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rararoro.~ STATE OF COLORADO ~ rwr aien Ura «ay <br />°~° OFFICE OF THE STATE ENGINEER <br />e18 CMWnLI slap, tats Shrm~n S!, Ds'Mr, Cokndo Be200 <br />poi! eestel <br />OR PRINT W BLACtC WK <br />WELL ABANDONMENT REPORT *: <br />ABANDONED WEL1_ NUMBER IF REGU~rERm H of e T p X ~ <br />WDMDU MPANY F <br />mou.n i n ti w,,p~ L.I.~C~ <br />NAME(S) , ~ e S ~ f;1 k ~ ~- <br />MauTptg Address , ~ D ~ ~ 5a I <br />Ciy, St. Tip 5 o m=a,r S ~ .k ~ G- - Ss 1~ 3~ <br />Phone 970 Q ~q - ~ 3 D ~i <br />2 ACTUAL WELL LpCAT10N: <br />PROPERrr aoDRess 5 <br /> <br />~f- <br />1/4 t/4, Sec. Twp~ ^ N. ^ S., Flange ^ E ^ W. _ <br />Dismnces from Section Lfnes~Ft tram ®N. ^ 3. Line,~~ 3-I~FL From ®E a ^ W. line. <br />1 jlse), report that an existYlg wet was phgged and abandoned ror the folbwing reason(s): <br />Ttw wet was p4rgged and abandoned as regtdred under the cortdiHor~s of <br />approval of Wet Pemr~ No. <br />The wet was riot in use and was abartdwwd <br />Other (Please e~lacl) . <br />s. The wet was plrtrged and abandonned according >o the Water Wet Corrstniction <br />and Pump krsmYatiort Rules on_ ~'4 <l n 3 a5 . asa ,~00 I <br />i l The wet was pkrgged wit- the fotlolL <br />AFAOUNT AND TYPE OF MATERVIL <br />trwteriats placed at the frrdicarted iraervals: <br />METHOD OF PLACEMENT <br />n,9 f ~' 0' <br />INTERVALS of CASING REMOVED/RIPPED w FEED <br />fl:rr~:~TI_q <br />from feet to feet <br />rrom~teet to 5 C~ teat <br />from teat m reef <br />rran teat to rear <br />from feet to feet <br />morn feet to , _ _ _ - feet <br />1 (we) have read fns made herein and lotow the corurmts thereof and that they are true to my (Dort <br />Iotowledge~ [Ptrsuarr to Section 2a-a404 (13)(a) c.FLS., me makctg or false S7~trer~s tte<ein constiaazs peritQy <br />in the second degree and is ptmisltable ors a doss 1 rrdsdemeanor.) <br /> <br />T10N- n is the respormbtdy or the wet owner a helre the wet property and abandoned. <br />rneu oortstructiort oorltraaor is resparabte tar rtooifyirg the wPJ owner or the pigging and abartdor-rnern re <br />This tam may ba reproduced by Pt~~PY a word process4tg nreanes. <br />