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San Juan Drilling Inc. <br /> San Juan Drilling Inc. 57528 Ida Road Montrose CO 81403.970-209-6424 <br /> i <br /> j Drill Hole Abandonment Form <br /> Project Name: <br /> Drill Hole Dw - it- i Dates Drilled: $-y -to RVS-i$ <br /> Azimuth: Dip: - Go Zone: <br /> Drill Hole Location: <br /> Casing Size: N ' Casing Depth: S <br /> Core Size:—PQ Hole Depth: 9S2 <br /> Date Abandoned: '- <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement:.,?- go3w 4& & eb <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 /> i <br /> Driller: f� Date: S- iS--'s <br /> Drill Foreman: Date: <br /> Geologist: <br />