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Folta STATE OF COLORADO <br />NO OFFICE OF THE STATE ENGINEER <br />GW S-9 g18 Centennial Bldg.. 1317 Sherman St.. Denver, Colorado 80203 <br />12/95 (303)866-3581 <br />WELL ABANDONMENT REPORT <br />(To Report Plugging and Sealing Wells) <br />PERMIT NUMBER OFPLUGCEDWELL Hole No. HG-1 <br />INDIVIDUAL/COMPANY RESPONSIBLE FOR PLUGGING <br />NAME: Monteomerv Watson Minin¢ Grouo <br />Mailin_ Address: P O Box 774018 <br />City, St., Zip: Steamboat Sprin¢s CO 80477 <br />Phone: 970/879-6260 <br />For OfTice Use Onl}~ <br />Approval No. G W 59-96-Og <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Havden Gulch Mine. Routt Countv Road 53 <br />SW I/4 SW 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 ~ 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) Gal n...s w.Ae~r~errwy ~~1, aYwYe~eY ~ ~'~~4' n~~ yy~ry <br />eF t4le.,,~. D,~,.,o..eF <br />The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 6. 1998. <br />was p <br />AA10UN F AND T\'PE OF h1ATERIAL <br />17 bags - cementPoentonite grout <br />at <br />METHOD OF PLACEMEM' <br />tremie <br />INTERVALS OF CASING REMOVED/RIPPED IN FEET <br />Pull rop :3 Cc off 4" P1'C <br />from 0 feet to p80 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 />from 0 feet to g feet. <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 />?4-4-104 (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 />1 <br />TIM RIMES, General Manager ~ P Dale: 10/13/98 <br />Rimes Drilling Company, Inc. r <br />?390 Hwy 6 & 50. Grand Jct CO 81505 ~ h'r 2' ~' <br />970/?4?-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 requvements. This form may be reproduced <br />by photocopy or word processing means. <br />