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~, STATE OF COLOFiI1D0 <br />rAS OFFiCE OF THE STATE ENGINEER <br />eta c«+wrr t31da., fate Shrm~n St. Duerrr. Colorado eoxo <br />t~ eet:sse~ <br />•tYPE OA PFiafT Qd BLACK Q~oC <br />WELL ABANDONMENT REPORT <br />ABANDONED WELL NUMBER 1F <br />10 "Y " <br />W AAPANYL~ <br />NAME(S') ,m W~ S ~- b I k TYl i~ ©~ L L <br />MaTvtg Address , P v~ o X 5 a I <br />Pftone v~o _ a a9 - a ~3 n ~ <br />ACTUAL wELL LOCATION: cool <br />PaoPFRrir ADDI~ss 51 ~ <br />Fa atla un o~Jj <br />(Aaa...I caM isrr.! <br />714 t/4, Sea Twp. ^ K ^ S.. Range ^ E ^ W. . <br />from Section Lines~i 381 a . FL from ®N. ^ s. UneJ'~, 3~~3~1 •g Ft hom ~ E. ar ~ w. Ltrte. <br />~ (we), report that an eating wed was plugged and abandoned tar the to0owing reason(s): <br />The wee was p4ngged and abandoned as nrqulred under eta carditiars d <br />approval of WeD PerrNt No. <br />The we0 was not to use and was abandoned. <br />Other (Please agtlaim) . <br />lira weo was pkgged and ~~ <br />and Ptsrlp lrrstaYatiort Rules on la <br />The wes was Plugged with aw toaou <br />AMOUNT AND TYPE OF MATERWL <br />to the Water WeY CaaUrucaar <br />~- .~s eon i <br />metertals placed a< the tnd~ated iruerva~ <br />MEiHOD OF PLACEMENT <br />~a~. C(.m~.n~ ~ UAL Tr.~~ ~ ~ <br />~,~_ PI~a ~ 50 ~ <br />-~ <br />INTERVALS OF cr~,slNG REMONED/RIPPEO w FEET <br />aarrERVVAL <br />Tram feet to feet <br />iram~_teet to 5 ~ feet <br />from feet to feet <br />from feet m feet <br />front tee to feet <br />from feet to ... _ feet <br />1 (we) have read the staterrterus made hereto and lutow the caaencs thereof, and atat they are true'to my («~ <br />btowledge. lPursuarlt m section 24.4-too (73)(a) C.RS., ate ntalang of false statemeros hereto oonstIDlmas perjury <br />in ale second degree and is plarLsttable as a doss t misdemeanor.) <br />Martte/fitle (Please type or priru) Sigtanse Date <br />enry Q lOSSrle; owner -/y~~e ~ ~ ~9hvl ~l3!! ~~ <br />77ofa- rt ~ are respor~sibi7ty of are woo owner to haore the wee properly Plugged and abandoned <br />we0 oormrmcaat contractor b rasparts~le for notifying ale wet owner of ale ptrggQrg and abarutoranern re <br />The form may be reproduced Cry ptotocopy tx wad procesrirg rttearts. <br />