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Form Approved UMB No 200-0042 Approval Expires 6-313, <br />UNITED STATES ENVIRONMENTAL PROTECTION AGENCY <br />V"�EPA 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, Co, 81635 <br />LOCATE WELL AND OUTLINE UNIT ON <br />SECTION PLAT 640 ACRES <br />STATE <br />CO. <br />ivulGix <br />RIO Slant) <br />PERMIT NUMBER <br />C03858-04574 <br />N <br />SURFACE LOCATION DESCRIPTION <br />%of NW %of NE %of %of Section 29 Township 1S Range 97W <br />1111' S. and 766' W. of NE corner of Section 29, 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 111 1' (S) from section comer and 766'(W) from section corner <br />Elevation Casing Head = 6388' Elevation Ground Level = 6384' <br />14,342.70 Easting 11,812.18 Northing <br />X <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 />CC4ss II <br />Brine Disposal <br />Enhanced Recovery <br />HydrocaMon Storage <br />O CERss III �Maficolne rrouucdon vvell) <br />JiOo Dy JIOc Dual 7" C:Esinq LzIrmi-4ution <br />Well Number /—V—Z/ <br />S <br />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 />bict Wr(LBIFT) 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 - 1776' (short 19" <br />& N-80 stria <br />7" 26# -J-55 & 0 6- 2052' (long 19" <br />N-80 stria <br />CEMENTING TO PLUG AND ABANDONED DATA PLUG #1 PLUG #2 PLUG #3 PLUG 94 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. 1776' 2052' <br />Depth to Cast Iron Bride Plug ft. 1610' 1610' <br />Sacks of Cement Used eachplug) a0 i auu i <br />Slurry Volume Pumped cu. ft. 3.46 346 <br />Calculated Top of Plug ft. urface surface <br />Measured Top of Plug if tagged ft. Surface Surface <br />SlurryWt. LbJGal. 15.8 15.8 <br />Type cement or other material Class III Type G Type G <br />LIST ALL NK1t:U (it an <br />From To From 10 <br />a/ AA/ z015• Dissolution surface dt i�'o0'. Coil cubing piacemenc of cement at Oriuge plug (.L60'). PumpeO 3O.t sacRs of i ype G. i. -3.a pounus/gallon, 1.15 <br />fL'/sack cement in the short string r" casing. 8/AA/1.013 — Coil tubing placement of cement dt bridge plug (1QlO'). Pumped nui sacks of I ype v, LD.a <br />pounds/gallon, x.15 ft3/sack cement in the long bLring 7" casing. <br />CERTIFICATION <br />I certify under the penalty of the law that 1 have personally examined and am familiar with the information <br />submitted in this document and all attachments and tha4 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. I 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 />sIGAr,i OKE <br />DATE SIGNED <br />August XX, 2015 <br />EPA Form roc0-i4 <br />