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Form No. OFFICE OF THE STATE ENGINEER Mw-12 <br />GWS-25 COLORADO DIVISION OF WATER RESOURCES. <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />APPLICANT <br />(303) 866-3581 <br />EXST <br />WELL PERMIT NUMBER 280593 - <br />DIV. 1 WD 3 DES. BASIN MD <br /> APPROVED WELL LOCATION <br /> WELD COUNTY <br /> NW 114 NE 1/4 Section 36 <br />LAFARGE NORTH AMERICA Township 6 N Range 67 W` Sixth P.M. <br />C/O ENVIROGROUP LIMITED DISTANCES FROM SECTION LINES <br />3561 STAGECOACH ROAD #205 675 Ft. from North Section Line <br />LONGMONT, CO 80504- 2632 Ft. from East Section Line <br /> UTM COORDINATES (Meters, Zone: 13,NA083) <br />(720) 494-2600 Easting. Northing: <br /> PERMIT TO USE AN EXISTING WELL <br /> I fil 1AN(,F nF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />1) This well shall be used in such a way as to cause nonmaterial injury to existing water rights. The issuance of this permit' <br />does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from <br />seeking relief in a civil court action. <br />2) The construction of this well shall be in compliance with the Water Well Construction Rules 2CCR 402-2, unless approvar <br />of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation <br />Contractors In accordance with Rule 18. <br />3) Approved pursuant to CRS 37-92-602(3)(b)(I) for uses as described in CRS 37-92-602(1)(0. Use of this well is limited to <br />monitoring water levels and/or water quality sampling. <br />4) Approved for the use of an existing' well acknowledged for construction under monitoring hole notice MH46987, and <br />known as MW-12.; <br />5) This well must be equipped with a locking cap or seal to prevent well contamination or possible hazards as an open well, <br />The well must be kept capped and locked at all times except during sampling or measuring. <br />6) Records of water level measurements and water quality analyses, shall be maintained by the well owner and submitted to <br />the Division of Water Resources upon request. <br />7) Upon conclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water <br />Well Construction Rules.A Well Abandonment Report must be completed and submitted to the Division of Water <br />Resources within 60 days of, plugging: <br />8) The owner shall mark the well in a conspicuous place with the well permit number and name of aquifer as appropriate, <br />and shall take necessary means and precautions to preserve these markings. <br />9) This well must have been constructed by or under the supervision of alicensed well driller or other authorized individual <br />according to the Water Well Construction Rules, <br />10) This, well must be located not more than 200 feet from the location specified on this permit. <br />11) Issuance of this permit does not guarantee that this well can be converted to aproduction well undera future permit. The <br />ability of this well to be converted to a production well is limited by all governing statutes, rules, regulations, orders, and/or <br />decrees.'t 1.N. OX107/09 , <br />APPROVED <br />BDH <br />Engineer <br />'Receipt No.3639673L State DA <br />05-07-201 <br />.