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Fort 3160.5 UNITED STATES FORM APPROVED (August 2007) DEPARTMENT OF THE INTERIOR Expires No J 1041 -Ot37 i•xplres lulu 31.2010 BUREAU OF LAND MANAGEMENT 5, Lease Serial No ❑ Deepen C- 0118327 SUNDRY NOTICES AND REPORTS ON WELLS 6 1f Indian, Alloneeor Tribe Name Do not use this form for proposals to drill or to re -enter an ❑ Reclamation ❑ Well Integrn) abandoned well. Use Form 3160 -3 (APD) for such proposals. ❑ Casing Repair SUBMIT IN TRIPLICATE— Other instructions on page 2 7 If Unit of CA Agreement, Name and'or No- I Type of 11'cll _..____...._ El Oil Well ❑ Gas Well m Other Hydrology Monitoring Well —_ _..._n._...._ ... . _....._ . K Well Name and No 1_3A 1 Name of Operator Natural Soda, Inc 9. API Well No 3a. Address 3h Phone No (iru lode ureu cock) 10 Field and Pool or Exploratory Area 3200 Rio alanco County Road 31 Rine Co 91850 (970) 878 -3674 4. Location of 11`ell (Foota ge. Sec, T.R.. V, orSnnc°r D wt iprisin) Latiude 39 W I I Country or Parish, State 92991 Lorigiwde 108 36379 N (NAD 27) S26, T16 R98W Rio Blanco County, Colorado 12 CHECK THE APPROPRIATE BOX( ES) TO INDICATE NATURE OF NOTICE, REPORT OR OTHER DATA TYPE OF SUBMISSION TVPI- OF ACTION ❑ Notice of Intent ❑ Acidim ❑ Deepen ❑ Production (StarUResurnel ❑ Water Shut-Off r ❑ Alter Casing ❑ I raoure Treat ❑ Reclamation ❑ Well Integrn) QSubsequent Rcpon ❑ Casing Repair ❑ \cta Construction ❑ Rcc omplcte ❑ Other ❑ Change Plans m Plug and Abandon ❑ Temporarily Abandon Final Abandonment Notice ❑ Comen to Infection ❑ Plug Back ❑ Water Disposal 13 Describe Proposed or Completed Operation: Clearly state all pertinent details, including estimated starting date of any proposed work and approximate duration thereof If the proposal is to deepen directionally or recomplete horizontally, give subsurface locations and measured and true vertical depths of all pertinent markets and zones Attach the Bond under which the nsork will be performed or provide the Bond No on file with BL?VFBIA, Required subsequent reports must be filed within 30 days following completion orthe involxcd operations If the operation results in a multiple completion or recompleuon in anew intcnal, a Form 31600 must be filed once testing has been completed. Final Abandonment Notices must be filed only after all requirements, including reclaniatiun. Iwce been completed and the operator has determined that the site is ready for final inspection.) Ran in hole, cleaned out well and circulated. Pumped 4 cu yards of Portland Type II cement (21 sacks/yard), Tagged top of cement at 1700' (BGL) Pumped 7 cu yards Portland Type 11 (19 sackslyard, 15% fly ash, 1% CaCI) Tagged top of cement at 1182' (BGL) Pumped another 7 cu yards Portland Type II (19 sackstyard, 15% fly ash, 1% CaCI) Tagged top of cement at 535' (BGL) Pumped another 7 cu yards Portland Type II (19 sacks /yard, 15% fly ash, 1% CaCI) Tagged top at -30' Topped off with 0 5 yards to 3.4' BGL 14 , ncrcuy cowry mat me toregomg is we and eormt Name (Prinrcdfriped) Gerald J. Daub _ fitic President. Daub & Associates, Inc, Signature Da =c �,/0/'X e P3 THIS SPACE FOR FEDERAL OR STATE OFFICE USE - -- - - ------- - --- ------ ._. .._. w__..m , ........... ..... vale Conditions o-fapprocal, ifany arc attached Approval o- f this not ice does not a int orecrt ify _ _ that the applicant holds legal or equitable title to those rights in the subject lease which %cold Office entitle the applicant to conduct operations thereon. Title 18 U.S.C. Section 1001 and Title 43 U.S C, Section 1212. make it a trine for any person knowingly and willfully to make to any department or agency of the United States any false. Fictitious or fraudulent statements or representations as to ap matter within itslurisrlictiun, _ (Instructions on page 2)