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Page 2 of 3 <br />ui LOCATI<OM <br />The following infwntation is rewired for ALL prospecting drill holes: <br />14 of the © 114 of Section � Township Range 7 �� <br />6TH PM Prime Meridian CUS 'ER - 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 11 North n South from the ❑ South ❑ North section line <br />feet ❑ east F West from the ❑ west ❑ East section line <br />NOTE: In the case of closely spared drill holes having similar geologic and hydrologi6 the Operator may, <br />with the approval of the Division, submit a single consolidated final report incduding the loauion of all drill holes and a <br />description of abandonment technique. In such case, complete arig 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 />iv. 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 />IR1. 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 />2a_ 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 />© 2c. Abandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />�TONITE:-B-AROID <br />