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X1°""10., STATE OF COLORADO Fa Ollk~ UM aYr <br />~° OFFlCE OF THE STATE ENGWEEA <br />r~ea <br />I 618 CWrvJd BWa. 1113 Sl, [>•nw, Colorado e@OS <br />QD3) aBIi.95e1 <br />OR PFiQ~ri W BLACK WK <br />WELL ABANDONMENT REPORT <br />ABANDONED WEIJ_ NUMBER ~ REGI5TEAmA~I~~D~' <br />~(S3 . rn W ~ S ~ 1 Y.. Yv0. ~-- p <br />Ma7ing address . ~ ~ 13 o~C 5 a 1 <br />cay, sl -zip S ~r ~ ~- ~ ~ <br />Phone 970 ~ ~l - .~ 3 ~ 3 <br />2 ACrIfAL WELL LOCATION: COUNTY <br />PROPEFm ADDRESS 51-7 ~ ~..:1 Y 13 S o ~ er s ~-k- C.7 <br />cry taM t~•l <br />1/4 1/4, Sea Twp. ^ N. ^ S., Range ^ E }^ W. . <br />Distances hom Section lL~es~~ 3RD l . a Ft. from ®N. ^ 3. Llne.l'} ,~~ 1. I Ft kom 13J E or ^ W. Litre. <br />3 1 (we), report t1ta1 an eodsting well ryas plugged and abandoned for the 1Wlorving reason(s): <br />^ The weo was plugged and abandoned as recµared under the candetons m <br />approval of We9 Permit Na <br />The vase ryas not h use and wes abandorwd <br />Other (please eogtlain) _ <br />s. The wee was plugged and ~~, to ttre Water Wee Carutrtrcdon <br />acrd Pump Utstaeatiort Rtdes~an4_,Y~.( of ~v .19~j ) <br />S. Tire wee was pkrgged with the r9 nvaterta~ placed at the indicated Interval.. <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT WTERVAf_ <br />(} C Tram feet to feet <br />l.;L -1`L.L lU{, ~J (71 ~ ~. ~r~ m ,I ~ frorrt~teet toc ~reet <br />5 0 ~ ~ nom teat to Teat <br />finnt Teat to Tact <br />INiT33iVALS OF CASINO REMOVED/RIPPED W FEET <br />from Teat to Teat <br />from Teat to , _ . _ -feet <br />I (we) have read the statements made herein and know the oorumtts thereof, and that they are true to my (our) <br />Imarrledge. (Pursuarrt to SeCtiort 2aa-1oa (te(a) c.R.s., the making of rake staternertre hentin ~r~es perjury <br />in the second degree and is patisitabte as a crass 1 misdemeanor.] <br />"am ~a I ~`' I ~~-c~ b ~~, ~ ~I3~ Joy <br />710N-his the respor~bi4ty of the weD owner to have ttte wetl propery plugged and abandoned <br />well corrsur,crort oonoractor is resporsble Tar rtotityiny the wee owner a trte phrggirtg and abartdortrnertt re <br />This ions may be reproduced by ptrolocopy or word pocessing means. <br />