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FORM NO. <br />GWS -31 <br />0412005 <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1313 Sherman St., Room 818, Denver, CO 80203 <br />Phone— Info (303) 866 -3587 Main (303) 866 -3581 <br />Fax 303 866 -3589 http://www.water.state.co.us <br />For Office Use Only <br />1. WELL PERMIT NUMBER: 285654 <br />2. WELL OWNER INFORMATION <br />NAME OF WELL OWNER: Western Fuels - Colorado LLC <br />MAILING ADDRESS: 1100 W. 116th Avenue <br />CITY: Westminster STATE: CO ZIP CODE: 80234 <br />TELEPHONE NUMBER: 970 254 -3071 <br />3. WELL LOCATION AS DRILLED: SE1 14, 5W1/4, Sec, 25, Twp. 47 ® N or ❑ S, Range 16 ❑ E or ® W <br />DISTANCES FROM SEC. LINES: ft. from ❑ N or ❑ S section line and ft. from ❑ E or ❑ W section line. <br />SUBDIVISION: —,LOT_, BLOCK , FILING (UNIT) <br />Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units must Owner's Well Designation: <br />be meters, Datum must be NAD83, Unit must be set to true N, ❑ Zone 12 or ® Zone 13 Easting: 186186 <br />STREET ADDRESS AT WELL LOCATION: Northing: 4244191 <br />4. GROUND SURFACE ELEVATION 5689 feet DRILLING METHOD air rotary <br />DATE COMPLETED 10/12/2011 TOTAL DEPTH 260 feet DEPTH COMPLETED 260 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 />12 3/4" 0' 56' <br />7 7/8" 56' 260' <br />0-52 <br />mine <br />asstd <br />blk gray <br />backfill <br />52-165 ss <br />coal <br />med /fine <br />gray, blk <br />7. PLAIN CASING: <br />OD (in) Kind Wall Size (in) From (ft) To (ft) <br />8 518" steel .322 01 56' <br />4 1/2" Certalok Sch 40 0' 220' <br />PERFORATED CASING: Screen Slot Size (in):.020 <br />4 1/2" Certalok Sch 40 220' 260' <br />shale <br />brown <br />165-180 sandstone <br />med <br />gray, qrn <br />180-194 sandstone <br />94-228 sandstone <br />med <br />red <br />siltstone <br />fine <br />qraV, brn <br />siltstone <br />228-260 sandstone <br />fine <br />white <br />28 -248 <br />8. FILTER PACK: <br />Material silica san <br />Size 6 -9 <br />Interval 212 -260 <br />9. PACKER PLACEMENT: <br />Type 8" inflate <br />Depth 3 ft <br />0. GROUTING RECORD <br />Material Amount Density Interval Placement <br />cement 40 bps 7 gl/bp 0-56 tremie <br />cement 24 bgs 7 gl /ba 70 -207 tremie <br />bentoni 6 b s chi 57 -70 pour <br />Remarks: 8" inflatable packer at 3' - to shut off <br />water at surface• bentonite seal 207' - 212'0 <br />top-off silica sand <br />11. DISINFECTION: TyRe 65% HTH I Amt. Used 12 oz <br />12. WELL TEST DATA: Lj Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD submersible puma 10ho <br />Static Level surface ft. Date/Time measured: 10/12/11: 10:00am Production Rate 42 gpm. <br />Pumping Level 162 ft. Date/Time measured 10112/11: 11:00 Test Length (hrs) 3 hrs <br />Remarks: well will flow at 6 gpm <br />13. 1 have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed and <br />certified in accordance with Rule 17.4 o the Water Well Construction Rules, 2 CCR 402 -2. [The filing of a document that contains false <br />tatements is a violation of section 37 -108 1 , C.R.S. and is punishable b fines up to $5000 and /or revocation of the contracting license. <br />,ompany Name: ° <br />Himes Drilling Company, Inc <br />Phone: <br />(970)242-8893 <br />License Number: <br />531 <br />Mailing Address: 2390 Hi hwa 6 & 50, Grand Junction CO 81505 <br />Signature: <br />Print Name and Title <br />Tim Himes, General Manager <br />Date <br />10/1912011 <br />