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w~P;zs,n <br />COLORADO DIVISION OF WATER RESOURCES <br />THIS FORM MUST eE SUBMITTED 1313 Sherman Street Room 818 <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 Melt fBR-14 <br />INK. <br />PERMIT NUMBER 1997_ <br />WELL OWNER ~ ~ % of the j~ '/. of Sec. u~ , <br />ADDRESS T. __ ~__ __, R.~6~._, it)~ti P.M. <br />DATE COMPLETED $apteuder 27y 19 ~ HOLE DIAMETER <br />WELL LOG <br /> <br />From <br />To <br />Type and Color of Material Water <br />Loc. <br />D 9 dark tirot~le to dark g cl~ye X <br /> sand tiitp grovel (ba~ <br />9 I6 lateri~edded lt. yny ahale. <br /> sil btone aad sandstone <br />75 260 tt. grey. ttne Ora1aed <br /> sandstone (Twatrletls 5S.) X <br /> TOTAL DEPTH ~ ft. <br /> Use a dditional pages necessary to complete log. <br />__ ~~ in. from __ 8__ to ~8__ (t. <br />__~ in. from ~ to ~~ ft. <br />_.~ in. from _~ to 7L~- ft. <br />DRILLING METHOD a1r/anrld rotary <br />CASING RECORD: Plain Casing <br />Size ~~}~& kind ~~rom __~_ to _~,~_ ft. <br />Size & kind from to ft. <br />Size & kind from to ft. <br />t~easN troll 74 to 260 tt. <br />Perforated Casing <br />Size k/A & kind _L/A from to ft. <br />Size & kind from to ft. <br />Size ____ & kind from to ft. <br />GROUTING RECORD <br />Material Pertlaed eetret <br />Intervals <br />Placement Method <br />GRAVEL PACK: Size <br />Interval H/A <br />TEST DATA <br />Date Tested <br />Static Water Level Prior to Test <br />Type of Test Pump <br />Length of Test <br />Sustained Yield (Metered) <br />Final Pumping Water Level <br />11/A <br />19 <br />ft. <br />