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~o~+" +.o• <br />c~s•zt <br />,;,'~ WILL GUNSTHUG I IUN AND. 1 t51 HtPOK I <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER F« ortk. u» o"n <br /> <br />R~C~f`JFI3 ~ <br />~. WELL PERh1ff NUMBER J(a ~.3i~ <br />, <br /> OWNER NAME(S) r c 4 / ~~ <br />ailing Address <br />ity, SL Zip r_ / n i rt f_ . ~X 7 7 Nn ~ <br />Phone ( 1 3) Jul ~~ <br />92 <br />V/gr[r, „~y;.,,:;~r,5 <br />S`nTe en,tY+~+ <br />cr. _r <br />3. WELL LOCATION AS DRILLED: A1G~ 1/4 X1/4, Sec.~L Twp. ? 3 5 , Range~7 ~ <br />DISTANCES FROM SEC. ONES: <br />~~ fL from Sec Ilne. and ~~ ft. from ~ t.t< sf Sea Ilne. OR ' <br />SUBDMSION: 'e l~.,q IQ/.~o y LOT "_5}' BLOCK FIUNG(UNff) <br />STREET ADDRE AT WELTL~O~ATION: <br />4. GROUND SURFACE ELEVATION 7~~o fG DRIWNG METHOD / .oI~~L ~nn <br />DATE COMPLETED TOTAL DEPTH / s n ft DEPTH COMPLETED / SD fL <br />5. GEOLOGIC LOG: ~ ~ l: ^• '~:~ <br />a,ut tb.atwwrt a ~.t+r+.+ (ryw. s+sa ca«. w.r. to»n«u '`.' <br />' fi. HOLE DIAM. (In.) From (ft) To ( ) <br />Sr , •n .~_ <br />; ~ ~' ~~. <br />s- l4 r3snran SPA/ T. " h~ <br />T r <br /> 7. PLAIN CASING <br />- OD pn) Klnd Wall Size From(ft) To(t~ <br /> <br />~ +~ <br />~ ~ G b <br /> <br />' <br />- PERF. CASING: Screen Slot Slze: <br />I non r <br />~ <br />+ •~ we <br />i <br /> <br /> & FILTER PACK: 9. PACKER PLACEMENT: <br />I Material nons_ Type Nn/ls_ <br /> Size <br />i <br />Interval <br />Depth <br /> <br /> 10. GROUTING RECORD: <br /> Malerial <br />Amount Density Iritervaf Placement <br />aEMAAKS: <br />_ _~.r It 4 rG J <br />[LMSN / ~Z~I ~32L 1:tYJ t Pas;': 1i y <br />~ ~ <br />n lAff fFJ <br /> ' <br /> <br />t DISINFECTION: T e ) Amt. Used ~•~ <br />'. WELL TEST DATA: Check box if Test Data is submitted on Supplemental Form. <br />TESTING METHOD <br />Static Level ,? N fL Date~me measured M,r,. / X 1992 A ~ no - r/;ro Production Rate~_gpm. <br />Pumping level .?N ft. Date/Tlme measuredy>r1f~ r ~Y~ 4; oo-rr~nr~est length (hrs.) o <br />Remarks <br />:. 1 haw naC Ur WbnwM mW. hu.ln uM Frtov/ Ow ao"txW E,.nof..nG Ut.t tfry .n trw to my bto..~.• lPw.u."t b S.ctlon 2a+tW (t~(y GR9. tn. <br />a W» wt.m.nta h.nin oorutlwtw p.Qury N ur...o«w Cprw w Y µw.n.d. » . d... 1 rnba.rrt..nor.l . <br />RACTOR / Phone (7/ 9) fi_ yG -! y/2 Uc. No. £tI 4 _ <br />;.~ Address ~ <br />ame~tle (Please type or print) <br />~a~a tV ~) ~ l; ~ Signature Date <br />~ ~ ~ Z <br />/ ~ / <br />