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Cnr Ctffira I Ica nnr <br />WELL CO ION ANIJ I lt? I Kcr°vm t ? <br />FORM NO. <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />GvvS-31 <br />0412005 1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) 886-3581 <br />Fax 303 866-3589 h :/lwww.water.state.co-us <br />T4 T5 0 -MH <br />'l. WELL PERMIT NUMBER: <br />WELL OVVNF-K INFORMATION <br />2 <br />. <br />NAME OF WELL OUVNER: powerTech (USA), Inc. <br />5575 DTC Parkway, Suite 140 <br />MAILING ADDRESS: <br />Greenwood VillageSTATE: CO ZIP CODE: 80111 <br />CITY: <br /> <br />790-752 <br />M-T <br />TELEPHONE NUMBER: 0 7 <br />? E or fy W <br />WELL LOCATION AS DRILLED: 1/4, 1/4, Sec. Twp. N or ? S, Range _C, 7 <br />3 <br />. <br />DISTANCES FROM SEC. LINES: 1 6 S ft. from FX) N or [) S section line andg _ ft. from ? E oraW section fine. <br />SUBDIVISION: LOT BLOCK FILING (UNIT)-??08-3: <br />Owner's Well Designation: <br />Optional GPS Location: GPS Unit must use the following settings: Format must be U T M, Units Easting: <br />? Zone 12 or ? Zone 13 <br />N <br />, <br />Datum must be NAD83, Unit must be set to true <br />must be meters <br />, <br />STREET ADDRESS AT WELL LOCATION: Northin : <br />GROUND SURFACE ELEVATION _ feet DRILLING METHOD Mud Rotary <br />341 <br />feet <br />DATE COMPLETED 9 - 2 5 - 0 9 TOTAL DEPTH 3 4 4 feet DEPTH COMPLETED <br />6. GEOLOGIC LOG: 6. HOLE DIANA (in. From ft To ft <br />0 3 2 6 <br /> <br />De th Grain Size Color Water Loc. <br />T <br />0-10 Alluvial 101 /2 <br />/4 <br />Laramie <br /> 7. PLAIN CASING: <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 1 325 <br />R17 <br /> + <br />6 PVC SD <br /> <br /> <br /> 030 <br /> PERFORATED CASING: Screen Slot Size (in): . <br /> h80 325 340 <br />VC <br /> sc <br />3 P <br /> <br /> <br /> <br /> 8. FILTER P vil 9'dPACKER PLACEMENT: <br /> 1 <br />? S <br />Material <br /> ? <br />1 <br /> Size <br /> Interval 325-340 Depth <br /> 1 <br />110. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> 326 Hallibur <br />131b <br />0 <br />l <br />561 <br /> s <br />- <br />ga <br />s <br />Bent- <br />Remarks: C em <br /> <br />11. DISINFECTION: T e Amt. Used <br />? Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />ST DATA <br />: <br />12. WELL TE <br />TESTING METHOD <br />Static Level ft. Datef 'lime 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 know 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 37-91-1080)(e). C.R.S. and is unishabie b fines u to 000 and/or revocation of the contracting license. <br />License Number: <br />1316 <br />Company Name: Sharpe Drilling Company 32 9523 <br />P) .01, <br />Mai,inaAddress: Box 20147 Cheyenne, WY 82003 <br />. <br />Signature,,' <br />T <br />Print Name and Title Lyle Sharpe, President D1ate-26-09 <br /> <br />-?--/ vw %,j v -- - -- <br />3-M01 <br />M02 <br />:on <br />Attachment E