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Page 3 of 3 <br />Marsh Funnel viscosity of abandonment fluid: :D sec. <br />Type of surface plugging used: <br />Depth at which plug set: _I feet below ground surface, <br />Method: <br />El2d. Other method used with approval of the Division of Reclamation, Mining and Safety; describe in detail <br />method and materials used on a separate attached sheet. <br />B. CONVERSION TO A WATER WELL <br />State Engineer's Permit No.: (attach copy of permit) <br />County Where Well is Located: <br />Water Well Use: <br />V. METHOD OF RECLAIMING DRILL SITE SURFACE DISTURBANCE: <br />Drill sites were not constructed. No disturbance. Holes were drilled from existin roads. <br />Seeded the area where the hole was drilled. BLM approved seed mix was used. <br />i ne operator who conclucted the prospecting drill operation states that the information set forth <br />hereupon is true to the best of their knowledge. <br />David Andrews <br />(Name of Operator's Representative) <br />(Signature of Operator's Representative) <br />Managing Member <br />(Title) <br />i2a-v. � X017 <br />(Date) <br />