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07/10/2006 16:32 7192751715 CONST SERVICES BLDG ~ ~'f' PAGE 03 <br />D7/07/20DD 08:50 FAY 71B 8Ja 0713 A11aA UP1111.D[r ~ SAL' a <br />F"" <br />:;as- <br />is/oa "° WELL CON ' ~ ' TION AND TEST REPORT <br />51 <br />STATE OF COLORADO, OFFIC'c OF THE STATE ENGINEER a ~ <br />'++'Far Office Uae Only <br />1 WELL PERMIT NUMBER MN-16887 <br />2. <br /> <br /> <br /> <br />. <br /> <br /> <br /> <br /> <br /> <br />. OWNER NAME(Sj Allen Drlllinp, Int <br />Ma~inp Address Pont OfFlw doz ~Y8 <br />Ciry, St. Zip Falrplay, Colorado 90440 <br />Phone 719 839.1872 <br />W ELL I QCATION AS D3111~0' SE 114 SW 1l4, sec. 11 twp. 10 SouthT ,range 77 West <br />DISTANCES FROM SEC. LINES; ~ ~~ <br />800 iL from South Sec. line, and 1100 H. from Weat Sec. Ilne, OR <br />(north or south} (east or west) <br />SUBDIVISION: N!A Lot Bt Filing(unltj <br />STREET ADDRESS AT W ELL LOCATION 44580 Stafe Hwv 9 <br />GROUNq SURFACE ELEVATION ~ ft. ORILLINC~ METHOD Air Rates <br />DATE COMPLETED 8/28(08 . Tohtl De th 20 ft. De th Com leted 20 n. <br />6. GEOLOGIG LDG: <br />bepdt Deerriptlon of Metedai {Type. Slze, Color, Water Locetlon) <br />0 ~ 20 Sand & Gravel Allwfal e. HOLE DIAM- (In.) From (ft) 70 (h) <br />y 7/8 0 20 <br /> <br /> <br /> 7. PLAIN CASINO <br /> OD (in) Kind Well Size Frpm(M) To(R) <br />Monitorln Hole fl4 7 Steel 199 +1 10 <br />Static Lave1- 14'8" <br /> <br /> <br /> PERF. CASING: ScraDn Slot Size: ,032 <br /> 7 Steel 188 18 20 <br /> <br /> <br /> <br /> <br /> 8. F)LTER PACK: y. PACKER PLACEMENT: <br /> Materlal NIA Type <br /> Size ; <br /> Interval Depth <br /> 10. GROUTING RECORD: <br /> <br />REMARKS: Materlal Amount Density Interval Placement <br />Cement 9Cf 15 0 - 16 poured/ <br /> ~_ Vlbreted <br /> Hi Earlv 1% <br /> <br />11. DI5INFEC710N: T s: Amt. Used: <br />12. <br />J WELL TEST DATA: Check Dbx R,R,- eSt Date Ia submitted On Farm No. GWS 39 Supplemental Wen Teat. <br />TESTING METHOD NIA , <br /> <br />~~ Static Level 14'8" h. Date/Time measured 6/28108, ,Production Rate gpm <br />Pumping Level N1A ft. Dats/Tlmt4 measured ,Test Length (hrs.) <br />13. I have read the statemenre matle heroin and lanovr the eententa thereof, ono that Ihey era true to my knpwladge. (PUrauant to Bectlon 24.4~tOd J731 <br />{a) <br />C.R.S., the making o1 Wlaa atetsnwnta nerWn conetltuiea par)ury In the aecontl degree end la punlahe6le as s cleea 1 mledeme9na.) <br />CONTRACTOR Allen DrillinD & Excavating Compenv. Inc. Phone (2181 836.2872 LIC. No.. 7§,~_ <br />MgNiny Addragg Past Ot(Ice Box 399. Felrolea f . <br />NamelTitle (Please typo or prim) , Signature <br />Jack Allan /President I Date <br />g~gi08 <br />ReceivEd <br />JUL 10 ~~~~ <br /> <br />JUt 9 22006 <br />~iVISIWI ut MIIWllris JA,"". _::modY <br />Durango Field OtSce <br />pMstDn of Mins.~i^, & Geology <br />