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From I 10 j Type a :,ulor of matunai <br />0 ~- ~-L.~ <br />~ ~ ~'~~ ~, <br />r <br />r~'T~ <br />~ ~ 9~ <br />r , -~ . <br />~fi, ~ ~rs _,f~" <br />C~~ i/ itrs.i <br />Loc. Type Dnllmg ~,fe _~(!, ~~ <br />HOLE DIAMETER: / <br />`{j,_in. from_Q_tt. to 6 , <br />r //~~~~ <br />tin. from~lt. toll~fi.. <br />in. from ft. to ft <br />CASING RECORD <br />Plain Casing <br />it ~. / <br />Siz kind~hom~_ft. to h. <br />Size, kind from It. to tt. <br />Size, kind from tt. to !' <br />Perforated Casing <br />Size-. kind from h. to f.. <br />Size, kind from ft. to 1;. <br />i <br />i • <br />Size-, kind from ft. to f;. <br />GROUTING RECORD <br />_ ,i <br />Material ' = • 7 ~ ' <br />Intervals <br />Placement Method <br />GRAVEL PACK RECORD <br />Size Interval I <br />TEST DATA <br />Date Tested ~ - ~d ~ ~ <br />Type of Purtp , C..-i~{~ ' <br />r <br />Length of Test S ~-."~• <br />-~ .. ... , <br />Sustained Yield ~ uorrn•d r <br />c <br />Drawdown rf' ~ , <br />WELL DRILLERS STATEMENT <br />The undersigned, being duly sworn, delroses and <br />~ says: ne i; the driller of the well hereon <br />desCriued; n~ nos read the statement made hereon. <br />i knows the content thereof, and the same is true <br />i of his own knowledge. <br />Use additional paper if necessary to conplete top. ~ ~ <br />~ta[e o/ Colorado, County of ~ ~ ~~ ~t '~ t ~ a rc r •~t ) ss License No~~ <br />~ ,.,/ <br />Subscribed and sworn to be~fJorpe.me this ~ 'L' ~ day of "J`' ~ ~ . 19_ <br />My Commission expires 1 ~ <br />Notary Puhlic <br />