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Form 3160-5 UNITED STATES FORM APPROVED (June 2015) OMB No.]004-0137 DEPARTMENT OF THE INTERIOR Expires:January 31,2018 BUREAU OF LAND MANAGEMENT 5.Lease Serial No. COC-0119986 SUNDRY NOTICES AND REPORTS ON WELLS 6.If Indian,Allottee or Tribe Name Do not use this form for proposals to drill or to re-enter an abandoned well. Use Form 3160-3(APD)for such proposals. SUBMIT IN TRIPLICATE-Other instructions on page 2 7.If Unit of CA/Agreement,Name and/or No. 1.Type of Well 8.Well Name and No. ❑Oil Well ❑ Gas Well ©Other MMC-IRI-9 2.Name of Operator Natural Soda LLC 9,API Well No. 3a.Address 3200 Rio Blanco County Rd 31 3b.Phone No.(include area code) 10.Field and Pool or Exploratory Area Rifle,CO.,81650 (970)878-3674 4.Location of Well(Footage,Sec., T.,R.,M.,or Survey Description) 11.Country or Parish,State 2832.6 FSL,4174.1 FEL,S34,T1S,R98W,6th PM Rio Blanco County,CO 12.CHECK THE APPROPRIATE BOX(ES)TO INDICATE NATURE OF NOTICE,REPORT OR OTHER DATA TYPE OF SUBMISSION TYPE OF ACTION ❑Notice of Intent ❑Acidize ❑Deepen ❑Production(Start/Resume) ❑Water Shut-Off ❑Alter Casing ❑Hydraulic Fracturing ❑Reclamation ❑Well Integrity ©Subsequent Report ❑Casing Repair ❑New Construction ❑Recomplete ❑Other ❑Change Plans ©Plug and Abandon ❑Temporarily Abandon ❑Final Abandonment Notice ❑Convert to Injection ❑Plug Back ❑Water Disposal 13. Describe Proposed or Completed Operation:Clearly state all pertinent details,including estimated starting date of any proposed work and approximate duration thereof.If 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 the Bond under which the work will be performed or provide the Bond No.on file with BLMBIA.Required subsequent reports must be filed within 30 days following completion of the involved operations.If the operation results in a multiple completion or recompletion in a new interval,a Form 31604 must be filed once testing has been completed.Final Abandonment Notices must be filed only after all requirements,including reclamation,have been completed and the operator has determined that the site is ready for final inspection.) All depths referenced to GL.The MMC-IRI-9 well reached the end of its useful life and has been plugged and abandoned.A 2.9375"bit was tripped into the 3.0"OD open hole to a depth of 1,695'and tagged(native fill 1,695'to 1,710').The 3.5"OD casing was perforated at depths of 200',500',800',1,100', and 1,250'.Each perforation interval consists of four 0.38"holes at 90 degree phasing and with 15.0"of penetration.All cement plugs were set using the balance method.Plug 1 cement consisted of 9.6 bbis(42 sks)of 14.5 lb/gal Portland Type 1/II LA cement and was pumped in two lifts,the first of 6.2 bbls from 1,675'and the second of 3.4 bbls from 1,335'.Plug 1 was allowed to set 20 hours,after which the top of cement was tagged at 982'.The calculated volume of the plug 1 interval(1,695 to 982')was 6.4 bbls(35.9 cu ft)which meant that 50%excess(3.2 bbls)cement was used to plug the open hole section and lower cased portion of the well.Plug 2 cement consisted of 13.0 bbls(56.7 sks)of 14.5 lb/gal Portland Type I/II LA cement and was pumped in four lifts from the depths of 955',755',555',and 195'to surface.The calculated volume of the plug 2 interval(982'to surface)was 6.4 bbls(46.9 cu ft) with which meant that 46%excess(4.1 bbls)cement was used to plug the upper cased and annular portion of the well.The well was dug out at surface and the casing was cut off 3 feet below GL.A total of 22.6 bbis(98.7 sks)of cement was used to P&A the well. A steel cap with the well name was welded onto the 5.0"conductor casing and buried on 10/6/2021. For additional information please see attached As-Built Plug and Abandonment diagram. 14.I hereby certify that the foregoing is true and correct. Name(Printed/Typed) Gerald J.Daub Title President/Daub&Associates Inc. Signature Date G 2 S` yO z/ THE SPACE FOR FEDERAL OR STAT9 OFICE USE Approved by Title Date ------------------------------------------------------------------------ Conditions of approval,if any,are attached.Approval of this notice does not warrant or certify that the applicant holds legal or equitable title to those rights in the subject lease Office which would entitle the applicant to conduct operations thereon. 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 any false,fictitious or fraudulent statements or representations as to any matter within its jurisdiction. (Instructions on page 2)