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c ew /11 g33~ eQg~.~ <br />Wp J~25~76 ~~~~ <br />COLORADO DIVISION OF WATER RESOURCES <br />TrPE OR 818 Centennial Bldg., 1313 Sherman St. <br />PAINT IN BLACK INK <br />COPY OF ACCEPTED Denver, Colorado 80203 <br />STATEMENT MAfLED <br />DN REOUttsT. STATE OF COLORADO AFFIDAVIT <br />COUNTY OF Jefferson ~SS. <br />X STATEMENT OF BENEFICIAL USE OF GROUND WATER <br />_ AMENDMENT OF EXISTING RECORD <br />LATE REGISTRATION <br />PERMIT NUMBER 118331 <br />tHE AFFIANT(5) Adoiph Coors Company <br />whose moiling <br />oddressis Corporate Real Estate -Water Resources <br />epar men <br />Cuy Golden CO 80401 <br />{a. 1111 Innl <br />cLS~nr, <br />LOCATION OF WELL <br />Weld <br />N. E. y, ,t the <br />T..v. 3 N. .Ray <br />~w pn 51 <br />S.E. ~, serr,o., 25 <br />64 W. 6th. v <br />- ~E o, w1 <br />befog duly sworn upon oath, deposes and says that he (they) is (ore} the owner(s) of the well described hereon; the well i <br />located as described above, at distances of 3200 feet from the _N01't}t section line and 790 feet From 11 <br />East section line; water from this well was first applied to o beneficial use For the purpose(s) described herein on the 1' <br />lL1)1 OP W!r\1 <br />day of May 19.80_ ;the maximum sustained pumping rate of the well is 50 gallons per minute, the pvmpi <br />~te claimed hereby is _ 100 gallons per minute; the total depth of the well is 61 feet; the overage annual amou <br />of water ro be diverted is N•A• acre-Feet; for which claim is hereby made For fire protection ' <br />purpose(s); the legal description of the land on which the water Eram this well is used <br />T, 3 No.. R. 64 W. Sections 25 26t 35 and 36 _ aEwhi <br />acres ore irrigated and which is illustrated on the mop on the reverse side of this form; that this well was completed <br />compliance with the permit approved therefor; this statement of beneficial use of ground wnter is Eiled in compliance with low: ! <br />(they} fios (hove) read the statements made hereon; knows the content thereof- and that the same are true of his (their) knowlede <br />(COMPLETE REVERSE SIDE OF THIS FORM) <br />signature(s) -~r•Jl:,.: k. ~j,-..~SL-~ . <br />TGe rest en - o pora a ea s a e <br />Subscribed and sworn /J,, FOR OFFICE USE ONLY <br />to br`Sre me on this"y ~d day of ~'E ~'~1 19 J~'~ <br />~:- -' Op <br />MyZommrssi0r, expires: - ~ o~• <br />. ~~. ~GLJ C l-/C.iG ~L~ <br />ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLOR <br />PURSUANT-TO THE FOLLOWING CONDITIONS: <br />u <br />D~...~~ <br />5.r --~ <br />w.n ~f,. _ <br />Cry. <br />~.. , . y <br />Bose Mon Da ____.. <br />6tnic FNG~NFFP _. .._ __ __ __ ._.. __.. <br />