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FORM NO. <br />11/96 <br />11/90 WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use only <br />1. . WELL PERMIT NUMBER 163758 M. W. -4 <br />. OWNER NAME(S) Cotter Corporation <br />Mailing Address 12596 West Bayaud Avenue, #350 <br />City, St. Zip Lakewood, Colorado 80228 <br />Phone ( 303 ) 980-1292 <br />3. WELL LOCATION AS DRILLED: NW 1/4 SE 1/4, Sec. _25 Twp. 2 S , Range 71. W <br />DISTANCES FROM SEC. LINES: <br />1726 ft. from South Sec. line. and 1530 ft from East Sec. line. OR <br />(north or south) (east or west) <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 6596.8 ft. DRILLING METHOD Hammer/Ai r <br />DATE COMPLETED 06/16/89 TOTAL DEPTH 38.9 ft. DEPTH COMPLETED 38.9 ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type. Size, color, water Location) <br />0' - 36.3' Topsoil and Fill with some old 6. HOLE DIAM. (in.) From (ft) To (ft) <br />6" 0 38.9 <br />timber fragments an minor <br />amounts of sand <br /> 7. PLAIN CASING <br />36.3' - 38.9' Bedrock - Competent Amp Ibotyfe 00n) Kind Wail Size From(ft) To(ft) <br />(Hornblende Gneiss) 2" PVC Sch 40 +4 25.9 <br /> -0 35.9 38.9 <br />2" PVC Sch <br />1 U. _ <br /> <br />t water PERF. CASING: Screen Slot Size: <br /> 2" PVC Sch 40 -77T- Jb <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material . Silica' Sand Type <br /> Size 8-12 Mes <br /> Interval 23.0 - 35.9 Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: Neat Cement <br />- Tentoni e TSU. - . anua . y <br /> <br /> <br />i DISINFECTION: Type Amt. Used <br /> WELL TEST DATA: ? Check box if Test Data is submitted on Supplemental Form. <br />TESTING METHOD <br />Static Level ft. Date/T`ime measured Production Rate gpm. <br />Pumping level ft. Date/Time measured Production <br />length (hrs.) <br />Remarks <br />3. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section 24.4104 (13)(a) CAS., the making <br />of false statements herein constitutes per(ury in the second degree and is punishable as a class 1 misdemeanor.) <br />CONTRACTOR Cotter Corporation _ Phone (303 ) 980-1292 Lic. No._?. <br />Mailing Address 12596 West Bavaud Avenue, #350 - Lakewood CO 80228 <br />Name/Title (Please type or print) <br />Thomas C. Lepry <br />Cline Geologist Signature <br />_ Date <br />