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~~, STATE OF COLOFf/100 <br />Tay OFFICE OF THE SPATE ENGWEER <br />I are c.ro.~tr emo.. era su.m,.~, se, o.mnr. Cowrado ee¢ro - <br />po~ e5saset <br />~E OR PFtQJT IN BLACK WK <br />WELL ABANDONMENT REPORT <br />ABANDONED WELL NUMBER ~ REGISTERED ` <br />1. MDU OMPANY PO BLE FOR P <br />~1~7 . mO,,S'~ 5T ~~'K Mr ~ I m p~o~rz ~. ~ , L <br />Mating Address . ~U . (3 0~ 5 q I <br />cxry, sL z~ Somer.s~,+, G7- ~ I ~ 3~ <br />Phone 9~0 ~, a g - a ~ ~ <br />2 ACTUAL Wt71 LOCATION: COUNTY <br />PROPERTY ADDRESS 51 ~ `-4 L W Y ~1,~?~~0n <br />For OEkr Use ony <br /> <br />r+~~ ~ t~ I~al <br />1/4 1/4, Sec. Twp. ^ N. ^ S, Range ^ E ^ W. <br />t»~ from Section Lines 3 9 37 34, l FL tram ®N. ^ s. Line, l~ 5 ~ Ft tram ~ E or ~ W. Line. <br />I (rre), report that an existing weu was plugged and abardorted ror the rolbwirtg reason(s): <br />The weY was p4igged and abandoned as required under the cortd~ions of <br />approral of Web Permit No. <br />The wail was not h use and was abartdorwd <br />Other (please e~la"ut) . <br />3. The wail was ptugged and abandoned accord(ng to the Water Weti Corutruction <br />and Pump 4rstaraticn Rules on - -~ ~sdOQ I <br />i The wail was pkrgged with ttw - matelots placed at the indicaRed irttervaLs <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTERVAL <br />Se,-I' n ~ a+ 0 ~ <br />WTERVALS OF CASING REMOVED/RIPPm W FEET <br />from feet to teat <br />from © teat to ~ 0 Teat <br />from feet to feet <br />from feet to feet <br />from teat to feet <br />tram teat to . -feet <br />i 1 (we) have read the statentertts made -ttereirr and Imow the contertp thereof. and that: they are true to my (our) <br />imorrledge. ]Pursuant to section 2a-a.toa (13)(a) e.R.s.. the maktrtg of false sta<emenLV herein constih,tas parlay <br />in the second degree and is punLshable as a class 1 misdemeanor.] <br />Nartte/ritle (Please type or Prim) SigrtaCre n 7/ . • Dale <br />t>u,~ a owner /_~~-G[.~ ,[~G[~~~ t ~ 3 I ~ ~~-. <br />TtON- R is the respor~b~dy of the we0 owner to Crave the web property p4gged and abandoned. <br />welt corwuuetion oorttratxor>s rosparw8rle for rrou<ytng the wets owner d the pMiggirg and abardomrern re <br />this farm may be repodtced M pttamcopy or word procemrrg means. <br />