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Page 2 of 3 <br />III. LOCATION: <br />The following information is required for ALL prospecting drill holes: <br />114 of the 1�0 114 of Section Township Range 72 <br />E] <br />DTH I Nme Meridian [OUSTER County <br />If the area has not been surveyed, supply the Longitude West and Latitude 1 North,, <br />OTA h a location map, preferably a USGS Quad_ <br />The following additional information is required for artesian flowing holes: <br />Feet` North r South from the ❑ South ❑ North section line <br />feet ❑ east ❑� West from the ❑west L} Frost section line <br />NQ E: In the case of closely spaced drill holes having similar geologic and hydrologic dn}racEeri LLsticJsJ the Operator may, <br />with the approval of the Division, submit a single consolidated filial report including the location of all rill holes and a <br />description of abandonment technique. In such case, completerhe abandonnxmt 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 I or subsection 2 boxes as appropriate and provide the <br />requested information) <br />0 1. Plugged dry hole, method of plugging: LCGNCRETE PLUG <br />Depth at which concrete ping 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 n:taterials): <br />® 2b. Neat Cement Grout, interval grouting: grout mixture used: <br />Intervals grouted (feet beneath ground surface, method and materials): <br />11 2c. Abandonment Fluid Mixture (Such as Sodium Bentonite with Polymer) Brand Name: <br />6ENTQNITE: BARQID EXTRA GEL <br />