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Ft]fiA1P10.~ - ---STATE OF COLORADO ~ Far Oek~ Ua ody <br />errae OFFICE OF THE STATE ENGUJEER <br />r~ <br />878 CaNwial 81de.. 1315 sn.'m.n St, o.rMr. Cdoodo e[1203- - <br />PoW e@s<i58t <br />OR P1fWT W BIJU'.K INK <br />WELL ABANDONMENT REPORT <br /> <br />ZD~~F., <br />DU COMP PO FOR <br />NIMAE(S7 ~'e~t I /vl i n a" tsw' ~ c~-~-`~ LL C, <br />Marling Address . i° o -~ ~X 5 ~ 1 <br />ciy, sc zp S o~m.e,rs-~~- .~f~ - g ~~-I 3~ <br />Pfane 9~o Qd.A - x.30.3__ _ <br />2 ACTUAL WELL LOCATION: COUNTY <br />PROPERTY ADDRESS 5 I "1 y !~~ Y ~ 13 ~ S~~r~-e~ ~ <br />~~ t~ I$>rmrl <br />~~. 1/4, sec. Twp. ^ ra ~ s.. Range ^ E ^ W. _ <br />Da7~rroe4 from SecSotr floes 3~9a . Ft from ®N. ^ S Li*>erl ~13~`~•`~.I Ft from ®E ar ~ W. Lfie. <br />3 I (we), report thaw an aidstirtg weG ryas plugged and abandoned for the ioibwing reason(s): <br />The weY was p4ggad and abandoned as ragtmad under the dons of <br />~~ tt approval or WeB Penn[ No. <br />x The wei r~ rat in use and was abandoned. <br />Otter (P~ ~-) . <br />i. The well was pltgged and accord4ig to the Water We0 Corufnrction <br />and Pump kistaMadort Rules an ~ a~ ~9~_00 I <br />~. The vres was pkrgged wYtt the idlowirg matedals placed at the Indicated kuervaL~ <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTERVAL <br />I ~ ham teat to feet <br />t'Y~-e-llT ~ ~j'.1~. m i i/ fram_~feet to~Qfeet <br />.~_ lu~i ~ 5c~ ~ - horn feet to rem <br />,ton, feet ro feet <br />INTERVALS OF CASING REMOVEDIRIPPED IN FEET from feet to feet <br />from feet to feet <br />.. 1 (we) have read the statemerrts rtiade herein and know the coruerus thereof. and tftat they are true to my (curl <br />Iaroudedge. [PiasuarY to Section 241-104 (131(a) C.R.S., the maka-g ~ false statertrents herein cor>sUaites te11mY <br />in the second degree and is purtisliable as a class 1 mtsdentearar.] <br />fJartte/Tala (Please type a taint) Signature Date <br />RMATION-- n is the Y a the well owner to taxe the well - and abandoned <br />wee wrsuuco~on oorwactor is responsible for ratifying the we9 owner or the pluggktg and abandorvnertt re <br />This form may be reproa,oed by pttotoriopy or word prooassig meanie. <br /> <br />