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Form STATE OF COLORADO For Office Use Only <br />No. OFFICE OF THE STATE ENGINEER <br />GWS-1 <br />6/2006 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203 <br />(303) 866-3581 Fax (303) 866-3589 <br /> hftp://water.state.co.us/default.htm <br />REGISTRATION OF EXISTING WELL <br />NAME. ADDRESS AND PHONE OF THE WELL OWNER: <br />NAME(S) <br />Fredrick G. Hoe tner et All Partners c/o Scott Hayden <br />MAILING ADDRESS <br />360 S. Monroe, 5th Floor <br />CITY: STATE: ZIP CODE: <br />Denver CO 80209 <br />TELEPHONE NUMBER E-MAIL (OPTIONAL) <br />(303) 756-2999 <br /> <br />WELL LOCATION County Routt Owner's Well Designation (optional) OKa <br />N/A N/A CO N/A <br />(Address) (City) (State) (Zip) <br />NW 1/4 of the NW 1/4, Sec. 20 , Twp. 4 ® N. or ? S., Range85 ? E. or ® W., 6th Principal P.M. <br />Distance from Section Lines 573 Ft. ® N. or ? S. Line, 23 Ft. ? E. or ® W. Line. <br />PLEASE ATTACH A COPY OF A CURRENT DEED FOR THE SUBJECT PARCEL <br />Subdivision Name N/A Lot , Block , Filing/Unit <br />Optional: GPS well location information in UTM format. The following GPS settings are required: Easting 333464.98 <br />Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true <br />north. ? Zone 12 or ® Zone 13 <br />Was GPS unit checked for above items? ® YES ? NO Northing 4464233.87 <br /> <br />The well has historically been used for the following purpose(s): Monitoring/Stilling Well <br /> <br />Water from the well was first used beneficially by the original owner for the above described purposes on Unknown <br />The total depth of this well is Unknown feet. <br />The pumping rate of this well is N/A gallons per minute. <br />The average annual amount of water diverted is N/A acre-feet. <br />The lawn and garden irrigated (watered) by water from this well is N/A ? Acre or ? Square feet. <br />Number <br />The making of false statements herein constitutes perjury in the second degree, which is punishable as a.class 1 misdemeanor pursuant to <br />C.R.S. 23-3-104(13)(a). I have read the statements herein, know the contents thereof, and state that they are true to my knowledge. <br />Signa ur s) of the Well caner <br />r; -Print Name and Title of Well Owner T- <br />r &TA I ?A 4r- h-r S <br />hl[1? ?Yle Date <br />r - <br /> <br />For Office Use Only <br />WE <br />WR <br />CWCB <br />TOPO <br />MYLAR Div WD _ Basin MD