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'ON _+ro. WELL CONSTP" MON AND TEST REPORT Y tror OMM ilas ony <br />GM-11 STATE OF COLORADO, FFICE OF THE STATE ENGINEER <br />11/90 y ?j z 4 3 <br />1. WELL PERmrr NUMBER r <br />z OWNER NAME(S) L s RECEIVED <br />Mailing Address <br />City. SL zip (m. Phone ( arlm 1 -7 0- -7,4 JAN 18 2D02 <br />3, WELL LOCATION AS DRILLED: ?l 1 /4 [lfGr 1/4, sec. •^•_ T1nrp. sTR <br />D TANCES FROM SEC. UNES: <br />ft. from Sec. line. and ,94V lt from Sec. line. OR <br />or sonde) or VA" <br />SUBDIVISION: LOT BLOCK FIUNG(UNIT) <br />STREET ADDRESS AT wFLL i eA-.Amnm- <br />GROUND SURFACE ELEVATION fL DRILLING METHOD -.Q&77tMY 7- <br />DATE COMPLETED _ ?l ,o I . TOTAL. DEPTH -%A-ft DEPTH COMPLETED <br />5. GEOLOGIC LOG: <br />Opts Osaw"m of tMaAww (rym Sim color, Wass troeadon) <br />IL HOLE DIAM. (Kn.) From (ft) TO ;K) 1 <br />..e)_ Sr 0 <br />7. PLAIN CASING <br />ODLn, Kind Wall Size From) To(ft) <br />PERF. CASING: Screen Slot i e:rtS <br />u ur <br />b <br /> <br /> <br /> <br /> <br /> <br />REMARKS: Qljujlpz a FILTER PACK- 9. PACKER PLACEMENT: <br />Material Type <br />size <br />interval Death <br />1Q GROUTING RECORD: <br />Wapftial Amount Deft <br />d o ara,.? ,? 2 <br />interval <br />011 DISINFECTION: Type t4 T If <br />Amt. Used iB A <br />WEL ATA: <br />? Check box d Test Data is submiaed on Supplemental Form. <br />TESTLNG METHOD irct?e.L <br />Static Level % Dal me measured Production Rate gpm. <br />Pumping level It Date/Time measured . Test length (hrs.0 <br />36 I raw read ens SUMMO node tank and kmw des wrasno? dare0? and duet Ow we bus to am kwwledpa (Pwawat ID Section 244.104 (13)(4 C.A8., nm Maki <br />of wise. statsreeaets tarok eonaftuft pwMy in ft i a, m depros and is pendsnabb as a dews 1 n*dennarar.K e? <br />CONTRACTOR L-( ^/r- Phone 2- 3 Uc. No, 2 11 Mailing Address 6-9 <br />Name/TNe (Please type or print) S nature