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`°"'" "°' <br />GW531 <br />tc~a WELL CONSTRUCTION AND TEST REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />13 r t. Rm 8 Denv r CO 8 For Office Use only <br />1. WELL PERMIT NUMBER 2 S~ `15 3 <br />2 OWNER NAME(S) SE H~ c q Coc. ~ Co <br />Mailing Address Do X 6'l0 <br />City, St. Zip ~ dn~.. co `3 16 3 ~i <br /> Phone(~{70) 6 -3701 <br />3. WELL LOCATION AS DRILLED: SI.J 1/4 S W 1/4, Sec. a 6 Twp. S ~_, Range~_ (.t. _ <br />DISTANCES FROM SE <br />OU ft. from kJ Sec. line. and 30 ft. from Sec. line. OR <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br /> <br />4. r <br />GROUND SURFACE ELEVATION S O ft. DRILLING METHOD Iro ~Iu~yu, w~.tl'e~' <br />DATE COMPLETED ~{~ J 6 - Oi~ TOTAL DEPTH I y S ft. DEPTH COMPLETED y ~I: ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type, Size. Color, Watre-r Locatlon) <br />o-ao 3ei I [ u~~..I L.ev c,Q ~ocU 6. HOLE DIAM. (in.) From (ft) To (ft <br />S • 6 ~ S ~ - <br />_QO-78 s•,Ids ov.a fslnolP <br />.~~-~I Co41. ^LPKIAaK <br />41 - 13a Sr W S~o,.~ cb,~lo 7. PLAIN CASING <br />133 - !4S Cual- 40~.eR~sz OD (n) Kind Wall Size From(ft) To(ft) <br />" <br /> 3- S 'SRO Pl)L O.3 <br />~~ 15. <br /> <br /> <br /> <br /> PERF. CASING: Screen Slot Size: y-o3o" <br /> <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: (~ 9. PACKER PLACEMENT: <br /> Material s l ~ ic4 S4 ti ~ -Type ~ <br /> <br />Size to-20 _ <br /> Interval ~ 3 ~ <br />ly 5 Depth <br /> _ <br />_ <br /> 10. GROl1TING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: t coo ¢1 ~+ o., ;d Q_ le <br />/Ha 6Qrn~o,,.:IQ c6.:~5 'o1.OI ~t3 ~_ 113_133 po...1r <br />10•$~t3 ,. 8'113 'TI <br /> cQw.ekd• O. w _ a <br />1 DISINFECTION: Type Irtptwe lMocr.~~ov fJ~ll Amt. Used <br /> WELL TEST DATA: ^ Check box 'tf Test Data is submitted on Fonn No. GWS 39 Suppiemerttal Well Test. <br />TESTING METHOD <br />Static Level ft. Date/Time measured ,Production Rate gpm. <br />Pumping level ft. Date~me measured ,Test length (hrs.) <br />Remarks <br />3. I have read the statements made herein and know the contents thereof, and that they are hue to my knowledge. [Pursuarrt to Section 244104 (13) (a) <br />C.R.S., the making o} false stffiemer~4 herein constitutes perjuryiJ'the second degree end is punishable as a class t misdemeanor.) <br />CONTRACTOR r.~J~Sr/e„„ ~.~-,~-, rct..~ ~/ i/-r c. Phone ~v jib JEY~'' Lic. No.l~_ <br />Mailin Address _ ~:. ,~~,~ ~sv ; ~: ~ rG k. <br />Name/T'Rle (Please typ ~r print) Signature Date <br />I~~.-, /<~kE ~~ ~~ 1i ~E-~.~ <br />J <br /> <br /> <br />, ~ t , ~ '~ t~ i= ,~, <br />