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ROVED <br /> Form 3160-5 UNITED STATES OMB N�P004 0 377 <br /> (June 2015) DEPARTMENT OF THE INTERIOR Expires:January 31,2018 <br /> BUREAU OF LAND MANAGEMENT 5.Lease Serial No. COC-0118327 <br /> SUNDRY NOTICES AND REPORTS ON WELLS 6.If Indian,Allottee or Tribe Name <br /> Do not use this form for proposals to drill or to re-enter an <br /> abandoned well. Use Form 3160-3(APD)for such proposals. <br /> SUBMIT IN TRIPLICATE-Other instructions on page 2 7.If Unit of CA/Agreement,Name and/or No. <br /> 1.Type of Well <br /> ❑Oil Well ❑Gas Well m Other 8.Well Name and No.10H-R <br /> 2.Name of Operator Natural Soda LLC 9.API Well No. <br /> 3a.Address 3200 Rio Blanco County Rd 31 3b.Phone No.(include area code) 10.Field and Pool or Exploratory Area <br /> Rifle,CO.,81650 (970)878-3674 Boies Bed <br /> 4.Location of Well(Footage,Sec.,T.,R.,M.,or Survey Description) 11.Country or Parish,State <br /> Lat:39.928400 Long:-108.349547 NAD 83 Rio Blanco <br /> 12.CHECK THE APPROPRIATE BOX(ES)TO INDICATE NATURE OF NOTICE,REPORT OR OTHER DATA <br /> TYPE OF SUBMISSION TYPE OF ACTION <br /> ❑Notice of Intent ❑Acidize ❑Deepen ❑Production(Start/Resume) ❑Water Shut-Off <br /> ❑Alter Casing ❑Hydraulic Fracturing ❑Reclamation ❑Well Integrity <br /> ©Subsequent Report ❑Casing Repair ❑New Construction ❑Recomplete ❑Other <br /> ❑Change Plans ©Plug and Abandon ❑Temporarily Abandon <br /> ❑Final Abandonment Notice ❑Convert to Injection ❑Plug Back ❑Water Disposal <br /> 13. Describe Proposed or Completed Operation:Clearly state all pertinent details,including estimated starting date of any proposed work and approximate duration thereof.If <br /> the proposal is to deepen directionally or recomplete horizontally,give subsurface locations and measured and true vertical depths of all pertinent markers and zones.Attach <br /> the Bond under which the work will be performed or provide the Bond No.on file with BLM/BIA.Required subsequent reports must be filed within 30 days following <br /> completion of the involved operations.If the operation results in a multiple completion or recompletion in a new interval,a Form 3160-4 must be filed once testing has been <br /> completed.Final Abandonment Notices must be filed only after all requirements,including reclamation,have been completed and the operator has determined that the site <br /> is ready for final inspection.) <br /> All depths referenced to GL.The 10H-R well reached the end of its useful life and has been abandoned.The 7.625"casing was cleaned with water and a <br /> 7.625"casing scraper to a depth of 2,064 feet.Damaged casing(assumed parted couplings)was encountered with the scraper at 1,940,1,979,and 2,064 <br /> feet.A Cast Iron Bridge Plug was set in the 7.625"casing at a depth of 1,976 feet. The 7.625"casing was perforated at depths of 1,268,853,583,and <br /> 348 feet.Each perforation interval consists of four 0.38"holes at 90 degree phasing and 20.5"of penetration. All cement plugs were set using balance <br /> method and consisted of Portland Type 1/11 LA cement. Plug 1 was pumped at 1,973 feet and consisted of 7.5 cu yds(157.5 sks)with High Early <br /> accelerant. Plug 1 was allowed 5 hours to set,then top of cement was tagged at 1,349 feet. Plug 2 was pumped at 1,316 feet and consisted of 7.5 cu yds <br /> (157.5 sks)with High Early accelerant. Plug 2 was allowed 15.75 hours of set time,then top of cement was tagged at 610 feet. Plug 3 was pumped from <br /> a depth of 600 feet and consisted of 6.5 cu yds(136.5 sks)with High Early accelerant. Plug 3 reached surface and eventually fell back to 35 feet below <br /> GL.The well was dug out and casing cut off 3 feet below GL and topped off with 0.34 cu yds(7.2 sks)of Portland 1/11 LA cement on 11/19/20. A plugged <br /> and abandoned hole marker was installed on the capped well.The calculated volume of the 1,976 feet of 7.625'casing is 19.4 cu yds(523.4 cu ft),a total <br /> of 21.84 cu yds(589.7 cu ft)of cement,12.5.%excess,was used to plug and abandon the 10H-R.For additional information please see attached As-Built <br /> Plug and Abandonment diagram. <br /> 14.I hereby certify that the foregoing is true and correct. Name(Printed/Typed) <br /> Title ' <br /> Signature Date -a 8 a <br /> THE SPACE FOR FEDERAL OR STATE OFTCE USE <br /> Approved by <br /> Title Date <br /> ------------------------------------------------------------------------ <br /> Conditions of approval,if any,are attached.Approval of this notice does not warrant or <br /> certify that the applicant holds legal or equitable title to those rights in the subject lease Office <br /> which would entitle the applicant to conduct operations thereon. <br /> Title 18 U.S.0 Section 1001 and Title 43 U.S.0 Section 1212,make it a crime for any person knowingly and willfully to make to any department or agency of the United States <br /> any false,fictitious or fraudulent statements or representations as to any matter within its jurisdiction. <br /> (Instructions on page 2) <br />