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F02M STATE OF COLORADO <br />No OFFICE OF THE STATE ENGINEER <br />G14S-9 818 Czntennial Bldg., 1313 Sherman 51.. Denver, Colorado 80203 <br />I'J9? 1703)866-3581 <br />WELL ABANDONMENT REPORT <br />(To Report Plugging and Sealing Wells) <br />PERMIT NUMBER OF PLUGGED WELL Hole No. UC-2 <br />INDIVIDUAL/COMPANY RESPONSIBLE FOR PLUGGING <br />NAME: Monteomerv Watson Minine Group <br />Mailing Address: P O Box 774018 <br />Ciry. St., Zip: Steamboat Sorines CO 80477 <br />Phone: 970/879-6260 <br />For <br />Approval No GWS9-96-OB <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Havden Gulch Mine. Routt County Road 53 <br />SW I/4 NE I/4, Sec. 30 Tvvp. 5 ®N. ~ S., Range 88 ~ E. ® W. P.M. <br />Distances from Section Lines F[. from ~ N. or ~ S. Line, Ft. from ~ E. or ~ 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 no[ in use and was plugged and sealed. <br />Other (please explain) Ce~l nwu..-.s.~~er~wA r.e/l , o6+.ry... eyrr p~.yYlay „D iy(y~ pv ~,e,~,,,a e~ Colee~~b ~rJrs/~.~ .r <br />The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 7. 1998. <br />was olueeed vvitn [he tollowine materials placed at <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT <br />-4 bags - cementPoen[oni[e grout tremie from p feet to p00 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 0 feet to 2 feet. <br />Cut off'?" pvc and 8" protective casing, 0' - 2' <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 statements herein constitutes perjury in the second degree and is punishable as a class I <br />misdemeanor.) <br />TIM HIMES,GeneralManager Date: 10/13/98 <br />Himes Drilling Company, Inc. <br />2390 Hw}' 6 & 50. Grand Jct CO 81505 '~~~ ~-~' <br />970/242-8893 <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 abandortment requirements. This form may be reproduced <br />by photocopy or word processing means. <br /> <br />