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FoR,M STATE OF COLORADO <br />No OFFICE OF THE STATE ENGINEER <br />GWS-9 818 Centennial Bldg. 1313 Sherman St.. Denver, Colorado 80207 <br />I2/9~ (}03)866-3581 <br />WELL ABANDONMENT REPORT <br />(To Repon Plugging and Sealing Wells) <br />PERMIT NUMBER OF PLUGGED WELL Hole No. <br />NAME: Monteomerv Watson Minine Grouo <br />Mailing Address: P O Box 774018 <br />City, St., Zip: Steamboat Sorines CO 80477 <br />Phone: 970/879-6260 <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Hayden Gulch Mine. Routt County Road 53 <br />SE I/4 SE 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, F[. from ~ E. or ~ W. Line. <br />report that an existing well was <br />reason (s): <br />~ The well was plugged and sealed as requ'ved 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) ~a.(....c .-~+~~ <br />~..9 ~~.I,.~pee ~„~.,Lb„ or 41e,_2 <br />The well was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 6. 1998. <br />1 ne wen was pluggeu wttn the touowmg macenals places at the matcatea mtervats: <br />.4A10UNT AND TYPE OF MATERIAL METHOD OF PLACEMENT <br />l7 t)aRS ~ cement/bentanite grout tremie from 0 feet to ?34 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 REMOVEDIRIPPED IN FEET from 0 feet to 15 feet. <br />Pulled a" top piece, 0' - 15' <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 />TlM HIMES, General Manager ., Date: 10/13/98 <br />Himes Drilling Company, Inc. ~I <br />2390 Hwv 6 & 50. Grand Jct CO 81505 -~ ~' C .v <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 />