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FORM NO, <br />GWS -31 <br />4/2012 <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1313 Sherman St., Ste 821, Denver, CO 80203 <br />Main (303) 866 -3581 Fax (303) 866 -3589 vwvw.water.state.co.us <br />For Office Use Only <br />1. WELL PERMIT NUMBER: <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: Climax Molybdenum Company <br />MAILING ADDRESS: Fremont Pass, Highway 91 <br />CITY: Climax STATE: CO ZIP CODE: 80429 <br />TELEPHONE NUMBER w /area code: 917- 486 -7584 <br />3. WELL LOCATION AS DRILLED: SW 1/4, NE 1/4, Sec., 33 Twp? 17 N or S, r!I Range 79 AI E or W <br />DISTANCES FROM SEC. LINES: 1720 ft. from Ix• N or f1 S section line and 2525 ft. from 131 E or W section line. <br />SUBDIVISION: , LOT , BLOCK , FILING (UNIT) <br />Owner s Well Designation: Ev - MW - 0c I <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units <br />Easting: 394637 <br />must be meters, Datum must be NAD83, Unit must be set to true N, 1 Zone 12 or Ill Zone 13 <br />STREET ADDRESS AT WELL LOCATION: 11236 Hwy 91, Fremont Pass, Climax, CO 80429 Northing: 4362043 <br />4. GROUND SURFACE ELEVATION Est. 10 800 feet DRILLING METHOD air rotary <br />DATE COMPLETED 09/12/2012 TOTAL DEPTH 210 feet DEPTH COMPLETED 210 feet <br />5. GEOLOGIC LOG: <br />6. HOLE DIAM (in.) From (ft) To (ft) <br />Depth <br />Type <br />Grain Size <br />Color <br />Water Loc. <br />ODEX (8.75 ") 0 210' <br />hammer (7.5 ") 0 210' <br />0 -3' <br />Fill <br />Gravel <br />2,5Y5/3 <br />3 -13' <br />Silty sand <br />Gravel <br />2.5Y5/3 <br />13 -15' <br />Granodiorite <br />medium <br />GLEY14 /N <br />7. PLAIN CASING: <br />OD (in) Kind Wall Size (in) From (ft) To (ft) <br />4" PVC 0.237 0 160 <br />15 -30' <br />Granodiorite <br />fine <br />GLEY14 /N <br />30 -55' <br />Shale <br />fine <br />GLEY12.5 /N <br />55 -80' <br />Rhyolite <br />fine <br />10YR5/1 <br />80 -130' <br />Shale <br />fine <br />GLEY12.5 /N <br />130 -145' <br />Granodiorite <br />fine <br />GLEY16 /N <br />PERFORATED CASING: Screen Slot Size (in): 0.020 <br />145 -167' <br />Shale <br />fine <br />GLEY13 /N <br />4" PVC 0.237 160 210 <br />167 -210' <br />Granodiorite <br />fine <br />GLEY16 /N <br />180' <br />8. FILTER PACK: <br />Material silica sand <br />9. PACKER PLACEMENT: <br />Type <br />Size 10/20 <br />Depth <br />Interval 154 -210 <br />10. GROUTING RECORD <br />Material Amount Density Interval Placement <br />Grout 14 bags 1.2kq /L 151.8 -0 tremie <br />Remarks: Grout 20% solids mix <br />11. DISINFECTION: Type 1 Amt. Used <br />12. WELL TEST DATA: is Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. Date/Time measured: , Production Rate gpm. <br />Pumping Level ft. Date/Time measured , Test Length (hrs) . <br />Remarks: <br />13. I have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed (or <br />name entered if filing online) and certified in accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402 -2. The filing of a <br />document that contains false statements is a violation of section 37- 91- 108(1)(e), C R.S., and is punishable by fines up to $5000 and/or revocation <br />of the contracting license. If filing online the State Engineer considers entering of licensed contractor name to be compliance with Rule 17.4 <br />Company Name: <br />Arcadis <br />Phone w /area code: <br />720 - 344 -3500 <br />License Number: <br />Mailing Address: 630 Plaza Dr., Suite 100 Highlands Ranch, CO 80129 <br />Sig n Senent9r name if filiqg online) <br />/f,/; r J 4- j ' / i - <br />Print Name and Title <br />I Richard Walther, Senior Geologist <br />Date <br />10/24/2012 <br />