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F°fO"1°-I STATE OF COIOFIADO <br />~° I OFFICE OF THE STATE ENGWEEA <br />rAs <br />I 876 C„srrid May, 1315 stwm.n St, D~rMr. Colooae exam <br />t~l ees.~set <br />OR PfteYT OV IiL/-CdC OVK <br />WELL ABANDONMENT REPORT <br />AB~/WDONED WElL NUMBER IF HEC~Ia''TERm N ~ ~ e = 0 ~ `T <br />t. WDMDU PANY F <br />NAtrIE(S7 miV e s+-~~ 1 0.M ~ r.- r'~' PCe-.n,`~ ~"LL <br />Mfg Address . Q ~ ~ G X 59 I <br />Ciy, SL Tp S o rrt.e..r 5;:+ , C.j ~d i~-13 <br />Phone 970 9~~ - a bo 3 <br />2 ACTUAL WELL LOCATION- COUNTY <br />PROPERTY ADDRESS ~ r ~ ~I- ~-kvJ ~( ~ 1 ?,'~~ 5 ~ <br />Tar amw u.. ody <br />Haa~..a (a9~ - ~ <br />t/4 t/4, Sea Twp. ^ N. ^ S., Range ^ E ^ W. _ <br />DistancaB from section tLres~Jq 3~ ~6..~Ft. fran ~ N. ^ 3. L3re,~ 3518 ~ Ft from ~ E a ^ W. Line. <br />3 I (we), report that an e»assting wee was p4rgged and abandoned for the falbwing reason(s): <br />The Tree was plugged and abarworted a: required under the oondetor~s or <br />approral of Wee Pena[ Na <br />The wed wasrtwt in uee and was abaftdorwd <br />Other (Please e~iain) . <br />The wee was plugged and abanda~ied acoorrQng to the Water Wei Cormrucrbn <br />and Ptranp Irwtaearion wiee on (~, ~ r~,c 2.5 . ts~t oo i <br />The wee was plugged wish ttte foeo~{ <br />AMOUNT aND TvPE of MATI3ilAl <br />materials placed at the indicated tr-terval~ <br />METHOD OF PLACEMENT <br />`rrvm~ _ <br />INTERVAL <br />from feet to feet <br />kom~feet w 5 O teat <br />6om feet to fee[ <br />INT[3RVALS OF CASINti REMOVED/RIPPm W FEET <br />Dorn teat to teat <br />from few to feet <br />from teat to , .. _ _feet <br />i. I (we) have read the sr~errtarxs made heretrt and Imow the oorueras thereof, and that they are true to my (out <br />Imowledge. (Ptasuant to section 2a-a-toa (t3)(a) c.R.s.. the matting or false staterr~rrts r-erein ca>stinmes pergtty <br />in the second degree and is ptutisttable as a class 1 rrdsderrteanor.] <br />3 ~ a~ <br />~OFTMATi0h4- K is the respors~lWity of the wee owner to have the wee propery plugged and abatdonect <br />wee wnstrrrction contractor Is responsible for rtotlyFg the wee owner d the pYrgging and ~ re <br />This tam may be repodtred M pttotooopy a word processitg means. <br />