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FQit11MO.~ fiTATE OF COLOFlADO F« 001c~ tAo oNy <br />ayvse OFFICE OF THE STATE ENGINEER <br />7/e0 <br />1 878 Gnlrodd 81dp. 1?I9 s~ s<.. Dv~rrr. Cobndo s07D7 <br />4~ 8863501 <br />~YPE OR PFfR~Ii W fi1J1ClC tNK <br />WELL ABANDONMENT REPORT <br />ABANDONED WELL NUMBER IF REGJSTEAED Hole T~'J `~ ~C <br />1. DU MPANY pPO~NSIBLE F <br />NAMED . W k: ~}' I ~ ~ r`~ ° w, c~ rv~ l,L C, <br />MaLng Address , P a 13 O~ 5 °I I <br />Cir. s< ~ 5 G' Yvtie;rS"et° ~ . c;y :~ $ ~ a 3'~- <br />Phone 9~o GaG - x303 <br />2 ACTUAL WEl1 LOCATION• <br />PROPERTY ADDRE53 <br />(Add~~ ~ (Cy9 (sdhi <br />t/4 1/4, Sec. Twp. ^ N. ^ S, Range ^ E ^ W. <br />Di~anoes from Sectlort Uses 1< Ft. Lom ®N. ^ 3. Line,~`~131~3(v5 Ft from ~ E or 0 W. L.1rre. <br />I (we), report that an e7dsting weY was plugged and abandoned for the following rea.son(s): <br />The wao was pk7gged and abartrf«ted as taqulred under the cortdirior7s a <br />approval of Wep Pam7it No. <br />The wed was rtat in use and was abandorwd <br />Oder (P~ ) . <br />s. The weo was pkgged and abandoned axordir7g to the Water We9 Car7struction <br />and Pump ktstauaaort RWes on Ca..~.rv r~~l . 19_~Db I <br />i The wet was pkrggett wdh tf7e tolto~a7g materials placed at the indipted truervals: <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT WiF14YAL <br />,! from feet to feet <br />-rl.Q,ll~.~ J Y' ~ iram~_feet toyr~ feet <br />(,(_ GJ(~ r from feat >p few <br />from feet to feet <br />INTEF'NAW OF GASING REMOYEDIRIPPED IN FEET from feet to feet <br />from feet to , -fare <br />L 1 (we) have read the statements made herein and know the cor7teras thereof, and that they are true to myr (our) <br />knowledge. (Ptas7iart< to Section 24-4-1[W (19)(a) C.RS„ the making at false statemerus herein cotuGhrtes perjury <br />in the second degree and is punishable as a class 1 misdemeanoc] <br />Name/Tdle (P~ type a priru) S,l/~/g~r-aure Z DJat7e <br />fllN Q Owner ,'i'~~J ~ ~~ '! O Il o~, <br />TION- n is the responw'b~y of the well owner w have the watt properly p4gged and abandot7ed <br />weB oor7stnacoar7 oorraractor 1s rea;l7onsihle for r7atdying the weC owr7er of the pkrggir7g and abarWorvr7ertt re <br />This forth may be reproduced dY photocopy a word processk7g means. <br />