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IFVRxI ST,\T_V. lU_UfL4U0 <br />`!' OFFICE OF THE STATE ENGINEER <br />~'~t S-J 91 B Ctnlenn wl BWg.. I- 13 Sherman SI . Denser. Colorado 80~Oi <br />I--'~~ IiU 71866-381 <br />WELL ABANDONMENT REPORT <br />(To Repon Pluegmg and Sealin¢ Walls) <br />PERMIT NUYIBER OF PLUGGED WELL Hole No. LC-1 <br />INDIVIDUAUCOMPANY RESPONSIBLE FOR PLUGGING <br />NAME: Montsomerv Watson Minine Grouo <br />~~tailing Address: P O Box 771018 <br />Cln. Se. Zip: Steamboat Springs CO 80477 <br />Phone: 970/879-6260 <br />.ACTUAL WELL LOCATION: COUNTY: Routs <br />PROPERTY ADDRESS: Havden Gulch Mtne. Roust Countv Road 53 <br />N\f I!1SE I/1. Sec. 30 Twp. 5 ®N. ~ S., Range ~8 ~ E. ® W. P.M. <br />Distanczs From Section Lines Ft. from ~ N. or ~ S. Line, Ft. from ~ E. or ~ W. Line. <br />We report that an existing well was plugged and sealed for the following reason (s): <br />~ The well was plugged and sealed as required under the conditions of approval of Well Permit No. <br />~ The well was not in use and was plugged and sealed. <br />® Other (please explain) C-0•I „„~ ,.,,,~~ .r.fl , a~,..Yi+,!'t /1~~...Y se.~rJ' /otr Yr~...~••a e~ Ce~.r.J6 flt~n... <br />_ n.l., en. s ~w ^ V4 eT~ <br />Tltz will was plugged and staled according to the Water Well Construction and Pump Installation Rules on October 6. 1998. <br />was plu~getl w <br />~x1UUNT A^~D T4PE OF M1IATERIAL <br />hn QS ~ eemenWentomte grout <br />a[ <br />METHOD OF PLACEMENT <br />tremie <br />INTERVALS OF CASING REMOVED/RIPPED IN FEET <br />Cu[ ot('?' PCC and 9" protective casing, 0' - 2'. <br />from 0 feet to pg0 feet. <br />from teat to feet. <br />from feet to feet. <br />from feet to feet. <br />from feet to feet. <br />from feet to lees. <br />from 0 feet to 2 feet. <br />I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section <br />'_1-1-104 113)(a) C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class I <br />misdzmeanor.) <br />1 <br />Tlfvl HIMES,GaneralManager Date: 10/13/98 <br />Himes Drilling Company, Inc. <br />?390 Hs~s 6 & i0. Grand Jct CO 81505 ` ~n ti 7L~C <br />970/212-8893 <br />•NFORMATION - It is the responsibility of the well owner to have the well properly plugged and sealed. The well construction <br />contractor is responsible for notifying the well owner of the plugging and abandonment requirements. This form may be reproduced <br />by photocopy or word processing means. <br />