonment <br />Repert (term GtNS•a) must be atdunkted witbir, 6'O days of pludplnp lk seaikq. <br />The owner of tM Mk(ai elt«dd matntaB[ rceorda of water mraity tesdn0 end subn,R thin dare to [Ira sate Eriyrser upon request, <br />The metdtotina M1e rAUr,her, owe,er'a atruenes name and Mk owner's rams and sddreso must ba pro,Aded tm a0 wep permle' <br />appTieadetdal. wag cettstrue6m[ and abandormettt rtyoAe. <br />A moettorinp Mk an net be eonvertsd m • produettm, wets wad lothe than a Iewvsty we(q unksa the hole m wall was <br />oridrtoMy wnsOVe[ed by a ficeread wep cotextn,ation wmraotor. <br />TtOS ACKNOMIL~OtTa@IT OF NOTICE OOl3S NOT IaICIGATE Tt1AT tlYEll PBtg11T(S) CJIN ttE APPROVE. <br />Adfr[jsr,rl Cor[d(tb.s <br />`/ <br />COLORADO DIvIS10N OF WATER'RESOU(tCES-1813 SHERMAN ST'-itM 821-pENVER-CO 80203 303~8663681/FAX 303.8663L8: <br />TI"IT/~I O ryi ^I <br />