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P2014-004 SITE #2 <br />Complete 1) of Either Subsections A ig B; and Subsection C. <br />A. ABANDONMENT (Chock the appropriate box mW provide information) <br />Pluggod dry hole, method of plugging 114f �emct i' �fyr�..�l-� l -V & q 63 Feel <br />�,�1eoW Svrr4�e � APAf'�efi��i- C��o✓t �luq .F•�t � �°1t ae/pw s✓/�qc <br />B, <br />A <br />Depth at which concrete plug set: feet below ground surface. <br />Elsealed Hole: ' <br />Neat Cement Grout, top to bottom: grout mixture used: <br />❑Pkat Cement Ov out, mtatval grouting; grout mixture used: <br />Intervals grouted (foot beneath ground surface, method and matetiala): <br />FlAbandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />Marsh Runnel viscosity of abandonment fluid <br />Type of surface plugging used <br />Depth at which plug set: T - feet below ground surface, <br />Method: <br />sec. <br />EI).&W method used with approval of the Division of Reclamation, Mining and Safety; describe in <br />detail method and amnank used on a separate attached sheet <br />ice' i•: � � 11.�._'_ . <br />Static Engitcces Permit No.: <br />County Where Well is Located: <br />Water Well Use: <br />(attach copy of permit) <br />i+ MOD OF RECLAIMING DRILL SITE DISTURBANCE: Initial reclamation smnnthana <br />and cleaningof the site has been accomplished. Seeding and sprayina will start Sorina 2015-.--_. <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 />Nam of operator's Rept'emtttative: &P t�OC �� n Title• li roi ec-t ry17 f 0/ - <br />Signature of Operator's Representative: 99 ! _ ___--- Date: <br />M:v W42r6?rospwft Fm=OH Abudm m m VMW Rpt -&x <br />