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F M <br /> M STATE OF COLORADO For Office We only <br /> Fro <br /> a OFFICE.OFTHE STATE ENGINEER <br /> 121sa eta Cwd@nnyl Bldg.. 1313 Shrmn St., Denver, Gbrdo.8020 <br /> TYPE OR PRINT IN BLACK INK <br /> WELL ABANDONMENT REPORT <br /> fro tiepert Plugging and Styling Well*) <br /> PERMIT NUMBER OF PLUGGED WELL MH-37352 <br /> 1 INDIVIDUAL/COMPANY RESPON I9 E FOR PLu rlf�r <br /> NAME(S) Umetco Minerals Cori) <br /> Melling Address P.O. Box 1029 <br /> City, St. Zip Grand Junction, CO 81502 <br /> Phone (_970 ) 295,3700 <br /> 2 ACTUAL WELL LOCATION,, COUNTY San Mlauel <br /> PROPERTY ADDRESS <br /> 1 (Addrona) Icityl IStare) Rol <br /> I Sw 1/4 SE 1/4, Sec. 2 Twp, 42 N. ❑S., Range 20 ❑E. I W. NM P.M <br /> { Distances from Section Lines 1340 Ft. from❑N. MS. Line, 1410 Ft.from E)DE,or❑W. <br /> 3 1 (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 <br /> approval of Well Permit No. <br /> 1 The well was not in use and was plugged and sealed. <br /> i 0 Other (please explain) Well was dry and could not be used for a monitor well <br /> I 4 The well was plugged and sealed according to the Water Well Construction <br /> Rules on Dec 13 , 1999 <br /> 6 The well was plugged with the following materials placed at the indicated intervals: <br /> AMOUNT AND TYPE OF MATERIAL METHOD OF PLACEMENT INTERVAL <br /> 24 sacks Dement 0.75 sacks hentonite Tremi from 3 feet to 75 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 fetit to feet <br /> Surface casing was cut off 3 feet below the sudaos and permanent <br /> steel capwelded to the top from fact to fist <br /> 8. 1 (we) have read the stets morns made herein and know the contents thereof, and that they are vue to my(our) <br /> knowNdae. [Pursuant to Section 24-4-104 1131(a) C.R.S., the making of false statements herein conttiurtsa poijim <br /> in the second decree and is punishable as a class 1 misdemeanor.! <br /> Nome/Tilde (Plsew type or prim) Signature Dots <br /> O'D �eas�/rl,f <br /> —NFORMATION— It is the responsibility of the well owner to have the well property plugged and saslad. The Wall <br /> Construction Contractor is responsible for notifying the well owner of the plugging and sealing rwtulroment. <br />