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San Juan Drilling Inc. <br /> San Juan Drilling Inc. 57528 Ida Road Montrose CO 81403.970-209-6424 <br /> Drill Hole Abandonment Form <br /> Project Name: <br /> Drill Hole G - IS ' 3 Dates Drilled: �� A A`� <br /> Azimuth: Dip: — `>♦ 5 Zone: <br /> Drill Hole Location: <br /> Casing Size: y Casing Depth: /O <br /> Core Size: N IQ Hole Depth: .3 4- [1 / <br /> Date Abandoned: 7- ,ZL -iS <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement: J- 0o A s�uecpWph, v " /b /o <br /> Super Plug: <br /> Bentonite: <br /> Grout: <br /> Mixtures: <br /> Drill Hole Making Water: Yes <br /> (contact geologist before abandoning hole) <br /> Cement Plug: <ZiD No <br /> Survey picket at bore hole: Yes No <br /> Geologist check site after abandonment Yes No <br /> Photograph: Yes No <br /> Other/Remarks <br /> Driller: `` Date: -7- <br /> Drill Foreman: Date: <br /> Geologist: <br /> i <br />