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San Juan Drilling Inc. <br /> San Juan Drilling Inc,57528!da Road Montrose CO 81403.970.209&24 <br /> Drill Hole Abandonment Form <br /> Project Name:_ <br /> Drill Hole WC--l8 3$ Dates Drilled <br /> Azimuth: Dip. Zone: <br /> Drill Hale Location:_ <br /> Casing Sae: Casing Depth: 3 <br /> Core Sae: P Hole Depth: l q l <br /> Date Abandoned 7 .26-/B <br /> Abandonment Materials Used From To Total depth of Plug <br /> Cement: 9 Aa"s k_ crr C is Ap <br /> Super Plug: <br /> Beptonite: <br /> Grout: <br /> Mixtures: <br /> Drill Hole ma wl;watw: Yes <br /> (contact geologist before almatwing hok)� <br /> CcmcmPlug: LrS� NO <br /> Survey picket at bore hole: Yes No <br /> GaeotoFist check dae after ahandooment Yes No <br /> Photograph: Yes No <br /> OthertRemarks <br /> Driller. Date: 7-s 6-/e <br /> Drill Foreman: Date- <br /> Geologist: <br /> Geologist chcck site after aban&mmcnt Yes No <br /> Photograph: Yes No <br /> Other/Remarks <br /> Driller.• �— Date: <br /> Da71 Foreman: Date: <br /> Geologist: <br />