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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 Wr- " $" 3 Dates Drilled: 7 /2 //8 10 7.G• /8 <br /> Azimuth: Dip: - 6 O Zone: <br /> Drill Hole Location: <br /> Casing Size: N Casing Depth: S ' 0vur,0 <br /> Core Size: H Q Hole Depth: 3 (4.7i <br /> Date Abandoned: -24 -/9 <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement: 3- Sow <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: 7 26-/a <br /> Drill Foreman: Date: <br /> Geologist: <br />