A06_-_140L1721Q0055-Well_Construction_and_Test_Report.pdf

GNS31

WELL CONSTRUCTION AND TEST REPORT

STATE OF COLORADO OFFICE OF THE STATE ENGINEER

1313 Sherman St Rm 818 Denver CO 80203

For Office Use only

RECEIVED

1 WELL PERMIT NUMBER 241418

OCT 2 8 2002

2 OWNER NAMES Bureau of Land Management Mailing Address PO Box 1009

City St Zip Glenwood Springs CO 81602

WATER RESOURCES

STATE ENGINEER

COLD

Phone 303 9702800 Q4

3 WELL LOCATION AS DRILLED NE 14 SE 14 Sec 30 Twp 1 N Range 84 W

DISTANCES FROM SEC LINES

1650 ft from South Sec line and 1250 ft from East Sec line OR narerarsantni sMraranr

SUBDIVISION LOTBLOCK FILINGUNIT

STREET ADDRESS AT WELL LOCATION

4 GROUND SURFACE ELEVATION ft DRILLING METHOD Air Rotary

DATE COMPLETED 25 September 20Q2TOTAL DEPTH 75 ft DEPTH COMPLETED 75 ft

C GEOLOGIC LOG

Depth Description of Material Type Size Color Water Location

HOLE DIAM in From ft To ft 1075 0 39 7875 39 75

02 Topsoil 24 Claybrown 45 Boulder 7 PLAIN CASING 538 Siltstone tan OD On Kind Wall Size Fromft Toft 3875 Shaleblack 8625 Steel 215 1 39

55 PVC 250 10 50

Water loc 47 55 PVC 250 60 75

PERF CASING Screen Slot size 0020

55 PVC 250 50 60

FILTER PACK 9 PACKER PLACEMENT

Material GleiaagTtd Type Size 1020 Interval 40 75 Depth

10 GROUTING RECORD

Material Amount Density Interval Placement

REMARKS 8625 well seal installed 92502

Neat Cement 1451b gal 539 Pumped N meet 145j2gal 3040 Pu4d between PVC casin steel casin

1 DISINFECTION Type Chlorine Powder Amt Used 2 oz

12 WELL TEST DATA Check box If Test Data Is submitted on Form No GWS 39 Supplemental Well Test

TESTING METHOD AirLift

Static Level 20 ft DateTime measured 92502 Production Rate 30 gpm

Pumping level ft Daterrime measured Test length hrs 15 Remarks

3 1 have read the statements made herein and know the contents thereof and that they are true to my knowledge Pursuant to Section 244tG4 13a CRSthe making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor

CONTRACTOR Aztec Drilling Company Phone 9 70 8795252 Lic No 1198 Mailing Address PO Boy 772771 Steamboat SpringsCO 80477

NameTitle Please type or print Keith Branstetter

Signature Date

102102