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WJR -26.77 <br />THIS FORM MUST BE SUBMITTED <br />WITHIN 60 DAYS OF COMPLETION <br />OF THE WORK DESCRIBED HERE- <br />ON. TYPE OR PRINT IN BLACK <br />INK. <br />WELL OWNER Superior 011 COM any NE '/, of the NW <br />1 <br />ADDRESS _P 0 Box 17772 Denver, Co. 80217 T 1 N _ R 97 <br />DATE COMPLETED <br />WELL LOG <br />Type and Color of Material <br />COLORADO DIVISION OF WATER RESOURCES <br />1313 Sherman Street - Room 818 <br />Denver. Colorado 80203 <br />WELL COMPLETION AND PUMP INSTALLATION REPORT <br />PERMIT NUMBER 142520 <br />, 19 .._ <br />From <br />0 <br />13 <br />20 <br />35 <br />To <br />13 <br />20 <br />35 <br />50 <br />Sand & Clay <br />Blue Clay <br />Sand Stone <br />Shale <br />The water was tested <br />for T.D.S. which was too high. <br />The casing was pulled, gravel v <br />put into the hole to a depth of <br />15', cement to a depth of 5', <br />then filled with dirt to surfac <br />TOTAL DEPTH 01') <br />Use additional pages necessary to complete log. <br />Water <br />Loc. <br />X <br />as <br />e <br />HOLE DIAMETER <br />6 . _ in. from _ 0 to S ft <br />in. from �_ to ` ft. <br />_ in. from to ft <br />DRILLING METHOD Cable Tool <br />CASING RECORD: Plain Casing <br />Size __ S'_'_ & kind PVC from <br />Size __. 51 <br />_ & kind PVC _ from <br />Size .__ __ & kind _____ from <br />Perforated Casing <br />Size __5 "__ & kind PVC from _ 20 ' to 40 ft <br />Size & kind <br />Size ___ __ & kind _ <br />GROUTING RECORD <br />Material <br />Intervals <br />Placement Method <br />GRAVEL PACK: Size <br />interval <br />TEST DATA <br />Date Tested <br />YdATER RLSOl1ROIS <br />sta • DltGitiEER <br />w <br />from <br />''4 of Sec. 1 <br />bth <br />PM <br />10' to _ 20 ft <br />40' to 5 0 ft <br />to___ ft <br />to ft <br />_ from to ft <br />,19__ <br />Static Water Level Prior to Test <br />Type of Test Pump <br />Length of Test <br />Sustained Yield (Metered) <br />Final Pumping Water Level <br />ft. <br />