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1 <br />t <br />i <br />WELL CONSTRUCTION AND TEST REPORT 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) 866-3581 <br />Fax 303 866-3589 ft/twwwwater.state.co.us <br />1. WELL PERMIT NUMBER: 49459-MH <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: Exxon Mobil Corporation <br />MAILING ADDRESS: GSC-GP2-224 P. 0. Box 2567 <br />CITY: Houston STATE: TEXAS ZIP CODE: 77252 <br />TELEPHONE NUMBER: 281 654-6246 <br />3. WELL LQCATION AS DRILLED: NN„)I (114, W114, Sec. L Top. 5 ? N or ® S, Range ? E or [@ W <br />DISTANCES FROM SEC. LINES: 2 332 ft. from ? N or ® S section line and 1018 ft. from ? E or ® W section line. <br />SUBDIVISION: , LOT , BLOCK , FILING (UNIT) <br />Owner's Well Designation: E.- <br />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 [I Zone 13 <br />must <br />STREET ADDRESS AT WELL LOCATION: Northi : <br />GROUND SURFACE ELEVATION 7150 feet DRILLING METHOD Air Rot@Ky <br />DATE COMPLETED 11/8/2010 TOTAL DEPTH 175 feet DEPTH COMPLETED 175 feet <br />5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft <br />Depth T e Grain Size Color Water Loc. 6.25 0 175 <br />175 Oil Shale 120,160 <br />- <br /> <br /> 7. PLAIN CAStNG: <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 4.5 Ralok 250 +1 130 <br /> 4.5 Certal .250 170 175 <br /> <br /> <br /> PERFORATED CASING: Screen Slot Size (in):,032 <br /> 4.5 Certo .250 130 170 <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica Type <br /> Size 10-20 <br /> Interval 125-170 DepIt <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br />Remarks: 3/8chiD 1 bkt 170 175 <br /> 3/8chip_ 1 bkt :125 120 <br /> Grout 875 Gal 12# 120 0 <br />11. DISINFECTION: T e Amt. Used <br />12. WELL TEST DATA Check box If Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD i ' <br />Static Level 166 ft. Date/Time measured: 11-6-2010 Production Rate c 1 gpm. <br />Pumping Level ft. Datelrime measured Test Length (his) <br />Remarks: Minimal production measured 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 i, signed and certified in <br />accordance 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 />section 37-91-108 t e C.R-S. and is punishable fines u to $5000 and/or revocation of the contracting license. <br />Company Name: Phone: License Number. <br />Himes Drillin Company (970)242-8893 531 <br /> <br />50, Grand Junction Colorado 81505 <br />Mailing Address- 0 U. S. 6 and <br />- <br />Signature: Print Name and Title Date <br />Tim Himes Owner <br />I 11/29/2010 <br />