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STATE OF COLORADO R�:C <br /> iic:CC FORM 4 OIL AND GAS CONSERVATION COMMISSION 11IIlIlI I I�III ,, <br /> Rev. 1/78 DEPARTMENT OF NATURAL RESOURCES Q <br /> File in duplicate for Patented and Federal lands. a• LEASE DESIGNATION 4 lA <br /> File in triplicate for State lands. <br /> SUNDRY NOTICES AND REPORTS ON WELLS IF INDIA 1I' <br /> (Du not use this fonn for proposals to drill or to deepen or plug back to a different reservoir. <br /> Use "APPLICATION FOR PERMIT—"for such proposals.) <br /> 1. 1. UNIT AGREEMENT NAM► <br /> OIL GAS <br /> WELL ® WELL ❑ OTHER <br /> 2. NAME OF OPERATOR E. FARM OR LEASE NAME <br /> Prospect Valley Oil Company, C/o Paul Page Painter1�r�0 <br /> 3. ADDR9U OF OPERATOR B. WELL NO., <br /> Box 450 Erie Colorado 80516 #1 <br /> 4. LOCATION OF WELL(Report location etearty and in accordance with any State re0uirements. 10. FIELD AND POOL,OR WIL AT <br /> See also space 17 below.) <br /> At surface Empire <br /> NE NE Sec. 11-3N-61W ae li. 88C..T.,R.,M.,OR BLK.AN <br /> At Propend prod.so <br /> SURVEY OR AREA <br /> Sec. 11-3N-61W <br /> 14. PERMIT NO. 15. ELEVATIONS(Show whether DF,RT,OR,etc.) 12. COUNTY IS. STATE <br /> 4593' KB 458711 GL Weld Co. <br /> 118- Check Appropriate Box To Indicate Nature of Notice, Report or Other Data <br /> NOTICE OF INTENTION TO. SUBSEQUENT REPORT OF: <br /> TEST WATER SHUT-OFF PULL OR ALTER CASING WATER SHUT-OFF- REPAIRING WELL <br /> P RACTURF:TREAT MULTIPLE COMPLETC FRACTURE TREA'rMENT ALTERING CASING y <br /> SI/OO1 OR ACIDIZE ABANDON SHOOTING OR ACIDIZING ABANDONMENT* q <br /> REPAIR WELL. CIiANGE PLANS. (Other) <br /> (Note:Report results of multiple completion on Wall <br /> (Other) _ Completion or R_ecompletlon Report and Log form.) <br /> 17. DESCH IhF: PIIOPOSF:D OR COMPIJKTED OPERATIONS (Clearly state all pertinent details,and give pertinent dates,including estimated date of <br /> startuig au) proposed work. If well is directionally drilled,give subsurface locations and measured wid true vertical depths for all markers and runes <br /> pertinent to this work.) <br /> IS. Date of work 6-17-85 through 6-24-85 * Must be accompanied by a cement verification report. <br /> Ran sand from 6500' to 6200' . Set 10 sacks cement on sand. Pumped 25 sacks <br /> cement on stub at 2500' . Pumped 25 sacks cement from 250' to 186' . Mudded <br /> to 28' . Set 10 sacks cement to base of cellar. Welded on cap. <br /> -r 1 <br /> 19. 1 hereby certify that the 1preaoing its true and correct DONNELLY CASING PULLING CO.SIGNED '1. '�,L-I �;� TITLE �f DATE ,_.�—2-85 <br /> (This space for Fedee��FaIVV/p/orState uffi�sca6r DIri;``TO <br /> APPROVED BY�(y� '" TITLE f CAS. Comm. DATE J 2 3 19$': <br /> CONDITIONS OF APPROVAL,IF ANY: <br />