DDW-2025-000648

pineer within30 moor,82d filed with the State Eng neer,in accordance with the laws of Utah.
‘titutes «2iiea wita the State Engineer within 80 days after the completion or se of the well,Failure to file such
reports constitutes a misdemeanor.)
(1).WELL 0
NameAdiren beype(2)LOCATION OF WELL:County.(Chek...“reendveeaeaedALO.1mHOOtu tombe bere
of Section.QO”><a7.fen:z a)Daeoutwordsnotneeded)
(3)NATURE OF WORK (check):New Well fyReplacementWell2DeepeningCjRepair(J Abandon [JIfabandonment,describe material aud procedure MessealaeccesasOeOerwscien
(4)NATURE OF USE (check):|
Domestic [Industrial [J Municipal pe Stockwater (JIrrigation(j Mining §=(]Other=og Tet Well(5)TYPE OF CONSTRUCTION (check);
|ty Dug oO :
Retary
dotted oOCableODriver.Oo Bored oO(0fASINGSOEEDUEwoaysn.’Dinan trom...)tautto.SA)tennamstteonae"Diam.from.__nnfet to.fet Gage.onBees*Diam.from...feet COfeet GageNewRajectUsed J(7)PERFORATIONS:Perforated?Yes []No meTypeofDerforatorusedtheeseteneaictnanehametiaaevenees
~aSizeofperforations...inches by ~-neaCHESwrits--raeeeDD Orforations from.feet tofeat“wretssseoeeae DDOPforations from feet to.featsriaetigs~----perforations from.«ne -sron LOBE tohaatrowee—eee-DORforations from.....fear togeet |~—+-+-—.....perforations from...feat to.haatarvanaeeneste,————(8)SCREENS:el)screen installed?Yes BM No Ofanufacturer’s Name folio vncyecriteMeeesesseecmeeeee,Model No.iam.Oo.7 .Slot sizeC20)set from...ft to.on&m gosion sie20)__set trom.)CONSTRUCTION:
+well grave}packed?Yes No [>Size of aravel:CoSod'el placed from...GIIO feet to....._.YOO...+neet@surfacesea)provided ?Yes m No C7‘Oo what depth?__
fal used in seal: (2y¥strata contain unusable water?Yeu Tj No mefwater:__Fret creceres teen 6.Depth of strata.of sealing Strate off:a ee
face casing used Tf Yes Li No oetmentedinplace?Yes {)No C}————eken scopingVATERLEVELS:
et “oufeet below Jand surface eeeressure.4/feet above land surface Dated.“JO-§Q.—CEIVED:|(11)FLOWING WELL:
PEPEmeee ,Controlled by (rha-b)wre 8 ~s
(12)WELL TESTS:Drandown &Gre distance in feet the water level is low.
_Temperature of water.~Was &chemical analysis made?No(13)WELL Log:
Was @ pump test Inade?l Yes Re No ©Ig sco,by whom?_.___“Yield...Ge gal./min.withoo|feet drawdown after...hoursbi
@ 1 Woes Aéewanste weartes So.)=
SAMOS oeomenreme cenewmesecee =ONS
CCNSane
teeta ™=sremtas$(eeeeor exaincad cacenye om
PteT eenees ememmecmenn cereus *CLOSo0eseen
eLIES
od‘Baller test.gal./min.With...teat drawdown afterhemesArtesianflow...OO)em Date“IO-FR
Depth drilled...YOY)-~-~-feet..Depth ofcompleted welSO)tansNOTE:Place an “X"in the space or combination ofOrcombinationofmaterialsencounteredfneachdepdesirablenotesastooccurrenceofwaterandthecounteredineachdepthinterval,Use additional
MATERIAL
(14)PUMP:
A Ye O
Viameter of well.__a .inekes
th interval Under Sneakmake any$color,size,nature,ete.,of ranterial
REMARKS
Manufacturer's Name .Bl wicca odds aceanctin datisd,
euiaaiais
Depth to pump or bowles
pac
arenasannatanaibaneanieprtecaees eemeCnn
CNP
reese
car
Well Driller’s Statement:
.feet
This well was drilled under my supervision,and this report is true tothebestofmyknowledgeandbelief.Name LDYT t Abs on.+(freon,firm,OY cCornoratian i HirD t aA ing