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~~', STATE OF COLORADO For Olsen t)a ody <br />~'° OFFICE OF THE STATE ENGINEER <br />~~ <br />I ate a~l.l t~laa., ta+a sn.~.n se, on.tir, Colowdo eaevt <br />taxi! etasset <br />OR PRINT IN BLACK IP6C <br />WELL ABANDONMENT REPORT <br />ABANDOfdED WElL NUMBER lF REGISTERIDHOIezO"k" <br />1. MP <br />P1AME(S~, WJe tl E/ I ~ Yvl0.i ~ LLC., <br />f,~utg Address. ~U >30~ 5a 1 <br />cn~r, sr. zip ~o~rr~rse.~-~, C:~ ~ 1 ~ 3+- . <br />Pnone quo aa~~ - a3o3 <br />2 ACTUAL WE1L LOCAT1tNd: <br />PROPERTY ADDRESS <br /> <br />ry-ddnal lnr) (soul <br />1/4 1/4, Sea Twp. ^ K ^ S., Bantle ^ E ^ W. <br />oiswtees from section ones 36 Fc hom ®fJ. ~ 3. LLte,l~ 31 ~ Fc from ®E «^ W. Llrta <br />1 (rve), report that an mdstiig weC was phlpged and abarldorted for the totaowirtp reason(s): <br />The we0 was p41gged and abaldorad as ntglrired under tta corrdldorts of <br />approval of We0 Perna Na <br />The wet was not in tree and was abar[dorNd <br />Otlwr (Please ~+) . <br />s. The well was plugged and aooording to the water We0 Cor>sln~caon <br />and Pump 4ureYatort Rules,~_ l i ~ t,t) .19~QO I <br />i The vre~ was pMrgged wltt- the {9 ~b placed at the indicated Irrtervals: <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT UJTERVAL <br />from feet to teat <br />Cic ~Vl.(-.n~- ~ ~} ~ (~2 m i ~ tram~reet to r teat <br />l ~ o ~ - tram feet to teat <br />Trott( feet to teat <br />WTERVALS OF CASING REMOVED/Fi~PED fN FEET <br />from reM to feet <br />from feet to , .. -teat <br />1 (we) have read the statements made herein and lutow the cotuertts thereat. and that they are true to my (our) <br />Ivtowledrle. (P~ to Section 24-4-10a (t~(a] c.R.s., the maldttg a false smcea-eros ttereirt perµuy <br />in the second degas and is purlisllaWe as a class 1 m'sdemeanor.] <br />N~ewa a «~ ~ ~~~ u ~y~~~ I '/ 31 f ~~- I <br />T10N- a is the respormt5ty or the weu owner to have the we0 property f+tr~9ed and abandoned. <br />well corrstrucdort carmraaor Cs resp«uiele rot rtot7yiig the wet owner or the pkggsg and abartdorurrent re <br />This form may be reproduoea ey pttaooopy «word pocessing means. <br />