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*' COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />f +, , *" 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />COAL EXPLORATION DRILL HOLE OR WELL ABANDONMENT REPORT <br />This report is filed in accordance with Rule 4.07.3(3) of the Regulations of the Colorado <br />Mined Land Reclamation Board for Coal Mining, adopted in accordance with the Colorado <br />Surface Coal Mining Act, C.R.S. 34 -33 -101 et seq. This report is to be submitted within 60 <br />days of sealing and plugging of all drill holes approved under the specific drilling program. <br />This report can be used for single or multiple holes and can be modified as needed, provided <br />that the information contained in Rule 4.07.3(3) is supplied. Additional sheets may be <br />attached, if necessary. <br />Notice of Intent No.: <br />Project Name: <br />Prospector: <br />Address: <br />X2.013 -230 -off <br />Date: <br />'LQ13 'De SCRAbo 'Z9-NU-1N%(% WaS'E Cr <br />?a%-VF- JIAovrATV'k)N CfyP -' (ay <br />36%DI CvvNz� 120�� (,S <br />Z-0 13 <br />�AtiSL'rELt1 t C) $N(oy-% <br />County: _ 1�0`C F 'T' T2 t o %L;, N LO (A U N TI E S <br />Name of Drilling Constractor: <br />K <br />License of Drill and Rig: T'S R\ CA C.o Ll C.e-m Sr. 'A 17.A t) <br />(Continued on Next Page) <br />