2011-07-11_GENERAL DOCUMENTS - C1981041

• Permit No: C1981041
• IBM Index Class Name: General Documents
• Doc Date: 7/11/2011
• Doc Name: Well Abandonment Report Rollin #2 & #3
• From: J.E. Stover & Associates
• To: DRMS
• Permit Index Doc Type: Exploration
• Email Name: MPB
• Email Name: SB1
• Media Type: D
• Archive: No

Form No.
GWS -09
6/2006
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
(303) 866 -3581 Fax [phone] http: / /www.water.state.co.us
For Office Use Only
.
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells, monitoring and other holes. Type or
print in black or blue ink. Instructions and plugging standards are on reverse side of form.
Well Permit
MH File
Number of the well being plugged
Number MH- Hole ID
205586 or
# /Name loll in s Att 3
Individual /Company responsible for plugging and sealing the well:
NAME(S)
Mailing Address
City, St., Zip
Phone (
Himes Drilling Company, Inc.
2390 Highway 6 & 50
Grand Junction, CO 81505
970 ) 242 -8893
Well (Hole) Owner:
Phone ( 970 ) 241-8118
NAME(S)
Mailing Address,
Snowcap Coal Company
City, St., Zip PO Box 1428, Palisade CO 81526
ACTUAL WELL LOCATION: County Mesa
Property Address,
NW 1/4
City, St, Zip 3968 I 9/10 Road, Palisade CO 81526
6 P.M.
of the NW 1/4, Sec. 34 , Twp. :to •
N. or ® S., Range 98 • E. orta W.,
Distance from
Subdivision
Optional:
Format must
Easting
Section Lines 442 Ft. From N N. or • S., 123 Ft. From • E. or si
W. Line.
/Unit
Name Lot , Block , Filing
GPS well location information in UTM format. You must check GPS unit for required settings
as follows:
Unit must be set to true north.
be UTM, zone 12 • or zone 13
• ; Units must be meters; Datum must be NAD83;
Northing
I (we) report
the existing well (hole) was plugged and
was plugged and sealed as required under
was not in use and was plugged and sealed.
explain)
sealed on the date of May 17, 2011 for
the following reason(s):
Well Permit Number 205586 ,
Liz The well
■ The well
• Other (please
The well was plugged with the following materials placed at the indicated intervals:
Amount and Type of Material Method of Placement Interval
Portland Cement Type I /II Tremmie from 765 feet to 3 feet
from feet to feet
from feet to feet
Intervals of casing removed /ripped in feet - Surface sections removed
from 3 feet to c feet
Report must be signed by person who performed the
well plugging work or by the well owner if this person is unknown or not reachable. I
contents thereof, and that they are true to my (our) knowledge.
(we) have read the statements made herein, know the
Signatur7
♦_LL/,e LLLLALLA(_
Please print the Signer's Name & Title
Tim Himes, CO LIC 531
Date
May 19, 2011
Mimes Drilling Company, Inc.
It is the responsibility of the well owner to have
is responsible for notifying the owner of this requirement.
the well /hole properly plugged and sealed. The Well Construction Contractor