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Form 3160 -5 UNITED STATES <br />FORM APPROVED <br />(August 2(107) <br />DEPARTMENT OF THE INTERIOR <br />O \1B No 1004-0137 <br />Ex Tres July 31, 2010 <br />BUREAU OF LAND MANAGEMENT <br />5, Lease Serial No <br />C- 0118327 <br />SUNDRY NOTICES AND REPORTS ON WELLS <br />6 If Indian. Allonce or Tribe Name <br />Do not use this form for proposals to drill or to re -enter an <br />abandoned well. Use Form 3160 -3 (APD) for such proposals. <br />_ SUBMIT IN TRIPLICATE — Other instructions on page 2 _ <br />7. If Unit of CAiAgmement. Name andlor No <br />I Typc of \Veit <br />90`211 Name and No <br />❑ nil Well ED Gas Well m Other DS Monitoring Well <br />2 NameofOperator <br />9 API Well No <br />Natural Soda, Inc <br />3a Address <br />3b. Phone No (inchide area code) <br />10, Field and Pool or Exploratory Area <br />3200 Rio Blanco County Road 31 <br />Rifle. CO 81650 <br />(970) 878 -3674 <br />4 Location of Well (Footage. Sec., T,.R,Af, or Sun-cr Dcic'riprion) <br />1 1 County or Parish. State <br />Latitude 39 992766 W Longitude 108 36512 N (NAD 27) S26 T 1S, R98W <br />Rio Blanco County, Colorado <br />12 CHECK THE APPROPRIATE BOXES) TO INDICATE NATURE OF NOTICE, RL fORT OR 011ILR DA rA <br />TYPE OF SUBMISSION TYPE OF ACTION <br />�❑ Notice of Intent ❑ Acidize ❑ Dccpcn ❑ Production (Sion'Resunic) ❑ Wnter Shur OIT <br />❑AlterCusing ❑ fracturcIreat ❑ RLclamalion ❑ Welllntcgnty <br />OSubsequent Report ❑ Casing Repair ❑ News Construction ❑ Recomplete ❑ Other <br />❑ Change Plans ❑ Plug and Abandon ❑ Temporarily Abandon <br />❑ Final Abandonment Notice ❑ Convert to Injection ❑ Plug Back ❑ \Pater Disposal <br />13, Describe Proposed or Completed Operation Clearly state all pertinent details, including estimated starting date of any proposed work and approximate duration thereof It <br />the proposal is to deepen directionally or recomplete horizontally, give subsurface locations and measured and true vertical depths of all pertinent markets and zones <br />Attach the Bond under N%hich the work will be performed or provide the Bond No on file %%ith BLM'BIA Required subsequent reports must I$ filed within 30 days <br />following completion of the involved operations If the operation results in a multiple completion or recompletion in a new interval, a Form 31604 must be filed once <br />testing has been completed Final Abandonment Notices must be filed only after all requirements. including reclamation, havre been completed and the operator has <br />determined that the site is ready for final inspection ) <br />Fished out — 10' of stainless steel sample tubing stingers Could not fish out all Junk, Casing parted at —1815' Set bridge plug at 1800'. Perforated at 550' and <br />275'(four holes per interval) Cemented with —6.5 cubic yards of 15 ppg neat cement to 4' below ground level <br />is true and correct <br />Name (Prinicd1Tv1wd) <br />Gerald J. Daub <br />1 "cite President, Daub & Associates, Inc <br />Date ,01 , 3 <br />THIS SPACE FOR FEDERAL OR STATE OFFICE USE <br />Approicd <br />Conditions ofapproval, if arty, are attached .Approval of this notice does na wammt or certify <br />that the applicant holds legal or equitable title to those rights in the subject lease which vs ouW Fofflve <br />entitle the annlicant to conduct operations thereon. <br />Title 18 U S C Section 1001 and Title 43 U S C. Section 1212, make it a crime for any person knowingly and willfully to make io any department or agency of the United Sinter any false, <br />fictitious or fraudulent sta tements or representations as to any matter within its Junsdici ion <br />. <br />(instructions on page 2) <br />