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FORM NO. <br />cus-31 <br />11/90 WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office use only <br />t. WELL PERMIT NUMBER 163763 M.W.-0 <br />:- n- WNER 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: SW 1/4 NE 1/4, Sec. 25 Twp. 2 S , Range 71 W_ <br />DISTANCES FROM SEC. LINES: <br />2670 ft. from South Sec. line. and. 2097 ft. from East Sec. line. OR <br />(north or south) (east or west) <br />SUBDIVISION: LOT BLOCK FiJNG(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 6603.08 ft. DRILLING METHOD <br />DATE COMPLETED TOTAL DEPTH 23.0 ft. DEPTH COMPLETED 23.0 ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (type, Size. Color, Water Location) 6. HOLE DIAM. (in.) From (ft) To (ft) <br />2-1/211 <br /> <br /> <br /> 7. PLAIN CASING <br /> OD (in) Kind Wall Size From(ft) To(ft) <br /> <br /> <br /> <br /> <br /> PERF. CASING: Screen Slot Size: <br /> <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Type <br /> Size <br /> Interval Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: o.in ormation exists for this <br />drill hole Neat Cement 0' - 1.5' Manually <br /> <br /> <br />1 DISINFECTION: Type, N/A Amt. Used N/A <br />12 WELL TEST DATA: ? 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 />3. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making <br />of false statements herein constitutes pedury in the second degree and is punishable as a class 1 misdemeanor.) <br />-`INTRACTOR Cotter Corporation Phone 303 980-1292 _ Lic. No. N/A. . <br />Oiling Address 12596 West Bayaud Avenue, #350 - Lakewood CO.-80228 <br />Name/Title (Please type or print) <br />Thomas C. Lepry <br />f,line Geologist Signature <br />r Date