2013-07-19_PERMIT FILE - C2010089A

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COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS -45 (04/2012) DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 821, DENVER, CO 80203 Main: 303 866 -3581 Fax: 303 866 -2223 dwr ennitsonline st co.us GENERAL PURPOSE Water Well Permit Application Review instructions on reverse side prior to completing form. The form must be computer generated, typed or in black or blue ink. 1. Applicant Information 6. Use Of Well check applicable boxes Name of applicant — - ---- - - - - - -- Attach a detailed description of uses applied for. Western - Fuels- Colorado, LLC � ® Industrial ® Dewatering System Maitingaddress P.O. Box 33424 Municipal ❑ p ❑ Geothermal (production or reinjection) _____.._._..__-- ___....- cityy State zip code ❑ irrigation Dust suppression © Other (describe): pP Denver CO 80233 ❑ Commercial Telephone 8 (area code & number) E -mail (online filing required) 7. Well Data (proposed) (303) 255-5800 Mammum Wiping rate- j`A`nnu aal amount to be w/ gPm 2. Type Of Application check applicable boxes YP pp (check ) D 12-2 &aGOn DW12 -2 &_DW12 -3) _ .800 LSee Attachment B acre -feet Total depth I Avatar KI Construct new well ❑ Use existing well ❑ Replace existing well ❑ Change or increase use 85 feet Bedrock /Coal ❑ Change source (aquifer) ❑ Reapplication (expired permit) 8, Land On Which Ground Water Will Be Used ❑ COGCC Well ❑ Other: legal Description of Land (may be provided as an attachment) 3. Refer To (if applicable) Wall perrrrlrr watercourtcase# ' --- - -- West 1/2 of Section 25, Township 47 North, Range 16 West N/A III N/A Designated Basin Determnation # ! Well name or # of the N.M. P.M. f DW12 -1 4. Location Of Proposed Well (N used for crop irrigation, attach a scaled map that shows irrigated area.) Montrose SW 114 of the SW 114 - -� A. #Acres B Owner section Township Nor S Range E tx W ( Pnnupal Mendian 320 See Attachment A 25 147 Ix i 16 ❑ I N M. C. List any other wells or water nghts used on this lerw: - - - of -- - — Distance of well from section Imes (section lines are typically not property lines) thers wells and water rights operated under Case Nos. 452 Ft. from l� N I•X S 301 Ft. frorr+❑E OW lOCW2 08 and 09CW171 and related SWSPs . 9. Proposed Well Driller License # tional : p - - - - - - - -- - - For replacement wells ordy - distance and direction from old well to now well __ _ " -- _" 10. Sign or Entered Name Of Applicant(s) Or Authorized Agent feet direction wall location address (include city, state, Zip) El check if well address is same as in item 17 The making of false statements herein constitutes perjury In the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4 -104 (13)(a). I have read the statements herein, know the contents _ Optional: GPS well location information in UTM format You must check GPS unit for thereofarld state that they are true to In knowledge_ _ Sign or n of per s submitting application Date (- Wddyyyy) required settings as follows: j am: Zone 12 orlr l Zone 13 If signing print name and title Eastin i g Units must be Meters Datum must be NAD83 i Northing Office Use Only Unit must be set to true north Was GPS unit checked for above'? YES Datum ❑ Romember to set Da un to NAD83 map name DWR map no. Surface aim. T 5. Parcel On Which Well Will Be Located Receipt area only (PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL A. Legal Description (may be provided as an attachment): West 1/2 of Section 25, Township 47 North, Range 16 West of the N.M. P.M. AQUAMAP B. # of acres in parcel C. Owner 320 See Attachment A WE D. will this be the only well on tins parcel? C] YES NO (If no list other weds) WR Others wells operated under Case Nos. 10CW208 and CWca 09C W171 and related SWSPs. TOPO __ _.__ -__ ._.— ....... .__ - -.-_ -_ �- -. -- — _-_ -. - - -_ E. State Parcel ID# (optional). MYLAR S135 DIV WD BA MD