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Form No OFFICE OF THE STATE ENGINEER <br />GWS -25 COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg , 1313 Sherman St , Denver, Colorado 80203 <br />(303)866 -3581 <br />APPLICANT <br />HOLCIM US INC <br />C/O GOLDER ASSOCIATES INC <br />44 UNION BOULEVARD SUITE 300 <br />LAKEWOOD, CO 80228- <br />(303) 980 -0540 <br />EXST <br />WELL PERMIT NUMBER 290444 - - <br />DIV 1 WD 3 DES BASIN MD <br />APPROVED WELL LOCATION <br />LARIMER COUNTY <br />SE 1/4 NW 1/4 Section 17 <br />Township 8 N Range 69 W Sixth P M <br />DISTANCES FROM SECTION LINES <br />1961 Ft from North Section Line <br />2301 Ft from West Section Line <br />UTM COORDINATES (Meters,Zone 13,NAD83) <br />L.PJ�.' III 1V / V1 %J ll 1111 'yJV I'7LV <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />1) This well shall be used in such a way as to cause no material injury to existing water rights The issuance of this permit <br />does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right <br />from seeking relief in a civil court action <br />2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402 -2, unless <br />approval of a vanance has been granted by the State Board of Examiners of Water Well Construction and Pump <br />Installation Contractors in accordance with Rule 18 <br />3) Approved pursuant to CRS 37- 92- 602(3)(b)(1) for uses as described in CRS 37- 92- 602(1)(f) Use of this well is limited <br />to monitoring water levels and /or water quality sampling <br />4) Approved for the use of an existing well acknowledged for construction under morntonng hole notice MH- 051127, and <br />known as MW -7 <br />5) This well must be equipped with a locking cap or seal to prevent well contamination or possible hazards as an open <br />well The well must be kept capped and locked at all times except during sampling or measuring <br />6) Records of water level measurements and water quality analyses shall be maintained by the well owner and submitted <br />to the Division of Water Resources upon request <br />7) Upon conclusion of the monitoring program the well owner shall plug this well in accordance with Rule 16 of the Water <br />Well Construction Rules A Well Abandonment Report must be completed and submitted to the Division of Water <br />Resources within 60 days of plugging <br />8) The owner shall mark the well in a conspicuous place wrath the well permit number and name of aquifer as appropriate, <br />and shall take necessary means and precautions to preserve these markings <br />9) This well must have been constructed by or under the supervision of a licensed well duller or other authorized individual <br />according to the Water Well Construction Rules <br />10) This well must be located not more than 200 feet from the location specified on this permit <br />NOTE Issuance of this permit does not guarantee that this well can be converted to a production well under a future <br />permit Additionally, pursuant to Rule 14 2 of the Water Well Construction Rules (2 CCR 402 -2), monitoring holes <br />constructed pursuant to a monitoring hole notice shall not be converted to a production well (Upon obtaining a permit <br />from the State Engineer, a monitonng hole may be converted to a monitoring well, recovery well for remediation of the <br />aquifer, or a dewatering system for dewatenng the aquifer) <br />NOTICE This permit has been approved subject to the following changes The distances from section lines were <br />calculated from UTM coordinate values provided wrath the permd application You are hereby notified that you have the <br />right to appeal the issuance of this permit, by filing a written request with this office within sixty (60) days of the date of <br />issuance, pursuant to the State Administrative Procedures Act (See Section 24-4 -104 through 106, C R S ) <br />APPROVED <br />SVJ <br />State Engineer <br />No 3659022C <br />-0 ��' <br />By ' <br />EXPIRATION DATE '► ` r <br />