GENERAL38269

• Permit No: C1982057
• IBM Index Class Name: General Documents
• Doc Date: 10/18/2007
• Doc Name: W24 Series Well Abandonment Forms
• From: Seneca Coal Company
• To: DRMS
• Permit Index Doc Type: Exploration
• Media Type: D
• Archive: No

Form No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use Oaly
GWS-OI 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
6/2006 [phone] Fax [phone] http://www.water.state.co.us
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or
print in black or blue ink. Instructions and plugging standards are on reverse side of form.
Well Permit Number of the well being plugged a3 ~(~ 66 or
MH File Number MH- Hole ID #/Name W W e l~1 ~ ~
gging and sealing the well:
Individual/Company responsible for plu
1
` ~o t...~
S Cu ~
a
NAME(S) s~ Ke G
Q M
i
~
r1
^
r
Mailing Address Po 13a~C 6 f
co 8 16 3
City, St., Zip

c
Phone (~~O ) a 6 ~ J ~ ~~
Well (Hole) Owner:
NAME(S) cSrL 1.H.~ cLS 0. ~ ~ V ~ Phone ( )
Mailing Address, City, SL, Zip
nn
ACTUAL WELL LOCATION: County IC p k't'~^ t~ nn 1' (~
{
I
~
'
qy CAM ~
O ~ ~ 63
Property Address, City, Si, Zip 3 2 5 6 o COt~~`~ ti R og~y ~ 3 ~

. a1, Tw N. or S., Ran
~1/4 of thes~ 1/4, Sec p. r ® ^ g ~ ^
e _ E. or W , P.M.
pp
es ~_~~ Ft. From ^ N. or ^ S., O U Ft. From ^ E or ^ W. Line.
Distance from Section L
in
A
~
Subdivision Name I VA Lot ,Block ,Filing/Unit
Optional: GPS well location information in UTM format. You must check GPS unit for required settings as follows:
Format musi be UTM, zone 12 ^ or zone 13 ~; Units mu: t be meters; Datum must be NAD83; Unit must be set to true north.
Fasting Northing
,
I (we) report the existing well (hole) was plugged and sealed on the date of p' ~6 - O ! for the following reason(s):
^ The well was plugged and sealed as required under Well Permit Number
~ ~ The well was not in use and was plugged and sealed.
''
((
//~~ 11 ..~1. b
Other (please explain) wl Ohl lov` WaL~ T4., ec..~ wed W0.S r ~~+~{y~ ~-~G'U~ .
U bay :1 wee o Z9-~ - D
The well was plugged with the following materials placed at the indicated intervals:
A^mount and Type of Materia~(l p~Q Method of Placement Interval
3
5
_ Ge-tMewY_ b`04.~__ _ ~tMt ~_ from ~ _ feet to
o(. 3 (~ ~~
a feet
-- ~--- ---~-- p- - - -
from feet to feet
from feet to feet
Intervals of casing removed/ripped in feet from feet to feet
Report must be signed by person who performed the well plugging work or by the well owner if this person is unknown or not reachable. I
{we) have read the statements made herein, know the contents thereof, and that they are true to my (our) knowledge.
Signature(s) Please print the Signer's Name & Title Date
~-
V ~~~~$ ~o..e5

~ rXVO iS~ -7
~(7'2-a 1

It is the responsibility of the well owner to have the ~.aell/hole properly plugged and sealed. The Well Construction Contractor
is responsible for notifying the owner of this requirernent_ _ __