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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 Other 8.Well Name and No.BG-5(12H-C) <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 Boles Bed <br /> 4.Location of Well(Footage,Sec., T.,R.,M.,or Survey Description) 11.Country or Parish,State <br /> Lat:39.929111 Long:-108.351766 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 BG-5(12H-C)well reached the end of its useful life and has been plugged and abandoned.A cement plugback between <br /> the depths of 1,645'and 1,668'was drilled out with a 3.83"bit and a void in the 6.0"weilbore from 1,668'to 1,842'was circulated clean.The 4.5"casing <br /> was perforated at depths of 700 and 400 feet.Each perforation interval consists of four 0.38"holes at 90 degree phasing and with 20.5"of penetration. All <br /> cement plugs were set using the balance method. Plug 1 cement was pumped at 1,817 feet and consisted of 14 bbls(40 sks)of 13 lb/gal ASTM Type III <br /> "Thixo Plug"thixotropic cement blend.Plug 1 cement was allowed 21 hours to set,after which the top of cement was tagged at 1,603 feet. The calculated <br /> volume of the plug 1 interval(1,842 to 1,603')was 8.35 bbis(46.9 cu ft)with which meant that 67.7%excess cement was used to plug the open hole <br /> section of the well.Plug 2 cement consisted of 25 bbls(109.2 sks)of 13.9 lb/gal Portland Type 1/II LA cement and was pumped in six 200'lifts and one <br /> 400'lift from 1,595'to surface. The calculated volume of the 241 feet of 6.0"open hole and 1,601'of 4.5"OD cased hole(perforated)was 33.33 bbis <br /> (187.13 cu ft),for a total of 39 bbls(218.97 cu ft)of cement, 14.5%excess,was used to plug and abandon the BG-5(12H-C)well to surface.The well <br /> was dug out at surface and the casing was cut off 3 feet below GL.A steel cap with the well name was welded onto the 7.0"conductor casing and buried. <br /> For additional information please see attached As-Built Plug and Abandonment diagram. <br /> 14.I hereby certify that the foregoing is true and correct. Name(Printe&7jped) <br /> Title <br /> Signature Date <br /> THE SPACE FOR FEDERAL 06 ST E OFICE USE <br /> Approved by <br /> Title Bete <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 gee <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 />