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• <br />• <br /> <br />FORM 31 NO. <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />GWS-5 1313 Sherman SL, Room 818, Denver, CO 80203 <br />?? Phone - info (303) 868-3587 Main (303) 866-3581 <br />Fax 303 866-3589 httP:1A~wvw.state.co.us <br />WELL PERMIT NUMBER: 0 4 8 5 0 2 -MH <br />WELL OWNER INFORMATION <br />NAME OF WELL OWNER: PowerTech ( USA) Inc <br />UAIIINC. AnnRESS: 5575 DTC_Parkway Suite 140 <br />Use <br />TELEPHONE NUMttthc: _ - <br />V&LL LOCATION AS DRILLED: SW 1/4, NE 1/4, SM3 3 . TwR. 1 0 ®N or S, Range 6 7 ? E or ® W <br />DISTANCES FROM SEC. LINES: 2 0 81 ft. from ® N or 0 S section line and 3Z 0 2 ft from ? E or jRW section line. <br />SUBDIVISION: , LOT . BLOCK , FILING (UNIT) <br />Owner's Well Designation3 _ py,) ? <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Easting: I 1 <br />must be meters, Datum must be NAD83, Unit must be set to true N. El Zone 12 or ? Zone 13 <br />GROUND SURFACE ELEVATION _ feet <br />neTt rnMP1_FTFD 9i.=07-09 TOTAL DEPTH 5 2 <br />DRILLING METHOD <br />i, HOLE DIAM in. From ft To rt <br />/ n <br />4_ <br />8 3 - 59-2 <br />- <br />10 1/2 502 526 <br />_ <br />5--3-/4 526 528 <br />F. PLAIN CASING: <br />OF (in) PVC SDR17(in) +1 (ft) 500) <br />PERFORATED PCA ING. s Ch SO Slot Size (in): • 0 3 0 <br />q,00 <br />.-5 <br />FILTER PACK S. PACKER PLACEMENT. <br />Material S i 1 ; C- Type <br />Size 10, f n <br />Q. GROUTING RECORD <br />Material Amount Density Interval Placement <br />Remarks: Bent- a29-- 131x_0-500 Ha] 1 i bj on <br />cem sals <br />on <br />39 <br />TESTING METHOD <br />Static Level ft. DateMme measured: Production Rate gpm. <br />Pumping Level tt Date/Time measured Test Length (hrs) <br />Remarks: Moniter well to be tested at a later date. <br />13. 1 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 <br />a ordanoe with Rule 17.4 of the Water Weil constriction Rules, 2 CGR 402-2. [The fling of a document that contains false statements Is a violation of <br />-Sharpe Drilling Company <br />MadinqAddmO. .Box 20147 Cheyenne, WY 82003 <br />Qi, Print Name and Title f?te 2 6 - 0 9 <br />Completeness Issue Item #7 Attachment