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Page 3 of 3 <br /> Marsh Funnel viscosity of abandonment fluid: NA, no holes drilled sec. <br /> Type of surface plugging used: NA, no holes drilled <br /> Depth at which plug set: NA, no holes drilled feet below ground surface, <br /> Method: NA, no holes drilled <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.: NA, no holes drilled (attach copy of permit) <br /> County Where Well is Located: NA, no holes drilled <br /> Water Well Use: NA, no holes drilled <br /> V. METHOD OF RECLAIMING DRILL SITE SURFACE DISTURBANCE: <br /> The site was not disturbed by any prospecting or drilling activity <br /> The Operator who conducted the prospecting drill operation states that the information set forth <br /> hereupon is true to the best of their knowledge. <br /> H. Bruce Humphries President (Regulatory Permits Management, Inc.) <br /> (Name of Operator's Represent ' e) (Title) <br /> (Signature of perator' Re resentative) (Date) <br />