2016-08-19_HYDROLOGY - P2008002

• Permit No: P2008002
• IBM Index Class Name: Hydrology
• Doc Date: 8/19/2016
• Doc Name: Abandonment Report
• From: Shell Exploration & Production
• To: DRMS
• Annual Report Year: 2016
• Email Name: THM
• Media Type: D
• Archive: No

Form No. STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use Only
GWS-09 821 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
4/2012 [phone] Fax[phone] dwrpermitsonline(cDstate.co.us
WELL ABANDONMENT REPORT
Use to report plugging and sealing of permitted wells,monitoring and other holes. This form can be
computer generated,typed or printed in black or blue ink. Instructions and plugging standards are on
reverse side of form.
Well Permit Number of the well being plugged See Attached or
MH File Number MH- Hole ID#/Name
Individual/Company responsible for plugging and sealing the well:
Name(s) Shell Frontier Oil &Gas Inc
Mailing Address PO Box 478
City, St.,Zip Meeker, CO 81641
Phone(area code&no.) [phone] Email: [e-mail]
Well (Hole) Owner:
NAME(S) Shell Frontier Oil&Gas Phone(include area code) [phone]
Mailing Address, City, St.,Zip PO Box 478 Meeker, CO 81641
ACTUAL WELL LOCATION: County See attached
Property Address, City, St,Zip
1/4 of the 1/4, Sec. ,Twp. N. or ❑ S., Range E. or El W., P.M.
Distance from Section Lines Ft.from 17 N.or C S., Ft. from ❑E.or ❑W. Line.
Subdivision Name Lot Block , Filing/Unit
Optional: GPS well location information in UTM format. You must check GPS unit for required settings as follows:
Format must be UTM, zone 12 n or zone 13 lffl; Units must be meters; Datum must be NAD83; Unit must be set to true north.
Easting Northing
I (we)report the existing well(hole)was plugged and sealed on the date of for the following reason(s):
0 The well was plugged and sealed as required under Well Permit Number See attached
❑ The well was not in use and was plugged and sealed.
❑ Other(please explain)
The well was plugged with the following materials placed at the indicated intervals:
Amount and Type of Material Method of Placement Interval
See Attached from feet to feet
from feet to feet
from feet to feet
Intervals of casing removed/ripped in feet from feet to feet
Report must be signed or name entered by person who performed the well plugging work or by the well owner if this person is unknown or
not reachable. I(we)have read the statements made herein,know the contents thereof,and that they are true to my(our)knowledge.
Signore ter full
Jo�ann Neuname If signing print name&title Date(mm/dd/yyyyy)
Jo ann Neuman, Environmental Engineer Johanna Neuman, Environmental Engineer 08/18/2016
It is the responsibility of the well owner to have the well/hole properly plugged and sealed. The Well Construction Contractor
is responsible for notifying the owner of this requirement.