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li FORM No. <br /> <br />GWS-31 <br />0412005 <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />P1313 hone - Info (303) 66-3587$ gain (303) 866-3581 <br />Fax (3031866-3589 hM:/1www.water.state.Go.us <br />For office Use Only <br />1. WELL PERMIT NUMBER: 0 4 8 5 0 3- MH <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: PowerTech (USA), Inc. <br />{ <br />MAILINGADDRESS: 5575 DTC Parkway, Suite 140 <br />CITY: Greenwood Vi ageSTATE: CO ZIPCODE: 80111 <br />7 -528 <br />TELEPHONE NUMBER: - <br /> <br />Ear W <br />3. WELL LOCATION AS DRILLED: SW 114, NE 114. Sec.3 3 Twp. 10 N N or ®S, Range 67 <br />DISTANCES FROM SEC. LINES: 21 3 & ft. from(-N or ? S section line and 3: -Q 2 ft. from ? E or P W section line. <br />SUBDIVISION: -- LOT . BLOCK , FILING (UNIT) __..___ <br />Owner's Well Designation :T N 8 - , <br />Optional CPS Location: CPS Unit must use the following settings: Format must be UTM, Units Easting: <br />must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or [1 Zone 13 <br />STREET ADDRESS AT WELL LOCATION: Northin : <br />GROUND SURFACE ELEVATION feet DRILLING METHOD Mud Rotary <br />DATE COMPLETED 9-9-09 TOTAL DEPTH 3 68 feet DEPTH COMPLETED 367 feet <br />5. GEOLOGIC LOG: S. HOLE 1AM in. From ft To (ft <br /> <br />th <br />D <br />Tvoe <br />Grain Size <br />Color <br />Water Loc. <br />? <br />? 351 366 <br />- <br />10 <br />A uvia <br />a r2 <br />10-368 Laramie 366 368 <br /> 7. PLAIN CASING: <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br />350 <br /> 6 PVC SDR17 +1 <br /> <br /> <br /> <br /> PERFORATED CASING: Screen Slot Size tin?:. 03 0 <br /> 3 PVC sch80 350 365 <br /> <br /> l <br /> <br /> S. FILTER PACK: 9. PACKER PLACEMENT: <br /> Matenai s i l i r, a s a pe <br /> i Size 1 0 2 0 <br />7 <br />- <br />- <br /> 0 <br />-37' <br />Interval 3 5 Depth <br /> ti. GROUTING RECORD <br /> sAf- AN'?lgalsnq` lbs 1 1350 HafT'T%u <br />Remarks: ram <br /> <br />11. DISINFECTION: Type Amt Used <br />12. WELL TEST DATA: ? Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test <br />TESTING METHOD <br />Static Level ft. Date/Time measured: Production Rate gpm. <br />Pumping Level ft. 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 knovt the contents thereof, and they are true to my knowledge. This document is signed and certified in <br />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 <br />section 37-81-148 1 e C.R.S., and is punishable b fines u to $5000 and/or revocation of the contractin4 license. <br />Company Name: Sharpe Drilling Company 3-99 32-9523 Lj?erlS?Number <br />l S t <br />Mailin A d>`e`s i P:O. )BIOX 201 47 Cheyenne, WY 82003 <br />3i nat /_ f Print Name andTitieLyle Sharpe, President ? t 26-09: <br />4•. w v cs L r <br />3-M101 <br />ton <br />Attachment E