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Page 3 of 3 <br />Marsh Funnel viscosity of abandonment fluid: 71 sec. <br />Type of snrface pluggiung used: I <br />Depth at which plug set: feet below ground surface, <br />Method: <br />® 2d. 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 ropy of permit) <br />County Where Well is Located: <br />Water Well Use: <br />V. METHOD OF RECLAIMING DRILL SITE SURFACE DISTURBANCE: <br />The Operator who conducted the prospecting driiiI operation sues that the infonnahon set forth <br />hereupon is true to the best of their knowledge. <br />Consulting Geologist <br />(Title) <br />3/2312418 <br />(Date) <br />