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FORM NO. <br />GINS-31 STATE OF COLORADO, OFFICE OF THE SWE EKGINEER <br />04/2005 1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone - Info (303) 866-3587 Main (303) W&3581 <br />OF WELL OWNER: Exxon Mobil <br />rCLCrrlV1YC IYV1/1VGf?• ????-? ???-- - <br />WELL LOCATION AS DRILLED: NW1/4, S,_M1/4, Sec. Z, Twp. ? N or ®S, Range ? E or ® W <br />DISTANCES FROM SEC. LINES: 2359 ft. from ? N or ® S section line and 1182 ft. from ? E or ® W section line. <br />SUBDIVISION: , LOT , BLOCK , FILING (UNIT) <br />Owner's Well Designation: EF-V2 <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Owner's <br />g: <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 7157 _ feet DRILLING METHOD Air Rotary <br />DATE COMPLETED 11/3/2010 TOTAL DEPTH 175 feet DEPTH COMPLETED 174 feet To (ft) <br />6. HOLE DIAM (in.) _ From (ft) <br />Sae Color Water Loc. 6 5 0 148 <br />hm/blk 5 6125 _ 148 175 <br />F. PLAIN CASING: <br />OD (in) Kind Wall Sae (n) From (ft) To (ft) <br />4.5 Certlok 250 +1 129 <br />4.5 Certalok .250 169 174 <br />PERFORATED CASING: Screen Slot Size Cn):.32 <br />4.5 Certalok- .250 129 169 <br />8. FILTER PACK: 9. PACKER PLACEMENT: <br />Material Silica TYPO <br />Size $-12 _ <br />Interval 120-170 Depth <br />0. GROUTING RECORD <br />Material Amount Density Interval Placement <br />3/8chiD 1 5 bkt 170-1 dumped <br />Remarks: OrAned ora 'on hole 0'-149115-120 dumped <br />Deepened hole 149'-174' 318chig 1 bkt <br />^-....& A n v=si 19# 115-0 Pumped <br />is submitted on <br />TESTING METHOD Airlift <br />Static Level 154 R DateTme measured: 11-4-2010 Production Rate 5-9Pm- <br />Pumping Level R. DateTme measured Test Length (hrs) a .0 to. <br />MIN statements made herein and now the contents thereof, and they are true my no <br />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 />11-108 1 e C.R.S- and Is punishable b fines u to $5000 aryd/or revocation of the contracting. license. License Number: <br />Name: 19,'7n.5we_091014 531 <br />. Print Name and