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~'~i0' <br />roro+ WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For oreoo Use onN <br /> <br />t. <br />WELL PERMff NUMBER N~ ~ P1) •. <br />~'~ <br />2 0WNERNAME(S) Nel..ta... =..r~. <br />Mailing Address 3500 S+ofa N„ ..,..., 1 Zo <br />Ciry,St.Zip FloYe..e.e.; to tatz2b <br /> Phone (7/9) - ro3z.S <br />3 WELL LOCATION AS DRILLED: SE t /4 S F 1/4, Sec.~_ Twp. f 9 $ ,Range (0 8 W <br />DISTANCES FROM SEC. LINES: <br />rZac fL from se,.~ti.. Sec. Gne. and 35o ft. from east Sett line. OR ... <br />-pmrnrarsatm>i "-(sasrar'wes9' <br />SUBDIVISION: LOT BLOCK FIUNG(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 5ob3 ft. DRIWNG METHOD a.tr ro~-4.ry <br />DATE COMPLETED S- 3l - o c .TOTAL DEPTH ZG fL DEPTH COMPLETED Z ~ fL <br />S GEOLOGIC LOG: <br />OCation) <br />Depth Description of t <br />datarial [rype, Size, Color, Water L 6. HOLE DIAM. (tn.) From (ft) To (ft) <br />(o O Z!o <br />LL <br />/ <br />O ~ ZV SsLN c f'eNe, <br />, l~Y~V 70 ~T I~r~ <br />~ <br /> 7. PLAIN CASING <br /> OD (in) Kind Wall Size From(ft) To(ft) <br /> <br /> <br /> <br /> <br /> PERF. CASING: Screen Slot Size: %a a dr:l/ed <br /> /.5 ~ /c. ~sc./. o z! z <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material 5i/rc.o S...rl Type <br /> Size 8 t tz <br /> Maerval /S - 2 6 Depth <br /> <br /> 1Q GROUTING RECORD: ' <br /> Material Amoura Densely lrnerval..Placemern <br />REMARKS: Ci.p.a nr w.-. cr ivy ~ (btu}a+. ~~/~ 3-/S' ~~n„rsd~ <br />1 AISINFECTION: Type Atrq. Used <br /> VYELL TEST DATA: ^ Check bout if Test Data is t;ubmitted on Form Na GWS 39 Supplemental Well Test. <br />TESTING METHOD ~1..+~ <br />Static Level Zo.59 ft: DateJTlme measured 6- -co '° R Production Rate ""' aptR <br />Pumping level ft. D~e/Ttme measured .Test length (hrs.) <br />Remarks <br />3 1 nave rasa mo statamems made fuxein and know the comers tharoof, and ihat ftusy are vua fo mY knoaAedga. [Pursuant to soa«t zaatoa n~ (at) <br />C.RS, tho making of fatso statemams herein constitutes perjury in ttta second tlegree and is punishable as a class , niisdemeanorl <br />CONTRACTOR. Phone (_,~ Uc. No. <br />Mailin Address <br />Nam tUe (Please type or print) <br />r/.rr _.7r .7. .~.. S''',~,^''*~u <br />'~ //_.~~I~...~ Date <br />/_O_ni <br />