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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 L ' 18 - 1& Dates Drilled: f 5'1/g !a 7 Z y J/a <br /> Azimuth: Dip: 8 S Zone: <br /> Drill Hole Location: <br /> Casing Size: 44 Casing Depth: /0 <br /> Core Size: - Hole Depth: 89 / <br /> Date Abandoned: -/B <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement: I - 80 �08wfv <br /> Super Plu <br /> Bentonite: <br /> Grout:: <br /> Mixtures: <br /> Drill Hole Making Water: Yes <br /> (contact geologist before abandoning hole) <br /> Cement Plug: (1esb 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 /> J . <br /> Driller: Date: 7 <br /> Drill Foreman: Date: <br /> Geologist: <br />