2008-08-08_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 8/8/2008
• Doc Name: Well Abandonment Reports
• From: WWC Engineering
• To: DRMS
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

Form No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use Only
GWS-09 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
6/2006 [phone] Fax [phone] http://www.water.state.co.us
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or
tint in black or blue ink. Instructions and plugging standards are on reverse side of form.
Well Permit Number of the well being plugged Monitoring Well Not Permitted
or MH File Number MH- Hole ID #/Name 05-01-0004
Individual/Company responsible for plugging and sealinq the well:
NAME(S) WWC Engineering
Mailing Address 611 Skyline Road
City, St., Zip Laramie, WY 82070
Phone [phone]
Well (Hole) Owner:
NAME(S) United States of America, Bureau of Land Management Phone [phone]
Mailing Address, City, St., Zip BLM 455 Emerson Street. Craig. Colorado 81625-1129
ACTUAL WELL LOCATION: County Routt
Property Address, City, St, Zip 6 Miles Northwest of Oak Creek. Colorado
NW 1/4 of the NW 1/4, Sec. 30, Twp. 5 N. Range 85 W., 6 P.M.
Distance from Section Lines 1130.25 Ft. From N. Line, 648.46 Ft. From W. Line.
Subdivision Name N/A Lot N/A, Block N/A, Filing/Unit N/A
Optional: GPS well location information in UTM format. You must check GPS unit for required settings as follows:
UTM zone 13 Units Meters Datum NAD83
Easting 332482.52 Northing 4470249.37 Elevation 2158
1 (we) report the existing well (hole) was plugged and sealed on the date of 07/24/08 for the following reason(s):
The well was plugged and sealed as required under Well Permit Number N/A.
X The well was not in use and was plugged and sealed.
X Other (please explain) 7" Metal Monitoring Well was removed from Groundwater Monitoring Program of PN C-80-001.
The well was plugged with the following materials placed at the indicated intervals:
Amount and Type of Material Method of Placement Interval
Black Hills Bentonite: Bentonite Plug. 500 Pounds Funnel Downhole from 5 ft-bgs to 35.9 ft-bgs
Intervals of Casing Removed Ripped in Feet from 1 ft-ags to 5 ft-bgs
Report must be signed by person who performed the well plugging work or by the well owner if this person is unknown or not reachable.
I we have read the statements made herein, know the contents thereof, and that the are true tom our knowledge.
Signature(s) Please print the Signer's Name & Title Date
Troy Summers, Associate Geologist August 6, 2008
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.