2015-08-17_HYDROLOGY - M1999002

• Permit No: M1999002
• IBM Index Class Name: Hydrology
• Doc Date: 8/17/2015
• Doc Name: UIC Plugging and Abandonment Notice
• From: American Soda
• To: EPA
• Email Name: THM
• Email Name: GRM
• Media Type: D
• Archive: No

Form 3160-5 UNITED STATES
(Jane 1990) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
SuIRDRY NOTICES AND REPORTS ON WELLS
Du not ase this form for propusala to drill o, to deepen ur reentF y to a dine ant i-.aarvoir
Use "APPLI ;ATION FOR PERMIT-" Tur auoh aruaosals
SUBMIT IN TRIPLICATE
1. Type uT Well
❑ Oil Well ❑ vas WvlI 17 Other Nachulity Sulutio , Mining
2. Name ut Operator
American Soda, L. L. P.
3. Address and I elepftno No -
2717 L,ounty Road 215, Parachute, t olor_ado 81035 _
4. Location of Well (Fuctaye, Seo., T., R., M., ur Survey Description)
14,342.70 Eastiny NE i4 of NE i. of Sc .tiun 2g, T1 z5, R97W 61" P M.
11,812.18 Northing
IECK APPROPRIATE B(
TYPE OF SUBMISSION
ONoticc of Intent
❑ Subsequent Reports
FURM AePRuvED
Sauget Bureau No i004�uiao
Expires FlarEM di, iaa3
5 [ease Desgnation afl0 sena, no
Y amR— GaIM 00-1 1 es28
6 If Indian, Allottee or Tnt a Name
MMA
7 If Uni, or CA. Agreement Deslynadon
N/A
8 Well Name and No
American Sema [ [ P c0 -3o
EPA Clan, III COae5n-u40M
9 An well no
29-27 (Nahcolite)
tv ri210 aM Pool, nr Exploratory Area
Central Piceance Creek Basin
n Coast, or P.nafl Slat.
Rio Blanco, L;oloradc;
TO INDICATE NATURE OF NOTICE, REPORT OR OTHER DATA
❑ Final A5andunme„t Nutice
❑ Abando imcnt
❑ Recompletion
OPlayyging Back
❑ L,asing Repair
❑ Altering Casing
❑ uther
TYPE OF ACTION
❑ Change or Pla„s
❑ New Construction
❑ Nun -Routine Fracturing
❑ Water Shut -un
❑ Conversior, to Injection
❑ Dispose Watu
tt4ote Report results in multiple complefim on Well
C emplede., e. Resernpl.tion Report -.d Lop f-
13. Describe Proposed of Completed Operations (Clearly state all pertinent details, and give perlinein dales, including estimated date of
starting any proposed work. IT well is dirctiu„ally drillea, give 5065ur'tace luoations and measured and true vertical depths for all l,tarkers
and zones pertinent to this work.)=
• Well 29-27 di33olution carfare at 1560'.
On 7/27/2004 Rig up Key EnerisY on wzll. Pull 2288' (all) of 41/2" Innis tri.q. Set ca.t iron bridge pluis at 1610' on lun6 7- ca.ing.
On 7/28/2004 Pull 188/- jail) of a /_. snort string. Set cast iron bridge plug in /" snort string at 1610. Rig down Ke, Energy.
Both strings of well c7 Ai passed Milt on y/11/i0t s, a/1y/�t710. J/71/L01L_ and I5/D//01u.
• On 8/nX/20,5 RACS tripped coil tubing to the cast iron bridge plug a.1610' and pumped 301 sacks of Type G cement_ 13.8 r#/gallon. 1.10
ft3/sack cement, starry volume 346 ft3 in short string 7" casing.
On 8/XX/2015 RACS tripped coil tubing to the caA irun bridge plus at 1610' and pumped 301 3cick3 of Type G cErri 15.8 N/gallon, 1.15
ft3/33ck Zemlant, 31ar; yy volamz: 346 ft3 in lung String 7" ;,,-sins.
weilnea6 is cut Oown aria a cap is places on the cemeraeo casing strings intlicating ttie Gate of plugging ano a0an0anment aria the well
identification.
14. 1 hereby certify that the Tore -going is true and correct.
Signed
Title Plant Manager Date August XX, /-u-l5
(Thin space for FEwaill ur State offices uo'c)
Approved by Title Date
conditions of approval, if any:
Title 15 u.S.t✓ Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency or the United
States any take, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.
'See Instruction on Reverse Side