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RECEIVED <br />• STATE OF COLORADO <br />COUNTY OF LAS ANIMAS <br />WELL ABANDONMENT AFFIDAVIT* <br />) <br />) 55. <br />JUL 29 '76 <br />WATER HESOUCCES <br />SPATE p~p11EER <br />COLO. <br />I (we) John N. Bearden ,being <br />first duly sworn upon oath, despose and say: <br />That an old well, located in the ~ 1/4 of the l1E I/4, Section 30 , <br />Township 33 S Range 68 W 6th P.M., was replaced <br />for the following reason(s): Old well depleted and caved-in beyond repair <br />That the old well, which was replaced by a new well drilled under permit <br />number $38$4-A was plugged and abandoned according to the <br />rules and regulations of the State Board of Examiners of Water Well and Pump <br />Installation Contractors by John N. Bearden under Supervision of Marion M. S <br />(person(s) or company) Driller's <br />License #47 <br />on July 10th 19 76 , <br />That the old well was plugged with the following materials placed at the <br />indicated intervals: <br />Heavy cement <br />Concrete <br />Signature of affiant(s) <br />Subscribed and sworn to before me this <br />of July 19 76 <br />from 12 feet to 25 feet <br />from 0 feet to 12 feet <br />a7 d7. ~..~-.. ~ =-. <br />26th <br />My Comm i 55 i on expires : ~ t7,t~ i ~ / ~ / 9Q 0 <br /> <br /> <br /> Notary Pub l c <br />day <br />• *it is the owner's responsibility pursuant to the conditions of approval to see <br />that the affidavit is returned. <br />