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Page 2 of 3 <br />III. LOCATION: <br />The following information is required for ALL prospecting drill holes: <br />NW 114 of the N E 114 of Section 28 Township 48N Range 118W <br />New Mexico Prime Meridian Montrose County <br />If the area has not been surveyed, supply the Longitude West and Latitude North, <br />or attach a location map, preferably a USGS Quad. <br />The following additional information is required for artesian flowing holes: <br />Feet ❑ North ❑ South from the ❑ South ❑ North section line <br />feet ❑ east ❑ West from the ❑ west ❑ East section line <br />NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics, the Operator may, <br />with the approval of the Division, submit a single consolidated final report including the location of all drill holes and a <br />description of abandonment technique. In such case, complete one abandonment final report form and attach a list of drill <br />hole locations. If more space is needed to provide any of the information for this form, please attach separate sheets. <br />W. Complete Either Subsection A or B: <br />PERMANENT ABANDONMENT (Check either box 1 or subsection 2 boxes as appropriate and provide the <br />requested information) <br />1. Plugged dry hole, method of plugging: Cuttings & Concrete Plug <br />Depth at which concrete plug set: feet below ground surface. <br />® 2. Sealed Hole (when groundwater is encountered): <br />2a. Neat Cement Grout, top to bottom: grout mixture used: <br />Intervals <br />method and materials): <br />2b. Neat Cement Grout, interval grouting: grout mixture used: <br />Intervals grouted (feet beneath ground surface, method and materials): <br />2c. Abandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />