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IIL LOCATION: <br />The following information is required for ALL prospecting drill holes; <br />14 of the ® 114 of Section <br />�� <br />6TH PM I bode Meridian <br />Township Range <br />CUSTER County <br />Page 2 of 3 <br />�zw <br />If the area has not been surveyed, supply the Longitude I== <br />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 ❑ Fast section line <br />NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic sties, the Operator may, <br />with the approval of the Division, submit a single consolidated final ngport inrluding the location of all drill holes and a <br />description of abandonment technique. In such case, complete armee aboxionmcm final report faun and attach s list of drill <br />hole locations. If move space is needed to provide any of the information for this form, please attach separate sheets. <br />IV. Complete Either Subsection A or B: <br />PERMANENT ABANDONMENT (Check either box I or subsection 2 boxes as appropriate and provide the <br />requested information) <br />® l _ plugged dry hole, method of plugging: CONCRETE PLUG <br />Depth at which concrete plug set_ feet below ground surface. <br />® 2. Sealed Hole (when groundwater is encountered): <br />El2a_ Neat Cement Grout, top to bottom: grout mixture used: <br />Intervals grouted (feet beneath ground surface, method and materials): <br />® 2b. Neat Cement Grout, interval grouting: grout mixture used: <br />Intervals grouted (feet beneath ground surface, method and materials): <br />El2c. Abandonment FIuid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />BENTONITE: RAROID EXTRA GEL <br />