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WJR-]6 ]] ' <br />'• COLORADO DIVISION OF WATER RESOURCES <br />THIS FORM MUS7 BE SUBMITTED 1313 Sherman Street -Room 313 <br />WITHIN 60 DAYS OF COMPLETION Denver, Colorado 80203 <br />OF THE WORK DESCRIBED HERE- <br />ON. TV PE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT <br />INK. tell fYft-11-5 <br />PERMIT NUMBER <br />WELL OWNER + ,~ '/. of the ~ '/. of Sec. 16 , <br />ADDRESS ~„~ ~• ii~l~~ss cr• r._........ r., t:M79 T ~I~ _, R. ~ ~{ P.M. <br />DATE COMPLETED ~ . 19~ HOLE OIAME7ER <br />WELL LOG -~~ in. from ~_ _ to _~a_ ft. <br /> <br />From <br />To <br />Type and Color of Material Water <br />Loc <br />0 12 clayey tilt and gravel (wte) X <br />1? 240 lt. grey :hate - Lax1t Shale <br />240 252 cost. Garb. shale. and <br /> intsrbeddtd tlltttoae <br />2b2 325 lt. grsy. fi1,e grassed X <br /> sasdttwte <br />3Y6 413. dk, grey shale asd lt. grRY <br /> tMle <br />413. 570 lt. yny. flae-ard. yratsed X <br /> tasdstoea-•1lientyelile S5. <br /> <br /> TOTAL DEPTH 57fl ft• <br /> Use a dditional pages necessary to complete log. <br />~~~ in. from _'~~_ [o _41~ f[. <br />___~ in. from ~~ to ~~ ft. <br />DRILLING METHOD~~jyd~t~ r <br />CASING RECORD: Plain Casing <br />Size ~~! & kind ~{a~om _~__ to ~Q}__ ft. <br />Size & kind from to ft. <br />Size & kind from to ft. <br />tmceted froe 404 to 57fl ft. <br />Perforated Casing <br />Size M/A & kind __M/A_ from to ft. <br />Size & kind from to ft. <br />Size __ & kind from to ft. <br />GROUTING RECORD <br />Material PoPtli\Yd golRt <br />Intervals <br />Placement Method csaventto~al wil-bon dltplsce. <br />GRAVEL PACK: Size NSA <br />Interval M/A <br />TEST DATA <br />Date Tested <br />19 <br />Static Water Level Prior to Test flo~-it+4 ft. <br />Type of Test Pump <br />Length of Test <br />Sustained Yield (Metered) <br />Final Pumping Water Level <br />