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a~ Aso F P4'~ <br />H:s ^ORM MUST of <br />UOMITT ED PRIOR TO <br />HE EXPIRATION OF 1HE <br />'E'. MIT TYPE OR <br />'R INT IN BLACK INK. <br />Y OF ACCEPTED <br />~EME NT MAILED <br />pUEST. <br /> <br />COLORADO DIVISION OF WATER RESOURCES ~~%'' .i'r ~: <br />300 Columbine Bldy., 1445 Sherman St. !dd:L. ; ..;,.4. <br />.i(i., t ('. ~.C~Y <br />Denver, Colorado 80203 <br />STATE OF COLORADO t~lG. <br />AFFIDAVIT <br />Weld s5. <br />COUNTY OF j <br />_1L_ STATEMENT OF BENEFICIAL USE OF GROUND WATER <br />__ AMENDMENT OF EXISTING RECORD <br />PERMIT NUMBER 2465D-F LOCATION OF WELL <br />"HE AFFIANT(5) Adolph Coors Company C/0 Lvle Bush cnun~Y - Weld <br />hose mailing Corporate Real Estate Department <br />ddress is Mail Stop 309 _~.__ _NE__, 1. atlhw SE ~.,s~rlc,r. _~5 _ <br />:;,y Golden CO 80401 __._ I T_P, 3 N , Rnq. 64 W 6th P M. <br />IRr wrll Illwl IN OR 51 E7~ nn WI <br />eing duly sworn upon oath, deposes and says that he (they) is (arc) the owner(s) of the well described hereon; the well is <br />Icoted as described above, oT distances of 3150 feet From the North section line and 7DD feet from the <br />Iwowrq ow ruutwi <br />East section line; water from this wejl was first applied to a beneficial use for the purpose(s) described herein on the 5 <br />.rt aw wrrrl <br />oy o{ May , 19 $D ;the maximum sustained pumping rate of the well is 100 gallons per minute, the pumping <br />Ilt~imed hereby is _ 100 alions per minute; the total depth of the well is 510 Seet; the overage annual omoum <br />average annual appropriation from this well and No. 24651-F) <br />f water to be diverted is 167 acre-feet; for which claim is hereby mode For d0 a -7~, liv cfU(,k,, rntttmPrriaT <br />industrial , irrigation purpose(s); the legal description of the land on which the water from this well is used is <br />which tmols <br />1 dC 'Yares`s~an~w-htdtaCs"iRuslro'f~d on the map on the reverse side of this form; that this well was completed in romplionce <br />ith the pmmit approved therefor; this statement 04 beneficial use of ground water is filed in compliance with law; he (they) has <br />eve) read the statements mode hereon; knows the content thereof; and that the same ore true of his (their) knowledge. <br />gnat ure(s) ~(SFA.CS.l6 ~~a0~ __ .. <br />Sandra K. Woods, VTCe President <br />bscribed pr.d "sworn rn„port' tee Rea1~F~ a Department~~ <br />bt:fore me on~thi5:-~ do o ~ ~QJt+ •i/ 1 <br />Commission-expires: ~ - <br />CEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO <br />RSUANT TO THE FOLLOWING CONDITIONS: <br /> <br />FOR OFFICE USE ONLY <br />Court Core No. , <br />Prior. Mo. ~_ DaY __ Yr. _ __ <br />D... CIY. <br />src. 1.. r.. <br />Wall Vrr <br />Dirt. Garin Man. Dn. <br />STATE ENGINEER <br />