Laserfiche WebLink
Complete One (1) of father Subsections A sir, 8; <br />A. PF PUMN)~ NT ABANDONMENT <br />Mugged dry hole, method of plug, <br />r// 494 's fa a47 -C"o <br />Depth at which concrete plug set: _ <br />Sealed Hole: <br />Neat Cement Grout, top to <br />2 <br />Subsection C. <br />1 the appropriate box and provide information) <br />feet below ground surface. <br />grout mixture used: <br />FINeat Cement Grout, interval gro�ting: grout mixture used: <br />Intervals grouted (feet beneat ground surface, method and materials): <br />FL9Abandonment Fluid Mixture (' <br />Marsh Funnel viscosity of aband <br />Type of surface plugging used: _ <br />Depth at which plug set: vZ <br />Method: P <br />Elther method used with approva <br />detail method and materials used <br />B. <br />State Engineer's Permit No.: _ <br />County Where Well is Located: <br />Water Well Use: <br />C. <br />as Sodium Bentonite with Polymer) Brand Name: <br />t fluid: sec. ` <br />feet below ground surface, <br />of the Division of Reclamation, Mining and Safety; describe in <br />n a separate attached sheet. <br />(attach copy of permit) <br />Tate Operator who conducted the prospecting drill c{pe�ration states that the information set forth hereupon is true to the <br />best of their knowledge. <br />Name of Operator's Representative: D1f*' ;A'A D i/^! ✓ -- Title: <br />Signature of Operator's Representative: <br />._ yam- -- — �_..._ - - -- - Fate: <br />M: min share Prospeaing Fa n%,Dtt Ahandenmem final Kpt doc <br />