oe State law requires that the Bureau's copy be filed by the water well driller within 60 days after completion of the well. O30 Me ADIOS WELL LOG REPORT 1. WELLOWNER 1) Buzation oft Ping i Zh. eiitees yess econ time > J s — A) Beco watertew nc, at_/SA ater ‘2 CURRENT MAILING ADDRESS. 4 WELLLOCATION eS) aed Seton Tounship__2 7 NA) Range _12 ZEW County Sze aiT Govat Lot. orlot _ Block SubdiisionNane cee ase eueg pumpin stopped. ‘Wells intended to yield 100 gpm or more shal be tested fra period of 8 hours or more. The test shall follow the development ofthe wel and shall be Conducted continuously at a constant discharge at least a8 great asthe in tended appropriation. In adition tothe above information, water evel data shal be colected and recréed onthe Departments “Aquifer Test Data" " HOTE:Al wl shall be equipped ih an acess port eich minimum o ‘pressure gauge that wil indicate the shun pressure of aflowing wel Re movable caps are acceptable as access pots, Toei Wunder ‘1, WAS WELL PLUGGED OR ABANDONED? Yes_=—— No “4 PROPOSEDUSE Dom: Soka = 7 = Domestic Steck Irigaton © Otter 0 spect a = 12, WELLLOG =n ae 5 PEF WORK: to Farmation Now well “Metnod:Dug «Bored 0 z Perse Deopened Cable Dien 2 35. apae feeudy Reconditioned 0 Rotay Jetted 0 Zale ghetfooee by Shele? Dew? 7. CONSTRUCTION DETAILS: es lex Casing; Steel Dia. from. 4. [oe T 7 2 Teaded Welded Oia from, ftto ft Zo. Type SS _ Wal Thickness 2 =O Casing: Plastic dia_Y72 fom_20 ft.to_Zo2 1. Weight. Dia, from, ftto ft PERFORATIONS: Yes) NOE “Type tperforator used. ‘Size of perorations in. by. in perforations from ft ft perforations rom fo ft. perforation rom. fo ft ‘SCREENS: Yes No) Manufacture’s Nave__ C2 =\ 0 Te_stot Mode No. Dia, ‘Slotsie 2020 from__Zo fio £0 —f ha Slot size from to, ft GRAVELPACKED: Yes(] NoG~ Sizeof grave Gravel placed from __tt.to. GROUTED: —Towhatdeptn?_/& =f Material used in grouting Sete WELL HEAD COMPLETION PitossAdopler Yes No 8. PUMP installed) Manufacturer's name ATTACH ADDITIONAL SHEETS IF NECESSARY 13. YELLOWSTONE CLOSURE AREA: WATER TEMPERATURE, reasurementsshallbe rom the top ofthe wel cesing. ‘Allwells under 100 gpm mus be tested fora minimum of one hour and pro vide the following pees aes a A pee = =P Stealer el inmed ey belong fou ¥ 7 = = lll we 144. DATE COMPLETED. VALE, 10. WELL TEST DATA ‘Theinformaton requestedin his sections required forall wel. lldepth | 'S: DRILLERICONTRACTOR'S CERTIFICATION This well was clled under my jusciction nhs report the beso miykrowledge GL ZF, 5 ae ingcosedinptesaue al Ce. Perey hol ony a ree, Fata in peg eee Be eee 9 Suez eet res 26 21 ¢ shoed Lawdel 4 3 haat parame el| (777) SOK ‘pumping began. Bignature Tense No. 1820 EAST SIXTH AVENUE P.0.BOX 202301 HELENA, MON MONTANA DEPARTMENT OF NATURAL RESOURCES & CONSERVATION DNRC ITANA 59620-2301 444-6610 DEPARTMENT: | eb4 BUREAU COPY