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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 Dfi-I Ei - 13 Dates Drilled: Syi.i he- T /Z 1.6' <br /> Azimuth: Dip: Zone: <br /> Drill Hole Location: <br /> Casing Size: 1V Casing Depth: 2 o <br /> Core Size: r1 Hole Depth: <br /> Date Abandoned: -7 r Z w - /8 <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement: I- go CpksNck <br /> Super Plug: <br /> Bentonite: <br /> Grout:: <br /> Mixtures: <br /> Drill Hole Making Water: Yes <br /> (contact geologist before abandoning hole) <br /> Cement Plug: (� 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: <br /> Drill Foreman: Date: <br /> Geologist: <br />