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FORM NO- WELL CONSTRUCTION AND TEST REPORT For Office use only <br />111/90 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1/90 <br />?. WELL PERMIT NUMBER 162762 M.W.-8 <br />OWNER NAME(S) Cotter Corporation <br />L Mailing Address . lZb9b West ayau venue, #350 <br />City, St. Zip Lakewood, Colorado 80228 <br />Phone( 303) 980-1292 <br />3. WELL LOCATION AS DRILLED: SE 1/4 SE 1/4, Sec. 25 Twp. ? S , Range_ 71 W <br />DISTANCES FROM SEC. LINES: _ <br />862 ft. from South Sec. line. and 187 ft. from East Sec. line. OR <br />(north or south) (east or west) <br />SUSDIVISIOI* LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />GROUND SURFACE ELEVATION 5532.42 ft. DRILLING METHOD Hammer/Rotary-Air <br />DATE COMPLETED 12/08/90 . TOTAL DEPTH 12.5 ft. DEPTH COMPLETED_ 12.0 ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type, size. Color, Water Location) <br />0' - 1.0' Road fill <br />2.01 In a spars q z. ngu ar <br />appears to be a ou er very <br />hard <br />_2.0' - 8.5' Appears to be Float Microcline <br />- <br />hard)).-- large boulder (very <br />- hard <br />10-. Change from hard rock to a fine <br />grained, buff colored sand <br />1U.U 12.5 orn en a net ss - e r c <br />(see remar s e ow <br />M o roun wa er was intercepted <br />while dril Ing, even after the <br />well stabilized no water was <br />detected <br />REMARKS: Drill hole slouged in to 12.01 <br />No wa r <br />DISINFECTION: <br />(ft <br />11 86. HOLE DIAM. (in.) FroOm (ft) To 12.5 <br />7. PLAIN CASING <br />OD (in) Kind Wall Size From(ft) To(ft) <br />4" PVC Sch 40 +3.0 7.0 <br />PERF. CASING: Screen Slot Size: 7 <br />70'i''r- <br />4" PVC Sch 40b <br />8. FILTER PACK 9. PACKER PLACEMENT: <br />Material Si 1 i ca . Sand Type <br />Size 8-1 es. <br />Interval 5.0 - 12.0 nonti, <br />10.. GROUTING RECORD: <br />Material Amount ' Density Interval Placement <br />Neat Cement <br />Bentbn?te 3 0' Manua Y <br />Amt. Used <br />WELL TEST DATA: D Check box if Test Data is submitted on Supplemental Form. <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 <br />P3. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 24-4-104 (13) (a) C.R.S., the n <br />of false statements herein cons-+tutes perjury in the second degree and is punishable as a. class 1 misdemeanor.] <br />CONTRACTOR Cotter Corporation Phone 303 980-1292 <br />MailingAddress_ 12596 West ayau venue 0 - La ewood CO 80228 Lic. No. N/; ` <br />Name/Title (Pleasa type or print) Signature Tate <br />Thomas C LQ;) !-y _ <br />Mine Geologist