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Form 3160-5 UNITED STATES FORM APPROVED (August 20(17) OMB No.1004-0137 DEPARTMENT OF THE INTERIOR Expires:July 31,2010 BUREAU OF LAND MANAGEMENT 5.Lease Serial No. C-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 ❑ ell Oil Well ❑Gas Well �Other 16H-RIName and No. 2.Name of Operator 9.API Well No. Natural Soda LLC 3a.Address 3b. Phone No.(include area code) 10.Field and Pool or Exploratory Area 3200 Rio Blanco County Road 37 Piceance Creek Basin Rifle,CO 81650 (970)878-3674 4. Location of Well(Foatappe,Sec.,T.R.,M.,or Survev Description) 11.Country or Parish,State 146.9 FNL,533.$r FEL,sec 34,T1S,R98W) Rio Blanco County,Colorado 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(Stan/Resume) ❑ Water Shut-Off ❑Alter Casing ❑Fracture Treat ❑ Reclamation ❑ Well Integrity ❑Subsequent Report ❑Casing Repair ❑New Construction ❑ Recomplete ❑ Other ❑Change Plans m 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 recomplcte 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 BLM/BIA. 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 anew 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.) Remove all existing surface and downhole equipment from well. Run in the well to approximately—1939.8',top of ASI X packer,circulate and clean well. Run in hole with perforation gun and perforate(4 spf,90 or 120 degree phasing)4.5-inch intermediate casing. Perforation zones:1,887, 1,757,1,637,1,250, 1,040,440,200,and 100 feet. Cement to surface in stages with—189.25 bbls(39.4 cubic yards)of Portland 1/II cement.For additional detail please refer to the attached Drilling and Well Completion Diagram. This activity is anticipated to occur over a period of three to four days during the second or third quarter of 2022. This work will be performed under the Colorado Division of Reclamation and Mine Safety permit number M-1983-194. 14. 1 hereby certify that the foregoing is true and correct. Name(Printed/Typed) Gerald J.Daub Title President,Daub&Associates,Inc. Signature IlyDate gl L O L 2— THIS SPACE FOR FEDERAL 06 STATE OFFICE USE Approved by - - -• - - rile Date Cond--m--ons- ofapproval--• ,if--any---- ,are- attach- - eed.--A-pproval------of-•this--notice--•- does- not warra--n-- t or--c-ertify that the applicant holds legal or equitable title to those rights in the subject tease which would Office entitle the applicant to conduct operations thereon. Title 18 U.S.C.Section 1001 and Title 43 U.S.C.Section 1212,make it a crime for any person knowingly and willfully to make to any department or agency ofthe United States any false. fictitious or fraudulent statements or representations as to any matter within its jurisdiction. (Instructions on page 2)