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Form Approved UMB No 2040-0042 Approval Expires 6-30-9 <br />UNITED STATES ENVIRONMENTAL PROTECTION AGENCY <br />COEF A WASHINGTON, DC 20460 <br />PLUGGING AND ABANDONMENT <br />American Soda L.L.P. <br />27991 County Read 5 <br />Rifle, Co, 81650 <br />NAME AND ADDRE55 OF OWNERIOPERATOR <br />American Soda L.L.P. <br />2717 County Road 215 <br />Parachute, Co, 81635 <br />LOCATE WELL AND OUTLINE UNIT ON <br />SECTION PLAT 640 ACRES <br />STATE <br />CO. <br />%0017 i r <br />Rio Blanco <br />PERMIT NUMBER <br />C03858-04562 <br />N <br />SURFACE LOCATION DESCRIPTION <br />%of NW %of NE %of %ofSection29 Township 1S Range 97W <br />1067' N. and 1232' E. of SW corner of Section 20, Township IS, 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 comer and 553' (W) from section corner <br />Elevation Casing Head = 6484' Elevation Ground Level = 6482' <br />11,197.43 Eastin 13,704.50 Northin <br />X Individual Permit <br />Area Permit <br />Rule <br />Number of Wells -1— <br />Lease Name Yankee Gulch <br />WELL ACTIVITY <br />CCRSS r <br />CLASS II <br />Brine Disposal <br />EnMance0 Recovery <br />Hydrocarbon Storage <br />❑x CLASS III (Nahcohte Production Well) <br />aide By aide Dual 7" Lasing Completion <br />vveii marn6er 20-36 <br />W <br />NX <br />E <br />S <br />CASING ANS TUBING RECORD AFTER PLUGGING <br />METHOD OF EMPLACEMENT OF CEMENT PLUGS <br />The Balance Method <br />The dump Bailer Method <br />The Two -Plug Method <br />X Other <br />Tremie through Coil Tubing Unit <br />SIZE Wr(LB/FT) TO BE PUT IN WELL(FT) TO BE LEFT IN WELL(FT) HOLE SIZE <br />24" 95# - ERW 0 0- 71' 24" <br />7" 26# - J-55 0 0 - 2012' (short 19" <br />& N-89 strip <br />7" 26# -J-55 & 0 0- 2323' (long 19" <br />N-80 strip <br />CEMENTING TO PLUG AND ABANDONED DATA FLUU X1 PLUG 02 PLUG #3 PLUG #4 PLUG #5 PLUG #6 PLUG #7 <br />Size of Hole or Pipe in which Plug Will Be Placed inches 7" Short 7" Lon <br />Depth to Bottom of Tubingor Drill Pipe ft. 2012' 2323' <br />Depth to Cast Iron Bridge Plugft. 1785' 1785' <br />Sacks of Cement Used each plug)333 333 <br />Slur Volume Pumped cu. ft. aaq 3sa <br />Calculated Te of Plugft. Surface Surface <br />Measured Top of Plug H tagged ft. 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 if an <br />From To From To <br />a/xn/ ZD�3- 0651311.1tion surface at X72.t. Coil tubing placement of cement at bridge plug (,785'). Pumped 333 bdckb of rype G. Lz.a pounds/gallon, L..L:) <br />ft'/sank cement in the bh01 L bLring 7" caging. 8/XX/2015 – Coil tubing placement of cemt:nt at bridge plug (1785'). Pumped 333 sacks of Type G, 15.8 <br />puun&/gallon,1.15 ft3/3ack cEment in the Icing String 7" casing. <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. 1 am aware that there are sign cant penalties for submitting false information, including <br />the possibility of fine and Imprisonment. (Ref. 40 CFR 144.32 <br />ease type orpnn <br />David Valvoda Plant Manager <br />SIGNATURE <br />August XX, 2015 <br />EPA Form r520 -1v <br />