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2 <br />Complete ne (1) of Either Subsections A or B: and Subsection C. <br />A. PERMANENT ABANDONM NT (Check the appropriate box and provide information) <br />F-1 Plugged dry hole. method of plugging: <br />Depth at which concrete plug set: <br />MSealcd Hole: <br />ElNeat Cement Grout, top to bottom: <br />feet below ground surface. <br />grout mixture used: cement and bentonite <br />❑Neat Cement Grout, interval grouting: grout mixture used <br />Intervals grouted (feet beneath ground surface, method and materials): <br />❑Abandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />Marsh Funnel viscosity of abandonment fluid: sec. <br />Type of surface plugging used: <br />Depth at which plug set: feet below ground surface, <br />Method: <br />--Pther method used with approval of the Division of Reclamation, Mining and Safety; describe in <br />detail method and materials used on a separate attached sheet. <br />B. COIN VERSION TO A WATER WELL <br />State Engineer's Permit No.: (attach copy of permit) <br />County Where Well is Located: <br />Water Well Use: <br />C. METHOD OF RECLAIMING DRILL SITE DISTURBANCE, <br />The Operator who conducted the prospecting drill operation states that the information set forth hereupon is true to the <br />best of their knowledge. <br />Name of Operator's Representative: Jerald Schnabel w Title: President <br />44 - <br />Signature of Operator's Represertativ . tIC. Date: ✓ <br />WVninlshereTrospecting Focros'Dil Ahandomnent Fin 1 Rpt.doc <br />