2008-03-13_PERMIT FILE - C1992081 ‎(4)‎

• Permit No: C1992081
• IBM Index Class Name: Permit File
• Doc Date: 3/13/2008
• Doc Name: Well HGDAL1 Abandonment Report
• Section_Exhibit Name: Tab 07 Appendix 7-4.2
• Media Type: D
• Archive: No

dorm No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
GWS-09 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
6/2006 [phone] Fax [phone] http:/Iwvvw.water.state.co.us
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or
print in black or blue ink. Instructions and plugging standards are on reverse side of form.
or
Well Permit Number of the well beiHo el ID #/Name _HGDAL1
MH File Number MH-
Individual/Company responsible for pl~innina and sealing the well:
NAME(S) -John Weinman -Hydro-Environmental Solutions, Inc.
Mailing Address _P.O. Box 772996
City, St., Zip -Steamboat Springs, CO 80477
Phone: _.[phone]
For Office Use Only
Well (Hole) Owner: Phone: _(307) 687-3903
NAME(S) -Hayden Gulch Terminal, Inc.
Mailing Address, City, St., Zip _701 Market Street, Suite 700, St. Louis, MO 63101
ACTUAL WELL LOCATION: County _Routt
Property Address, City, St, Zip_37796 County R6 adN3oHSY Range 886 W., 6_ P.M.
SW_1/4 of the_SW_ 1/4, Sec. _14_, Twp. ,_ _
stance from Section Lines _80 Ft. From S., _200_Lot{ From W L~ Block Filing/Unit
Subdivision Name
Optional: GPS well location information in UTM format. You must check GPS unit for required settings as follows:
Format must be UTM, zone 12 or z Northingnits must be meters; Datum must be NAD83; Unit must be set to true north.
Fasting
for the following
I (we) report the existing well (hole) was plugged and sealed on the date of -Sept. 10, 2007
reason(s):
^ The well was plugged and sealed as reedland sealed. ell Permit Number
~ The well was not in use and was plugg
^ Other (please explain)
The well was plugged with the following materials placed atMethod of Placement Interval
Amount and Type of Material
-Gravity; hand poured ~-from _ 27.6_ feet to _3.0 feet
3 bags, Bentonite Grout Pellets Hand from _3.0 _ feet to -surface -feet
-Native soil material - from feet to feet
Intervals of casing removed/ripped in feet from _3.0 _ feet to surface feet
Report must be signed by person wh heeeinr know the conten9slthe eof, and that theyla e t ue tohmy (our) know edgen or not reachable. I
(we) have read the statements made ,
I Please print the Signer's Name & Title I Date
c..~a.. JIo4.~ er tJea.+,,n.«., ~ ~i~-.~t.~..e.1ef Q -8 0~
It is the responsibility of the well owner to have the well/hole properly plugged and sealed. The Well Construction Contractor
is responsible for notifying the owner of this requirement.