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Page 3 of 3 <br /> Marsh Funnel viscosity of abandonment fluid: F sec. <br /> Type of surface plugging used <br /> Depth at which plug set feet below ground surface, <br /> Method: <br /> El2d.Other method used with approval of the Division of Reclamation,Mining and Safety,describe in detail <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 /> needed. Any Tracks on non existing roads were graded <br /> and seeded with approved seed mix <br /> The Operator who conducted the prospecting drill operation states that the information set forth <br /> hereupon is true to the best of their knowledge. <br /> Harald Hoegberg constAting Geologist/Manager <br /> (Name o or s Rep ve) (Title) <br /> te <br /> Z <br /> (Signature of Operato ep tative) (Date) <br />