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iaiNt'lo-1 STATE OF COLORADO ~ For aen uw oNy <br />~~ ° OFFICE OF THE STATE ENtaWEER <br />et8 Grm.mtr eee- 13t3 Sharmn+ st, tMewr. Colorado eoatu <br />Prol tle6.i~iB1 <br />~E OR PFrafi N 81./\CIC B~IC <br />WELL ABANDONMENT REPORT is <br />ABANDONED WELL NUMBER IF REGISTERS loo I e. rt Q c~ <br />INDMDUAUCOMPANY RESPONSIBLE FOF1_~INQ <br />mo~ut ~n o ~~~~ -~,l.C~ <br />Ma3ng Address .~ U ~ o~ 59 I <br />cats. sc z+p 5 ~m.~-r s.a~-} ; Ct~ :~ 9r ~ ~-I 3~ <br />F'Itorre 970 ~aq- 0130.3 <br />2 ACTUAL WELL LOCJ1TitXd: <br />PROPERTY ADDRESS ' <br />(~.W - - l~ l~l <br />1/4 1/4, Sec. TMrp. ^ N. ^ S., Flange ^ E ^ W. _ <br />D'estarrces Darn Section Unes~- b~fl~-I , ~Ft dam ®N. ^ s. Una. W31re~, ( Ft. rrom ®E. or ^ w. Lane. <br />1 (we), report that an mdsting weG was phrgged and abandoned fa the roUawinp reason(s): <br />J The Mrm was plugged and attartdorted as regtdred under the cartditior>sa a <br />approiral a We9 Parma No. . <br />The wet wear trot h tree and was abarWawd. <br />a.l The wen was p4rgged and abandoned a~«~ to the water Well Consbuctiar <br />and Pt.ea 4tstaratlart Runes an (~ ~ , r.:2 oZ`~' . 4s~0 I <br />it The wet was pkrgged watt tta foUo~rirr, <br />AMOUNT AND TYPE OF MATERIAL <br />rrrateria~ placed at the irrdreated intervals: <br />METHOD OF PLACEMENT <br />INTERVAL <br />I:LXYI~, ~ ~ p _TY~ rn ~ P . <br />0' <br />INTERVALS OF CASING REMOVED/RIPPED W F'EE7_TT <br />from feet to feet <br />rrom_~reetto5~ rest <br />from feet to feet <br />from feet to feet <br />from feet to teat <br />from feet to , _ . , - feet <br />1 (M1e) bane read ttte saterrrerus made herein and lutow the coruerus thereof, and that they are true to my lav) <br />latowiedge. ]Pursuant to Sectior- 24a-too (13](a] c.R.s„ ate malartg a false statamerns herein corwtin,tes penury <br />in ale second degree and Fs ptmisltable as a class t m'sdemeanor.] <br /> <br />otIMnTKNd- R Ls ale respor>tiW'Ry a the wan owner to have the well properly pargged and abandoned. <br />we0 carAnrctiorr wrrrarxor is resportsatle for nwaylrrg the wet owner a the pltgg'urg and abartdorurrertt re <br />Tttis tam may be reproduced by photocopy a ward prora~irg rrrearts. <br />