PERMFILE131628

• Permit No: C1982057
• IBM Index Class Name: Permit File
• Doc Date: 5/23/2005
• Doc Name: Wolf Creek Coal Aquifer
• Section_Exhibit Name: Tab 07 Appendix 7-1
• Media Type: D
• Archive: No

coats rro. WELL CONSTRUCTION AND TEST REPORT For Office Use only
GWS3]
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STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
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WELL PERMIT NUMBER ~ S~ 1 S S
2 OWNER NAME(S) S e he c a Co 4 ~ Co .
Mailing Address ~CIC 67 O
City, St. Zip a e ... e o 8 6 3
Phone (q o) 6 - 370`
3. WELL LOCATION AS DRILLED: ~W 1/4 ~l~ 1/4, Sec. o~ ~ Twp.~_ , Range
DISTANCES FROM SEC. LINES: ~ q
d~
D
-
`
Sec. line. and ~
ft. from W~Sec. line. OR
pK
ol. O ft. from
SUBDIVISION: LO7_ BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. EVATION ,
s cI y ft. DRILLING METHOD Y'O "~'oiv cf / /,J a~e t/`
GROUND SURFACE EL
t/
p
DATE COMPLETED _, 1 - ~ 3' V l TOTAL DEPTH 3ai. ~ ft. DEPTH O PLETED 3oZ ~•-I ft.
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft)
Depth Desedption of Material (Type, Size, Color, Water locatianJ 5. 6 a 5 O 3 a 1.8
r~( vec.L(
1d
weaaL.
e ve
lo
So
i
b--a
11
/~
1
~
(
!
~
`
QV 71 JI FFSd'o MC FSIn4 `Q
_~~1--?4: cowl - Lel,.v.oit
7y - lab 5 i 1 t5~~e I S l.a lt` 7. PLAIN CASING
_ -A6- 139. Go41- Wa.ol OD (in) Kind Wall Size From(ft) To(N)
.~ 13'[-197 Sa.~JZsdev~e;Si I'IS o.,Q t I.a ~ 3.5 #Bo pUG C7_3" D .Z9
_ w'1- X03 . Goa - Saets ~~.
'Lo,3-.245 ~• nt~5 owc 5' 51...~
~q~ `3oZ Coc, - rA ev Cr.
302 -30~ G4c s i o a p PERF. CASING: Screen Star Size: 0.030 "
307 ~~Z s['f4 - for..>e.. weld Cam. ~5 ~ r5t)PUc o.3" a~~ 3 I•"1

& FILTER PACK: 9. PACKER PLACEMENT:

Material 5 i ~ i cg Sn.t,~ Type V~

Size ~b-2c~ -
Interval a,43.5- Sal I • g Depth

10. GROUTING RECORD:
Material Amount Density Irnerval Placement
REMARKS: ~ 't coa e ~ or..l e d c.la IQ'L• •Oaf 3 Nil i212'a93 `Oo~.y
3/R'I Ittekade.w;-!•t ~k:~ ~_23.Q.F+3 ,. ej~ ,t

1 DISINFECTION: Type 1/loh In..oh.Coi- Amt. Used
WELL TEST DATA: ^ Check box if Test Data is submitted on Form No. GWS 39 Supplemernal Well Test.
TESTING METHOD
Static Level ft. Date rime measured ,Production Rate gpm.
Pumping level ft. Date/%me measured ,Test length (hrs.)
Remarks
3. I have reed the statements made herein and know the contents thereof, and Nat they are true to my knowledge. [Pursuant to Section 24-4-7(}4 (13)(a)
C.A.S-. the making of false statements herein constRutes perjury in the second degree end is punishable es a class 1 misdemeanor.]
CONTRACTOR ~ ~-~:. ~>~tc'.cw-. ~~/!rt Phone `( r~-+) 3<c €cvy Lic, No.~-?a3
Mailin Address .%• c.%>r' 7S= ~%~F Cv- ga~c

Name/Title (Please type or print)
Signature '
Date