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~-' STATE OF COIOFlADO ~ F« omn u.. wr <br />~~ OFFICE OF THE STATE t7JOWEER <br />eta c.~tt taay, u+a sty se, osm.r. Cota~ao aoaao <br />pocl) ea6~9tie1 <br />ow PTtuvr w eLACIC wit <br />WELL ABANDONMENT REPORT <br />WELL NUMBER ~ <br />I~~a ., <br />~ID_MDUAUCOMPANY RE$PONSIBIF FOB_~!~ <br />~rati~r a ~~ n oa-1 orn~ga~.y ~~ <br />NAME(S'~ W es~ Cl e m ~ vim. <br />MaiSrtg Address t7 0 6 0 5 q l <br />Cay.scz~ Som~,rsp ~~. 4-:'. ~Sc~~3~4 <br />Pttme 9~o q ~ G - ~ 30 ~i <br />-ctuAL wtzL LocATION: couNTY <br />PROPERTY ADDRESS 51 ~ ~ <br />~~ ~ r~ ~ <br />t/4 1/a, Sec. Twp. ^ N. ^ s.. Range ^ E ^ W. _ <br />Distances from serYiorr Llnas' ~- `~ ~Ft tran ~ N. ^ 3. 1..vral ~4 3 ~C~ ft~.F~Ft. from ~ E. or ~ w Line. <br />I (we), report that an eASting wed was plugged and abandoned fa the foOowQtg reason(s): <br />The we0 was plugged and abardated as requked fader the cartdifiorts of <br />approral of WeD Penn3 No. <br />The vre0 was r-at in ttse and was abardawd <br />Other (Please explain) . <br />s. The weo was p4gged and abardoned ~ the water WeB Construction <br />and Pump IrrstaWtiort Rules «, ~, I.l.n,t . l9,~Qp <br />x The vrN was pwgged wdh ttw fdlddving matelots placed at the indkx~ed trKervaLs: <br /> AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTEFNAL <br /> from (eat to feet <br /> 1 1 r~ "" <br />L IY~..I (W ~ l37 ~ (. 'T'~P YYl ~ ~ fromQfeet to ~ feet <br /> d ~ from feet to teat <br /> <br /> from feet w teat <br />INTERVALS OF CASING REMOVED/R~Pm !N FEET <br />from tee to feet <br />from teat to . _feet <br />., t (we) have read the sfatemergs made herein and krow the contents thereof: and that they are true to my (our) <br />IetoMAedge, [Pursuant m Section 244.104 (13)(a) C.R.S., the making of false statements herein perjury <br />in the second degree and rs punLahable as a doss 1 mtsderneartoc] <br />Narnai/Tala (Please type a priru) S`T'~grtaare ,/] y ~ ~ '" - n Date <br />Dlly D. Owner /. ,CJF~t-C~,~ l 'l3~ ~os~. <br />TIOhI- a ie the respray or the w~ owner m have the wetl propery Ptir9g~ and abartda,ed. <br />wev cortstructiort carttractor ie tesportwble for notaying the we9 owner d the pkrggirtg and abandaranent re <br />This lam may be reproduced by prtoootwpy or word protesting means <br />