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ottn r+o. <br />Gu5.31 <br />i i ;l9o WtLL (.UN51 RUCTION ANU. I t5I REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER c« orro. u.. enh n <br />W 1~ h' <br />RECD <br />t. <br />' WELL PERMfT NUMBER <br />/ <br />~ n(a39 C <br />2 / <br />J <br />0WNERNAME(S) pr9 ~nf /(AA/G~ e7' ~~ <br />Railing Address G x 968 <br />iry, St. Zip 7a;,~, ann ~Co R/0 fi~ ~lb~~ <br />gESpl;acEs <br />TE Eht~TNEER <br /> <br />hone ( ) L _ ~ COLO. <br />3. WELL LOCATION AS DRILLED: ~E 1/4 X1/4, Sec.~L Twp.~ S ,Range 6 7 ~_. <br />DISTANCES FROM SEC. UN S: <br />X40 fL from ~~~ Sec, line. and /y/B : fL from •` ufuf Sec. Ilne. OR <br />trgrtrl « ecuthl ~.. (•••t « weer) <br />SUBDIVISION: ~it~_nE ~,r~~os LOT1~8LOCK FIUNG(UNIT) <br />STREET ADDR~ AT WELL LOO'ATION: <br />4. GROUND SURFACE ELEVATION 7Nt0 ri. DRIWNG METHOD Cs,L~ilr ~o <br />DATE COMPLETED Si 9 TOTAL DEPTH l SO R DEPTH COMPLETED / S 0 ft. <br />5. GEOLOGIC LOG: '• '~ '~ ~ ~ :"~!~ ~~ <br />oeat+ I)eeMpdon a W.ad.t Rrt», str.. cetor, wager taaad«p~h ~` <br />i c & HOLE DIAM. Qn.) From (ri) To (ri) <br />R r~n " _~ .7 O <br />G rrt ~ ~SO <br />_3- St ~LD/1rN .S/rNt7S Nf, 'riots <br /> <br />~~-39 ~ rg ~~ s elf. ' ~~~ 7. PLAIN CASINd <br /> OD~n) Klnd Wall Size From(ri) To(ri) <br />~ <br />/- /60 hrfy,~ Ss.vns nwr s w; _s hg It beoes T.•„ L ~i SSb -~- <br />Sf£L / 18'~ tl ao <br /> <br /> <br /> <br /> PERF. CASING: Screen Slot Size: <br /> <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material ~aN 5_ Type Wont f_ <br /> Size <br /> interval Depth <br /> <br /> 10. GROUTING RECORD: <br /> Amount Density Imerval Placement <br />Material <br />REMARKS: 4 ea,c SA.ra /rg,[ [Ems ,v f' fheynr / <br />~~~ ~ <br />9A/ o~ ~ngfref <br />~ f <br />l~L' 3 ~e / Oiu F_ <br />f <br /> <br />1 DISINFECTION: T e L,' !n IAc ARIL. Used SGU /.L~'>` .'n of <br /> WELL TEST DATA: Check box if Test Data is submitted on Supplemental Form. <br />TESTING METHOD <br />Static Level SSY' ri. DateTme measured ~ 0 'eo Production Rate 1'3 gpm. <br />Pumping level Sg ' ri. DateTme measured rr,hr~ '~ r99/ £~ sa f. //: e0 Test length (hrs.) <br />Remarks <br />3. I have rend Na autemanb made hen~n end Ivww dre COntenb drersoL end U,e! tney an true b my 1awwNdga. IPunuent b Ssctbn 2e-e•soe (1~(e) C.RS., the rne41 <br />OI lelea etntemenb heroin conadNtn parJury In dre eeoard dpree and 4 pmsrub4 ee • tleee f mbdemeanoCj <br />JTRACTOR Phone (7/9) SYX(,- L~!/2 Llc. No. ~i9 <br />g Address 0 0 <br />Na elTitle (Please type or print) <br />e Signature Date <br />/ -9 <br /> <br />