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FORxt STATE OF COLORADO <br />No OFFICE OF THE STATE ENGINEER <br />G WS-9 818 Centennial Bldg .1313 Sherman St., Denver. Colorado 80203 <br />t'-l9' (3031866-3581 <br />WELL ABANDONMENT REPORT <br />(To Report Plugging and Sealing Wells) <br />PERMIT NUMBER OF PLUGGED WELL Hole No. LC-2 <br />INDIVIDUAL/COMPANY RESPONSIBLE FOR PLUGGING <br />NAME: Montcomerv Watson Minin¢ Grouo <br />Mailing Address: P O Box 774018 <br />City. St., Zip: Steamboat Sorin¢s CO 80477 <br />Phone: 970/879-6260 <br />USC <br />Approval No. GWS9-96-08 <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Havden Gulch Mine. Routt Countv Road 53 <br />SW I/4 NE I/4, Sec. 30 Twp. 5 ®N. ^ S., Range 88 ^ E. ® W. P.M. <br />Distances from Section Lines Ft. from ^ N. or ^ S. Line, Ft. from ^ E. or <br />W. Line. <br />We report that an existing well was plugged and sealed for the following reason (s): <br />^ The well was plugged and sealed as required under the conditions of approval of Well Permit No. <br />^ The well was not in use and was plugged and sealed. <br />Other (please explain) <br />.+e.Jl <br />ww~ <br />The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 7. 1998. <br />was <br />at <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT <br />~i bags - cement/ben[onite grout tremie from p feet to 2d0 feet <br /> from feet to feet. <br /> from feet to feet. <br /> from feet to feet. <br /> from feet to feet. <br /> from feet to feet. <br />INTERVALS OF CASING REMOVED/RIPPED IN FEET from p feet to 2 feet. <br />Cut off'?" pvc and 8" protective casing <br />I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section <br />24-4-104 (13)(a) C.R.S., the making of false statemenu herein constitutes perjury in the second degree and is punishable as a class I <br />misdemeanor. ) <br />TIM H I M ES, General Manager 1 Date: l0/ 13/98 <br />Himes Drilling Company, Inc. <br />?390 Hwy 6 & 50. Grand Jct CO 81505 ~~7"t -t"7n'C" <br />97024?-8893 <br />INFORMATION - It is the responsibility of the well owner to have the well properly plugged and sealed. The well construction <br />contractor is responsible for notifying the well owner of the plugging and abandonment requiremenu. This fotm may be reproduced <br />by photocopy or word processing means. <br /> <br />