Laserfiche WebLink
FOAM NO. <br />GWS-9 STATE OF COL DO <br />~ or Office Uae arty <br /> <br />~~aa OFFICE OF TH <br />ATE ENGINEER <br />• 818 Cerrtenniel Bldg., 1J13 Shsrmen SL, Denver, Colorado 80203 <br /> (3031 ess-3set <br />E OR PRINT IN BLACK INK <br />WELL ABANDONMENT REPORT <br />ABANDONED WELL NUMBER IF REGISTERED <br />1. INDNIDUAL/COMPANY RESPONSIBLE FOR PLUGGING <br /> NAME{S) Battle Mountain Gold Company <br /> Mailing Address 700 Milan, P. 0. Box 1383 <br /> City, SL Zlp Houston. Texas 77251-1383 <br /> Phprle3( 71 ~) 220-971 q ~~__~,~j s _719-672-3362 <br />2 ACTUAL WELL LOCATION: COUNTY Costilla <br /> PROPERTY ADDRESS 3 1/2 Mi. N/E of San Luis cyy r.,,;~, ~ ('n 81152 <br /> (Addrw) (City) (State) Oral <br /> ~_i/aNLE 1/a, Sec. 30 Twp. 32 ^ N. ~S., Range 71 ®E, ^ W, 6th p_M, <br /> Distances from Section Lines 8 5 0 Ft. from ®N. ^ S. Line, 3 0 0 FL from ®E. or ^ W. Line. <br />3. I (we), report that an existing well was plugged and abandoned for the following reason( ): <br /> ® The well was plugged and abandoned as required under the condRions of <br /> approval of Well Permit No. 0 3 3 5 3 5 -M <br /> The well was not in use and was. abandoned. <br /> ^ Other (please explain) <br /> <br />4. The well was plugged and abandoned according to the Water Well Construction <br /> and Pump-Installation Rules on , 19 <br />5. The well was plugged with the following materials placed az the indicated intervals: <br /> AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT IN'IrERVAL <br /> Super Plasiciser admixture cement from feet to feet <br /> Approx. 3 cu. ft. of grout trimie from~ieetto 10'feet <br /> NOTE: Well aRnears to have bean rtrontarl from from~feet to feet <br /> 100' to 22' before we grouted the last 12' from feet to feet <br /> o f <br /> INTERVALS GF CASING REMOVED/RIPPED IN FEET from 1 feet to 0 feet <br /> 10' below ground level trom feet to feet <br />-~ <br />6. I (we) have read the statements made herein and know the contents thereof, and that they are true to my (our) <br /> knowledge. [Pursuant to Section 244104 (13)(a) C.R.S., the making Di false statements Herein constitutes perjury <br /> in the second degree and is punishable as a class 1 misdemeanor.] <br />Name/Tit1e (Please type or prim) Slgnazure Date <br />Irrigation .Engineering & Supply Inc. <br />A. Meriwether, Sec.-Treas. ~„~v. 8/8/95 <br />-INFORMA770N- It is the responsibility of the well owner to have the well properly plugged and abandoned. <br />The well construction cornractor is responsible for notifying the well owner of the plugging and abandonment requirement <br />This form may be reproduced by photocopy or word processing means. <br />