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FORM N0. <br />cus•37 <br />77/90 ,j WELL CONSTRUCTION AND. TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Fa om~. u.. only j <br /> <br />~L'A[~1/Lri- <br />,. WELL PERMff NUMBER i "1 /Ys y <br /> <br />WNER NAME(S) <br />ailing Address /fi~~ /emu t„ ~,$" <br />Ciry, St. Zip tl19~,.z t_ . /' fl//3~ <br />Phone ( / ) S7- a/• ~ 16 ~ <br /> <br />~F~ '";=- <br />,,.- <br />3. WELL LOCATION AS DRILLED: ,~1/4 SE 1/a, Sec. 1 S Twp. 33 S , Range~~ <br />DISTANCES FROM SEC. LINES: <br />~?~ O it. from Sec. line. and S/o'D . IL lrom '~ ,4s ~ Sec. Ilne. OR <br />x!~ yy,~ .MU. y,.:.~. . Wl0f wM0 <br />SUBDIVISION: ~/9 Vr/!£ KA/'lG~~ , LOT~BLOCK FILING(UNIT) <br />STREET ADDRESS T WELL LOCATION: <br />a. GROUND SURFACE ELEVATION ~ / D O fL ORIWNO METHOD ~'a-h ~t Tao ~ <br />DATE COMPLETED a us ,~ I TOTAL DEPTH l6 / fL DEPTH COMPLETED / O / tt. <br />5. GEOLOGIC LOG• ~ . t ~. tt -:~:::: Y.r.; ,~..: <br />o.Pm t>.~r+Pdwr a -7.a7.t (rr7». 97a. eowr. wm. ~y„a>e~ , & HOLE DIAM. (tn.) From (ft) To (ft)1 <br />~ ~'n ' ~• .S~n~ <br />_ /. <br /> <br />- 7. PLAIN CASINO <br /> Fr <br />To( <br />n) tan <br />Wall S <br /> ~ <br />~~ <br />~ <br />~ <br /> - <br />_ <br /> <br />u/,a // ~_ <br />~ SING: Screen Slot Size: <br />P F. CA <br /> 7 <br />3TFI ~ J ~_ ~ ~1 <br /> <br /> <br /> <br /> <br /> 8 FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Type l„on t <br /> Size <br /> Imerval Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: _? ose s / vwrc ~sncn c£mtn7' ~(f 3f~o/ onE <br /> _CA n0 <br /> <br />1 DISINFECTION: T e t i ui Amt. Used ( c u s £ ~f {,o ~?_ <br /> WELL TEST DATA: Check box ft Test Data is submined on Supplemental Form. <br />TESTING METHOD i <br />Static level /O ft. DateTme measured 1 :aa q Production Rate /~/ gpm. <br />Pumping level /o - ft. Date~me measured /t,,.,,</.t/ l9» BOO/d //'Test length (hrs.) 3 <br />Remarks ~- <br />~evs r~stl Ifta aWamenO m~tl~ ftaM1in end loges dH oonienb dMr~of, W dvtl d»y ~n M b my ImowNdp~. IPYRYY,(b " ylon Y~J•1 W (7~(y C.0.9_ Qv m~M1 <br />lae al~lem~nb h~r~ln owwdMM p~rlury In M Ncond dpnN W Y punWuD4 n ~ clue 1 mbd~uwr.l <br />TRACTOR ~lQyc~ (~ // /~,r,~l,,,,, Phone /T ~flo - L ~//2 Llc. No. 814 <br />Mailing Addresser 99 s /o r~~~ Co. h /c~2 <br />Name/Title (Please type or print) <br />ode llls Signature Date <br />l o <br />~ - ~ - - - <br />