GENERAL44018

• Permit No: M2001001
• IBM Index Class Name: General Documents
• Doc Date: 4/6/2004
• Doc Name: Response to Complaint Dated March 4 2004
• From: DMG
• To: Caloia Houpt & Hamilton P.C.
• Media Type: D
• Archive: No

Forst STATE OF COLORADO or Office Use Only
No. OFFICE OF THE STATE ENGINEER
QWS-10 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
3!2003 [phone] Fax [phone]
STATEMENT OF BENEFICIA4 USE
Insert the Well Permit Number 057737E
N@me address and phone of the well owner
NAME(S) Four States Aggregates, LLC

MaIIIngAddress PO Box 1568
St. Zlp Cortez, CO 81321-1568
City
,
Phone (970 ) 565-3388
WELL LOCATION; Cbutrty on eztutla Owner's WellDesignatlon Line amp it
21949 State Highway 145 Dolores CO 81323
(Addroee) (CM) (s~I @a)
SW 1/4 of the 9E 1/4, Sec.22 ~, 38 ~ N. or ^ S., Range 14 ~ E. a 0 W., 10 P.M.
pisfance from Section Lines 3 35 Ft. From ^ N, or ~ S., 1510 Ft. From 0 E. or ^ W. Line.
Subdivision Name N/A Lot ,Bock _, Ftli nit
The well is being used for the following purpose(s): Exposure of Ground Water in A (Gravel) Pit
and use of water for washing, dust control, and incidental use

for the above described purposes on 1 AUG 2 0 0 2
Water from the weft was first used beneflcfaity under this permit number
,
(DO not report a date of use before the Issued date of this penNt) -
The pumping rate daftned IB N A ~~ - ~- ~ ~-~ - galloms per minute. (From gre Pump Insfellafioh and Test Report) ~ ~ ~ '
The average annual amount of water diverted is axlmum ~ acre feet.
The land im(gated (watered) by water from this well k N/A ^ Acres ^ Square feet, described as:
N/A Number
or as N/A Subdivision Lots) Bock Filing/Unit
Well corutruded by: our a es ggrega es ug pi Ucanse No. N/A
Pumpinstalledby: Four States Aggregates LLC (will place/operate UcenseNo. N/A
Meter Mfg, By; N/A: do discharge as yet Serial No. Date Installed
I (we) Gaim and say that I (we) are the owner(s) of fhe well described above, Imow the contents of the statemerrts made herein, and state.
that they are true to mV (our) knovAedae.
Please print the Signer's Name & Title Signature(s) of the owner. Date
Aryol Brumley ~ JU~

Manager, F S A LLC

. ~ ~ - ~ For Office Use Only
Engineer By Date