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;~ <br />:~ <br />STATE OF COLORADO Far omw Uw wYy <br />OFFICE OF THE 5TATE ENGINEER <br />ate Cwmnid 131de., t~t9 Sh.tm~n sr.. o«w. Catoraao atQ09 <br />pOtr) ttesasat <br />OR 1?RWT 1N 131.ACK QrIC <br />WELL ABANDONMENT REPORT <br />ABANDONED WE71 NUMBER IF REGIS'117~T) Hole~O ~-y7.5 <br />1. DU MPANY F <br />ezxv~ IrLC_ <br />N+-~+IE(~ rnW ~, s+ i~ rr`:t~ ~"m P <br />Maifvg Andress P b 1'~ 6~c <br />Ciy. SL Zq~ S O ter S~L~- (~ `t31 ~~- <br />Plrare 970 g a g - a 303 <br />ACTUAL WELL LACAITON: COUNTY <br /> <br />t/4 1/4, Sea Twp. ^ K ^ S„ Range ^ E ^ W. _ <br />t from seolm Lines~q 3k UI.S Ft. from ®N. ^ S. L)ne~~ 3~a'hs.o Ft from ~) E or ~ W. Line. <br />3 1 (we), report that an e>asting wee was plugged and abandoned for the following reason(s): <br />The was was pkrgged and abandoned as ragtdred Larder the con~bns of <br />approval tx Wee Perme Na <br />The wee was not h use and was abarriawd <br />a.) The wee was plugged and abandoned according to the Water We9 Corrsfrtrction <br />and Pump kwtaeation Rules an (~ I A,1'~P ~ () .49~ I <br />x The wee was pkrgged with ttw toeow's~ rrratertals placed at the tndtcased htervals: <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEIdENT OVTERVAL <br />' from feet to feet <br />rrLe.r`~ ~ f~~Al " ~f•0 m ~ ~, trom~teet tom.) O feet <br />0 ~ - nom teat m teat <br />trout feet W feet <br />UJTERVALS OF CASINO REMOVED/RIPPm W FEET from feet to teat <br />born feet to , _ " -feet <br />~ 1 (we) have read the statemerus made herein and Iutow the contfmts thereof. and that they are true to my (curl <br />Imowledga (Ptasuant to Section 24-4-104 (13)(a) C.RS.. tl,e malting at false statetttents herein cottatautes periufy <br />in the second degree and is ptanahable as a Mass 1 ndsdenteargr.) <br />f~larrie/rals type or Pal <br />BIN Q Iasstet Owner -~ J !~((~(~ L'J .C.ci1~ h--~~J 1' " ~ 1 C~ ~. <br />T10N-1< is the resportstbt~y o! the wee owner to have the wee property pAx~ged and abar-doneti <br />well construction oorttractorls resportsrbla for notdyirry the wee owner of the plugging and abandonrnera re <br />This lam may be reproduced by photocopy or word processing rttearts. <br />