Laserfiche WebLink
2 <br /> Complete One(1)of Either Subsections A or B; and Subsection C. <br /> A. PERMANENT ABANDONNIENNT(Check the appropriate box and provide information) <br /> Plugged dry hole,method of plugging: <br /> Insert cuttings, plug with 5 ft concrete below collar <br /> Depth at which concrete plug set: 6 feet below ground surface. <br /> Sealed Hole: <br /> Neat Cement Grout,top to bottom: grout mixture used: <br /> Neat Cement Grout,interval grouting: grout mixture used: <br /> Intervals grouted(feet beneath ground surface, method and materials): <br /> ❑Abandonment Fluid Mixture(Such as Sodium Bentonite with Polymer)Brand Name: <br /> Marsh Funnel viscosity of abandonment fluid: sec. <br /> Type of surface plugging used: <br /> Depth at which plug set: _feet below ground surface, <br /> Method: <br /> [Z]Dther method used with approval of the Division of Reclamation, Mining and Safety; describe in <br /> detail method and materials used on a separate attached sheet. <br /> B. CONVERSION TO A WATER WELL <br /> State Engineer's Permit No.: (attach copy of permit) <br /> County Where Well is Located: <br /> Water Well Use: <br /> OF R9CLAIAIRNIG DRILL SITE D STCMBANCF,: <br /> Sp tin.gs,,_.scarify r d relvegetete area <br /> The Operator who conducted the prospecting drill operation states that the information set forth hereupon is true to the <br /> best of their knowledge. <br /> Name of Operator's Representative: Glen Williams ` .title: VP of Mining <br /> Signature of Operator's Representative: � .p Date: �f... <br /> M min`shareil'rospecting Forms%01-1 Abandonment Final Rpt.doe <br />