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Haldorson 9703236651 p.6 <br />~'9 <br />>~ YIIB.L CxNrSTT~JCAOH MID 7P5a T RI~OFiT <br />STATE OF COLORADO, OFFICE OF Tt+;E STATE El+ZG1Nt~R Fu 06oe Um ~Y <br />,. we.~. err rites a s y io7 e <br />~L WNFliNAME(by !fal~orSOn and Sevts Znc. <br />Na-Ing Address P. D . R nx /tl 19 <br />+SLTIp 1?7nriFreer ('~ <br />Rf~{(]~ <br /> _ <br />P-wne (9 0) a - Ss <br />8 WEt1 LOCATION AS OROlID: $ t- t!4 ~,l4, Sec_ ~' Twp.~,_ N ,Range l r) W <br />DIS7ANCE3 FAOM 9EC. LtdE$: <br />~_ R Nom • / Sec Gne. tmd / a ta 4 R lranSeC. lure. OR <br />SUBDM&IDN: LOT BLOCK FttJNG{UNf[] <br />SiAEET ADDR>~SS AT WELL LOCATION: <br />A GROUND SURFACE ELEVATION R DFt~L11VG ME"IHOD f1'.'r ko fa v-T <br />DATE OD61~LtfED 1-1 3 - O N .TOTAL DEPTH R DEPIIi COMPLETED O' ti. <br />S {iE0LOt310 IAB: <br />oepn, !?escripeon d (type, Sce. Com, wale I.oe~orv 6 HOLE DIAM. (n.) From (R) To (K) <br />S " 0 3. S ' <br />/~ •' 3. S <br /> <br /> <br /> <br />- 7. PLAIN CASt<3G <br /> OD (m) iGnd Wall S~ From(t[j To(tt) <br />.S7 '- G r/' /9/C ,~_y~ alaJe_ - se li G S/P'• S fee.( . ( f~ !.5 <br /> <br /> <br />1 <br /> PERF. CAS9~G: Screen Slot Size: , 0 3 a <br /> .~•• FdC .350 lam' ' <br /> <br /> <br /> <br /> <br /> 8. FfLTER PACK: 9. PACI~FI PLACEMFIJT: <br /> idaieriel Pea. ~ ra v~ I Type <br /> Sc28 3/g <br /> IlttelirJ~ p' Depth <br /> <br /> 10. GROUTWG RECOF1tJ <br /> idatedel Amomn Density Irnerval PLacemert <br />REEAAE~BeCS: ell - vet /' a <br />ua'1'ff QHaOKH feel'f r0 ~7a. ~t (~i~. ~~ins CunerrJ" ).56.~ /Se~dl Ofe7 ~a4I~ <br />l <br />, DLSNFECTION: Type !~T N - L 5?0 <br />Amt Used /a o ppp~ u sell ~ n dr.71,~ trr <br /> W~ EST D0.TA: Check bmc T Test Data iS subndtted on Form No. GWS 39 Supplemertai Well Test <br />TEti'I'!NG ItAE77')OD .4i r .- // ~FF . <br />Slaec LavRl ~/1' R Datell'Yne measaaed [-13 -01F /~ : r 5 /.m. Prodtction Rate ~/~ 0 9Pm- <br />Pumpirp leYd /4~' _ tt Dete/T~e measured t -/~-eY 1~ :OS ~...,. Tes[ tert9th (hTS.1 %z <br />Remarks f / <br />3 t Aan and the ateeleeeeb reds harem and 6eae tlfe oartarme Owed. and Uwe Mey an+riue m my kwruledga. lPiuauant m Sedon 2a-c-ro- p~ <br />GR8., tM nwWap d fiM ahlwowda Mein perjury ii tlw aeeond daeroe oral ie puniehabk m e dem 7 misdomeenerj <br />GONfAACTOR,~L~/ladca:lF O.-.'(1,:,c i /D~..,o Lnc Phone (47n 1 5156 -G SB.3 Lic. No. /ash <br />Mail' Address /~.0. Be T ~~ / / <br />Name(rit1B (Please LYPe ar pdrt) <br />.73.7! D. !~! scree. ~Pres,ole.e>~ Signature <br />~ Date <br />~ "al -D`{ <br /> <br />