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FORM
<br /> ROVED
<br /> Form 3160-5 UNITED STATES OMB No.
<br /> NI 004 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-1 V
<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:39.928359 Long:-108.358161 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 detennined that the site
<br /> is ready for final inspection.)
<br /> All depths referenced to GL.The 10H-1 V well reached the end of its useful life and has been abandoned.The 7.625"casing was cleaned out to a depth of
<br /> 1,503 feet.The 7.625"x 2.875'ASI-X arrow set packer and 521 feet of 2.875"tubing was removed from the well.The 5.5'liner was cleaned from 1530
<br /> feet to 1738 feet with a 4.75'string mill and 4.75"bit.Damaged liner(assumed parted couplings)was encountered with the string mill and bit at 1,664.5,
<br /> and 1,705 feet.A Cast Iron Bridge Plug was run but wouldn't go past 1,705 feet,and was removed.The 5.5"liner(inside the 7.625"casing)was
<br /> perforated at depths of 1,859,1,804,1,655,and 1,549 feet.The 7.625"casing was perforated at depths of 769,639,and 329 feet.Each perforation
<br /> interval consists of four 0.38"holes at 90 degree phasing and 20.5"of penetration.Tubing was set at 1,910 feet and 20 gallons(2.6 cu ft)of native fill
<br /> (formation cuttings)was poured down the tubing,and displaced with 300 gallons(40 cu ft)bentonite drilling gel mixed with lost circulation material(LCM)
<br /> and water.All cement plugs were set using balance method and consisted of Portland Type 1/11 LA cement. Plug 1 was pumped at 1,853 feet and
<br /> consisted of 5 cu yds(105 sks)with High Early accelerant. Plug 1 was allowed 15 hours to set,then top of cement was tagged at 1,718 feet. Plug 2 was
<br /> pumped at 1,680 feet and consisted of 5 cu yds(105 sks)with High Early accelerant and 1 packet of fiber LCM.Plug 2 was allowed 6.5 hours of set time,
<br /> then top of cement was tagged at 1,165 feet.Plug 3 was pumped from a depth of 1,128 feet and consisted of 7.5 cu yds(157.5 sks)with High Early
<br /> accelerant. Plug 3 was allowed 88.75 hours of set time,then top of cement was tagged at 430 feet.Plug 4 was pumped at 1,680 feet and consisted of 5
<br /> cu yds(105 sks)with High Early accelerant.Plug 4 reached surface and eventually fell back to 12 feet below GL.The well was dug out and casing cut off
<br /> 3 feet below GL and topped off with 0.12 cu yds(2.5 sks)of Portland VII LA cement on 11/19/20. A plugged and abandoned hole marker was installed on
<br /> the capped well.The calculated volume of the 478 feet of 5.5"inside 1,946 feet 7.625'casing is 18.9 cu yds(509.1 cu ft),a total of 22.12 cu yds(597.2 cu
<br /> ft)of cement,17.3.%excess,was used to plug and abandon the 10H-1 V.For additional information please see attached As-Built Plug and Abandonment
<br /> diagram.
<br /> 14.I hereby certify that the foregoing is true and correct. Name(Printed/73ped)
<br /> Title �.- J
<br /> Signature Date - A O r-Q
<br /> THE SPACE FOR FEDERAL OR STATE OFICE 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)
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