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Page 2 of 3 <br /> III.LOCATION: <br /> The following information is required for ALL exploration drill holes: <br /> NW 1/4 of the NW 1/4 of Section 16 Township 16S Range 67W <br /> 6th Prime Meridian El Paso County <br /> If the area has not been surveyed, supply the Longitude -104.9009369' West and Latitude 38.6605741° 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 E <br /> west ❑ East section line <br /> NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics,the Operator may, <br /> with the approval of the Division,submit a single consolidated final report including the location of all drill holes and a <br /> description of abandonment technique. In such case,complete one 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 /> 1V. 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 /> D1. Plugged dry hole,method of plugging: <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 />