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I.ULUMHUU UfV IJION Ur WA~I tfi HESUUHGtS <br />THIS FORM MUST BE SUBMITTED t313 Shernl.ln $IrP. Ci ~ Rnp111 818 <br />WITHIN GO DA yS OF COMPLETION Oenver, COlOradO 80203 <br />OF THE WORK DESCRI aEO HERE ~ .. <br />ON. IYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT <br />INK. PERMIT NUMBER 1~"V+c2 - . <br />.WELL OWNER Dni:F) a= P:~~r?'r=v __. .___~ '/. of the 11B '/. 01 Sec. In <br />ADDRESS Anx 7.4, Reton ;aFl,• :~.n~ri r^ R774~ _ r._ 3~ _. S_._. R. 5~ W 6th P.h <br />DATE COMPLETED June ?R ,19 p.F HOLE DIAMETER <br />WELL LOG A .__ in. from 0 _ to ~ It. <br />h~___. rn. Irom t.7 IO 7(ln ft. <br /> <br /> <br /> <br />From <br />To <br />Type and Color o1 Material Water <br />loc. <br />D 2 Fra r±'Ir?d conf', r•rnL <br />2 3?. Sgn+~r~rr <br />'f7 20D SandrnCk Hj '.!~ i}.i n lg~~n ~e <br /> nQ •:h?lf! <br /> 1 G.P.! nor <br /> t~y G.F.! 1!'d+' <br /> TOTAL DEPTH ~^~r <br /> Use ad ditional pages necessary to complete log. <br />__ in. Irom _-_. to _ It. <br />DRILLING METHOD. ~^~~.'___toel <br />CASING RECORD: Plain Casing <br />Size~?'~Rrr& kind .."! ~'^~ from ~ to t ~ f <br />Size _ ._. & kind _ from to <br />Size . _ __ & kind ._ from to <br />L~ ~~ ~r•lp Perforated Casing <br />Size - _. & kind _ _. _~ from to <br />Size _ _ & kind _. _ . _ from to <br />Size .__ ___ & kind _ from to <br />GROUTING RECORD <br />Material ___ Tye` ~ nvm"nt. <br />Intervals . Tnn_7;n f 7' <br />Placement Method _ h,nd <br />GRAVEL PACK: Size . _. <br />Interval ___._. <br />TEST DATA <br />Date Tested <br />.in„~ ~R <br />Static Water Level Prior to Test ~~ <br />Type of Test Pump _. "`? ~ `d <br />~i. hnilr= <br />Length of Test ____._~.-.-.-_ <br />Sustained Yield (141eE~Y~'d} ~= G•L•" <br />final Pumping Water Level in<r <br />i <br />i <br />f <br />i <br />19 .' <br />