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2 <br /> Complete One(1)of Either Subsections A or B;and Subsection C. <br /> A. PERMANENT ABANDONMENT(Check the appropriate box and provide information) <br /> Plugged dry hole,method of plugging: <br /> Casing was previously filled with rock or soil.Hand excavation> 1 ft.bgs.;cut casing;fd with concrete;backfill soil;reseed <br /> ncpth at which concrete plug set: feet below ground surf ce. <br /> aSealed Hole: <br /> Neat Cement Grout,top to bottom: grout mixture used: <br /> Neat Cement Grout,interval grouting: grout mixture used: <br /> Intervals grouted(feet beneath ground surface,method and mat is): <br /> âť‘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 /> 0.)ther 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. ( ON`,ERSION TO A WATER WELL <br /> State Engineer's Permit No.: n/a (attach copy of permit) <br /> County Where Well is Located: ----- <br /> Water Well Use: n/a <br /> C. METHOD OF RECLALMING DRILL.SITE PISTURBAN( <br /> Disturbed areas of drill site was reclaimed by hand and reseeded using DRMS <br /> approved seed mix applied at a rate of 80 live seeds per square foot of disturbed land. <br /> The Operator who conducted the prospecting drill operation states that the information forth hereupon is true to the <br /> best of their knowledge. <br /> Bryce Romig r M .Colorado Adminsistration <br /> Name of Operator's Representative:: _ Title: <br /> Signatures of'Operators Representative: <br /> _... __.__--- f .._. <br /> t <br /> W,min"AareTrospecting Norms\011 Abandonment Final Rpt.doc <br />