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1 Cnr (lffirs 1 lso fli7ht <br />WELL OONSTRUCTICIM ANL7 t t* i mcr` m i <br />FORM NO. <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER j <br />GWS-31 <br />0412005 1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) 866-3581 <br />Fax 303 866-3589 :/hvww.water.state.co.us <br />WELL PERRIIT NUMBER:0 4 8 5 0 7 -MH <br />1. <br />2. WELL OWNER INFORMATION <br />PowerTech (USA), Inc. <br />NAME OF WELL OWNER: <br />5575 DTC Parkway, Suite140 <br />MAILING ADDRESS: <br />CITY: reenwoo 1 ageSTATE: ZIP CODE: <br />TELEPHONE NUMBER: - <br />LOCATION AS DRILLED: NE 1/4 NE 114 sec. 3 3 Twp. 10 6Nor0S, Range 67 ?EorLXW <br />3. WELL <br />DISTANCES FROM SEC. LINES: -7 Q - _ R- from [kN or 0 S section line and --58 8.g_. ft. from ? E or q W section line. <br />SUBDIVISION: LOT BLOCK , FILING (UNIT) <br />Owner's Well Designation??0 8 - 3 <br />{optional OPS Location: GPS Unit must use the following settings: Format must be UTM, Units Easting: <br />Datum must be NAID83, Unit must be set to true N, n Zone 12 or ? Zone 13 <br />ust be meters <br />, <br />m <br />STREET ADDRESS AT WELL LOCATION: Northing:_ <br /> <br />Mud Rotary <br />GROUND SURFACE ELEVATION _ feet DRILLING METHOD <br />4 <br />. <br />DATE COMPLETED 9 -1 1 - 0 9 TOTAL DEPTH 2 6 9 feet DEPTH COMPLETED J 7 . feet <br />To ft <br />6. HOLE DAM in. From (ft) <br />8. GEOLOGIC LOG: 2 3 7 <br />De th T Grain Size Color Water Loc. 10 J/ ?- 237 -267 <br />f <br />- A uvla _ <br />5 3/4 267 269 <br />10-26 L <br />7. PLAIN CASING: <br />OD (in) Kind Wall Size (in) From (ft) To (ft) i <br />6 PVC SDR17 +1 236 <br />PERFORATED CASING: Screen Slot Size (in):. 0 3 0 <br />3 PVC sch80 236 266 <br />- <br /> 8. FILTER P4gK: <br />s 1 S 9. QACKER PLACEMENT: <br /> Material <br />10120 Yppe <br /> Size <br />-n 6-- 2 6 6 <br /> Interval Depth <br /> 0. GROUTING RECORD <br /> Mate ri I A t ensi lnterv l Placem nt <br />enV- M gags 31bs (-237 Habib <br /> <br />Remarks: - <br />- <br /> 6 <br />em <br /> <br />11. DISINFECTION: Type Amt Used <br />12. WELL TEST DATA: ? Check box if Test Data is submitted on Fora Number GAS 39 Supplemental Well Test <br />TESTING METHOD <br />Static Level ft. DatelTime measured: Production Rate gpm. <br />Pumping Level ft. Date/Time measured Test Length (hrs) <br />Remarks: Monitor well to be tested at a later date. <br />i 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 />13 <br />. <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 37-91-106(1)(e), C.R.S., and is punishable b fines u to $5000 and/or revocation of the contracting, license. <br />Phone: License Number. <br />Company Name: <br />1 316 <br />Sharpe Drilling Company 307632.9523 <br />WY 82003 <br />x 20147 Cheyenne <br />s? P <br />, <br />; o <br />Mailinq Ad <br /> <br />S'u / -' <br /> <br />z <br />Print Name and Title <br />Lyle Sharpe, President p <br /> <br />1e 26-09 <br /> <br />C:-, - V .- - I-- <br />-M03 <br />rtor <br />Attachment E