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Form Approved UMB No 2040-0042 Approval Expires 6-30-9 <br />;'�� UNITED STATES ENVIRONMENTAL PROTECTION AGENCY <br />WASHINGTON, DC 20460 <br />PLUGGING AND ABANDONMENT <br />NAME AND ADDRESS OF FACILITY <br />American Soda L.L.P. <br />27991 County Road 5 <br />Rifle, Co, 81650 <br />NAME ANDA DRESS OF OWNER/OPERATOR <br />American Sada L.L.P. <br />2717 County Road 215 <br />Parachute, Ca, 81635 <br />LOCATE WELL AND OUTLINE UNIT ON <br />SECTION PLAT 640 ACRES <br />STATE <br />CO. <br />0001il i r <br />Kiu lilal9Cv <br />PERMIT NUMBER <br />C03858-04556 <br />N <br />SURFACE LOCATION DESCRIPTION <br />%of NW %of NE %of %ofSection29 Township 1S Range 97W <br />463.52' N. and 553.35' W. of SE corner of Section 20, Township 1S, Range 97W 6" P.M. <br />LOCATE WELL IN TWO DIRECTIONS FROM NEAREST LINES OF QUARTER SECTION AND DRILLING UNIT <br />Surface Location 464' (N) from section corner and 553' (W) from section corner <br />Elevation Casing Head = 6297' Elevation Ground Level = 6295' <br />14,558.19 Easting 13,383.35 Northing <br />W <br />E <br />TYPE OF AUTHORIZATION <br />X Individual Permit <br />Area Permit <br />Rule <br />Number of Wells _1_ <br />Lease Name Yankee Gulch <br />WELL ACTIVITY <br />CLASS I <br />Cm5z) II <br />Brine Disposal <br />EnRancetl Recovery <br />Hydrocarbon Storage <br />O =C a III (Mallcolke Protlucaon vvell) <br />Side by Side Dual 7" Caoiny Corriplutian <br />Well Number /-U--I V <br />X <br />S <br />CASING AND TUBING RECORD AFTER PLUGGING <br />The Balance Method <br />The dump Bailer Method <br />The Two -Plug Method <br />X Other <br />Tremie through Coil Tubing Unit <br />WT(LB/FT) <br />TO BE PUT IN WELL(FT) <br />TO BE LEFT IN WELL(FT) HOLE SIZE <br />24" <br />95# - ERW <br />0 <br />0- 80' 24" <br />7" <br />26# - J-55 <br />& N-80 <br />0 <br />0 - 1712' (short 19 <br />stria <br />7" <br />26# -J-55 & <br />N-80st <br />0 <br />6- 2027' (long 19" <br />ring) <br />CEMENTING TO PLUG AND ABA UUNE:L) LPLUG #1 PLUG #2 PLUG #3 PLUG #4 PLUG #5 PLUG #6 PLUG #7 <br />Size of Hole or Pipe in which Plug Will Be Placed inches 7" Short7" Lon <br />Depth to Bottom of Tubing or Drill Pipe ft. 1712' 2027' <br />Depth to Cast Iron Bridge Plug ft. 1515' 1515' <br />Sacks of Cement Used eachplug) zea 280 <br />Slurry Volume Pumped cu. ft. JZ5 322 <br />Calculated To of Plu h. Surface Surface <br />easure o o u a e Surface Surface <br />Slurry Wt. Lb./Gal. 15.8 15.8 <br />Type cement or other material Class III Type G Type G <br />LIST ALL OPEN HOLE AND/OR PERFORATED INTERVALS WHERE CASING WILL BE VARIED ifan <br />From To From To <br />August XX, 2015- Dissolution surface at 1465'. 12/17/2008 - Long string of well plugged and abandoned to Cast Iron Bridge Plug set at 1515'. Coil tubing <br />placement of cement at bridge plug (1515'). Pumped 280 sacks of Type G, 15.8 pounds/gallon, 1.15 ft,/sack cement in the long string 7" casing. 8/XX/2015 <br />- Pumped 283 sacks of Type G, 15.8 pounds/gallon, 1.15 ft3/sack cement in the short string 7" casing. Short string of well plugged and abandoned. <br />CERTIFICATION <br />I certify under the penalty of the law that I have personally examined and am familiar with the information <br />submitted in this document and all attachments and that based on my inquiry of those individuals <br />immediately responsible for obtaining the information, I believe that the Information is true, accurate, <br />and complete. I am aware that there are signfcant penalties for submitting false information, including <br />the possibility of fine and imprisonment. (Ref. 40 CFR 144.32 <br />NAME AND OFFICIAL TITLE (Please type erprint) <br />David Valvoda Plant Manager <br />51GMM i ORE <br />DATE SIGNED <br />August XX, 2015 <br />ErA Form iac0-iz; <br />