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FORM NO. WELL CONSTRUCTION AND TEST REPORT <br />GWS-31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />04/2005 1313 Sherman St., Room 818. Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) 866-3581 <br />Fax 303 866-3589 http://www.waler.state.co.us <br />WELL PERMIT NUMBER: MH- 04 7 2 0 9 <br />WELL OWNER INFORMATION <br />NAME OF WELL OWNER: Powertech (USA) Inc. <br />MAILINGADDRESS:5575 DTC Parkway Suite 140 <br />CITY: Gre enwood Village STATE: Colorado ZIP CODE: 80111 <br />TELEPHONE NUMBER: 303 790 - 7528 <br />3. WELL LOCATION AS DRILLED: SW 1/4, NE 1/4, Sec. 33 , Twp. 10 ® N or ? S, Range 6 7 ? E or ® W <br />DISTANCES FROM SEC. LINES: 2500 ft. from ® Nor ? S section line and 1400 ft. from <br />®E or ? W section line <br /> <br />SUBDIVISION: . <br />. LOT , BLOCK , FILING (UNIT) <br />Optional GPS Location: GPS Unit must use the following settings: Units Owner's Well Designation: I S - 3 Tc <br />Format must be UTM <br />must be meters, Datum must be NAD83, Unit must be set to true N . <br />, ? Zone 12 or ? Zone 13 Easting: <br />STREET ADDRESS AT WELL LOCATION: East of CR17 & North of CR110 Northin : <br />4. GROUND SURFACE ELEVATION 5539. 343 feet DRILLING METHOD Air Rotary <br />DATE COMPLETED 09/12/07 TOTAL DEPTH 495 feet DEPTH COMPLETED 495 feet <br />5. GEOLOGIC LOG: 4 HOLE DIAM in. From k To ft <br />De th Type Grain Size Color Water Loc. 10 0 40 <br />0 Mudstone Clay Gra 6-1/4 40 495 <br />122 Sandstone Sand Gra <br />175 Mudstone Clay Gra 10 GPM 7. PLAIN CASING: <br />340 Mudstone Cla Gra OD <br />in) Ki <br /> <br />395 <br />Sandstone Sand <br />Gra ( <br />nd Wall Size (in) From (ft) To (ft) <br /> <br />495 <br />Mudstone Mud y 2 SCH 40 0.125 0 465 <br />Gra 35 GPM <br /> <br /> PERFORATED C <br /> ASING: Screen Slot Size (in): 0 . 020 <br /> 2 SCH 40 0 <br />125 4 <br /> . <br />65 495 <br /> <br /> <br /> <br /> 8 <br />FILTER PA <br /> . <br />CK: 9. PACKER PLACEMENT: <br /> Materi <br />l Sand <br /> a <br />Type N/A <br /> Size B-12 <br /> <br /> Inter <br />l 45 <br /> va <br />5-495 Depth N/A <br /> 10 <br />GROUTI <br /> . <br />NG RECORD <br /> Material Am <br />t D <br /> <br />Remarks: *G <br />rout consists of WYO-BEN oun <br />ensity Interval Placement <br />Grout* 81 FT3 10 <br />2 <br />. <br />0-452 Pumped <br />EnviroDlua - 30% Solids **Bentonite 1/4"Bent.**0.6 FT3 10.2 452-455 Tremie <br />time release Dellets ahn-,rP -Anrl <br />1. DISINFECTION: <br />IL. VVCLL ca uH t A. LJ Uheck box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level2 7 5 . 0 ft. Date/Time measured: Production Rate <br />Pumping Level ft. Date/Time measured gpm. <br />Test length (hrs) <br />Remarks: <br />3. 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 />ccordance 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 <br />ection 37.91-108 1 e , C.R.S.. and is punishable b fines u to S5000 and/or revocation of the contractin ? license. <br />Company Name: Phone: <br />License Number: <br />Ingram Drilling, Inc. 800 410-4542 1099 <br />FMZ: Box 342 Estes Park, Colorado 80517 <br />Print Name and Title <br />Ste hen E. In ram President Date JJ <br />Attachment D