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<br />TEST REPORT <br />{NEl.i. CONSTRUCTION AND <br />For Office Use Only <br />FORM NO. GvVS-331 STATE OF COLORADO, OFFICE. OF THE STATE ENGINEER <br />04/2005 1313 Sherman SL, Room 818, Denver, CO 80203 <br /> Phone - Info (303) 8e6-3587 Main (303) 888-3581 <br /> Fax 303 8$8-3889 JAwwi waW stMe.co.us <br />1. WELL PERMIT NUMBER: 0 09-MH <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: PowerTech (USA) , Inc. <br />MAILING ADDRESS: 5575 DTC Parkway, Suite 140 <br />CITY: e o V 1 STATE ZIP CODE <br />TELEPHONE NUMBER: 303 790 7528 <br />l t LOCATION AS DRILLED: SW 1/4, NE 1/4, Sec. 3 3 . Twp. p, . KIN or ? S, Range 67 ? E orKPW <br />3 <br />A <br />- <br />. <br />DISTANCES FROM SEC. LINES: 2315 IL from M N or ? S section line and 3 7 9 2 fL from ? E orj9W section line. <br />SUBDIVISION: 'LOT BLOC€C_-_,_,, FILING (UNIT) <br />Owner's Well Designation ,Z NN 0.? ?3 <br />optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Fasting: <br />must be meters, Datum must be NA083, Unit must be set to true N, ? Zone 12 or Q Zone 13 <br />STREET ADDRESS AT WELL LOCATION: Northin : <br />GROUND SURFACE ELEVATION feet DRILLING METHOD Mud- Rotary <br />DATE COMPLETED 9- 2- 0 9 TOTAL DEPTH 505 feet DEPTH COMPLETED 5 0 3 feet <br />S. GEOLOGIC LOG: 6. HOLE DIAM in. From (ft) To ft <br />0 477 <br />Depth Type Grain Size Color Water Loa <br />10 1/2 47$ 501 <br />5 5/8 501 505 <br />_ T. PLAIN CASING: <br /> (ft) <br />From <br />Wall <br />Cn) <br />(in) <br />() T <br />O <br /> 4 7 <br />11 <br />17 <br />P <br /> C <br />6 <br />+ <br /> <br /> <br /> <br /> PERFORATED CASING: Screen Slot Size (in):. 0 3 0 <br /> 3 PVC sch80 476 501 <br /> <br /> <br /> <br /> 8. FILTER PCK <br />i 9. PACKER PLACEMENT: <br />n <br /> c a s <br />Material s. o., <br /> Size 10/20 <br /> Interval 4 7 - 5 01- D th <br /> 110. GROUTING RECORD <br /> atenal Arn unt Density Interval Placement <br />als 13 lbs 0-477 Hallibu <br />nt- 19 ( <br />l <br /> g <br />e <br />Remarks: c em <br /> <br />Ii. DISINFECTION: T e Amt. Used <br />box if Test Data Is submitted on Forth Number GINS 39 Supplemental Well Test <br />Ch <br />c <br />k <br />e <br />12. WELL TEST DATA: <br />TESTING METHOD <br />Static Level it Date/Time measured: -_, Production Rate_ gpm. <br />Pumping Level it. Date/Time measured _ J Test Length (hm) <br />Remarks: <br />t have read the statements made herein and know the oontents thereof, and they are true to my wledge. This document is signed and certified in <br />13 <br />. <br />accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402-2. j7he filing of a document that oontains false statements is a violation of <br />section 37-91-108 1 e C.R.S., and is punishable fines to 35OW and/or revocation of cure c ontracli license. <br />Phone: License Number. <br />1 31 6 <br />Company Name: <br />Share Drillin Com an 303 <br />Mallin Address: P.O..-/Box 20147 Cheyenne, WY 82003 <br />Signature: <br />' P'rint Name and Title <br />Lyle Sharpe, President Date <br />10-26-09 <br /> <br />3'-MV <br />4mi <br />ton <br />Attachment E