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STATE OF COLORADO Fa ome. lM any <br />OFFICE OF TFIE STATE ENGINEER <br />eta c.ro.N,m ttiay, fate sty se, omM.r. Coloaao eo2oo <br />PoW eseaset <br />OR PRQJT W BLACK NOC <br />WELL ABANDONMENT REPORT <br />ABANDONED WELL NUMBER F RED Fk~le.1 Q ~5 <br />1. INDMDUAL/COMPANY POPtSIBLE <br />NAME(5). West ~~I K 1~1a~°m p0.nc~ LI.C. <br />Ma3ng address . (~ 0 , (J tr-X 5q I <br />Phone v~o 9a,~- otbo?, <br />2 ACTUAL WELL LOCATION: COUNTY <br />PROPERTY ADDRESS S I'r'-k ~ YJ Y l ~ ~ ~ So mw-S n~-~ C-O <br />Nddr~i ~ (ayt (earl <br />t/4 1l4, sea Twp: ^ N. ^ S.. Range ^ E ^ W. <br />Distances from Section Lstes3 900.5 Ft hom ®N. ^ 3. unet~3`I'FlD Ft tram ~ E ar ^ W. Lime. <br />3 I (we), report that an a>oMirtg wee was plugged and abarrtfoned for ttte foeowstg reason(s): <br />The weG was plugged and abardorted as requ4ed order the cortdLbrts a <br />approval a web Permit Na <br />The wee was not ti use and was abartdorwd <br />Other (please explain) . <br />s. The wee was pugged and abandoned aocordutg to the water wee Construction <br />and Pura 4~talfatiat Ruts on 49 a o o <br />i The wee was ph,89ed wdh ttte fouowing materials placed at the ktdk:ated trttenrals: <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTERVAL <br />from feet to feet <br />r~ Pl (i I rQm i e 1rcm~raet toy Zteat <br />5 ~' - hom teat to feat <br />from feet to feet <br />OvrERVals of cASwG REMOVmlRIPPED w FEET from fee to teat <br />tram feet to .... tam <br />i. 1 (we) have read the sfatertrerus made herein and knav the contents thereof. and that they are true to my (our) <br />Imowledga (Pusuant to section 24-v-1oa (te(a) c.Fts.. the making of false statertterss rterein cor~,oes perjury <br />in the second degree and is ptadshable as a class 1 rrdsdemeartor.] <br />Nante/T"s1e (Please type ar print) Sigrtaatre Date <br />TION- n is the resporsrbady a the welt owner to have the wee property and abandoned <br />welt oorstrucoat canararxar is respatsale far noalylrtg the wee owner d the pkggirrg and abartdattrttertt re <br />Thlss form cosy be reprodrred by f~~Pr «word pooessirrg rt>aarw. <br />