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OMB No.2040-0042 Approval Expires 1 2/3112 01 8 <br /> United States Environmental Protection Agency <br /> S7EPA Washington,DC 20460 <br /> PLUGGING AND ABANDONMENT PLAN <br /> Name and Address of Facility Name and Address of Owner/Operator <br /> Natural Soda LLC Natural Soda LLC <br /> 3200 RBC Rd 31,Rifle,CO..81050 3200 RBC Rd 31.Rifle,CO.,81650 <br /> State County Permit Number <br /> Locate Well and Outline Unit on <br /> Section Plat-640 Acres 0) Rio Blanco County C030358-00000 <br /> Surface Location Description <br /> N <br /> I 114 of S�\ 114 of SF 114 of-Sµ'1/4 of Section 25 Township I S Range 98 <br /> Locate well In two directions from nearest lines of quarter section and drilling unit <br /> Surface <br /> f Location 247 It.frm(NIS).S Line of quarter section <br /> and ft.from(EfW) LN Line of quarter section. <br /> TYPE OF AUTHORIZATION WELL ACTIVITY <br /> W I E Individual Permit CLASS I <br /> Area Permit � CLASS 11 <br /> 1I n Rule Brine Disposal <br /> — — — — Enhanced Recovery <br /> Number of Wells <br /> Hydrocarbon Storage <br /> 1 ( Q Vi CLASS III <br /> S Lease Name C 0118327 Well Number 403fl 1 <br /> CASING AND TUBING RECORD AFTER PLUGGING METHOD OF EMPLACEMENT OF CEMENT PLUGS <br /> SIZE WT(LB/FT) TO BE PUT IN WELL(FT) TO BE LEFT IN WELL(FT) HOLE SIZE E: The Balance Method <br /> 13.17 48 120 120 24 ❑ The Dump Bailer Method <br /> 7.0 ,3 2282 2282 9.5 The Two-Plug Method <br /> 4.5 1 1 A 3158-5228 3158-5228 6.125 Other <br /> CEMENTING TO PLUG AND ABANDON DATA: PLUG#1 PLUG#2 PLUG#3 PLUG#4 PLUG#5 PLUG#6 PLUG#7 <br /> Size of Hole or Pipe In which Plug Will Be Placed(Inche 4.57.0 4.5/7.0 <br /> Depth to Bottom of Tubing or Drill Pipe(ft na na <br /> Sacks of Cement To Be Used(each plug) na 345 <br /> Slurry Volume To Be Pumped(cu.ft.) na 475 <br /> Calculated Top of Plug(ft.) na 0 <br /> Measured Top of Plug(if tagged ft.) 2039 <br /> Slurry Wt.(Lb./Gal.) na 15.5 <br /> Type Cement or Other Material(Class 111) CIBP I -11 A' <br /> LIST ALL OPEN HOLE AND/OR PERFORATED INTERVALS AND INTERVALS WHERE CASING WILL BE VARIED(if any) <br /> From To From To <br /> Open Hole 2282'MD GL 5228'MD GL <br /> Estimated Cost to Plug Wells <br /> 535,0001 SD <br /> Certification <br /> I certify under the penalty of law that 1 have personally examined and am familiar with the information submitted In this document and all <br /> attachments and that,based on my Inquiry of those Individuals Immediately responsible for obtaining the Information,I believe that the <br /> Information is true,accurate,and complete. I am aware that there are significant penalties for submitting false Information,including the <br /> possibility of fine and imprisonment. (Ref.40 CFR 144.32) <br /> Name and Official Title (Please type or print) Signature Date Signed Gerald Daub,President,Daub&Associates.Inc. / 7- /7 <br /> EPA Form 7520-14 (Rev.12-11) / <br />