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Page 3 of 3 <br /> Marsh Funnel viscosity of abandonment fluid: sec. <br /> Type of surface plugging used: <br /> Depth at which plug set: feet below ground surface, <br /> Method: <br /> 2d_Other method used with approval of the Division of Reclamation,Mining and Safety,describe in detail ILI <br /> method and materials used on a separate attached sheet <br /> B. CONVERSION TO A WATER WELL <br /> State Engineer's Permit No_: (attach copy of permit) <br /> County Where Well is Located: <br /> Water Well Use: <br /> V_ METHOD OF RECLAIMING DRILL SITE SURFACE DISTURBANCE: <br /> A MINIMUM IMPACT PROGRAM. TRACK MOUNTED <br /> SMALL RIG._-NO PITS. ANY OSVIOUS_UV!�_CKS <br /> ROAD WILL BE GRADED AND SEEDED. <br /> The Operator who conducted the prospecting drill operation states that the infannation set forth <br /> hereupon is true to the best of their knowledge_ <br /> HARALD HOEGBERG CONSULTING GEOLOGIST AND MANAGER <br /> (Name Operas 's Re entative) (Title) <br /> µl_ <br /> (Signature of Operator' pr entative) ( C� C/(Date) <br />