2011-05-19_HYDROLOGY - M1980047

• Permit No: M1980047
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/19/2011
• Doc Name: Form GWS-46
• From: Exxon Mobil
• To: DRMS
• Email Name: THM
• Media Type: D
• Archive: No

FORM No.

GWS-31
0412005
WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1313 Sherman SL, Room 818, Denver, CO 80203' '-
Phone - Info [phone] Main [phone]
Fax [phone] h :Uwww.watecstate.co.us
For Office Use Only
1. WELL PERMIT NUMBER: 49459-MH
2. WELL OWNER INFORMATION
NAME OF WELL OWNER: Exxon Mobil Corporation
MAILING ADDRESS: GSC-GP2-224, P. O. Box 2567
CITY: Houston STATE: TEXAS ZIP CODE: 77252
TELEPHONE NUMBER: 281 654-6246
3. WELL LOCATION AS DRILLED: NW114, SW1/4, Sec. Z, Twp. 5 ? N or ® S, Range 95 ? E or ® W
DISTANCES FROM SEC. LINES: 2039 ft. from ? N or ® S section line and 1018 ft. from ? E or ® W section line.
SUBDIVISION: , LOT , BLOCK FILING (UNIT)
Optional GPS Location: GPS Unit must use the following settings: Format must be UTM. Units Owner's Well Designation: EF-V4
g:
must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or ? Zone 13
STREET ADDRESS AT WELL LOCATION: Northin :
. GROUND SURFACE ELEVATION 7150 feet DRILLING METHOD Air Rotaly --
DATE COMPLETED 11/6/2010 TOTAL DEPTH 175 feet DEPTH COMPLETED 175 feet
5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft
Depth T e Grain Size Color Water Loc. 6.25 0 175
0-175 Oil Shale fi_ne m/blk 120,160

7. PLAIN CASING:
OD (in) Kind Wall Size (in) From (ft) To (ft)
4.5 Certalok .250 +1 130
4.5 Certalo .250 170 175

PERFORATED CASING: Screen Slot Size (in):.032
4.5 erta ok .250 130 170

8. FILTER PACK: 9. PACKER PLACEMENT:
Material Silica Type
Size 10-20
Interval 125-170 Depth
0. GROUTING RECORD
Material Amount Density Interval Placement
Remarks: 3/8chin 1 bkt 170 175
3/8chip 1 bkt 125 120
Grout 875 Gal 12# 120 0
11. DISINFECTION: T e Amt. Used
12. WELL TEST DATA: Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test.
TESTING METHOD Airlift
Static Level 166 ft. DatelTime measured: 11-5-2010 Production Rate < 1 gpm.
Pumping Level ft. Date/Time measured Test Length (hrs)
Remarks: Minimal production measured during airlift
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
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
section 37-91-108 f e C.R.S., and is punishable b fines u to $5000 and/or revocation of the contracting license.
1 Company Name:
Himes Drilling Company Phone:
[phone] License Number:
531
Mailing Address• 0 U. S. 6 and 50, Grand Junction, Colorado 81505
Signature: Print Name and Title
Tim Himes Owner Date
11/292010