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WELL CONSTRUCTION A TESREPORT For Office Use Only <br />FORM NO. <br />OFFICE OF THE STATE ENGINEER <br />STATE OF COLORADO <br />, <br />GWS-31 <br />04/2005 1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) 888-3581 <br />Fax 303 8663589 h :1tvww.water.state.oo.us <br />1. WELL PERMIT NUMBER: 49458-MH <br />. WELL OWNER INFORMATION <br />NAME OF WELL OWNER' Exxon Mobil Corporation <br />MAILING ADDRESS: GSC-GP2-224 P. O. Box 2567 <br />CITY: Houston STATE: TEXAS ZIP CODE: 77152 <br />TELEPHONE NUMBER: 281 654-6248 <br />WELL LOCATION AS DRILLED: M1/4, $W114, Sec. 7, Twp. ;I ? N or ® S, Range 25 ? E or ® W <br />3 <br />. <br />DISTANCES FROM SEC. LINES: 869 ft. from ? N or ® S section line and 1166 ft. from ? E or ® W section line. <br />SUBDIVISION: , LOT , BLOCK , FILING (UNIT) <br />Owners Well Designation: EF-AW1 <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units fasting: <br />must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or ? Zone 13 <br />STREET ADDRESS AT WELL LOCATION:. Northin : <br />. GROUND SURFACE ELEVATION 6690 feet DRILLING METHOD Air Rotary - a in A a t <br />DATE COMPLETED 11/15/2010 TOTAL DEPTH 150 feet DEPTH COMPLETED 150 feet <br />S. HOLE DIAM in. From ft To ft <br />5. GEOLOGIC LOG: <br />144 <br /> <br />Water Loc. 7,125 0 <br />De th TVD8 I Grain Size <br />olor <br /> <br />44 150 <br />5.87§ 1 <br />C <br />Shal F01 <br />All v a <br />7. PLAIN CASING: <br />/bI <br />h <br />42-- 1150 it Sh I i fine m <br />OD (n) Kind Wall Size (in) From (ft) To (ft) <br />4.5 S H4 J 250 +1 - 93 <br />! 4.5 -- CH F 250 143 _ 150 <br />PERFORATED CASING: Screen Slot Size (in): A20 <br />4.5 H4 F .250 93 143 <br />I <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica _ Type <br /> Size 10-20 <br /> Interval 81-145 Depth <br />0. GROUTING RECORD <br />Material Amount Density Interval Placement <br />Remarks: 6 518 Casing Advanced through fill and 31chi 1 bl 145 1 <br />76 81 <br />3/8drip !AL <br />- <br />alluvium and pulled upon completion <br />3/8dii 26 sks 2 76 <br />Lost returns at 55' <br />11. DISINFECTION: T Amt' Used <br />ST DATA Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />12. WELL TE <br />TESTING METHOD Airlift <br />Date/Time measured: 11-15-201 Produc lon Rate -:51 _ 9Pm <br />ft <br />. <br />Static Level none - <br />Test Length (his) <br />Pumping Level ft. Date/Time measured <br />Remarks: No measurable water during airlift <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 />ment that contains false statements is a violation of <br />d <br />f <br />ocu <br />a <br />accordance with Rule 17A of the Water Well Construction Rules, 2 CCR 402-2. [The filing o <br />unishable fines u to $5000 and/or revocation of the contrar in license. <br />and is <br />R <br />S <br />C <br />p <br />. <br />. <br />. <br />section 37-91-1108(l)(6), <br />License Number. <br />Phone: <br />Company Name: <br />970 242-8893 531 <br />Himes Drillin Company <br />Mallin Add U. 6 and 50 Grand Junction Colorado 81505 pate <br />Date <br />Signature. ?- Print Name and Title <br />10 <br />Tim Hmes Owner <br />