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Ft ~R~I S~, A , c Or CO~O,L4J0 <br />~O OFFICE OF THE STATE ENGINEER <br />Gw5~9 gl9 Cemenmal nldg.l3lJ Sherman St. Denver. Colorado 80207 <br />1'_!95 (i0318h6-1531 <br />,z <br />'W'ELL ABANDONMENT REPORT <br />iTo Rzpun Plueging and Seating \VZlls) <br />PERMIT NUMBER OF PLUGGED WELL Hole No. LC-4 <br />NAME: Monteomerv Watson Minine Grouo <br />Mading Address P O Box 774018 <br />Cm. St.. Zlp: Stzamboa[ Sorines CO 80477 <br />Phone 970/879-6260 <br />Approval No. GW59-96-08 <br />ACTUAL WELL LOCATION: COUNTY: Routt <br />PROPERTY ADDRESS: Hayden Gulch Mine. Routt County Road 53 <br />SE I/d SW lid. Sec. 30 Twp. 5 ®N. ^ S., Range 88 ^ E. ® W <br />Ft. from ^ N. or ^ S. Line. <br />P.M. <br />Ft. from ^ E. or ^ W. Line. <br />We report that an zxisting well lvas plugged and sealed for the following reason <br />^ The hell was plugged and sealed as required under the conditions of approval of Well Permit No. <br />^ The will leas not in use and was plugged and sealed. n// ~//t (/-/~ ~//7 (//'~ r~ / /' /~ <br />® Other (please explain) i:a±~...,..e ~+«,{•n .~<~~r •~..J4w~J, ~~Wrt%w~J a•..ICJ Per yrrep~a~l •~ r4•r+Y• <br />rU/S//A • M,w/w 1 •n ed ~•r lU <br />The .yell was plugged and sealed according to the Water Well Construction and Pump Installation Rules on October 6. 1998. <br />The well was plugged lvith the following materials placed at the indicated intervals: <br />AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT <br />4 bags ~ cemenWentomte grout [remie from p feet to 119 feet. <br />from feet to feet. <br />from feet to feet <br />from feet to feet. <br />from feet to feet. <br />from feet to feet <br />INTERVALS OF CASING REMOVED/RIPPED IN FEET from 0 feet to Z feet <br />Cur off ~?" P1'C and G" steel protective casing, 0' ~ 2 <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 />23-~3-104 (13)(a) C.R.S., [he making of false statements herein constitutes perjury in [he second degree and is punishable as a class I <br />misdemeanor.) <br />TIM HIME$, General Manager Date: 10/13/98 <br />Himes Drilling Company, Inc. ~ ' <br />?390 Hwy 6 & 50. Grand Jct CO 81505 ~~~"t 'Lyn-"'h'' <br />9701242-8893 <br />INFORMATION - 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 lvord processing means. <br />