2009-07-15_HYDROLOGY - M1977344

• Permit No: M1977344
• IBM Index Class Name: HYDROLOGY
• Doc Date: 7/15/2009
• Doc Name: April 2009 Groundwater Monitoring Report- for Holcim ‎(US)‎ Inc.
• From: ARCADIS
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: BMK
• Media Type: D
• Archive: No

FORM NO.

GWS-31
04/2005
WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1313 Sherman St., Room 818, Denver, CO 80203
Phone - Info [phone] Main [phone]
Fax [phone] http://www.water.state.co.us
For Office Use Only
1. WELL PERMIT NUMBER:
2. WELL OWNER INFORMATION
NAME OF WELL OWNER: Holcim, Inc.
MAILING ADDRESS: 3500 Highway 120
CITY: Florence STATE: CO ZIP CODE: 81226
TELEPHONE NUMBER: 719 784-1118
3. WELL LOCATION AS DRILLED: SE1/4, SW114, Sec. 16, Twp. 19 ? N or ® S, Range 68 ? E or ® W
DISTANCES FROM SEC. LINES: 386 ft. from ® N or ? S section line and 1673 ft. from ® E or ? W section line.
SUBDIVISION: NA , LOT NA, BLOCK NA, FILING (UNIT) NA
Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Owner's Well Designation: MW-13
must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or ® Zone 13 Easting: 499188.275
STREET ADDRESS AT WELL LOCATION: Highway 120 Northin : 4249006.13
4. GROUND SURFACE ELEVATION 5.040 feet DRILLING METHOD Air Rota
DATE COMPLETED 04/03/09 TOTAL DEPTH 32 feet DEPTH COMPLETED 30 feet
5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To (ft)
Depth Type Grain Size Color Water Loc. 5 0 32
-3' SILT silt sized It bn g ay none
3-18.5' SANDSTONE e sand It gray 5-17'
18.5-32' LIMESTONE silt sized gray one 7. PLAIN CASING:
_ OD (in) Kind Wall Size (in) From (ft) To (ft)
2-inch PVC sch.40 0 15

PERFORATED CASING: Screen Slot Size (in): 0.010
2-inch PVC sch.40 15 30

8. FILTER PACK: 9. PACKER PLACEMENT:
Material sand Type NA
Size #10/20
Interval 13-32' Depth NA
0. GROUTING RECORD
Material Amount Density Interval Placement
Remarks: b chips bucket 1/8" 11-13' poured
grout 10 gal std. 2-11' poured

11. DISINFECTION: Type none Amt. Used NA
12. WELL TEST DATA: Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test.
TESTING METHOD
Static Level IV ft. Date/Time measured: 04/03109 / 08:50am Production Rate NA gpm.
Pumping Level NA ft. Date/Time measured NA Test Length (hrs) NA
Remarks:
13. t have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed and certified in
accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402-2. (The filing of a document that contains false statements is a violation of
section 37-91-108 1 e C.R.S. and is punishable b fines u to $5000 and/or revocation of the contracting license.
Company Name:
Layne Christensen Phone:
303 7SS-1281 License Number:
Mailing Address: 17800 East 22nd Avenue Aurora, Colorado 80011
Signatu _11: Print Name and Title /? r Date