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Form Approved UMB No z0zt0-O0yz Approval Expires 11-a'v-3 <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 AND ADDRESS OF OWNER/OPERATOR <br />American Soda L.L.P. <br />2717 County Road 215 <br />Parachute, Ce, 81635 <br />LOCATE WELL AND OUTLINE UNIT ON <br />SECTION PLAT 640 ACRES <br />STATE <br />CO. <br />rouriIr <br />Rio Blanco <br />PERMIT NUMBER <br />CE)3858-04563 <br />N <br />SURFACE LOCATION DESCRIPTION <br />%of NW %of NE %of %of Section 29 Township 1S Range 97W <br />1067' N. and 1232' E. of SW corner of Section 20, Township 15, Range 97W 6- P.M. <br />LOCATE WELL IN TWO DIRECTIONS FROM NEAREST LINES OF QUARTER SECTION AND DRILLING UNIT <br />Surface Location 868'(N) from section corner and 2296'(E) from section comer <br />Elevation Casing Head = 6416' Elevation Ground Level = 6414' <br />12,294.33 Easting 13,508.80 Northing <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 />CC4as II <br />Brine Disposal <br />Enhanced Recove,q <br />Hydrocarnon Storage <br />l7 CCRss III (AaRcolne ProOucuon vvell) <br />J1U@ Dy bide l3aw 7" uaainy Lzmpletion <br />Well Number 10-14 <br />W <br />E <br />X <br />S <br />CASING AND 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 />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 - 1913' (short 19" <br />& N-80 strip <br />7" 26# -J-55 & 0 0- 2228' (long 19" <br />N-80 strip <br />CEMENTING TO PLUG AND ABANDONED DATA PLUG #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. 1913' 2228' <br />Depth to Cast Iron Bridge Plug ft. 1685' 1685' <br />Sacks of Cement Used eachplug) 310 ' a t a <br />Slurry Volume Pumped cu. ft. 162 362 <br />Calculated Top of Plug ft. Surface Surface <br />Measured Top of Plug (if 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 />ran <br />From To From To <br />a/ AA/ z0.i5- Dissolution surface ac lout . Coil culling placement of cement at 17riOge plug ji6so'). Fumpel3313 sacRs of type G, 15.8 poundsTgallon, 1.15 <br />fc/sack cement in the short string r" casing. a/AA/z015 —Coil tubing placement of cement at bridge plug (1683'). PumpeO 313 sacs of type G, 13.a <br />puands/gallon, 1.15 ft3/sack cement in the long 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, 1 believe that the information is true, accurate, <br />and complete. 1 am aware that there are significant 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 orprint) <br />David Valvoda Plant Manager <br />sIGMm t 0RE <br />DATE SIGNED <br />August XX, 2015 <br />EFA Form ioc0--iu <br />