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FORM STATE OF COLORADO <br />NO OFFICE OF THE STATE ENGINEER <br />GWS-9 818 Centennial Bldg., 1313 Sherman St.. Denver. Colorado 80203 <br />12/9? (307)866-3581 <br />WELL ABANDONMENT REPORT <br />(To Report Plugging and Sealing Wells) <br />PERMIT NUMBER OF PLUGGED WELL Hole No. LC-1 <br />NAIv1E: MonteomervWatsonMinineGrouo <br />Mailin, Address: P O Box 774018 <br />City, S[.. Zip: Steamboat Sorines CO 80477 <br />P It o It e: 970/879-6260 <br />Approval No. GWS9-96-OS <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Havden Gulch Mine. Routt County Road 53 <br />NW I/4SE I/4, Sec. 30 Twp. 5 ®N. ^ S., Range 88 ^ E. ® W <br />Distances from Section Lines Ft. from ^ N. or ^ S. Line, <br />P.M. <br />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) 4~I M.w< ,.,,±, ICr~ ~ «.!I al...y.•Y , p~~qc~+~•/ sc.~ty prr y„<a.~..•s uE ~•r.,pe VIJU.sw <br />The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 6. 1998. <br />was omeeea wnn the touowme materials olacea at <br />,4MOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT <br />bags - cement/bentonite grout tremie from 0 feet to gg0 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 />mademeanorJ <br />TIM H 1 M ES, General Manager Dale: 10/ 13/98 <br />Himes Drilling Company, Inc. t <br />2390 Hwy 6 & 50, Grand Jct CO 81505 m ~L~-' <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 abandonment requirements. This form may be reproduced <br />by photocopy or word processing means. <br />