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WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />FOR OFFICE USE ONLY <br />(06° 33Y <br />RECEIVED <br />APR 2 3 2002 <br />WATE.? RESOURCES <br />STATE EKGINEER <br />COLO <br />APPROVAL # GWS31 -91 -03 <br />1. <br />WELL PERMIT NUMBER 237603 <br />2 <br />Owner Name(s): Bridget Rondell • <br />Mailing Address: 41009 RBD # 5 <br />City, State, Zip : Meeker, Co. 81641 <br />Phone # : 970 -878 -4127 <br />3 <br />WELL LOCATION AS DRILLED <br />NE 1/4 NW 1/4 Sec: 1 Twp: IN 111 Range: 97 W <br />DISTANCES FROM SEC. LINES <br />770 ft. from North Sec. line and 1810 ft. from West Sec. line OR Northing: Easting: <br />SUBDIVISION: LOT: BLOCK: FILING (UNIT): <br />STREET ADDRESS AT LOCATION t <br />4 <br />GROUND SURFACE ELEVATION ft. ' DRILLING METHOD Air Rotary <br />DATE COMPLETED: 3/7/2002 TOTAL DEPTH: 200 DEPTH COMPLETION: 200 <br />5. <br />GEOLOGIC LOG <br />6: HOLE DIAMETER (in) <br />FROM (ft) <br />TO (ft) <br />Depth <br />Type of Material (Size, Color, and Type) <br />9.0 <br />0 <br />40 <br />000 -009 <br />Dirt, Rocks <br />! 6.5 <br />40 <br />200 <br />009 -200 <br />Green River Formation <br />7. PLAIN CASING <br />OD (in) <br />Kind <br />Wall Size <br />From (ft) <br />To (ft) <br />7.0 <br />Steel <br />0.240 <br />-1 <br />40 <br />5.5 <br />PVC <br />0.250 <br />20 <br />90 <br />5.5 <br />PVC <br />0.250 <br />100 <br />200 <br />PERF. CASING : Screen Slot Size <br />5.5 <br />PVC <br />0.250 <br />90 <br />100 <br />1 <br />Water Located: 95 - 98 <br />Remarks : <br />8. , Filter Pack <br />Material : <br />Size : <br />Interval : <br />9. Packer Placement <br />Type : <br />Depth . <br />10. GROUTING RECORD <br />Material <br />Amount <br />Density <br />Interval <br />Placement <br />Cement <br />5 sks <br />6 gal/sk <br />10-40 <br />poured <br />11. DISINFECTION : Type : HTH ' Amt. Used : 7 oz. <br />12. WELL TEST DATA : () Check Box If Test Data Is Submitted On Supplemental <br />TESTING METHOD : Air Compressor <br />Static Level : 50 ft. Date/Time Measured 3/7/2002 Production Rate 2.5 gpm <br />Pumping Level : Total ft. Date/Time Measured 3/7/2002 Test Length : 2 hours <br />Test Remarks : <br />13 . [f � s matte S elton ham knowthe contents cl iz t a true to my bionic*, (Pursuant to Section 24 (13)(a) CRS, the mating of false statements <br />CONTRACTOR : Drilling Corp. Phone : (970) 927 -4182 <br />Mailing Address : P.O. Box 1059 Basalt, Co 81621 Lic. No. 1095 <br />Name / Title (Please Type or Print) <br />Wayne Shelton / President <br />Signa <br />Date <br />3/28/2002 <br />n n <br />1 (' 1 A 1 <br />t. t\ t0 II P r1 L <br />1 <br />