Form Wrfo-Mw - Historic Well Pad Component Form Page 2

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22. Historical / Archival Data:
V. Eligibility and Management Recommendations
23. Eligibility of Individual Historic Well Pad
Is this an official determination?
Eligible
Not Eligible
Need Data
Yes
No
Remarks / Justification:
24. Assessment of historic physical integrity related to significance:
25. National/State Register District Potential:
Yes
No Explain:
26. Cultural Landscape Potential:
Yes
No Explain:
27. If yes to 25 or 26, Is this well contributing:
Yes
No Explain:
28. Recorder’s Management Recommendations:
VI. Documentation
29. Photograph Numbers:
Files or negatives stored at:
30. Report Title:
31. Recorder(s):
32. Date:
33. Recorder affiliation:
Phone number / E-mail
Colorado Historical Society - Office of Archaeology & Historic Preservation
1560 Broadway, Suite 400 Denver, CO 80202
303-866-3395

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