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<br /> <br />`°"" "°' W CLL CONST TION AND TEST REPORT <br />°MA 31 <br />;~~ STATE OF COLORADO, OFFICE OF 7HE STATE ENGINEER For slice Uae only <br />1. WELLPERMR'NUMBERMN-374/0 haw-8) <br />2 0WNERNAME(S) o/wean, S,.re. <br />Mailing Address __3Soa S1-:. a L!'g tv /zo <br />City, SL Zlp F/n.ew+ce ~ CO B/2 /. <br /> Phone (7/ ) S•/- /Zo9 ' <br />3. WELL LOCATION AS ORILLEO• NE 1/4 $ E 1/4, Sec. 1-7 Twp. 19 S ,Range Co 6 W <br />DISTANCES FROM SEC. LINES: <br />2200 1t. Irom S Sec. line. and 50 ft. from ~ Sec, line. OR <br />SUBDIVISION: L~BLOCK _ FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 5175 It. DRIWNG METHOD Air ttanrwte/ <br />DATE COMPLETED 5~-/$ - oo .TOTAL DEPTH //i3 ft. DEPTH COMPLETED /! ® ft. <br />5. GEOLOGIC LOG: <br />Depth DsecripUon of Material (rype, Size, Color, Water Location) 6. HOLE DIAM. (in.) From (ft) To (it) <br />/O D 83 <br />~ /~3 <br />8 <br />O- ez L%MC3 ovule s c rr.6A/e 45 - <br /> <br /> 7. PLAIN CASING <br />B2 - //8' Sv..As_ e,ya , ~~ OD (in) Kind Wail Size From(ft) To(ft) <br />AIFGrw+o~'iwlc ~ ro,.am 'l'o H: grsy 8 ea 0.322 ~ t 2 6 <br /> <br />l4. ~r.~.r .Cr..,. 95- //Sr 'f ~VL Sa1.,'fo //3 <br /> <br />r.,i f. ~ a <br />/LB ~ - /5'3 S . e PERF. CASING: Screen Slot Size: o, oro" <br />~, <br />~ ~ ~ VC 5~1.. yo ~~ <br /> <br /> - <br /> #' Set., ~O ° O./2S" r.-'e(/ Sir <br /> <br /> e. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Colorado $,,l,e~ Type <br /> Size / o - 2a <br /> Interval 3I - 1 ?~' Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Atttaunt Density Interval Placement <br />REMARKS: .-~ ..ae a o. a ,.v s ~ <br />9 /a tsL lien o - B~' a wad 4 r.~-fed ro.`f' ' 6~.~ ~s.ck ~%r o- 83 ~ n.+r <br />.. " D - ZG .. <br />j ~ <br /> tu'i~' ~,~It <br />~'w+.~lt l <br />1 DISINFECTION: T e Nova- Amt. Used <br /> WELL TEST DATA: ^ Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD Nowra <br />Slatlc Level /05, ro h. Da1e/Time measured S a oc /2. o ,Production Rate gpm. <br />Pumping level fL Daze~me measured ,Test {ength (hrs.) <br />Remarks ' <br />3. 1 have read the slalemenle made hersln and Mnow the contents thereol, and Ihat they are Uue to my knowledge. (Pursuant to Section 244104 (13)(a <br />C.FLS., the making o{ false etalamenb hersln eonalilutee perjury M the second degree and Is punishable u a class 1 mlademsenor.] <br />CONTRACTOR Phone (_~ Lic. No. <br />i I ddr ss <br />N me(T//die (Please rype or print) 1 ~}. <br />~owaar~ '-j, /,+r,.+e% /~t7. Co A+Jc./7cW r Sig ~/~ <br />O'YLli`~ ~ DatSe q <br />- / - ~ ~ <br />